Risks and Benefits of Untreated Versus Treated ADHD Essay

Risks and Benefits of Untreated Versus Treated ADHD Essay

Risks and Benefits of Untreated Versus Treated ADHD Essay

Hi Michelle, I think that untreated ADHD may lead to functional impairment for the patient in this case it may impair the ability to learn and take tasks. Treatment of the disease improves symptoms and enhances better quality of life (Kazda et al., 2021). Untreated ADH may result to low self-esteem. ADHD may also make it difficult for the patients to learn as they are not able to pay attention for long enough in class. This worsens for teens as they progress to higher classes where the workload increases. the disorder leads to inability to function normally and may result to discrimination or negative attitude upon interaction with other people.

Anxiety and depression are some of the symptoms of ADHD that may persist and affect the overall quality of life of the patient if not managed in time. Patients with ADHD are also likely to have relationship problems since they lack the ability to regulate emptions (Cambron-Mellott et al., 2021). The disease may lead to substance use as a result of the symptoms and may also increase mortality risk resulting from accidents as well as suicide. In some cases, untreated ADHD may result in eating disorder as well as difficulties in tasks hence mistakes and felonies on activities such as driving. If the disease persists with age, when untreated, it may impair the ability of a patient to stay organized, meet deadlines and accept criticism easily.

ADHD treatment leads to better control of symptoms such as anxiety and depression. This results to improved quality of life. Treatment of the disease also leads to increased self-awareness that redeems self-esteem and balances expectations when interacting with others (Areces at al., 2021). Treated ADHD reduces risks of accidents and injuries as well as chances of substance abuse and better performance in school.

References

Areces, D., Rodríguez, C., García, T., Cueli, M., & González-Castro, P. (2021). The Influence of State and Trait Anxiety on the Achievement of a Virtual Reality Continuous Performance Test in Children and Adolescents with ADHD Symptoms. Journal of clinical medicine, 10(12), 2534. https://doi.org/10.3390/jcm10122534

Cambron-Mellott, M. J., Mikl, J., Matos, J. E., Erensen, J. G., Beusterien, K., Cataldo, M. J., Hallissey, B., & Mattingly, G. W. (2021). Adult Patient Preferences for Long-Acting ADHD Treatments: A Discrete Choice Experiment. Patient preference and adherence, 15, 1061–1073. https://doi.org/10.2147/PPA.S311836

Kazda, L., Bell, K., Thomas, R., McGeechan, K., Sims, R., & Barratt, A. (2021). Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA network open, 4(4), e215335. https://doi.org/10.1001/jamanetworkopen.2021.5335

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PLEASE ANSWER THIS QUESTION PROVIDED BY MY CLASSMATE, I NEED TO RESPOND TO HER DISCUSSION POST QUESTIONS

1. What are the risks and benefits of untreated vs treated ADHD?

Week 7: Grand Round Assignment

College of Nursing, Walden University
PRAC 6675-8-2022 PMHNP Care Across the Lifespan II
Dr. Ashley Lockhart
April 13, 2022

