Adult ADHD Attention deficit hyperactivity disorder (ADHD) is a common behavioural disorder that affects about 1 in 20 adults and is still under-reported.
It is a combination of persistent problems like difficulty paying attention, hyperactivity and impulsive behaviours which are severe enough to cause unstable relationships, poor academic or vocational performance and thus spiralling an individual into a cycle of multiple other psychological and social problems. Although its called adult ADHD, symptoms are fairly chronic, starting from early childhood. Adult ADHD symptoms may not be as prominent as child ADHD as with psychological maturity and age hyperactivity may decrease. The struggle is mainly with mental functioning-impulsivity, restlessness and attention. ADHD is a highly comorbid condition with other mental health disorder like anxiety and depression. Often people are misdiagnosed and wrongly treated for anxiety-depression leading to consistently poor quality of life and poor treatment outcomes. We all may struggle with a mild degree of these, and those transient difficulties are not ADHD. ADHD is diagnosed with symptoms are severe enough to cause chronic disruption in multiple areas of functioning.
ADHD assessment and Management Diagnostic process
Step 1-Assessment and diagnosis
If have a formal pre-existing diagnosis and substantial paperwork, move to step 2 STEP 2-Management plan and initiation of pharmaco-therapy (if needed). Once diagnostic assessments are over and target symptoms are identified, a comprehensive management plan will be discussed with the patient (and family, if appropriate), which includes medication options (Dexamphetamine, Ritalin, Atomoxetine, others), Psychological and Social interventions. Please refer to information in this document for information on medication options. Information and psycho-education about ADHD/ADD will be provided. Please refer to https://www.adhdaustralia.org.au/ for further info re diagnosis and management of ADHD/ADD. A written report will be provided to your nominated GP and Psychologist (if any). In case of treatment with stimulants please refer to the medico-legal framework for stimulant therapy in this document. Your psychiatrist will do the notification to Stimulant board of WA on your behalf and seek PBS approval (for authority script) after a urine drug screen. Please note that process for co-morbid substance abuse disorder, Psychiatric disorder or other conditions may require a pre-approval.
Step 3-Followup-Review within 1-3 months of initiation of treatment and then at 6 months With or without urine drug screen,
Preferred review with family/support person (encouraged specially if psychologist is not involved).
For evaluation of benefit with therapy and monitor side-effects, if any.
Step 4- Longterm treatment and followup.
6 to 12 monthly reviews by Psychiatrist (and Psychologist) from this point onwards.
Stimulant and non-stimulant medications Medication is often an important part of treatment for an individual with ADHD. Central nervous system (CNS) stimulants are the most commonly prescribed class of ADHD drugs. These drugs work by increasing the amounts of the brain chemicals called dopamine and norepinephrine. The effect improves concentration and helps them focus better. Common CNS stimulants used to treat ADHD include:
Methylphenidate is used to help ADHD/ADD and narcolepsy with idea to improve the quality of life.
MEDICO-LEGAL FRAMEWORK FOR STIMULANT PRESCRIPTION As you may be aware, the medications used for ADHD are highly regulated and specifically controlled by the relevant department at State and National level. The psychiatrist needs to seek approval from these regulating agencies at the time of prescribing the medications and regularly reporting its use. The regulations are in place for prevention against misuse, diversion, overuse and co-morbid use of other illicit substances that may interfere with the treatment. Further, it may show up in regular urine drug screen preformed for certain roles like mining and may warrant some further special testing. The psychiatrist needs to follow the following process:
At time of treatment initiation a notification of treatment using stimulant medications form need to initiated.
The department may notify the prescribing psychiatrist if there are any concerns or irregularities in the reporting process.
If PBS subsidies are applicable, the prescribing psychiatrist will do the needful.
For anyone over 13 years of age, routine urine drug screen need to precede commencement of medication as this is a mandatory regulatory requirement and your psychiatrist does not have much discretion on this issue.
Please find attached the request form for urine drug screen and other routine blood test required to commence treatment.
Regularly monitoring of benefits and risks associated with medications.
Random urine drug screen every 3-4 monthly.
6 to 12 monthly review. Notification is applicable for a year.
MANDATORY, IMMEDIATE SUSPENSION OF TREATMENT.
Emergence of psychotic symptoms
Any misuse of prescribed medication including diversion, sharing, and excessive use of any other illicit substance.
Any other significant side effect.
While you are under care one psychiatrist, it is illegal for any other doctor to issue you with a prescription for stimulants expect in an emergency with permission from HDWA.