Epidemiology

Etiology

Pathophysiology

Clinical features

Diagnostics

Treatment

Options include stimulant and nonstimulant therapy.
Stimulant therapy is usually first-line treatment for children ≥ 6 years of age and adults.

Stimulant therapy

• Options: methylphenidate or amphetamine analogues (e.g., lisdexamfetamine, dextroamphetamine)
• Mechanism of action: indirect and central sympathomimetic activity → increased release and blocked reuptake of norepinephrine and dopamine (minor effect on serotonin) → increased concentration of norepinephrine and dopamine in the synaptic cleft → increased mental performance (e.g., improved concentration, cognition, short-term memory) and fine motor skills
• Adverse effects
  • Sympathomimetic effects
    • Anxiety, agitation, restlessness, bruxism, tics
    • Difficulty falling asleep (insomnia)
    • Reduced appetite, nausea, vomiting, weight loss
    • Increased arterial blood pressure, tachycardia

Nonstimulant therapy

• SSRI
  • Options: atomoxetine or viloxazine
• Alpha-2 adrenergic agonists
  • Options: guanfacine extended-release or clonidine extended-release