Running head: OPIOID USE DISORDERS
Opioid Use Disorders
Student Name
Course:
Instructor:
Institution
July 10th, 2019
OPIOID USE DISORDERS
Advanced Psychopharmacology
Opioid Use Disorders Video Transcript
Joe:I promise you, I have more problems than you’re going to want to deal with.
Off Camera:What sort of problems?
Joe:I’d say chronic pain, but that can also describe my wife.
Off Camera:So you have physical pain problems and you have problems with your
wife?
Joe:[Laughter] No, you can’t take a joke, Doc. You know, I guess that just goes against
your training, huh?
Off Camera:Oh, OK. I get the joke now. No, you don’t. That’s alright, that’s alright. My
wife’s fine, sex is great, no risk of pregnancy, it’s heaven. So you do have physical pain.
Joe:Oh, yes. Everywhere. All over my body. And I won’t even get into the blood
pressure and all that crap. I’ve had three stents, and you know I could probably do a
Wilford Brimley commercial on diabetes.
Off Camera:OK. So you have many health issues.
Joe:Many! They could use me to teach an entire encyclopedia of medical problems.
Off Camera:So, why is it you’re here? Why are you seeing me today?
Joe:I have sleep problems, a non-sexual kind, and lately, lately I’ve been having these
friggin attacks.
Off Camera:Uh-huh.
Joe:I can tell you exactly what I need.
Off Camera:OK.
Joe:I need something like Percocet or Oxycontin.
Off Camera:OK, well first let’s talk more about these attacks you’re having.
Joe:No, let’s talk more about Percocet.
Off Camera:So you want to talk about the medications, first.
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Joe:Doc, when it comes to my health. I don’t like being jerked around.
Off Camera:Do you feel like you’re being jerked around?
Joe:No offense, but I’m old.
Off Camera:OK.
Joe:I’m broken and I need to be fixed. And I don’t want to waste any time talking about
where my hurt came from. My body tells me enough of that.
Off Camera:OK, OK. But, so I can understand better to help you, I need to know
what’s going on with these attacks that you said you’re having.
Joe:Ah hell. Alright [sigh]. I get tightness in the chest. I’m out of breath and I start
sweating.
Off Camera:OK.
Joe:Hell, they’re panic attacks. And if you had any decent training, you already knew
that.
Off Camera:When was your first panic attack?
Joe:About two weeks ago. Yeah. The wife and I took a road trip. We have an RV and
Harleys and so forth. And we found a campsite at Joshua Tree.
Off Camera:Nice.
Joe:Actually, the trip was a little more stressful than normal. Susie, my wife, she left
medication back at the house; actually it was her extras that she includes in some of her
dosage. And it was too late to turn back.
Off Camera:OK.
Joe:So, I’m setting the RV up. Actually putting the awning up and Susie thought I was
having a heart attack. She called the rangers and there they were and they even
brought an ambulance all the way up there. You know, can you imagine what that must
have cost the government?
Off Camera:Wow, yeah.
Joe:Had to be a shitload.
Off Camera:And then what happened after that?
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Joe:Well, they released me. Next day, we went home like nothing had happened.
Off Camera:Hm. So, I do treat people for panic attacks. How much Oxycontin do you
take?
Joe:Just what the doctor prescribes.
Off Camera:Uh-huh. How many pills a day is that.
Joe:The dosage? I don’t know. I just pop the pills they give me.
Off Camera:Do you think it’s two, three, or more pills a day?
Joe:No.
Off Camera:Did you recently stop taking the Oxycontin?
Joe:Mark cut my dosage about three weeks ago.
Off Camera:Uh-huh.
Joe:Which left me with nothing but my Ambien and a little Klonopin.
Off Camera:OK. So your doctor has you on both Ambien and Klonopin.
Joe:Ambien, yes. It helps me sleep. But my wife takes the Klonopin. And during the
day I take a little of her Klonopin too.
Off Camera:So you mix the medications.
Joe:When that’s what my doctor prescribes, yeah. It seems to work well.
Off Camera:Are you and your doctor pretty good friends?
Joe:Oh! Mark and I? [Laughter] hell, yes! We ride together, on the weekends we’ve got
a big group of us. I’ve even been to Sturgis with him.
Off Camera:Sturgis.
Joe:Big bike rally. Harleys. South Dakota in the Black Hills. Everybody should have a
doctor that they can kick back with and down a beer or two.
Off Camera:You and your doctor drink beer together?
Joe:[Laughter] Beer? A lot more than beer, Doc. Mark’s a champ.
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Off Camera:What do you mean?
Joe:Well, one of the craziest things, if not the craziest things we’ve done, it was one of
these loco Indian ceremonies.
Off Camera:Right.
Joe:And, well, fuck me with a hot poker. You take this hallucinogenic drug. It’s ah,
whatchamacallit. You stay up all night, the drums are beating all night long and you’re in
a sweat lodge hallucinating with other people.
Off Camera:And are there any other drugs?
Joe:Oh no. No, I did all that when I was young. I guess the only time I really get carried
away is the annual trip to Sturgis. Then I let ‘er rip.
