Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder
Patient evaluation on intake•
31-year-old man with a chief complaint of anxiety of “different types” •Patient states that he “has been successful in graduate school, has financial worries, but states that he worries and is tense most of the time”
•Has been anxious for many years, mostly since college and now graduate school •Working part-time and going to school part-time and feels “torn in many directions” •Generally is tense, restless, irritable, and worries about things even outside school and work–When legitimate stressors diminish, the anxiety lowers, but is still present and discouraging •This causes him to be argumentative and temperamental most of the time •He says he is active and likes to stay busy all of the time, but he wonders if “he is doing too much, as he has no time for all of the things” he wants to do
Social and personal history
•Graduated high school, college, and is enrolled in a graduate-level training program for family counseling •Gainfully employed now in a clinical setting •Married and without children •Does not use drugs or alcohol.
Write a response to the following: Provide the case number in the subject line of the Discussion. List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used. List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why. List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided. Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.