Grand Round Assignment
This patient presentation reflects an assessment had with the patient, parent, and the patient’s teacher, via the parent, to obtain pertinent information to assess how the patient is responding to the treatment plan previously set forth.
The intent of this case scenario is to provide adequate documentation to support the diagnosis and care plan. The following learning objectives are specific for this case and are the goal upon completion of the presentation.
OBJECTIVES:
1. The reader/viewer should be able to understand how to interpret symptoms to meet criteria needed for a DSM-5 diagnosis.
2. The reader/viewer should be able to determine how alternate therapies can be implemented to address specific concerns.
3. The reader/viewer should be able to formulate and organize a patient-appropriate care plan based on current needs.
CASE SCENARIO:
INITIALS/AGE/GENDER: T.J. is 16-year-old male
PERSONS IN SESSION: Patient and patient’s mom
SUBJECTIVE:
CHIEF COMPLAINT (CC): T.J. is a 16-year-old male who is an established patient and presents for ongoing psychiatric treatment.
HPI: Patient was diagnosed with ADHD, onset of behaviors between age 5-7, with mild severity. Symptoms are improving but continue to present with fluctuating frequency. Symptoms and behaviors are witnessed both at home and at school. He endorses distractibility, impulsivity, difficulty waiting his turn, intruding, or interrupting others, difficulty with attention as it relates to details, organization, tasks, and activities, maintaining sustained effort, and forgetfulness. He also reports hyperactive symptoms such as difficulty staying still, unable to stay sat when expected to, restless/fidgety, and talking excessively. He finds it difficult to listen and focus during conversations. He acknowledges these behaviors are problematic.
MOOD/SYMPTOMS TODAY: Today he reports mild depression and increased anxiety, but better in that his focus and attention has somewhat improved at school, he is not getting as easily distracted but still endorses difficulty sitting still, hyperactivity, interrupting others, and restlessness. This information was confirmed by his mother, who also reports his teacher reports the same. He experiences feeling anxious daily, every morning upon awakening. His anxiety worsens with school because “there are too many people there, and it is stupid and boring”. Mom reports he misses school often either because of doctor’s appointments or because she doesn’t wake up on time to get him on the bus.
PSYCHIATRIC/MEDICAL HX:
PREVIOUS DIAGNOSIS AND/OR PSYCHOTHERAPY: ADHD, hyperactive presentation; migraines. Currently engaged in therapy weekly through school.
CURRENT MEDICATIONS/SIDE EFFECTS:
• Divalproex ER 250 mg 2 tablets every night at bedtime. Compliant with medication.
• Fluoxetine 20 mg 1 tab every morning. Compliant with medication. Reports Fluoxetine nauseates him.
• Vyvanse 70 mg 1 capsule every morning. Compliant with medication.
PSYCHIATRIC HOSPITALIZATIONS: None.
FAMILY SUBSTANCE/PSYCHIATRIC HX: Sibling with ADHD.
PSYCHOSOCIAL HX: Patient lives at home with mom and siblings and attends Rocky High School. He is single without children. He does not drive. He has no history of legal problems. His preferred language is English.
TRAUMA/ABUSE/VIOLENCE: Grandmother attempted suicide but did not complete.
SUBSTANCE USE: Patient was using his brother’s Adderall in addition to his own prescription for Vyvanse but is now being drug-screened, and it has not been an issue.
ETOH/NICOTINE/CAFFEINE: Denies alcohol and/or nicotine use, but second-hand exposure noted, does not use caffeine.
MEDICAL/SURGICAL HX: Migraines.
ALLERGIES: No known allergies.
RISK ASSESSMENT FOR SUICIDALITY: After considering variables that influence suicide risk including prior suicide attempts, psychiatric diagnoses that elevated risk, age, gender, family background, interpersonal relationships, physical health, suicide risk variables regarding lethality/access/planning, affective control, degree of hope, family history of completed suicide, degree of willingness to seek help, and degree of psychosocial support for dealing with current life stressors, current suicide risk is judged to be: MINIMAL.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: Denies any new onset of weakness, fever, or chills, weight changes.
HEENT: No changes to vision or hearing, no nasal congestion or sore throat reported.
CARDIOVASCULAR: Denies heartburn.
RESPIRATORY: No changes to respiratory status reported.
SKIN: No new lesions, rash, or changes to skin integrity reported.
GASTROINTESTINAL: Endorses nausea associated with fluoxetine administration. Denies change to appetite, reports good appetite. Denies vomiting, abdominal pain, and/or changes stool such as constipation or diarrhea.
GENITOURINARY: Not reviewed.
NEUROLOGICAL: Migraines. Denies sleep disturbances.
MUSCULOSKELETAL: Denies new or worsening back, joint, or muscle pain or weakness.
HEME/LYMPH: No notice of enlarged lymph nodes or report of unexpected bleeding/bruising reported.
ENDOCRINE: There is no report of heat of cold intolerance.
OBJECTIVE:
VITAL SIGNS: Deferred.
LABS: Urine drug screen is negative.
SCREENING SCALES:
1. DEPRESSION: PHQ-2 = 1, further testing indicated
2. DEPRESSION: PHQ-9 = 6, mild depression
ASSESSMENT:
MENTAL STATUS EXAM: Patient is a 16-year-old Caucasian male who appears his stated age, appropriately dressed for time, weather, and circumstance, somewhat disheveled with overgrown, messy hair. Maintained good eye contact. Some speech latency but otherwise normal rate, rhythm, and tone; speech is clear and audible. Thought process is logical; no loose associations noted. Patient denies hallucinations and/or delusions, and none were observed. Mood is depressed and anxious with congruent affect. Patient is alert and oriented. Memory good; able to recall recent events. Maintained average attention and engagement throughout the consultation with some distractibility and indifference. Average intelligence. Good insight and judgement. Restless at times, no tics or tremors noted.