Off Camera:So, the rest of the year, do you feel like you have your drug use and your
alcohol use pretty much under control?
Joe:No, damn straight, yeah. I’m too old. I don’t bounce back like I used to. And I just
said it; I am getting old, Doc.
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective,
Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to
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develop your style of SOAP in the psychiatric practice setting. Refer to the Psychiatric SOAP
Note PowerPoint for further detail about each of these sections.
Criteria Clinical Notes
Subjective The patient is a male whose chief complaint is chronic pain. The
patient complains about symptoms such as physical pain all over his
body. He has suffers high blood pressure , which has seen him have
three stents in order to reduce the chance of having a heart attack.
The other key symptoms reported by the patient are sleep problems
and tightness in the chest which resorts to panic attacks.
According to the patient, the panic attacks begun about two weeks
ago. He usually suffers tightness in the chest, which causes shortness
of breath and sweating.
The patient has been taking Oxycontin to relive his severe pain.
However, his doctor cut his Oxycontin dosage about three weeks
ago. This left him with only Ambien and Klonopin which he takes to
help him sleep. Also, his wife takes Klonopin.
Include chief
complaint, subjective
information from the
patient, names and
relations of others
present in the
interview, and basic
demographic
information of the
patient. HPI, Past
Medical and
Psychiatric History,
Social History.
Objective Klonopin. The first lab test that must be conducted is Opiniod test to
confirm the presence of opinions in the patient’s urine, blood, sweat,
or saliva. The second test that must be conducted is urine drug
screen to help detect the presence of drug in the patient’s system
(Mumba et al 2018).
This is where the
“facts” are located.
Include relevant labs,
test results, vitals, and
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Review of Systems
(ROS) – if ROS is
negative, “ROS
noncontributory,” or
“ROS negative with
the exception of…”
Include MSE, risk
assessment here, and
psychiatric screening
measure results.
A MSE risk assessment must also be undertaken to establish if the
opinions can be safety prescribed to the patient.
Review of Systems (ROS)
Systems Examples
Constitutional
symptoms
Fatigue, loss of appetitive, fever,
sweats,
Sleeping patterns
Cardiovascular Chest pains, breathe shortness,
exercise intolerance, and
palpitations.
Respiratory Wheezing, coughing, shortness of
breath, and sputum.
Psychiatric Sleeping patterns, anxiety,
depression, concentrations problems,
paranoia, and sexual binges.
Assessment ICD-10 Codes
i. F11.11 for opioid abuse (mild OUD)
ii. F11.21 for opioid dependence (moderate or severe OUD)
Treatments options
Include your findings,
diagnosis and
differentials (DSM-5
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and any other medical
diagnosis) along with
ICD-10 codes,
treatment options, and
patient input
regarding treatment
options (if possible),
including obstacles to
treatment.
The treatment options of the patient’s opioid abuse and addiction
include;
i. Medications
ii. Behavioral/counselling therapy.
iii. Medication-assisted therapy (MAT). These may include
a combination of medications, counselling therapies,
behavioral therapies. A combination of these options
would help to increase the patient’s chances of an
effective and successful recovery (Bertholf & Reisfield,
2017).
iv. Hospital-based treatment.
Plan
Medication- Methadone. It is sold under several brand name such as
Dolophine Methadose, Methadose Sugar-Fre aamong others.
Dosing
The patient will have starting dosage of 2.5 mg-10 mg IV every 8-12
hours (Mayo Clinic, 2019).
In the event the patient requires switching from a chronically
administered opioid to this drug, he should consult a qualified
physician/psychiatrist because essentially, Methadone needs a lot of
caution as a result of the uncertainty associated with dose conversion
ratios. In some instances, deaths have been reported among opioid
Include a specific
plan, including
medications & dosing
& titration
considerations, lab
work ordered,
referrals to
psychiatric and
medical providers,
therapy
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recommendations,
holistic options and
complimentary
therapies, and
rationale for your
decisions. Include
when you will want to
see the patient next.
This comprehensive
plan should relate
directly to your
Assessment.
tolerant individuals during the conversion process.
Therapy Recommendations
Below are some of the most effective therapies suitable for this
particular patient;
i. Cognitive Behavioral Therapy
This therapy will help the patient achieve certain specific goals
such as the way he acts, feels, thinks, and deals with physical
and medical problems. Noteworthy, CBT is more effective when
combined with mediations that help in blocking the effects of
opioids.
ii. Mindfulness Meditation
According to Priddy et al, 2018), mindfulness meditation
training is an effective intervention in substance use disorders
and preventing relapses. It essentially helps the patient to be
aware of what he experiences in his body as well as mind. The
patient also trains to observe wat he experiences without
judgment. Also, mindfulness intervention is also an effective
complimentary therapy for the patient’s treatment.
iii. Motivational Interviewing
This is a patient-centered approach to counseling that seeks to
enable a patient to change problems behaviors. In this case,
motivational interviewing will help to enhance the patient’s
intrinsic motivation to overcome his opioid use disorder.
