Posted: December 1st, 2022

Decision making with management of ADHD

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Decision making with management of ADHD

Decision- making with Treatment of Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a mental health disorder mostly seen in children which is characterized by difficulty paying attention and controlling impulsive behaviors (National Institute of Mental Health (NIMH), 2017). ADHD manifestations include inattentiveness, hyperactivity, and impulsivity with affected children feeling fidgety, unable to concentrate on school work and other tasks, impatient, switch very often from one activity to another, call out frequently in class, and unable to complete tasks (Rosenthal & Burchum, 2018). ADHD is not just a childhood disorder, even though the symptoms begin in childhood, it can progress into adolescence and adulthood. According to NIMH (2017), the cause of ADHD could be attributed to interaction between genetics and environmental factors or non genetic factors.

Decision step applied

In the given scenario involving Katie, an 8-year- old girl presenting with ADHD, the following decision steps were applied;

Step 1

Drug management with Ritalin (Methylphenidate) chewable tablets 10 mg orally in the morning, with a follow up appointment in four weeks. Four weeks later, Katie’s parents returned to the clinic with Katie and report improved symptoms in the morning and better academic performance according Katie’s teacher but not in the afternoon as Katie day dreams and lacks attention in the afternoon. Katie’s parents are also concerned because Katie reported that her “heart felt funny.” On examination, Katie’s pulse is about 130 beats per minute.

Step 2

Since the symptom improvement only occurs in the morning with the current dose, the next action according to Laureate Education (2019c) will be to change the drug Ritalin from immediate release to long acting form and increase the dosage to 20mg. So, the new drug therapy will be Ritalin LA 20mg orally daily in the morning. When Katie and her parents return to the clinic in 4 weeks later, they reported continued improved academic performance, day long symptom improvement and no side effects since Katie’s heart does not “feel funny” any more and pulse on assessment is 92 beats per minute.

Step 3

At this point, since symptoms are managed throughout the day with the current drug regimen with no side effects, no changes to drug therapy is required and Katie will continue current dose of Ritalin LA 20mg and to be reevaluated in 4 weeks.

Impacts of Ritalin on Katie’s ADHD

Ritalin is a stimulant which acts as a norepiphrine and dopamine reuptake inhibitor and in turn promote the release of norepinephrine and dopamine neurotransmitters in the cerebral cortex thus improving concentration, focus and other ADHD symptoms (Rosenthal, & Burchum, 2018).

Suggested Treatment Plan

Katie and her parents should be informed about the side effects of Ritalin which includes increased heart rate. According to Rosenthal and Burchum (2018), the increase in heart rate does not have clinical significance, unless the patient has preexisting cardiovascular problems. The parents should be informed of the importance of adhering to treatment regimen. According to Rosenthal and Burchum (2018), drug therapy with stimulants is the first line of therapy. In children 6 years and older, behavior therapy in addition to medications may be more effective (Centers for Disease Control and Prevention (CDC), 2019). Parents should be encouraged to be active participants and equal partners with other care providers including healthcare providers, teachers and others. They parents should be encouraged to report any changes in behaviors to the care providers. They parents should also help Katie manage symptoms and behaviors at home by following certain tips which according to CDC (2019) include creating routines, limiting choices, being clear and specific, help the child plan and decreasing distractions.

References

Centers for Disease Control and Prevention. (2019). Attention -deficit/hyperactivity disorder (ADHD). Treatment of ADHD. Retrieved from https://www.cdc.gov/ncbddd/adhd/treatment.html
Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.
National Institute of Mental Health (NIMH), (2017). Attention deficit hyperactivity disorder (ADHD). Retrieved from https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier

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