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REFLECTION:
I believe the assessment went as well as it could have. Pertinent information was gathered from both the patient and the mother, with feedback to the mother from the teacher. If anything, I would ask if the patient and mother could move to a quieter environment, as competing with the tv and other background noises and actions were distracting even for me, making the interview more challenging (Lai et al., 2017). If I could follow up with this patient, I would be sure to ask for an update on his therapy sessions, his sleep hygiene interventions, his school attendance, and what he would like to see improved, in other words, what symptoms he feels the medications are not addressing. The interventions are effective, as is evidenced by reports of improvement and good reports when he does attend school, but I sense there is room for improvement. For the next appointment, if it were necessary to change anything, it would be based on his feedback. I anticipate if the fluoxetine helps with depression/anxiety, then I would consider increasing or augmenting his existing treatment for ADHD (Hodgkins et al., 2012). I would also continue to emphasize the importance of routine, structure, and proper sleep hygiene (Chang et al., 2020). Cultural considerations may have contributed to his early diagnosis and treatment, as Caucasian children are identified with ADHD sooner and earlier than African American and Latino children in the United States (Sadock et al., 2015).
DIAGNOSIS (American Psychiatric Association [APA], 2013):
Attention deficit hyperactivity disorder, combined type, in partial remission 314.01 (F90.2) Patient meets criteria A1 Inattention: A1b, A1c, A1f, A1h, A1i and criteria A2 Hyperactivity and Impulsivity: A2a, A2c, and A2i. This diagnosis was established on 02/04/2010, but with treatment, the patient is now in partial remission, and thus does not need to meet full criteria.
Other specified anxiety disorder, generalized anxiety not occurring more days than not 300.09 (F41.8) I consider this because I don’t know if criteria F for GAD can be met since he has an ADHD diagnosis. If that excludes GAD, then this would be accurate because he will not be able to meet the full criteria for generalized anxiety disorder then.
Generalized anxiety disorder 300.02 (F41.1) (Working diagnosis) Patient meets criteria A, B, C1, C3, D, E, and F if ADHD is to be excluded.
Oppositional defiant disorder 313.81 (F91.3) (Established, diagnosed on 11/25/2015) I carried this over, although I cannot justify this diagnosis presently, based on only one interaction with the patient.
CASE FORMULATION:
1. To reduce symptoms of anxiety and depression.
2. Regarding migraines – Patient’s mother will follow up with the neurologist to make an appointment.
3. Medications were reconciled and reviewed.
4. It is important for the patient to continue going to therapy weekly to work on coping and social skills and does so through his school (Rajeh et al., 2017).
5. Mom and patient were reminded of the importance of structure, routine, and good sleep hygiene for best patient outcomes and response to treatment.
6. Patient and mom are encouraged to make school attendance a priority.
7. Patient and mom were reminded of the side effects of Fluoxetine and Vyvanse. Fluoxetine side effects include increased risk of suicidality, rash, swelling, chest pain or shortness of breath. Vyvanse side effects include headache, insomnia, anorexia, abdominal pain, irritability, increased heart rate and anxiety
8. Patient and mother expressed understanding of emergent symptoms/behaviors and when to go to emergency room or call 911. Both patient and mother were also encouraged to call office with any concerns, questions, or change or worsening in symptoms or behaviors.
9. Consent and release of information discussed.
10. Safety plans for decompensation or active thoughts of suicidal/homicidal ideations occur reviewed with patient who voices understanding, which includes calling the suicide hotline, presenting to the local ED and/or calling 911.
11. Time allowed for questions and answers were provided to client’s satisfaction.
TREATMENT PLAN:
1. Medication treatment: Increase fluoxetine from 20 mg to 40 mg daily for anxiety/depression (Stahl, 2021). Patient to take medication in the morning. No other changes.
2. Continue weekly therapy through school, working on coping skills, structure, routine, and sleep hygiene.
3. Patient’s mom will follow up with neurologist regarding migraines.
4. Follow-up appointment made for 4-6 weeks.

