Trastorno déficit de atención e hiperactividad
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Trastorno déficit de atención e hiperactividad
- 1. Trastorno por déficit de atención/hiperactividad Daniel Stiven Marín Materno-infantil I
- 10. Fisiopatología
- 11. Fisiopatología
- 13. Criterios diagnósticos Característica discriminante 1.Falta de atención e hiperactividad-impulsividad importantes antes de los 7 años de edad. Características compatibles 1.Se produce en dos o más contextos 2.Deterioro social y académico 3.Ausencia de enfermedad psicótica 4.Ausencia de TGD 5.Ausencia de trastorno del estado de ánimo o de ansiedad 6.Ausencia de trastorno disociativo o de la personalidad 7.Ausencia de trastorno fisiológico que explique los síntomas Características variables 1.Se produce con más frecuencia en el sexo masculino 2.Agresividad 3.Antecedentes familiares de TDAH 4.Hipoperfusión de los lóbulos frontales y el estriado en el TEP 5.EEG cuantitativo anormal 6.Presencia simultánea de TND o TC 7.Trastorno depresivo simultáneo
- 17. Kewley G. Attention deficit hyperactivity disorder: recognition, reality and resolution. London: David Fulton, 1999. Manifestaciones clinicas
- 18. Monuteaux, M., Mick, E., Faraone, S., & Biederman, J. (2009). The influence of sex on the course and psychiatric correlates of ADHD from childhood to adolescence: A longitudinal study Journal of Child Psychology and Psychiatry . Manifestaciones clinicas
- 20. Diagnóstico diferencial TGD y retraso mental
- 21. Evaluación • Historia clínica del desarrollo • WISC • Conners rating scale: padres (PQ-93, PQ- 48) y profesores (TQ-39, TQ-28) • Plomo y TSH séricos
- 22. Tratamiento • Multimodal • Formación de los padres • Tratamiento cognitivo-conductual • Intervenciones educativas
- 23. Tratamiento
- 25. • Control de PA y FC c/6 meses o si cambio de dosis • RAMs: anorexia (disminución del crecimiento), insomnio, dolor abdominal, cefalea y tics. • Tricíclicos, clonidina
- 26. • MPH 0,3 mg/kg tres veces al día • MPH 0,6 mg/kg tres veces al día • MPH 1 mg/kg tres veces al día
Notas del editor
- encefalitis letárgica, enfermedad que se caracteriza por la languidez creciente, apatía y somnolencia, que lleva, finalmente al letargo.
- Perceived negative impact (strong and moderate) of ADHD on everyday life as reported by parents/caregivers of children and adolescents with ADHD in the European Lifetime Impairment Survey14
- Activation abnormalities are associated with ADHD in children, adolescents and adults,with meta-analyses demonstrating significant activation reductions in various frontal regions of the brain including the anterior cingulate; dorsolateral prefrontal and inferior prefrontal cortices; and related regions including the basal ganglia, thalamus, and areas of parietal cortex.8 Furthermore, atypical functional network connectivity in the default mode network (a network of brain regions that are active during resting) has been observed in children and adolescents with ADHD.26 In addition, there is some evidence that patterns of under- and over-activation of certain regions of the brain differ between children and adolescents versus adults, as indicated by a meta-analysis of 55 fMRI studies which compared children, adolescents and adults with ADHD with healthy controls A meta-analysis of worldwide studies reported that quantitative electroencephalography (EEG; the recording of electrical activity along the scalp) may be used to identify changes in brain electrical activity. An increase in the theta/beta (two EEG frequency bands) ratio was observed in all studies included in the review.27 Further research is required to substantiate EEG findings for use as a biomarker in ADHD diagnosis.28 Individual EEG patterns associated with ADHD are under early investigation for utility in personalising neurofeedback protocols — computer-assisted training to self-regulate brainwave activity — as non-pharmacological treatmentoptions for ADHD. Delayed maturation of certain dopaminergic neural pathways has been observed in children and adolescents with ADHD,30 as well as an imbalance in the levels of both dopamine and noradrenaline in the brains of children, adolescents and adults with ADHD compared with healthy controls.10,11,31,32 Dopamine and noradrenaline have been implicated in influencing impulsivity,10 and dopamine in influencing inattention.11 Emerging evidence also suggests possible roles for other signalling systems in the neurobiology of ADHD. Deficiencies in glutamate signalling in some regions of the brain may have a modulatory role in adults with ADHD.33,34 Furthermore, polymorphisms in the serotonin transporter gene have been associated with differential response to ADHD treatment,35 and the presence of comorbid conduct disorder in children and adolescents with hyperkinetic disorder (an alternative description of ADHD).36
- In men who had ADHD, PET scans showed that they processed a memory task in visual areas in the occipital lobe of the brain, as indicated by the yellow spots in the left image. Non-ADHD men used the temporal and frontal lobes, shown at right.
- Beta waves oscillate between about 13 and 35 times per second. Beta waves are prominent during states of concentration and problem solving. Beta waves are common in the EEG’s of most waking adults but may also be present during drowsiness. Beta waves tend to be more visible in the EEG when the patients eyes are open. Spindling Beta generally reflects increased cortical irritability and is most likely seen in clinical conditions such as…ADHD Epilepsy Psychoses including during hallucinations Anxiety disorders Excessive Beta activity on quantitative analysis can relate to symptoms of brain over arousal such as anxiety, obsessiveness, sleep difficulties, hyperactivity, etc.
- ADHD=attention deficit hyperactivity disorder; ODD=oppositional defiant disorde
- it is believed to modulate dopamine and noradrenaline† signalling in brain regions associated with motivation and reward.2 Treatment with methylphenidate has been demonstrated to block dopamine transporter molecules3,4 and increase extracellular levels of dopamine3,5 in the striatum of healthy adults