Week 9 Discussion 1: Harold or Greg ADHD Case Study

Post#1: Harold Case Study by Ivan

What symptoms of ADHD does your patient present with?

After viewing the case studies, I selected Harold's case study for the discussion. Some symptoms of ADHD that the patient in this case study presents with include being unable to concentrate on tasks. The patient in the case study has difficulties focusing on the given tasks. The main issue that brings him to the therapist is concentration difficulties. Individuals with ADHD exhibit concentration difficulties in almost every reading they do (Bijlenga et al., 2019). The other symptom that the patient reports is being forgetful/forgetful/losing things. The patient notes that he sometimes forgets his shoes, socks, phone, and jacket and cannot find them. At other times, he fails to pay his bills and ends up paying a fine. Another symptom that the patient present is hyperactivity. The patient is easily distracted, impulsive and aggressive. He asserts that when they were all cramming for the big exams in school, he could be easily distracted by whispers from other people. Besides, he always finds it difficult to sit still and listen. And the last symptom that the patient exhibits is disorganization. He asserts that he finds it difficult to follow a calendar, despite his friend buying it as motivation.

What are other possible causes of his symptoms?

The possible causes of the patient's symptoms are as follows. One of the causes is genetics. ADHD can run in the family, and in most cases, the genes that an individual gets from the parents are likely to result in the condition. Studies show that parents and siblings of an ADHD individual are more likely to have the disorder themselves (Faraone & Larsson, 2019). There is, therefore, a probability that the patient in the case study could have inherited the condition from the family lineage. Another factor that could have contributed to the disorder is brain function and structure. Brain scans show that an individual's brain structure may largely contribute to a condition (Stahl, 2017). It has been found that individuals with brain disorders have certain brain areas being lesser, whereas others may be larger. Other studies show that imbalance in neurotransmitters, including dopamine and norepinephrine, may primarily contribute to the disorder (Stahl, 2013). The other symptom is the environment; exposure to environmental toxins such as lead found in pipes may contribute to ADHD. And the last factor is maternal drug use, alcohol use, or smoking during pregnancy.

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

I would like to know about the case study are genetic factors, environmental conditions, and whether the patient is allergic to any food or medications. The provider in the case study has addressed most of the elements, including the past medications, history of the disease, and symptoms. However, the provider has not addressed the above-said factors. Therefore, if I were diagnosing the patient, I would like to know whether any family member has/had any mental disorder. Besides, I would like to know whether the patient has ever been exposed to various environmental toxins such as lead in the past. Finally, I would inquire whether the patient is allergic to any food or medication. All the above information is essential since it can help understand the causes of the patient's disorder and the various treatment options that can best address the situation.

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

With the assumption that the patient does have ADHD, the best medication that would best address the condition is Methylphenidate (Ritalin). The patient should start with an initial dosage of 20 to 30 milligrams (mg) per day when taking the drug. This can be adjusted as needed but should not be more than 60 mg per day (Stahl, 2017). Another essential thing to understand is that the medication should be administered 2 or 3 times a day, with the patient taking it 30 to 45 minutes before meals. Methylphenidate is the best medication, in this case, study because it controls symptoms of attention deficit hyperactive disorder, including concentration difficulties, holding actions, remaining still, among many more. This medication blocks dopamine and noradrenaline reuptake into the terminal by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT), increasing levels of dopamine and noradrenaline in the synaptic cleft (Stahl, 2017). This, as a result, helps manage the persistent and dysfunctional pattern of hyperactivity, impulsiveness, and distractibility

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

Various safety information and screenings that need to be evaluated before administering Methylphenidate are as follows. First, individuals with low levels of white blood cells should not take the medication because it might result in more complications. Another contraindication is that individuals should not take the medication with manic behavior. Studies show that patients with manic behaviors who receive methylphenidate monotherapy display an increased rate of manic episodes (Hegerl et al., 2018). Finally, the medication should not be taken by individuals with uncontrolled epilepsy because it can lower the seizures threshold (Stahl, 2017). On the other side, various lab tests that need to be administered before taking the medication include Complete Blood Count (CBC), blood pressure to measure the pulse rate, and height, weight, and appetite.

References

Bijlenga, D., Vollebregt, M. A., Kooij, J. J., & Arns, M. (2019). The role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11(1), 5-19.

Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular psychiatry, 24(4), 562-575.

Hegerl, U., Mergl, R., Sander, C., Dietzel, J., Bitter, I., Demyttenaere, K., ... & Kluge, M. (2018). A multi-center, randomized, double-blind, placebo-controlled clinical trial of Methylphenidate in the initial treatment of acute mania (MEMAP study). European Neuropsychopharmacology, 28(1), 185-194.

Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Stahl, S. (2017). Stahl's essential psychopharmacology prescribers guide (6th ed.). Cambridge University Press.