Yes! We've encountered this in our neuropsych testing services. Had two cases where the patient tried to argue the diagnosis and one in borderline personality disorder that became agitated and had to be asked to please leave the clinic. Not surprisingly, that patient was later found with multiple flags in PDMP.
I don't refer to those places. Nor do I accept those results.
Patients find the crappy places on their own and will go there anyways, because they will give the answer they want LOL
So you only refer for tests that have a negative predictive value below 0.2?
This makes many psychiatrists feel better. In most cases, I don't know why (maybe because of the time spent factor?). But it is not based on much empirical evidence clinical psychological or psychometric science has to offer at this time...but nevertheless people really like to grab on "testing" to "confirm" it.
Absolutely. Mostly it's an attempt to weed out patients who can't / won't pony up $$$$ for treatments that aren't indicated. A good way to ensure the patient either makes 7 figures or has damaged executive functioning when it comes to financed.
The person lives in another state and is having great difficulty finding this testing
It's the schools requirements. If you take the patients word for it. That will be a ton of false positives for controlled substances.
Well.... dont know about all that.
Schools dictate your treatment plan/decisions?
It dictates when they ask for that specifically for the school testing and won't accept other testing
The only person responsible is the prescriber. And I don't need it for the DEA, but to see if there are comorbidities. I only refer to one place that I like. That's just me. I don't look for a rubber stamp.
Who pays for that?
You need Psychological Tests to see if patient has 'other' DSM diagnoses???
You are you suggesting that people should ignore the DSM’s instructions that neuropsych testing is part of the standard evaluation of neurocognitive disorders? Or are you suggesting that people ignore the case book diagnostic procedure? Or are you unfamiliar with these standards?
The student.
??
Learning disabilities, developmental etc
That's only if something in the history makes you concerned for other learning disabilities that you think may be causing the symptoms and you're unable to tease this apart from your line of questioning. It most definitely shouldn't be used routinely as it simply can't diagnose ADHD nor is it purported to. The gold standard for ADHD diagnosis is the clinical interview and collateral hx. Routinely doing neuropsychological testing for a clinical diagnosis is a waste of the patient's time and money. It's as ludicrous as ordering routine neuropsychological testing for anxiety or depression.
The student and families pay for the testing. No one is expecting centene to pay for it.
Its what makes me comfortable. People usually have something else and were wrong about ADHD in the testing results I see. There's many people who have bought or gotten stims from someone else, since they are overprescribed, and then decided they have ADHD. Why are there always so many stims floating around for sale if it's not overprescribed or for the secondary gain of selling them?
Do you know how many parents want their kids to have an edge in school as these college prep schools are difficult? I'm not going to give it to them for performance enhancement. Can't believe the collaterals all the time as they may have gain as well.
Not quite as ludicrous, but close. 😉
What tips and strategies do you recommend and have seen work? By the time they reach me, all they want is Addy
in situations where the patient is not an adderall candidate, I am LOVING the shortage.
Thank you for sharing this information. May I ask the formulation and dose? It should work and years ago I used to try Wellbutrin in those who I felt might benefit from treatment when I wanted to avoid a stimulant but with minimal to no results. In all fairness to the med however they were all angling for a stimulant.
If all they want is addy and think that an increase in the medication is what they need every time hey are stressed out, then they probably won’t do anything else. However, if the patient wants to improve functioning without overreliance on stimulants, the tips and strategies just involve effective management of stress and coping and organization. Some of the same stuff that works for helping anyone else works for people with attentional problems and most of the time there are stressors or negative thought patterns and maladaptive strategies that are making it worse. Helping a client learn what works for them individually is key. Prioritizing of tasks, small chunks vs big chunks, time of day, structuring the week, using a planner or calendar and whether it is electronic or paper; all of these will vary in what works from individual to individual regardless of distractibility. When a patient is actively trying to improve, we can come up with things to try at every session and review what works and what didn’t. Exercise and good nutrition and general self-care also seem to help improve function.
FWIW I've had a number of patients, who were themselves looking for a nonstim options or were at least not strongly pushing for adderall/seemed more reliable, find bupropion helpful. And usually at 150 or 300 (mostly 300.)
I guess there expectations are different by the time they meet me. So all they wasn't is Adderall. None of my recommendations similar to what small-town said are heeded.
Agree with Flowrate. I just use XL formulation unless there's reason not too (causing significant sleep issue, absorption issues, etc) and I've found patients with legit ADHD almost always require 300mg for decent benefit. 450mg may be necessary, but I've found side effects very common above 300mg, and I did not tolerate 450mg myself. For adults with legit ADHD who have never been on anything for it, Wellbutrin is my first line and most do feel it's at least somewhat helpful.
For 450 mg, I often suggest taking 150 mg at lunchtime as opposed to all in AM
I can't even find psychologists to do cbt I versus having me do it. And the people who want stims don't give a hoot. They want instant gratification
They often take the 150 mg prn; Some say it makes a marginal difference. I mean it makes sense pharmacologically
While serum concentrations may spike using an afternoon dose, it takes time to reach steady state centrally and there's some data that central binding of dopamine and noradrenergic receptors is maintained well over 24 hours. So not really sure what is being accomplished by a PRN dose of XL. So doesn't really make that much sense to be pharmacologically as there's a reason that we tell patients they have to take their bupropion daily as prescribed while stimulants can still have clinical effects when used PRN.
And heck, the binding to DAT is pretty feeble.
Esp when they crush it and snort it
