Attentional deficit Hyperactivity Syndrome. Frequency/prevalence 4 – 6 % of school children more boys than girls About 75 % are affected in adulthood.

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Presentation transcript:

Attentional deficit Hyperactivity Syndrome

Frequency/prevalence 4 – 6 % of school children more boys than girls About 75 % are affected in adulthood

Symptoms Attention deficit: distractable, problems to concentrate, to finish a task Hyperactivity: inability to remain seated talking too much Impuslivity: interrupts other spakers can‘t wait for anything antisocial behaviour No insight into their own disease-state

Cause There is a strong genetic component Speculative: Polymorphism of the D4 gene ??? of the DA-transporter Gene ??? Environmental factors alone can not explain the disease

Psychostimulants in ADHD Amphetamines: Amphetamine (Adderall®)) Methamphetamine (Adderall ®) Methylphenidate (Ritalin ®) Non Amphetamines: Pemoline (Cylert ®) Atomoxetine (Strattera®) Modafinil Under Ivestigation: ABT-418 (N-ACH-R-Ago) S-Citalopram (Escitalopram®, Lexapro®) Histamine H3 receptor antagonists (Komater et al. 2002)

1-Methylphenidate: Ritalin ®, Medikinet®, Equasym®, Concerta ® Methadate ® 2-D-Amphetamine Dexamphetamine Tx for those who do not respond to Ritalin 3-Adderall ® is an amphetamine coctail Amphetamines:

Behavioural pharmacology of amphetamine Self-administered Dopamine-dependent, mediated by the brain reward system Dose dependent increase in: -All behaviours resulting in fragmentation of behaviour swichtching – finally stereotypy Dopamin-dependent, mediated by striatum and N.accumbens

Methylphenidate is a derivative of piperidine and is structurally related to dextroamphetamine, an older drug still used to treat AD/HD

Atomoxetine (Strattera®) Approved in USA and UK for ADHD in children, adolescents and adults. In Germany: March 2005 No psychostimulant drug Contraindication: MAO inhibitors Metabolism: P450 pathway

Atomoxetine: Mechanism of action Selective noradrenaline reuptake inhibitor SNARI Some selectivity for the prefrontal cortex Reboxetine

Atomoxetine effects in humans 1-Mood brightening, but no psychostimulant-like high. 2-Neuropharmacology a-Enhancement of noradrenaline tone b-Facilitates neuronal differentiation during developent c-Facilitates neuronal plasticity d-protects against various neurotoxins. 3-Behavioural pharmacology Alerting effects

Histamine H3-antagonists in ADHD The H3 receptor is a presynaptic auto- and Heteroreceptor. It inhibits histamine an Catecholamine release H3-antagonists enhance catecholamine release

Nicotine-R agonists in ADHD Nicotinic ACH-Receptors are located Presynaptically as heteroreceptors on Catecholaminergic terminals Nicotine-R-agonists enhance catecholamine release

ADHD in adulthood Untreated ADHD persists in about 66% to Adulthood and results in: adverse/inappropriate/antisocial behaviour addiction.

Misuse of ADHD drugs as enhancers For combating sleep For enhacement of motivation for work For mood brightening For cognition enhancement (learning, memory, communication)