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. 

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  Reply to  these posts with a reflection of their response.Minimun 200words each one 

1. In this week’s discussion, I was able to: Integrate nursing and related sciences into the delivery of care to patients. I was also able to analyze quality initiatives to improve patients’ health outcomes.

     Alternative and Complementary medicines are considered health-cultured practices, that are not part of traditional medicine and that have been part of the holistic culture of the populations. They are used as an alternative or in addition to traditional medical treatments with the goal of improving patients’ outcomes (Lee, Richard, et al., 2022). Alternative and Complementary medicines can include therapies such as dietary supplements, herbs, acupuncture, Chinese medicine, yoga, reiki, ayurvedic medicine, complementary supplements, etc (Adeniyi, Washington, et al., 2021). The reasons for using these alternative methods can be many: Cultural, religious, economic, etc. However, as many people use it most of the time, it is important to analyze this point and share our opinion on this matter.

     It is well-known that many people from the general population are used to taking self-prescribed natural treatments. In the first term, we can name herbal medications. In general culture and even in religion, people believe that herbs have a good effect in the treatment of some diseases such as hypertension or Diabetes Mellitus. Many people think that herbs were created by God in order to provide natural treatment for diseases. Actually, many people believe that herbal medicines are better choices as they don’t have undesirable effects at all. Some people prefer to take natural medication rather than medical treatments, as they think that pharmacological preparations are made of chemical and artificial ingredients that can be harmful to the body. Moreover, people trust natural treatments for cancer, as it is thought that they can potentially inhibit oncology cell growth. However, researchers have determined that about 80% of the patients do take their pharmacological treatment in addition to a natural treatment (Adeniyi, Washington et, al. 2021). However, there are some natural treatments that, in addition to pharmacological treatment, can cause adverse effects, for example, ginkgo can increase the anticoagulant effect; ginseng and some teas can decrease the anticoagulant effect (Izzo 2005). Other natural treatments such as exercises, meditation, yoga, and acupuncture, are also used and well-known as coadjuvants to release stress and that way help improve clinical condition.

     In conclusion, the healthcare team needs to accept that alternative and natural treatments are part of the culture and religion of the population. So it is very important to establish a good and trustable relationship with the patient, so he/she can feel confident enough to tell the healthcare provider about the alternative treatments that are been taken, as sometimes they can help, but sometimes they can be harmful. In the end, a closed and trustable relationship with the patient and a good assessment is the basis for the best possible outcomes.

2. The allopathic or conventional medicine is practiced by doctors and health personnel. Complementary medicine refers to the practice of medicine that complements conventional medicine, that is, it is used in conjunction with conventional medicine. An example includes the use of acupuncture in pain management. Alternative medicine, on the other hand, is the use of complementary and alternative medicine as a replacement for traditional medicine

Complementary and alternative medicine are very varied. Within them, we find natural products related to botanical medicine and probiotics. We also find mind and body therapy, such as meditation techniques, yoga, acupuncture, hypnotherapy, and deep relaxation exercises, among others.

In the treatment of cancer, it has been proven that the use of complementary and alternative therapy has been useful in managing the patient’s symptoms. However, it is not considered a miraculous medicine in the cure of cancer; it simply helps, in conjunction with conventional medicine, to manage some symptoms that cancer patients experience. For example, acupuncture treatment can help alleviate symptoms related to pain, therapeutic massages have been shown according to some research studies to reduce depression, pain, and depressive anxiety disorders related to cancer disease (American Cancer Society, 2019). However, some harmful health effects and interactions with medications have been shown, especially in treatment with botanical medicine, so it is recommended that your doctor be notified of its use before starting treatment to avoid drug interactions and potential harm to health (American Cancer Society, 2019).

Holistic medicine, unlike conventional medicine, is not focused on treating diseases as allopathic medicine does. Rather, it is preventative medicine, although it can be integrated with allopathic medicine in some instances. Holistic medicine is based on the fact that illnesses appear as a consequence or result of environmental, physical, social and/or emotional imbalances (Cannon, 2023). Therefore, its essence is to heal the body and mind with alternative therapies to maintain their balance and prevent the onset of illness. Holistic medicine dates back to ancient times, and after the appearance of conventional medicine, it was somewhat abandoned. However, in around the 1960s in Europe and America, the properties of holistic medicine regained popularity. An example of this is homeopathy, which can be used to recover body vitality as holistic medicine, but it can also be used as an adjunct treatment to allopathic medicine. The use of phytotherapy has had great success in the management of certain diseases, such as those of the immune system, favoring healing.

In the management of high blood pressure and diabetes, the practice of natural medicine plays a fundamental role as an adjunct to integrated medicine; even natural medicine can be used as a technique for the prevention of these diseases. The practice of a balanced and healthy diet, daily physical exercise, relaxation techniques and stress management are determining factors in the prevention of arterial hypertension, cancer, and diabetes. Other natural medicine can be used, for example omega 3 is an essential oil that can be used to prevent special hyperlipidemia in patients with chronic disease.

Both allopathic and holistic medicine have an important role on patient care, and together, they can give the best result in the management of the disease. As a provider, we need to offer the patient different option to treat their condition, but we need to be respectful of patients’ autonomy in their decision.

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