Around the Practice: Management of Adult with Attention Deficit/Hyperactivity Disorder (ADHD) - Episode 12

Patient Case #2: A 23-Year-Old Patient With ADHD

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Stephen Faraone, PhD, presents the case of a 23-year-old patient with ADHD.

Stephen Faraone, PhD: Let's move on to our next case presentation. This patient is a 23-year-old female. She presents for evaluation to her psychiatrist with moderate depressive symptoms, mild anxiety, and complains of a lack of ability to focus. During the interview, her chief complaint includes decreased energy and depressed mood. She's also reporting difficulties in paying attention, organizing her day, and accomplishing tasks at work, and recently, she lost her job. In her past psychiatric history, the patient had been diagnosed with ADHD in middle school during which time she responded well to methylphenidate. She continued to do well on methylphenidate until her college years, at which time, she began having trouble falling asleep and also irritability. She was then switched to multiple different therapies, stimulants, and non-stimulants, however, kept failing therapy and stopped going to the PCP provider who was managing her therapy. When asked which medication she failed, she could not recall. The patient was diagnosed with anxiety during her college years, during which time she responded well to buspirone and alprazolam. She currently still takes buspirone daily and alprazolam as needed. The patient was also diagnosed with depression during the same time, these symptoms are not new to her, and she is currently managed by her PCP. They have been managed but have flared up over the past 6 months. She learned after consulting with her therapist that they were related to significant psychosocial stress stemming from the loss of her job and struggling to find a new one. The patient reported that she still finds enjoyment in talking to friends and socializing. She has hope of finding a new job and is constantly looking. At this time, she is not taking any medications for ADHD, she has been practicing mindfulness and yoga daily, which has helped her residual ADHD symptoms. However, this has not been found to be effective, she believes that her symptoms are what caused her job loss and she's open to taking medication again. She has no history of suicidal thoughts or behaviors, or self-injurious behaviors, no psychiatric hospitalizations, and no problems with substance abuse. She does have type II diabetes, diagnosed 1 year ago, and currently managed by metformin. Her A1c is not poorly controlled, most recently being 7.8%. Depression was first diagnosed 2 years ago, as was hypertension which is currently managed by lisinopril, and anxiety was diagnosed 4 years ago, and that's currently managed by buspirone and alprazolam. Her BMI is 31.2 obesity is a problem that she must cope with. All her other lab values are within normal limits, significantly, TSH [thyroid stimulating hormone] was in the normal range, and her urine toxicology screening was negative.

Transcript edited for clarity