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ADHD Dr Hamelijnck Part 2 of 2

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Dr Jacobus Hamelijnck (Arts, MRCPsych)

Welcome to part two of this video on managing and diagnosing adhd in adults i’m dr. hamlin consultant psychiatrist in the next 10 minutes or so be talking about the main treatments of adhd in adults next slide when people start treatment it’s very important to first realize steve if there’s any physical health investigations that need to be done most stimulant

Medication can cause a rise in blood pressure and pulse and therefore this needs to be checked before starting treatment a family history of any hard difficulties like sudden death needs to be investigated and ecgs not normally required as a routine and neither are any routine bloods except if the non-stimulant atomoxetine is used they aim for the treatment is to

Start on a low dose and to slowly increase until the required level of medication has been reached the patient is offered ongoing support during the titration of medication i don’t telephone or email and to see if there’s an emerging side effects and to adjust the dose after medication has been started the blood pressure pulse should be monitored annually by their

Gp next time the first-line treatment in adults with adhd is similar to children with adhd stimulants are the first choice there are two main options in prescribing stimulants first one is methylphenidate and the second one is amphetamine which has now been provided through a preparation called list exon pétomane which will be covered in a later slide stimulants

Provide as slow continuous blockage of the noradrenaline and dopamine and should be given up to a dose of 100 milligrams a day it’s important to realize that stimulant medication does not provide 24 hours a day cover of symptoms but the response rate is very high new slide side effects with stimulants are very mild most people will have no difficulties occasionally

People will experience headaches or sleep difficulties and blood pressure and pulse should be monitored if required no routine ecg is necessary the warrior on stimulants is the abuse potential in reality this proves to be quite and low potential drugs of abuse have in common that they tend to be high dose and a fast delivery just think of the delivery of cocaine

Through the nose in stimulant medication with adhd this does not happen the medication is swallowed and therefore there’s a slow uptake in the stomach and gut there is no quick emergence of effect leading to a low abuse potential new slides methylphenidate has been around for a long time and is the first choice of stimulant medication normally i would start patients

On a dose of 5 or 10 milligrams twice or three times a day and monitor weekly to look for response the main effect of methylphenidate is people reckon is an almost immediate improvement in their ability to focus and concentrate and they get more things done that able to organize themselves better but this will last for a few hours for a normal release preparation

This raises the possibility of considering modified release preparations like inserter echoes him which will give a more smooth response effect new slide amphetamines have long been known to be very effective in adhd but the immediate release preparations caused concern with regards to abuse i’m feta mean just like methylphenidate blocks the noradrenaline reuptake

Molecule but in addition to that it also has an effect on the dopamine reuptake molecule the other main difference with amphetamines is that it causes an active release of noradrenaline and dopamine adna nerve terminal leading to very significant effects due to the slightly higher abuse potential the pharmaceutical industry have brought out lists exxon feta mean

This is a prodrug of amphetamine weight lysine which gets split in the red blood cells leading to a very slow but steady and smooth release of amphetamine in the bloodstream and therefore leading to a very low abuse potential but very good effect on adhd symptoms news sly his second line treatment in adhd in adults is through noradrenaline reuptake inhibitors and

The most widely prescribed medication is atomoxetine this is at the moment the only licensed drug for uk use in adults when started in adulthood childhood tricyclic antidepressants have long been used in managing adhd and can be very effective who pro peon is a noradrenaline acting drug but the effect on adhd symptoms is not huge new slide the main side effect for

Noradrenaline reuptake inhibitor drugs are similar to stimulant drugs but there are some additional difficulties just like antidepressants they can cause some sexual dysfunction sweating and there have been reports of suicidal ideation also anticholinergic side effects like dry mouth and difficulty focusing when reading can occur in my experience these symptoms

Don’t tend to happen very often and are often easily managed by the patient newsline a further drug is an or drennan agonist and clonidine is the most widely prescribed drug in the uk clonidine is quite a sedative drug and is therefore very helpful to be used at night sometimes clonidine is used in addition to stimulants to help patients shut off their mind in

Favor of them to sleep new slide clonidine has also been helpful with the use of emotion regulation difficulties like aggression and anger there is a hypothetical increase in ticks when stimulant medications are prescribed and clonidine could be a better option for patients with an existing diagnosis of tic disorder because of the hypertensive effect blood pressure

Needs to be monitored carefully new slide as a third line treatment people may need to be prescribed a combination of drugs i already mentioned the combination of clonidine with stimulants but also other noradrenaline reuptake drugs like atomoxetine with stimulants the use of these is not very common and the psychotic drugs like a tire pain i used in managing adhd

Symptoms particularly aggression and there is some pharmacological evidence that this should be helpful however in reality quetiapine and it is more of a sedative and some patients want is helpful to sleep noise guidelines are very clear that antipsychotic drugs should not be used routinely in patients with adhd use lime i would like to end his presentation on handled

Adhd to draw your attention to the difficulties of prescribing when your patient becomes pregnant there is not enough data to say that methylphenidate is definitely safe but the risks are likely to be very low it is asked to be balanced up with the risks of the mother when she is not taking any medication particularly high risk taking behavior and impulsivity it’s

Worth considering stopping the medication during the first trimester and also before giving birth or to reduce the dose to the lowest dose that will manage the symptoms satisfactory when the patient prescribed amphetamines the advice is to change to methylphenidate thank you very much for listening to this presentation on adult adhd and i hope enjoyed it further

Information can be found on our website anchor psychiatry group code uk on this website there will be further links to national resources from the royal college of psychiatrists and other organizations including aed norfolk thank you

Transcribed from video
ADHD Dr Hamelijnck Part 2 of 2 فرط الحركة وتشتت الانتباه عند البالغين By قناة الدكتور ياسر حميد أخصائي الأمراض النفسية