TY - CHAP M1 - Book, Section TI - Attention Deficit/Hyperactivity Disorder A1 - Dopheide, Julie A. A1 - Stutzmann, Danielle L. A1 - Pliszka, Steven R. A2 - DiPiro, Joseph T. A2 - Yee, Gary C. A2 - Posey, L. Michael A2 - Haines, Stuart T. A2 - Nolin, Thomas D. A2 - Ellingrod, Vicki Y1 - 2020 N1 - T2 - Pharmacotherapy: A Pathophysiologic Approach, 11e AB - KEY CONCEPTS Untreated or ineffectively treated childhood attention deficit/hyperactivity disorder (ADHD) can lead to poor school performance, poor socialization, and increased risk for traffic accidents, psychiatric comorbidities, unemployment, and incarceration during adolescence and adulthood. ADHD is 74% genetic in origin, and is associated with decreased brain volume, a delay in cortical maturation, and possible dysregulation of the “default mode network,” a brain system that regulates attention, prioritization of information, memory, and impulse control. Symptoms of inattention or hyperactivity and impulsivity or all three must be present during childhood and cause functional impairment in two different settings for 6 months to meet DSM-5 diagnostic criteria for ADHD. Adult-onset ADHD requires further study. Prior to initiating pharmacotherapy, overall physical and mental health and psychiatric comorbidities must be assessed, and goals of treatment must be set. Preschoolers, school-age children, adolescents, and adults with ADHD all can benefit from nonpharmacologic interventions that include a healthy diet, education on ADHD, and potentially effective educational, cognitive, and behavioral treatments. The stimulants are the most effective pharmacologic treatment option for all ages with a rapid therapeutic effect, typically within 1 or 2 hours of an effective dose. Methylphenidate is recommended as first-line for children and adolescents while amphetamines are first-line treatment for adults based on efficacy and tolerability. α2-Adrenergic agonists such as extended-release preparations of guanfacine and clonidine are less effective than stimulants as monotherapy and are used in combination with stimulants or as monotherapy in youth to improve symptom control, particularly oppositional behaviors and insomnia. When ADHD coexists with other neuropsychiatric conditions, such as anxiety disorders, major depression, autism spectrum disorder (ASD) or Tourette disorder, it is optimal to treat the most functionally impairing disorder first (whether it is ADHD or the co-occurring condition) and then treat the second disorder. When ADHD coexists with bipolar disorder, it is necessary to first stabilize the mood with lithium, an anticonvulsant, or an atypical antipsychotic before adding an ADHD-specific medication such as a stimulants. Atomoxetine is a good option to manage ADHD symptoms in adolescents and adults with substance-use disorders or when stimulants are intolerable. It has a delayed onset of effect (2–4 weeks), but it has no abuse potential. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1182448154 ER -