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So for folks who are managing stimulants in adults, after the decision is made to start a patient on a stimulant, I'm curious what sort of medical workup (e.g., vitals, physical exam, labs) everyone is doing in an outpatient setting at the initial appointment and follow ups.
It seems BP and pulse are important, especially at the initial appointment. Do you think they need to be taken again at each follow up appointment? Only with dose adjustments?
Taking a good medical history is obviously important. You'd want to ask about things like seizures, strokes, heart problems, history of early cardiac death in the family, ect. Is there any reason to insist patients have a recent physical if they haven't seen a PCP recently?
I've seen a lot of people insist UDS gets checked, and sometimes random UDS at follow ups. Any issues getting insurance to pay for this?
How about EKG? When I was doing a child psych rotation as a resident several years ago, it seemed we would only check EKGs in preparation for a new stimulant start for very young children. Anyone get an EKG routinely for every patient? Only if there are specific cardiac risk factors? How about for older adults (>55 or 60)? I recognize new stimulant starts in this age range are going to be rare, but I did just recently inherit a patient in her 60s who had been on a stimulant for several decades.
Anything else I'm missing?
It seems BP and pulse are important, especially at the initial appointment. Do you think they need to be taken again at each follow up appointment? Only with dose adjustments?
Taking a good medical history is obviously important. You'd want to ask about things like seizures, strokes, heart problems, history of early cardiac death in the family, ect. Is there any reason to insist patients have a recent physical if they haven't seen a PCP recently?
I've seen a lot of people insist UDS gets checked, and sometimes random UDS at follow ups. Any issues getting insurance to pay for this?
How about EKG? When I was doing a child psych rotation as a resident several years ago, it seemed we would only check EKGs in preparation for a new stimulant start for very young children. Anyone get an EKG routinely for every patient? Only if there are specific cardiac risk factors? How about for older adults (>55 or 60)? I recognize new stimulant starts in this age range are going to be rare, but I did just recently inherit a patient in her 60s who had been on a stimulant for several decades.
Anything else I'm missing?