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The patient will be observed at the end of every week to monitor
his progress and possibly, make a few treatment changes
according to his needs.
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References
Bertholf, R. L., & Reisfield, G. M. (2017). Opioid Use Disorders, Medication-Assisted
Treatment, and the Role of the Laboratory.CLaboratory medicine,C48(4), e57-e61.
Mayo Clinic, (2019). “Methadone (Oral Route).” Retrieved from
https://www.mayoclinic.org/drugs-supplements/methadone-oral-route/description/drg-20075806
Mumba, M. N., Findlay, L. J., & Snow, D. E. (2018). Treatment Options for Opioid Use
Disorders: A Review of the Relevant Literature.CJournal of addictions nursing,C29(3), 221-225.
Priddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E.
L. (2018). Mindfulness meditation in the treatment of substance use disorders and preventing
future relapse: neurocognitive mechanisms and clinical implications.CSubstance abuse and
rehabilitation,C9, 103.
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Opioid use disorder (OUD) is a condition that occurs when a person becomes dependent on
opioids, including prescription painkillers or illegal drugs like heroin. OUD can lead to serious
physical, psychological, and social problems, including overdose and death.
Treatment for OUD often involves a combination of medications, counseling, and behavioral
therapies. Medications used to treat OUD include methadone, buprenorphine, and naltrexone,
which work by reducing cravings and withdrawal symptoms. Counseling and behavioral
therapies, such as cognitive-behavioral therapy and contingency management, can also be
effective in helping individuals recover from OUD.
Preventing OUD involves strategies such as increasing access to addiction treatment and
recovery support services, promoting safe and responsible prescribing practices among
healthcare providers, and educating the public about the risks associated with opioid use. It is
important to address the underlying factors that can lead to OUD, such as chronic pain and
mental health disorders, in order to prevent opioid misuse and abuse.
In addition to treatment and prevention efforts, there are also harm reduction strategies that can
help reduce the negative consequences associated with OUD. These strategies include
providing access to naloxone, a medication that can reverse an opioid overdose, and
implementing syringe exchange programs to prevent the spread of infectious diseases like HIV
and hepatitis C among people who inject opioids.
It is also important to address the social determinants of health that contribute to OUD, such as
poverty, unemployment, and lack of access to healthcare. This can involve advocating for
policies that address these issues, such as increasing access to affordable housing and
healthcare, and addressing systemic racism and discrimination.
Overall, addressing the opioid epidemic and OUD requires a comprehensive, multi-faceted
approach that involves prevention, treatment, and harm reduction strategies, as well as
addressing the underlying social determinants of health that contribute to this issue.
OPIOID USE DISORDERS
Efforts to address OUD and the opioid epidemic have become a public health priority in many
countries, including the United States. In the US, the opioid epidemic has been fueled in part by
the overprescription of opioids for pain management, as well as the availability of illicit opioids
like heroin and fentanyl.
To address the opioid epidemic, the US government has taken several steps, including
expanding access to addiction treatment and recovery support services, increasing the
availability of naloxone, and implementing policies to reduce opioid prescribing practices.
Additionally, the US government has launched public education campaigns to raise awareness
about the risks associated with opioid use and to promote safe opioid use and disposal.
While progress has been made in addressing the opioid epidemic, there is still much work to be
done to reduce the harm caused by OUD and prevent future cases of opioid addiction. This
requires ongoing efforts to expand access to addiction treatment and recovery support services,
promote safe opioid prescribing practices, and address the social determinants of health that
contribute to OUD.
It is also important to address the stigma and misconceptions associated with OUD,
which can prevent individuals from seeking treatment and contribute to negative attitudes
towards those with addiction. This can involve promoting education and awareness about
addiction and its causes, as well as advocating for policies that reduce stigma and
discrimination towards people with OUD.
Finally, individuals can play a role in addressing the opioid epidemic and OUD by educating
themselves about the risks associated with opioid use, properly disposing of unused opioids,
and advocating for policies and resources that support addiction treatment and recovery.
Overall, addressing OUD and the opioid epidemic requires a comprehensive approach that
involves multiple stakeholders, including healthcare providers, policymakers, community
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organizations, and individuals. By working together, we can reduce the harm caused by OUD
and prevent future cases of opioid addiction.
One important aspect of addressing OUD is ensuring access to effective and evidence-based
treatments. Medications like methadone, buprenorphine, and naltrexone have been shown to be
effective in reducing opioid use, preventing overdose, and improving health outcomes for
individuals with OUD. However, access to these medications can be limited by factors like cost,
insurance coverage, and stigma.
In addition to medication-assisted treatment, counseling and behavioral therapies can also be
effective in helping individuals recover from OUD. These therapies can help individuals address
the underlying causes of their addiction, develop coping skills and relapse prevention strategies,
and improve their overall well-being.
Ultimately, addressing OUD and the opioid epidemic requires a comprehensive and coordinated
effort that involves multiple stakeholders and strategies. This includes increasing access to
addiction treatment and recovery support services, promoting safe opioid prescribing practices,
implementing harm reduction strategies, addressing the social determinants of health that
contribute to addiction, and reducing stigma and discrimination towards people with addiction.