CONCLUSION
I believe the criteria is met for the identified diagnosis of ADHD, as well as anxiety disorder. The treatment plan is patient specific and uses both pharmacological and psychotherapy approaches, which have been proven to be beneficial in achieving optimal outcomes (Faraone et al., 2021).
Discussion prompts/questions for my classmates:
2. What are the risks and benefits of untreated vs treated ADHD?
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). American Psychiatric Publishing.
Chang, J. G., Cimino, F. M., & Gossa, W. (2020). ADHD in children: Common questions and answers. American Family Physician, 102(10), 594–602. Retrieved January 18, 2021, from
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M., Asherson, P.,…Wang, Y. (2021). The world federation of adhd international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat adhd. CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000
Lai, W., O’Mahony, M., & Mulligan, A. (2017). The home observation measure of the environment is associated with symptoms of adhd and oppositionality in a camhs sample. Clinical Child Psychology and Psychiatry, 23(4), 503–513. https://doi.org/10.1177/1359104517740712
Rajeh, A., Amanullah, S., Shivakumar, K., & Cole, J. (2017). Interventions in adhd: A comparative review of stimulant medications and behavioral therapies. Asian Journal of Psychiatry, 25, 131–135. https://doi.org/10.1016/j.ajp.2016.09.005
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh ed.). Wolters Kluwer.
Stahl, S. M. (2021). Prescriber’s guide (stahl’s essential psychopharmacology) (7th ed.). Cambridge University Press.

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Rubric Detail

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Name: PRAC_6675_Week7_Discussion_Participant_Rubric

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		Excellent	Good	Fair	Poor
ResponAses		77 (77%) – 85 (85%) Responses exhibit synthesis, critical thinking, and application to practice settings. Responses provide clear, concise opinions and ideas that are supported by at least two scholarly sources. Responses demonstrate synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Presenters’ prompts/questions posed in the case presentations are thoroughly addressed. Responses are effectively written in standard, edited English.	68 (68%) – 76 (76%) Responses exhibit critical thinking and application to practice settings. Responses provide clear, concise opinions and ideas that are supported by 2 or more credible sources. Communication is professional and respectful to colleagues. Presenters’ prompts/questions posed in the case presentations are addressed. Responses are effectively written in standard, edited English.	60 (60%) – 67 (67%) Responses are on topic and may have some depth. Responses may lack clear, concise opinions and ideas, and only one or no credible sources are cited. Responses posted in the Discussion may lack effective professional communication. Presenters’ prompts/questions posed in the case presentations are inadequately addressed.	0 (0%) – 59 (59%) Responses may not be on topic and lack depth. No credible sources are cited. Responses posted in the Discussion lack effective professional communication. Responses to colleagues’ prompts/questions are missing.
Participation		14 (14%) – 15 (15%) Meets requirements for participation by responding at least twice to each colleague who presented this week. Responses are carried out over multiple days between Days 4 and 7.	12 (12%) – 13 (13%) Meets requirements for participation by responding at least twice to each colleague who presented this week, over at least 2 days.	11 (11%) – 11 (11%) Participants respond at least twice to each colleague who presented this week, but responses may occur all in 1 day.	0 (0%) – 10 (10%) Does not meet requirements for participation by responding at least twice to each colleague who presented this week.
Total Points: 100

Name: PRAC_6675_Week7_Discussion_Participant_Rubric