Pharmacotherapy of Adult ADHD - from Clinician's Guide to Adult ADHD - Assessment and Intervention

Towards the goal of education and learning, I have excerpted a few interesting notes from a chapter entitled "Pharmacotherapy of Adult ADHD" from Clinician's Guide to Adult ADHD - Assessment and Intervention edited by Sam Goldstein and Anne Teeter Ellison.

Pharmacotherapy of Adult ADHD
by Jefferson B. Prince and Timothy E. Wilens

"Overview of the Neurobiology and Genetics of ADHD

The Neurobiology and genetics of ADHD includes the following characteristics.

• Highly familial disorder with heritability estimated to be 0.8
• Primary disturbance of catecholamine neurotransmission
• Anterior cingulate, frontal cortex, basal ganglia, corpus callosum, and cerebellum manifest decreased size in ADHD
• Variations in genes that code for dopamine transporter protein (DAT) and dopamine D4 receptor (DRD4) associated with distinct ADHD subtypes
• No current role for neuorimaging or genetic testing in diagnosis of ADHD in clinical practice (but stay tuned)

Clinical Features of ADHD in Adults

Adults with ADHD typically present with the following clinical picture:

• Problems with regulating attention and concentration
• Disorganization, failure to plan ahead, forgetfulness
• Poor time management skills
• Difficulty initiating and completing tasks
• Difficulties in job, parenting, marriage
• While adults with ADHD usually can be relied on to accurately report their symptoms, additional informants often helpful

Assessment and Diagnosis of ADHD in Adults

The assessment and diagnosis of ADHD in adults has the following features.

• DSM-IV is the gold standard.
• Several available scales are available to aid assessment, including the Brown Attention Deficit Disorder Scales, Conners Adult Attention Deficit Scale, DuPaul ADHD Rating Scale, and the Wender Utah Rating Scale.
• Recent reports validate the reliability of data collected from adults with ADHD.
• There is a potential for use of neuroimaging and genetic testing to identify certain subtypes of ADHD.
• Disentangling comorbidities and associated impairments (e.g., executive functions) are a prime clinical challenge.

Stimulants in the Treatment of Adults with ADHD

Stimulant treatment of adults with ADHD can be characterized as follows.

• Stimulants represent the first-line pharmacotherapy for ADHD in adults.
• The two main types of stimulants, methylphenidate and amphetamine compounds, have different effects and are metabolized differently.
• Methylphenidate does not show up on urine drug screens.
• Stimulants are not effective for comorbidities within ADHD.
• Stimulants generally have few medication interactions (except with MAOIs)"

Thanks for reading! If you enjoyed this, perhaps you'd like to subscribe to the RSS feed.

Cheers,

Mungo