Another important strategy for addressing OUD is early intervention and prevention. This can
involve educating individuals about the risks associated with opioid use, as well as providing
access to non-opioid pain management options for those who experience chronic pain.
Additionally, addressing mental health disorders like depression and anxiety can help prevent
the development of OUD in some cases.
Efforts to prevent OUD can also involve increasing access to resources and support for
individuals who are at risk of developing addiction, such as those who have a history of
substance abuse or a family history of addiction. This can include programs that provide
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education, counseling, and support for individuals and families, as well as policies that promote
early identification and intervention for individuals who may be at risk of addiction.
Finally, addressing OUD and the opioid epidemic requires ongoing research to better
understand the underlying causes of addiction and develop more effective treatments and
prevention strategies. This can involve supporting research on addiction biology, the
development of new medications and therapies, and the implementation and evaluation of
prevention and treatment programs.
In conclusion, OUD is a complex and serious condition that requires a comprehensive and
coordinated approach to address. Efforts to address OUD and the opioid epidemic require a
range of strategies, including increasing access to addiction treatment and recovery support
services, promoting safe opioid prescribing practices, implementing harm reduction strategies,
addressing the social determinants of health that contribute to addiction, and reducing stigma
and discrimination towards people with addiction. Additionally, early intervention and prevention
efforts, as well as ongoing research, are critical components of addressing OUD and the opioid
epidemic. By working together, we can reduce the harm caused by OUD and prevent future
cases of opioid addiction.
It is also important to note that the opioid epidemic and OUD have disproportionately affected
certain populations, including low-income individuals, rural communities, and communities of
color. Addressing these disparities requires a focus on health equity and ensuring that all
individuals have access to the resources and support they need to prevent and treat addiction.
Furthermore, addressing the opioid epidemic and OUD is not just a matter of public health, but
also of social justice. Policies and practices that have contributed to the epidemic, such as
overprescribing of opioids and insufficient access to addiction treatment, have disproportionately
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impacted marginalized communities. Addressing these issues requires not only increased
resources for addiction treatment and prevention, but also broader structural changes to
address systemic inequities and promote health equity.
Ultimately, addressing OUD and the opioid epidemic requires a sustained commitment from
policymakers, healthcare providers, community organizations, and individuals. By working
together and prioritizing evidence-based approaches, we can reduce the harm caused by OUD
and prevent future cases of opioid addiction.
Finally, it's important to note that addressing OUD and the opioid epidemic is not just a problem
for individual countries or regions, but a global issue. Opioid use and addiction are prevalent in
many countries around the world, and the impacts of the epidemic are felt on a global scale.
International efforts to address the opioid epidemic and OUD can involve sharing information
and best practices between countries, as well as promoting global policies and resources to
support addiction treatment and prevention. Additionally, addressing the opioid epidemic and
OUD requires a focus on reducing the global supply of illicit opioids, as well as promoting
alternative pain management options and addressing the root causes of addiction.
In conclusion, addressing OUD and the opioid epidemic is a multifaceted and complex issue
that requires a comprehensive and coordinated approach. By working together across sectors
and borders, we can reduce the harm caused by OUD and prevent future cases of opioid
addiction.
Efforts to address OUD and the opioid epidemic require a significant investment of resources
and a sustained commitment from policymakers, healthcare providers, community
organizations, and individuals. This can involve increasing funding for addiction treatment and
OPIOID USE DISORDERS
prevention programs, as well as promoting policies that support access to evidence-based
treatment, harm reduction strategies, and safe opioid prescribing practices.
Additionally, addressing OUD and the opioid epidemic requires a focus on reducing the stigma
and discrimination that can prevent individuals from seeking treatment and accessing support.
This can involve promoting education and awareness about addiction and its causes, as well as
advocating for policies that reduce stigma and discrimination towards people with OUD.
Finally, it is important to recognize the importance of collaboration and partnership in addressing
OUD and the opioid epidemic. This includes working together across sectors and borders, as
well as engaging with individuals and communities affected by addiction to ensure that their
voices and experiences are heard and valued.
In conclusion, addressing OUD and the opioid epidemic is a complex and multifaceted issue
that requires a comprehensive and coordinated approach. By investing in evidence-based
treatment and prevention strategies, promoting harm reduction and safe prescribing practices,
reducing stigma and discrimination, and working together across sectors and borders, we can
reduce the harm caused by OUD and prevent future cases of opioid addiction.
It's important to also recognize that addressing OUD and the opioid epidemic requires a focus
on improving the overall health and wellbeing of individuals and communities. This includes
addressing the social determinants of health, such as poverty, unemployment, and lack of
access to healthcare, that can contribute to addiction and make it more difficult for individuals to
recover.
Additionally, efforts to address OUD and the opioid epidemic require a focus on prevention,
including promoting non-opioid pain management options, addressing mental health disorders
and other co-occurring conditions, and supporting healthy lifestyles and behaviors. This can
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involve working with schools, community organizations, and healthcare providers to provide
education and resources on healthy living and prevention strategies.
