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Taking people off stimulants

Discussion in 'Psychiatry' started by resident1985, Nov 21, 2017.

  1. resident1985

    2+ Year Member

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    Whats your strategy for seeing evals when patients are on stimulants but you don’t think they actually have adhd? Obviously they “work” and patients are very upset about this. If they’re not abusing them and they’re functioning well I’m growing weary and sometimes just want to leave it alone.
     
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  3. bashir

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    I feel the same way and am interested in others' response to this question. I also am getting wildly divergent answers when I ask different faculty how to go about evaluating these patients. Some say it's a clinical diagnosis, go through the DSM criteria and don't overthink it. Others recommend starting with self report scales. Others say they never prescribe stimulants to adults without a Connors computerized test (which I don't have access to). I feel lost when it comes to diagnosing adult ADHD and am trying to figure out how far my responsibility extends when continuing stimulants based on another clinician's diagnosis.
     
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  4. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    Functioning.

    Does the patient have actual impairment without said medication. If so, what are the (100?) possible causes for this impairment. Its a slippery diagnosis, but falls within the realm of your job, technically. History is important. Which you may or may not have time for.

    As far as computerized vigilance tests...well: What role should cognitive tests of attention play in ADHD diagnosis?

    A full neuropsychological evaluation for every person claiming AD/HD is cost prohibitive and makes little clinical sense. An isolated vigilance test without full psychiatric background/history that concludes "AD/HD" is just poor clinical practice.
     
    #3 erg923, Nov 21, 2017
    Last edited: Nov 24, 2017
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  5. bashir

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    That article was very helpful. Thank you. The problem with people already on stimulants is that it makes it even harder to discern true impairment. It often feels like impairment to them to be without the stimulant once they're used to being on it, whether or not they actually have ADHD. Slippery indeed. I often really struggle with these situations and wonder whether I made the right call. I can usually handle diagnostic uncertainty but I really want an easily administered, well-validated test for ADHD to take out the guesswork. I guess like anything else you get better at recognizing it with experience.
     
  6. smalltownpsych

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    Discuss your thoughts on it along with the pros and cons with the patient and let them make the choice on what kind of treatment they have. If you do not agree that a stimulant is indicated at all for their case, then they need to get treatment elsewhere if they do think it is.
     
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  7. resident1985

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    What do you guys think of the purported "hyperfocus" phenomenon in ADHD? Had a patient wanting stimulants who had been on them before. Before being on stimulants scored a 32 on his ACT, he won awards for science in high school as a kid was taking apart electronics. Says was able to focus because these things were challenging and he can't focus on the mundane.
     
  8. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    That...that's not AD/HD. Who doesn't have trouble focusing on things that are uninteresting to them?!
     
  9. NickNaylor

    NickNaylor Thank You for Smoking
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    Yeah... I hear that all the time, to which I think to myself, “great, me too.”
     

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