Week 9 Discussion 1: Harold or Greg ADHD Case Study

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Week 9 Discussion 1: Greg ADHD Case Study

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Week 9 Discussion 1: Greg ADHD Case Study

What symptoms of ADHD do your patient present with?

Greg manifests with poor concentration, forgetfulness, getting distracted, restlessness, feeling hyper, and loss of focus. These symptoms are consistent with ADHD. The patient also demonstrates a highly irritable nature even with minimal triggers as evidenced by the angry response to questions on the name of the clinic he was treated in his childhood to help recover his medical records. The response “I can’t remember shit” all but indicates Greg’s frustration with the inquiries from the psychiatrist. The patient also admits to having difficulties with the mother and that they are not seeing “eye to eye”. Poor social relationships are characteristic elements in an individual with ADHD and are associated with low tolerance levels to frustration or external demands Greg also admits that he is having difficulties with his schoolwork and has been getting Bs and Cs while he should be getting As and on the worse he should be getting Bs (CDC, 2020). Learning disability is a notable feature in individuals with ADHD and may be associated with the elements of loss of concentration, restlessness, fidgeting, and loss of focus in class and with his assignments/course work (American Psychiatric Association, 2018).

What are other possible causes of his symptoms?

According to the DSM-5 criteria, ADHD is also likely to manifest with signs of impulsivity where the individual may for instance act without engaging in much critical thinking. In instances of impulsivity, the individual will for instance tend to buy items they see in the store without considering whether they need them or not. These impulsive behaviors are a steppingstone to future financial strain for the patient (CDC, 2020). Further, these impulsive behaviors may be characterized by an excessive obsession with some activities including sex with multiple partners with the risk for unsafe sex due to minimal critical thinking or consideration of repercussions. An individual with ADHD is also likely to demonstrate difficulty in keeping through a conversation as may be characterized by constant or frequent interruption of conversations (CDC, 2020). ADHD also tends to trigger mood swings with the individual demonstrating extreme reactions of low and high moods at different times. ADHD also tends to compromise an individual’s ability to multitask. Individuals with ADHD also demonstrate difficulty in coping with stress and are likely to manifest a hot temper when they fail to cope with the stress. In the later or severe stages of ADHD, the individual is likely to manifest depressive symptoms especially when subjected to relatively excessive external pressure (American Psychiatric Association, 2018). 

What further information, if any, would you like about this case?

It would be important to inquire from Greg whether he has had difficulties completing school projects or assignments especially in the tail head of those tasks. The inability to see through a project is one of the characteristic behaviors associated with ADHD. With Greg having admitted to poor academic performance in recent times, this inquiry will inform whether the poor results are generally due to performances in the exams or overall difficulty in completing key parts of the course work. It would also be necessary to inquire from Greg whether he has difficulties with completing tasks that require a high level of organization. The elements of restlessness and fidgeting are the likely causes of the inability to engage in highly organized tasks in ADHD cases (CDC, 2020). I would also request Greg to rate his likelihood of forgetting obligations or appointments. Memory loss is a characteristic symptom of ADHD, and it sets the stage for a decline in the individual’s functional status and reliability. An inquiry on Greg’s history of substance abuse would be useful in determining whether the emerging symptoms are being triggered by the drug/substance abuse. This inquiry would focus on determining whether Greg feels better or worse with his symptoms before and after the use of substances/drugs if any (American Psychiatric Association, 2018). In ADHD cases, individuals tend to delay or avoid tasks that require significant thinking. I would request Greg to rate his likelihood for avoiding/delaying tasks on a scale of 1-10. I would also inquire from Greg whether he feels as though he is not in control and being controlled or driven by a motor that he can rarely control. An inquiry on the patient’s medical history to assess whether they had any incidences of thyroid conditions or sleep apnea would help rule out these elements especially because such conditions present with similar symptoms and behaviors as those witnessed in ADHD cases (American Psychiatric Association, 2018). 

With the assumption that the patient does have ADHD, what medication would you prescribe (list name and dose)? Why?

Dexedrine 5mg twice daily would be the best medication for Greg (Caporuscio & Pharm, 2020. With the patient admittedly having been on Dexedrine in the past, and with the outcomes having been as desired, sustaining the medication would be the best choice. The choice of Dexedrine also is informed by the reality that it is less likely to impose any particular side effects that would affect his functional status at least from his experience with the medication (Mattingly et al., 2017). The medication will be prescribed for the next four weeks considering that the optimal effects of Dexedrine tend to emerge from the fourth week. Dexedrine is a short/intermediary-acting stimulant that contains dextroamphetamine sulfate. The dextroamphetamine mechanism of action is two-way; on one hand, it inhibits the reuptake of monoamines in the synaptic cleft while on the other hand it enhances or stimulates the release of dopamine and noradrenaline (Caporuscio & Pharm, 2020). The effect of these processes is improved mood due to dopamine release. On the other hand, noradrenaline is involved in the regulation of specific behaviors such as attention, memory, learning, attention, vigilance, motivation, reward, and arousal. Typically, ADHD presents with manifestations of compromised behaviors or memory loss, lack of concentration, inability to tolerate relatively minimal stressors, and loss of interest in activities. These behaviors are noticeable in Greg’s case further justifying the choice of Dexedrine (Mattingly et al., 2017). 

List any relevant safety information and screening (labs, etc) related to your medication choice.

The diagnosis of ADHD is firmly based on a physical assessment and a comprehensive review of the patient’s medical history (Anbarasan et al., 2020). The physical assessment focuses on ruling out any other conditions that may trigger symptoms associated with ADHD. The comprehensive health and family history examination focuses on identifying any familial or genetic correlations. Self-reports from the parents or school nurse on their assessment of the patient’s behaviors is also a viable tool to inform diagnosis. For optimal outcomes, at least two self-reports from two settings such as home and school would be useful in informing a diagnosis to identify behaviors that deviate from the norm (Anbarasan et al., 2020). Objective assessment via standardized screening tools such as the Barkley Adult ADHD Rating Scale-IV, Adult ADHD Self-Report Scale, or the Connors Scale is considered a primary element of the diagnostic process since these tools are primarily based on the DSM-5 criteria for ADHD (CHADD, 2018). A complete blood count test and thyroid function tests can be used to rule out any associated abnormalities that may cause behaviors or symptoms similar to ADHD. The clinician must seek to collect as much evidence as possible and to analyze or align it to identify consistencies and inconsistencies to rule out any conditions with almost similar symptoms. Importantly, the clinician should seek to assess the patient’s risk for addiction considering that Dexedrine is a stimulant that can cause dependency, especially when used for a prolonged period (Anbarasan et al., 2020). 

References

Anbarasan, D., Kitchin, M., & Adler, L. A. (2020). Screening for Adult ADHD. Current Psychiatry Reports, 22(12), 1-5.

American Psychiatric Association. (2018). What is ADHD? Psychiatric.org. https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Caporuscio, J., & Pharm.D. (2020). ADHD medication list: A comparison guide. Medical and health information. https://www.medicalnewstoday.com/articles/325201#list-of-adhd-medications

CDC. (2020, September 21). Symptoms and diagnosis of ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/diagnosis.html

CHADD. (2018, May 24). Diagnosis of ADHD in adults. https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/

Mattingly, G. W., Wilson, J., & Rostain, A. L. (2017). A clinician’s guide to ADHD treatment options. Postgraduate medicine, 129(7), 657-666.