Finally, it's important to recognize that addressing OUD and the opioid epidemic is an ongoing
process that requires ongoing monitoring, evaluation, and adaptation of strategies to ensure
they remain effective and relevant. This can involve collecting and analyzing data on opioid use
and addiction rates, as well as evaluating the effectiveness of prevention and treatment
programs.
In conclusion, addressing OUD and the opioid epidemic requires a comprehensive and
sustained approach that involves addressing the social determinants of health, promoting
prevention strategies, and ongoing monitoring and evaluation of strategies. By working together
across sectors and borders, we can reduce the harm caused by OUD and prevent future cases
of opioid addiction.
It's important to also recognize that addressing OUD and the opioid epidemic requires a multi-
pronged approach that involves not only healthcare providers, but also law enforcement,
policymakers, and community organizations.
Law enforcement plays an important role in addressing the opioid epidemic, including efforts to
reduce the supply of illicit opioids and combat the trafficking and distribution of these drugs. At
the same time, it's important for law enforcement to work in partnership with healthcare
providers, community organizations, and individuals to ensure that their efforts are focused on
promoting public health and reducing harm.
Policymakers also play a critical role in addressing the opioid epidemic, including efforts to
promote evidence-based treatment and prevention strategies, reduce stigma and discrimination
towards people with OUD, and address the social determinants of health that contribute to
addiction. This can involve advocating for policies that support access to healthcare and
OPIOID USE DISORDERS
addiction treatment, as well as promoting funding for research and education on opioid use and
addiction.
Community organizations and individuals also have an important role to play in addressing OUD
and the opioid epidemic. This can involve promoting education and awareness about addiction,
as well as providing support and resources to individuals and families affected by addiction. It
can also involve advocating for policies and practices that promote health equity and reduce the
social determinants of health that contribute to addiction.
In conclusion, addressing OUD and the opioid epidemic requires a multi-pronged approach that
involves collaboration and partnership across sectors and communities. By working together
and investing in evidence-based strategies, we can reduce the harm caused by OUD and
prevent future cases of opioid addiction.
Finally, it's important to recognize the role of technology in addressing OUD and the opioid
epidemic. Technology can play a critical role in improving access to treatment and support for
individuals with OUD, as well as promoting prevention and harm reduction strategies.
For example, telemedicine and digital health platforms can provide remote access to addiction
treatment and support services, reducing barriers to care for individuals who may not have easy
access to healthcare facilities. Additionally, technology can be used to track opioid prescribing
practices and monitor the distribution of opioids to reduce the likelihood of overprescribing and
diversion of these drugs.
Artificial intelligence (AI) and machine learning (ML) technologies can also be used to develop
predictive models for identifying individuals who may be at risk of developing OUD, as well as
improving the accuracy of diagnosis and treatment of addiction. These technologies can help
healthcare providers and policymakers develop more targeted and effective prevention and
treatment strategies.
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In conclusion, technology has the potential to play a critical role in addressing OUD and the
opioid epidemic by improving access to care, promoting prevention and harm reduction
strategies, and enhancing diagnosis and treatment of addiction. By leveraging the power of
technology and working together across sectors and communities, we can reduce the harm
caused by OUD and prevent future cases of opioid addiction.
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Harold Case Study: Week 9
What symptoms of ADHD does Harold present with?
The Attention Deficit Hyperactivity Disorder (ADHD) symptoms that Harold is currently presenting
with inattentiveness and hyperactivity (Stahl, 2013). According to Stahl, the core symptoms of
ADHD are inattentiveness, impulsivity and hyperactivity (Stahl, 2013).
ADHD (Attention-Deficit/Hyperactivity Disorder) is a neurodevelopmental disorder that can
present with various symptoms including difficulty sustaining attention, hyperactivity, impulsivity,
forgetfulness, disorganization, and difficulty with time management and task completion.
However, to provide a more accurate answer, I would need more specific information about
Harold's behavior and symptoms.
ADHD symptoms can present differently in each individual, and a diagnosis is typically
made based on a thorough evaluation by a healthcare professional. Some common
symptoms of ADHD include:
Inattention: Difficulty sustaining attention during tasks, easily distracted, forgetful,
disorganized.
Hyperactivity: Constantly fidgeting, excessive talking, difficulty sitting still, constantly
on the go.
Impulsivity: Acting without thinking, interrupting others, difficulty waiting for one's turn,
making hasty decisions.
Other symptoms may include trouble with memory, poor time management, difficulty
with social interactions, and problems with following instructions. However, it's
important to note that these symptoms can also be caused by other factors, such as
anxiety or depression, so a proper evaluation by a healthcare professional is necessary
for an accurate diagnosis.
In addition to the symptoms mentioned earlier, adults with ADHD may also struggle
with:
Chronic lateness and forgetfulness
Poor organizational skills
Impulsivity
Low frustration tolerance
Mood swings
Difficulty multitasking
Problems with self-esteem
Substance abuse or addiction
Relationship problems
It's worth noting that not everyone with ADHD will experience all of these symptoms.
