Di6PR1&2

4/16/2023

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What part of the brain is involved in ADHD?

 The key brain areas that are thought to be involved in ADHD are:

 Prefrontal Cortex: This region of the brain is responsible for executive functions such as attention, decision making, and impulse control. People with ADHD often have lower activity levels in this area, leading to difficulties with self-regulation and attention.

 Basal Ganglia: This group of structures plays a role in motor control and reward processing. Abnormalities in the basal ganglia have been linked to the hyperactive and impulsive symptoms of ADHD.

 Limbic System: This part of the brain is involved in emotion regulation and motivation. Some studies suggest that people with ADHD have weaker connections between the prefrontal cortex and the limbic system, which may contribute to difficulties with emotional regulation.

What neurotransmitters are involved in ADHD?

 Several neurotransmitters are believed to be involved in ADHD, including:

 Dopamine: This neurotransmitter plays a critical role in reward processing, motivation, and movement control. Low levels of dopamine have been associated with ADHD symptoms such as inattention, impulsivity, and hyperactivity.

 Norepinephrine: This neurotransmitter is involved in regulating attention and alertness. Some ADHD medications, such as stimulants, increase the availability of norepinephrine in the brain, which can help improve focus and attention.

 Serotonin: This neurotransmitter is involved in regulating mood, anxiety, and impulse control. Although the exact role of serotonin in ADHD is not yet fully understood, some studies suggest that abnormalities in serotonin signaling may contribute to ADHD symptoms.

 Glutamate: This neurotransmitter plays a role in learning and memory. Some research has suggested that abnormalities in glutamate signaling may contribute to ADHD symptoms such as impulsivity and inattention.

What is the first line, second line, and third-line treatment for ADHD

 The first-line treatment for ADHD usually involves stimulant medications, which are known to be effective in reducing symptoms of inattention, hyperactivity, and impulsivity such as:  Methylphenidate (Ritalin)  amphetamine (Adderall),

 The second-line treatment for ADHD typically involves Non-stimulant ADHD medications come in many varieties: FDA- approved non-stimulants, antidepressants, blood pressure medications, and more. These are second-line treatment options for ADHD patients who don't respond to stimulant medication, or experience too many side effects. Such medication like Intuniv (guanfacine), Kapvay (clonidine)

 The third-line treatment for ADHD involves Strattera is considered a third-line treatment for ADHD by the American Academy of Child and Adolescent Psychiatry (AACAP) because the response rate to atomoxetine is only approximately 50%. Meaning, it works for roughly half of the people who take it. Another medication being used is tricyclic antidepressant one study showed. Whether tricyclic antidepressants (TCAs) reduce hyperactivity, impulsivity and inattentiveness in children and adolescents aged 6–18 years with attention deficit hyperactivity disorder (ADHD). The review included studies that compared TCA with placebo ± an alternative medication.

Name some common medications in ADHD? What are some adverse and side effects?

Adverse effects: Stroke, HTN, MI, seizures, rhabdomyolysis, priapism, anaphylaxis, psychosis, and Steven-Johnson syndrome.

Side effects: nervousness, anxiety, insomnia, weight loss, stomach pain, nausea, vomiting, dizziness, headache, tachycardia, fatigue, constipation and diarrhea.

Adderall (dextroamphetamine/ amphetamine)

Adverse effects: HTN, MI, stroke, sudden death, seizures, priapism, rhabdomyolysis, hepatotoxicity, arrhythmia, Tourette syndrome.

Side effects: nervousness, anorexia, abdominal pain, tachycardia, nausea, disturbance, weight loss, and hyperhidrosis.

Ritalin (methylphenidate)

Adverse effects: MI, HTN, Stroke, seizures, priapism, rhabdomyolysis, psychosis, Stevens-Johnson syndrome and sudden death.

Side effects: anorexia, insomnia, abdominal pain, irritability, weight loss, nausea, BP elevated, tachycardia and dizziness.

Vyvanse (Lisdexamfetamine)

Adverse effects: MI, HTN, tachycardia, hepatotoxicity, priapism, angioedema,

Side effects: xerostomia, headache, abdominal pain, anorexia, dysmenorrhea,

Strattera (atomoxetine)

MECHANISM OF ACTION.  Stimulant medications: Methylphenidate and Amphetamine

 The prefrontal cortex's arousal is raised by stimulants.

 Methylphenidate and amphetamine formulations specifically operate to increase norepinephrine and dopamine neurotransmission in the prefrontal cortex.

 Methylphenidate works by stopping central adrenergic neurons' presynaptic dopamine transporters.

 Moreover, it only slightly inhibits the transporters of norepinephrine.

 Dopamine concentration in the synaptic cleft rises as a result, enhancing dopaminergic neurotransmission.

 Amphetamine functions as a pseudo-substrate to attach to the binding sites of the dopamine transporter and the norepinephrine transporter, acting as a competitive inhibitor of dopamine.

 Both methylphenidate and amphetamine boost dopamine release, which improves one's responsiveness to environmental stimuli. Amphetamines also increase catecholamine release as a major mechanism.

 By activating the and receptors, amphetamines can exert a peripheral sympathomimetic action.

MECHANISM OF ACTION.

 Non-stimulant medications: atomoxetine

 Atomoxetine is a selective norepinephrine reuptake inhibitor, which causes increased concentrations of norepinephrine and dopamine in the prefrontal cortex.

 Atomoxetine does not cause increased norepinephrine or dopamine in the nucleus accumbens and lacks abuse potential.

 In children and adolescents with ADHD treated with atomoxetine, initial response may be slower than that seen with stimulant medications.

 ADHD symptoms may respond over the course of several weeks and after the dose is titrated up to the maximum daily dose; symptom improvement may continue over 2 months (Brown et al., 2017).

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4/16/2023

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Share resources in child psychiatry that will benefit your peers to specialize in this area.

 The American Academy of Pediatrics (AAP) is a great resource for practitioners specializing in child psychiatry.

 The American Academy of Child and Adolescent Psychiatry (AACAP) is a professional organization that provides resources and support for those interested in working with children and adolescents.

 Society of Clinical Child and Adolescent Psychology (SCCAP) - Psychological assistance and intervention should always be given in addition to psychiatric care. It is advisable for prescribers to be familiar with the fundamental behavioral changes that can benefit kids with ADHD.

REFERENCES  Stahl, S. M. (2021). Stahl's essential psychopharmacology: Prescriber's guide (5th ed.).

Cambridge University Press.

 Brown, A. K., Sharmeen, S., & Patel, R. D. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review of practioners. Translational Pediatrics, 7(1), 36 – 47. doi: 10.21037/tp.2017.08.02

 Stephen Soreff, M. D. (2023, March 24). Attention deficit hyperactivity disorder (ADHD) treatment & management. Approach Considerations, Medical Care, Diet. Retrieved April 2, 2023, from https://emedicine.medscape.com/article/289350-treatment

 Meyer, S.M., Farrar, M. A., Yates, R. J., & Biezonski, D. (2023). Psychopharmacology Drugs, the Brain, and Behavior. (4th ed.). Oxford University Press.

 Tricyclic antidepressants - Wiley Online Library. (n.d.). Retrieved April 2, 2023, from https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.13031

THANK YOU!!!

Group 8

• Waweru, Mary • Williams, Kurvin

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