Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23
Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old. On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time.
Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job.
Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.
Mr. Deliver is 5'11″ and his weight is 165 lb. He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.
1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?
2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?
Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver
meets the criteria for ADHD?
The first tool I would use to affirm that this patient meets the criteria for ADHD would be
the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of
the symptoms in either category 1 (inattention) or category 2 (hyperactivity and
impulsivity) that last for at least 6 months and to a degree that negatively impacts social,
academic or occupations activities. These symptoms also need to be present in two or
more settings, be present prior to age of 12 years and do not occur exclusively during
the course of schizophrenia or another psychotic disorder and are not better explained
by another mental disorder (American Psychiatric Association, 2013). There are also
many screening tools to use in addition to the DSM-5. Rating scales are used in
conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically
designed for use in adults include: Brown Attention-Deficit Disorder Symptom
Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);
ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).
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2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,
inattentive type. What is the current recommendation for pharmacological
treatment for Mr. Deliver?
I would recommend either an amphetamine or methylphenidate. I am slightly
concerned about this patient’s history of hypertension and hyperlipidemia, as both
of these psychostimulant classes have been shown to raise blood pressure. Long
term studies have shown that stimulant use is not associated with increased risk of
heart attacks, cardiac death or stroke. Those with well-controlled hypertension have
been shown to manage ADHD symptoms effectively with amphetamines and
methylphenidates. This still does not negate the fact however, that the product
labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this
patient to partake in behavioral therapy as well as using prescription medication.
3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male
that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on
any medications at this age). How will your pharmacological treatment change?
For an adolescent patient the treatment plan is not a lot different than for adults
with ADHD. Stimulants are more effective than non-stimulants, but there can be a
risk for growth restriction. There are other non-stimulant medications that could be
tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with
adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,
2017).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing
Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of
Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD
with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real
World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2
This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00
https://www.coursehero.com/file/123197904/discussion-9docx/
Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry
(Edgmont (Pa. : Township)), 2(11), 44–53.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/
Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing
Platform
1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?
The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).
2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?
Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.
3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)
Step-by-step explanation
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2
Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/
Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform.