Symptoms can also vary in severity and may be more pronounced in some situations
than others. If you or someone you know is experiencing symptoms of ADHD, it's
important to seek evaluation and treatment from a qualified healthcare professional. A
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healthcare professional can provide a proper diagnosis and recommend appropriate
treatment options, such as medication and/or therapy, to help manage symptoms and
improve quality of life.
In children, ADHD can manifest in a variety of ways, including:
Difficulty paying attention and staying focused on tasks
Forgetfulness and losing things frequently
Difficulty following instructions and finishing tasks
Avoidance of tasks that require sustained mental effort
Fidgeting and squirming when sitting
Talking excessively and interrupting others
Difficulty waiting their turn and taking turns in games or group activities
Acting impulsively and without considering consequences
It's important to note that these symptoms must be present to a degree that is
inappropriate for the child's age and developmental level, and must cause impairment
in more than one area of the child's life, such as at home, at school, or with peers. If you
are concerned that a child you know may have ADHD, it's important to speak with their
pediatrician or a qualified mental health professional for evaluation and appropriate
treatment.
There are three types of ADHD that can be diagnosed:
1. Predominantly Inattentive Presentation: This type is characterized by symptoms of
inattention, such as difficulty sustaining attention, forgetfulness, disorganization, and
being easily distracted. Individuals with this type of ADHD may appear quiet,
disengaged, or forgetful.
2. Predominantly Hyperactive-Impulsive Presentation: This type is characterized by
symptoms of hyperactivity and impulsivity, such as fidgeting, restlessness, interrupting
others, and acting without thinking. Individuals with this type of ADHD may appear
fidgety, talkative, or impulsive.
3. Combined Presentation: This type involves a combination of symptoms of inattention,
hyperactivity, and impulsivity. This is the most common type of ADHD and individuals
with this type may display symptoms from both the inattentive and hyperactive-
impulsive presentations.
It's worth noting that ADHD is a highly treatable condition. Treatment can include
medication, such as stimulants or non-stimulant medications, as well as therapy and
other forms of support. A healthcare professional can help determine the most
appropriate treatment plan based on an individual's specific symptoms and needs.
In addition to medication and therapy, there are also a number of lifestyle changes and
strategies that can be helpful for managing ADHD symptoms. Some of these include:
1. Regular exercise: Exercise can help reduce hyperactivity and improve mood and overall
health.
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2. Healthy diet: Eating a balanced diet with plenty of fruits, vegetables, whole grains, and
lean protein can help improve focus and energy levels.
3. Sleep: Getting enough sleep is important for overall health and can help reduce
symptoms of ADHD.
4. Organization: Developing good organizational habits, such as keeping a daily planner or
using a to-do list, can help individuals with ADHD stay on track and manage their time
effectively.
5. Mindfulness and relaxation techniques: Practicing mindfulness, meditation, or relaxation
techniques such as deep breathing can help reduce stress and improve focus.
6. Support groups: Joining a support group for individuals with ADHD can provide a sense
of community and support.
7. Environmental modifications: Simple changes to the home or work environment, such
as reducing clutter and distractions, can help improve focus and productivity.
It's important to note that not all strategies will work for everyone with ADHD, and it
may take some trial and error to find the most effective treatment plan. A healthcare
professional can help guide individuals with ADHD in developing a personalized plan for
managing symptoms and improving overall quality of life.
Another important aspect of managing ADHD is developing effective coping strategies
for dealing with challenges and stressors. Some coping strategies that may be helpful
for individuals with ADHD include:
1. Self-advocacy: Learning to advocate for oneself and communicate needs and
challenges to others can help reduce stress and improve outcomes.
2. Time management: Breaking tasks down into smaller, more manageable steps and
setting clear deadlines can help individuals with ADHD stay on track and manage their
time effectively.
3. Relaxation techniques: Practicing relaxation techniques, such as deep breathing or
progressive muscle relaxation, can help reduce stress and improve focus.
4. Mindfulness: Practicing mindfulness and staying present in the moment can help reduce
distractibility and improve focus.
5. Social support: Building a strong support network of friends, family, and healthcare
professionals can provide valuable resources and support in managing ADHD.
6. Positive self-talk: Encouraging and positive self-talk can help individuals with ADHD stay
motivated and focused on their goals.
7. Creativity: Engaging in creative pursuits, such as music or art, can provide a sense of
enjoyment and fulfillment that can help reduce stress and improve mood.
It's important to remember that managing ADHD is an ongoing process, and it may take
time and effort to develop effective coping strategies and treatment plans. With the
right support and resources, however, individuals with ADHD can lead fulfilling and
successful lives.
It's also important to note that ADHD is a neurodevelopmental disorder that often co-
occurs with other conditions such as anxiety, depression, and learning disorders. These
conditions can sometimes exacerbate ADHD symptoms and require additional
treatment and support.
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If you or someone you know is struggling with ADHD, it's important to seek the help of a
qualified mental health professional. A mental health professional can provide a
thorough evaluation and develop an individualized treatment plan that takes into
account the unique needs and challenges of each person.
