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.
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Although its called adult ADHD, symptoms are reasonably chronic, starting from early childhood. Adult ADHD symptoms may not be as prominent as child ADHD, as 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 disorders 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 that are severe enough to cause chronic disruption in multiple areas of functioning |
ADHD Continuum
Treatment options for ADHD
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.
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.
Dexamphetamines are also used to help ADHD/ADD with idea to improve the quality of life.
Atomoxetine is a stimulating anti-depressant used to help ADHD/ADD symptoms.
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 the State and National levels. The psychiatrist needs to seek approval from these regulating agencies when prescribing the medications and regularly to report 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 performed for certain roles like mining and may warrant some further special testing.
The psychiatrist needs to follow the following process:
The psychiatrist needs to follow the following process:
INITIATION
- 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.
MONITORING
- 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.