Journal
BIOLOGICAL PSYCHIATRY
Volume 57, Issue 11, Pages 1377-1384Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.biopsych.2004.08.019
Keywords
ADHD; prefrontal cortex; norepinephrine; dopamine; stimulants
Categories
Funding
- NIA NIH HHS [R37 AG06036] Funding Source: Medline
- NIMH NIH HHS [MH R21 MH 066393] Funding Source: Medline
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The prefrontal cortex guides behaviours, thoughts, and feelings using representational knowledge, i.e., working memory. These fundamental cognitive abilities subserve the so-called executive functions, the ability to inhibit inappropriate behaviours and thoughts, regulate our attention. monitor our actions and plan and organize for the future. Neuropsychological and imaging studies indicate that these prefrontal cortex functions are weaker in patients with attention-deficit/hyperactivity disorder and contribute substantially to attention-deficit hyperactivity disorder symptomology. Research in animals indicates that The prefrontal cortex is very sensitive to its neurochemical environment and that small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behaviour. Optimal levels norepinephrine acting at postsynaptic alpha-2A-adrenoceptors and dopamine acting at D1 receptors are essential to prefrontal cortex function. Blockade of norepinephrine alpha-2-adrenoceptors in prefrontal cortax markedly impairs prefrontal cortex function and mimics most of the symtoms of attention-deficit/hyperactivity disorder, including impulsivity and locomotor hyperactivity. Conversely, stimulation of alpha-2-adrenoceptors in prefrontal cortex strengthens prefrontal cortex regulation of behavior and reduces distractibility. Most effective treatments for attention-deficit/hyperactivity disorder facilitate catecholamine transmission and likely have their therapeutic actions by optimizing catecholamine actions in prefrontal cortex.
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