In conclusion, ADHD is a complex condition that can have a significant impact on an
individual's life. However, with the right diagnosis, treatment, and support, individuals
with ADHD can learn to manage their symptoms and lead fulfilling and successful lives.
What are other possible causes of his symptoms?
Harold could be suffering from an undiagnosed anxiety disorder, mood disorder (mixed episode
Bipolar) or substance use disorder (Stahl, 2013).
What further information, if any, would you like about this case?
Substance use should be evaluated, as well as when these symptoms became prominent and
began to effect daily functioning (Stahl, 2013).
With the assumption that Harold does have ADHD, what medication would you prescribe (list
name and dose)? Why?
Harold would benefit from atomoxetine 40mg po daily (Stahl, 2013). Atomoxetine is FDA approved
for ADHD in adults and children over age 6 (Stahl, 2013). Atomoxetine works by boosting the
neurotransmitter norepinephrine/noradrenaline and may also increase dopamine in the prefrontal
cortex (Stahl, 2013). This medication will increase dopamine neurotransmission in the frontal cortex,
largely hypothesized to be lacking in the region (Stahl, 2013). Unlike other medications used for
ADHD, atomoxetine does not have abuse potential (Stahl, 2013).
ADHD is a complex condition, and the medication prescribed may vary depending on the
severity of symptoms, the patient's age, medical history, and other factors. Common
medications used to treat ADHD include stimulants like Ritalin, Adderall, and Vyvanse, as well
as non-stimulants like Strattera and Intuniv.
It is essential to note that prescribing medication for ADHD is a decision that should be made
only after a thorough evaluation by a qualified medical professional. The medication, dose, and
treatment plan should be tailored to the individual patient's needs and monitored closely over
time to ensure its effectiveness and safety.
carry on
I apologize for any confusion caused. However, I can provide general information on the
medications used to treat ADHD.
Stimulant medications are often the first line of treatment for ADHD as they can improve
attention, focus, and impulse control in many individuals with ADHD. Some commonly used
stimulants include:
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Methylphenidate (Ritalin, Concerta): It comes in various forms and doses, including immediate-
release and extended-release versions. The initial dose for Ritalin is 5 mg twice daily, which can
be increased gradually as needed.
Amphetamines (Adderall, Vyvanse): These drugs also come in different forms and doses.
Adderall is usually started at a low dose of 5 mg once or twice daily, while Vyvanse is started at
a dose of 30 mg daily, which can be increased over time.
Non-stimulant medications like atomoxetine (Strattera) and guanfacine (Intuniv) can also be
used to treat ADHD, especially in individuals who do not tolerate stimulants or have comorbid
conditions such as anxiety or tics. The initial dose for Strattera is 40 mg once daily, which can
be increased as needed. Intuniv is usually started at a low dose of 1 mg once daily and
gradually increased to a maximum of 4 mg daily.
It is important to remember that medication management for ADHD should always be under the
guidance and supervision of a qualified medical professional. The medication, dose, and
treatment plan should be tailored to the individual patient's needs and monitored closely over
time to ensure its effectiveness and safety.
List any relevant safety information and screening (labs, etc) related to your medication
choice.
Use cautiously with individuals with underlying Bipolar Disorder (Stahl, 2013), Monitor patients for
activation of suicidal ideation, especially in children and adolescents (Stahl, 2013). For patient with
moderate liver impairment – dose should be reduced by 50% (Stahl, 2013). Monitor blood pressure
and heart rate (Stahl, 2013).
References
Stahl, S. (2013). Essentials of Psychopharmacology, (4th edition). Cambridge University Press,
ISBN-13: 978-1107025981
After watching the video, I was able to identify that Harold is presenting with several symptoms of
ADHD. The signs and symptoms of ADHD include inattentiveness, the inability to control impulsive
behaviors, and hyperactivity (Lichtblau, 2011). Harold appears to have difficulty focusing on
conversations and tasks. He began talking about how he struggled when he was in school,
particularly when he was trying to study but had difficulty because he looking out the window and
thinking about going for a walk.
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Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects
individuals of all ages. The symptoms of ADHD can be divided into two categories: inattention
and hyperactivity/impulsivity.
The signs and symptoms of inattention may include:
1. Difficulty paying attention to details or making careless mistakes
2. Trouble staying focused on tasks or activities
3. Being easily distracted or forgetful
4. Difficulty following instructions or finishing tasks
5. Avoiding tasks that require sustained mental effort
6. Losing things regularly
7. Forgetting daily activities, such as appointments or chores
The signs and symptoms of hyperactivity/impulsivity may include:
1. Restlessness and excessive fidgeting
2. Difficulty staying seated during class or other activities
3. Talking excessively or interrupting others
4. Difficulty waiting their turn in conversations or games
5. Acting without thinking of consequences
6. Interrupting or blurting out answers to questions before they are finished
7. Engaging in risky behavior without considering the consequences
It's important to note that the symptoms of ADHD can vary from person to person and may not
always be present in every situation. It's also possible for individuals with ADHD to only exhibit
symptoms of inattention or hyperactivity/impulsivity, and not both. If you suspect that you or
someone you know has ADHD, it's important to consult with a healthcare provider for an
evaluation.
