Overview/Core Features
Background of ADHD
childhood onset-dx by age 12
associated with maturation of PFC circuitry
can persist into adulthood
combination of genetic and environmental component
no genomic or etiology discovered
adult prevalence(commonness) 1/2 has much as children
ADHD is _________ information processing in various circuits in the ____________
inefficient
PFC
ADHD is failure to activate _________ in response to those task that require attn and problem solving
PFC
The PMHNP knows when prescribing ADHD medication one has to find the "____ _______" to optimize cognitive fxning
Sweet spot
The goal in ADHD tx with DA is to ________ phasic DA signaling so the _________ task can be performed efficiently.
increase (enhance)
Cognitive
Core sx of ADHD
Inattentiveness
Hyperactivity
Impulsivity
ADHD sx may ________ with other disorders like Bipolar or schizophrenia
overlap
When ______ & ______ are too ________ the strength of the signal output in the _______ ____ is low.
This results in __________ signal and _________ noise
NE & DA
low,
PFC
decreased, increased
DA neurons supplying (activating) in the PFC are too _______
low
Uncontrolled DA firing is associated with?
Drug Abuse- cravings/reinforcement, compulsive drug use
Describe Inattentiveness and where its located
selective attn: dACC- Dorsal Anterior Cingulate Cortex
sustained attn with problem solving: DLPFC Dorsal lateral PFC
fails to finish task
disorganized
(Can't process)
Pt with ADHD have a _______ times higher risk of _________ use
2
nicotine
What is the goal of tx with ADHD r/t NE:
Increase signal and decrease noise by increasing what 2 NTS?
NE and DA
Low DA stimulates the MOST sensitive DA receptor, _______ followed by ______ (modestly sensitive ), then ______
D3.
D2
D1
Excessive DA release is associated with
Panic/fear to tics to hallucinations. psychotic symptoms
Examples of hyperactivity and where it is located?
Prefrontal Motor cortex
fidgets , leaves seat, climbs
(get your motor running)
Increased nicotine use in ADHD pts is in r/t the _________ of DA
increase
What causes cognitive dysfxn in ADHD
Low NE neurons in the PFC
The ________ DA firing reussults in a "________" of DA release that reaches all receptors
Phasic (in phases)
Flurry
The PMHNP knows before treating ADHD what must be addressed?
Underlying disorders
ex: mood, anxiety, and SUD
What is impulsivity?
Orbital Frontal cortex
interrupts, does not wait turn, blurts out
(see something and want it)
Inadequate tuning of the Ventromedial Prefrontal cortex (VMPFC)results in:
1. Conduct disorder
2. Bipolar/anxiety spectrum (mood instability, mania, anxiety)
3. Defiant disorder
Increasing NE too high causes?
Negative consequences such as anxiety, SUD, mania, and decreased working memory
Phasic DA firing results in ?
reinforced learning
reward conditioning
motivation
task completion
PMHNP knows that pt may want a stimulant for other uses such as
weight loss
energy
focus