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In addition to the above symptoms, ADHD can also have an impact on a person's daily life,
including their academic, social, and occupational functioning. People with ADHD may struggle
with organization, time management, and completing tasks on time, which can lead to difficulties
at work, school, or home. They may also have difficulty in social situations, such as maintaining
friendships or following social cues.
ADHD can be diagnosed through a comprehensive evaluation by a healthcare professional,
including a medical exam, a review of symptoms, and information from family members or other
sources. Treatment for ADHD typically involves a combination of medication and behavioral
therapy, which can help manage symptoms and improve daily functioning. In addition, there are
many strategies that individuals with ADHD can use to manage their symptoms, such as
breaking tasks into smaller steps, using reminders and schedules, and practicing mindfulness
and relaxation techniques.
It's important to remember that having ADHD does not mean that a person is incapable or
unintelligent. With appropriate treatment and support, individuals with ADHD can lead fulfilling
and successful lives.
Thank you again! It's worth noting that ADHD can be diagnosed in children as well as adults,
and the symptoms may change over time as a person grows and develops. For example,
hyperactivity may be more apparent in children, while inattention and difficulty with organization
may be more prominent in adults.
It's also important to recognize that ADHD can co-occur with other conditions, such as anxiety
or depression. In some cases, addressing these underlying conditions may help improve
symptoms of ADHD.
Finally, it's worth mentioning that there are many myths and misconceptions about ADHD that
can make it difficult for individuals with the condition to get the support they need. For example,
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some people believe that ADHD is caused by poor parenting or lack of discipline, but this is not
true. ADHD is a neurodevelopmental disorder that is believed to be caused by a combination of
genetic and environmental factors.
If you or someone you know is struggling with symptoms of ADHD, it's important to seek out
help and support from a qualified healthcare professional. With the right treatment and support,
individuals with ADHD can learn to manage their symptoms and lead happy and fulfilling lives.
It's also important to note that ADHD can affect people of any gender, race, or cultural
background. However, some studies have shown that ADHD may be underdiagnosed in certain
populations, such as girls and women, people of color, and individuals from low-income
backgrounds. This may be due to a variety of factors, including cultural attitudes towards mental
health, lack of access to healthcare, or bias among healthcare providers.
It's important for healthcare providers to be aware of these potential disparities and to take
steps to ensure that all individuals with ADHD receive appropriate evaluation, diagnosis, and
treatment. This may involve using culturally sensitive assessment tools, providing education and
resources to underserved communities, and advocating for policies that improve access to
mental health care.
He additionally had difficulty listening to his management team each day about goals and struggling
to sit and listen to others. Organization is another issue that Harold faces. He states that “I am a bit
of a mess, and messy.” Harold is clearly an intelligent and competent man, however he has difficulty
sustaining focus, is disorganized, and appears restless with extreme amounts of fidgeting present
during the interview (American Psychiatric Association, 2013). There are definitely other possible
causes of his symptoms. For instance, he talked about the stress he is experiencing at work due to
the accelerated deadlines. However, I believe that many of the issues Harold is facing are due to his
condition. At the end of the conversation, Harold stated that caffeine actually helped him with his
symptoms.
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I believe that the therapist did a nice job asking questions around Harold’s past including how he
was as a student in school. He additionally asked him about tasks like paying bills, missed events,
his organization skills, and if he had previously been on any medications. I would have liked to know
more information around what tasks if any have helped him focus in the past and if he has received
any type of psychotherapy in the past. I think it would also be beneficial to ask about his social
situation, if he has a support system, and if he has a history of alcohol or drug abuse. Alcohol and
drug abuse is important to know if a stimulant medication is prescribed since many stimulants have a
high potential for abuse (Nursing 2018 Drug Handbook, 2018)
With the assumption that Harold does have ADHD, I would prescribed a stimulant medication since
the patient had previously mention that caffeine has helped him. I would prescribe him Concerta 18
mg/day to start off. If needed, we can increase each week by another 18 mg/day to a maximum dose
of 72 mg/day (Stahl, 2017). I chose to prescribe Concerta because it is only taken 1x daily, and if the
patient struggles to remember paying bills he might struggle taking medications more than 1x daily.
The patient is additionally older, so there would not be any growth suppression with long term use
(Stahl, 2013). Prior to starting the medication, I would check for any cardiac disorders, a family
history of cardiac disease, an EKG, and blood pressure (Stahl, 2017). Once the medication is
started, I would periodically complete a CBC, CMP, platelet counts, and blood pressure (Nursing
2018 Drug Handbook, 2018 and Stahl, 2017). It is also important to routinely asses for dependence,
abuse, and tolerance to the medication (Nursing 2018 Drug Handbook, 2018).
References
American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental
Disorders(5thed.). Washington, DC: American Psychiatric Association Publishing
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