SSP - ADHD Review Template

Specialty: Psychiatrist Current Medication: - Methylphenidate ER 36mg, once daily in the morning, oral. Patient reports good adherence, no missed doses. No recent changes. - Multivitamin, once daily, oral. Patient reports good adherence. Response to Medication: Patient reports significant improvement in ability to focus on tasks at work and during conversations since starting methylphenidate. Academic performance has improved, with fewer assignments missed and better grades. Social interactions feel less overwhelming, and patient reports being able to maintain conversations more effectively. However, patient notes that the medication's effectiveness seems to wane in the late afternoon, leading to increased distractibility during evening activities. Current Symptoms: Patient continues to experience occasional difficulties with task initiation and organisation, particularly for non-preferred activities. While inattention has largely improved with medication, some mild difficulties with sustained attention remain when fatigued. Hyperactivity is well-controlled, with less fidgeting and restlessness. Impulsivity is also reduced, though patient sometimes still interrupts others in conversation when excited. Side Effects: Patient reports mild appetite suppression, primarily in the morning, which has improved over time. Initially experienced some insomnia, but this resolved with a slight adjustment to the medication timing (taking it earlier in the morning). No other significant side effects reported. Physical Monitoring: - Weight: 72 kg (stable) - Blood pressure: 120/75 mmHg - Heart rate: 78 bpm - Sleep patterns: Generally 7-8 hours per night, occasional difficulty falling asleep if medication is taken too late. - Appetite: Mildly suppressed in the morning, otherwise normal. Duration of Action: Patient consistently reports that the effects of methylphenidate begin to wear off around 4-5 PM, approximately 8-9 hours after administration. At this point, they notice a gradual return of inattention and increased difficulty concentrating, impacting their ability to complete evening chores or engage in hobbies effectively. This decline in efficacy leads to increased frustration and a feeling of being overwhelmed in the evenings. Investigations: - Conners 3 Rating Scale (self-report and parent report) completed 3 months prior, demonstrating significant reduction in symptom scores post-medication initiation. - ECG performed 6 months ago, within normal limits. Risk Assessment: No current suicidal ideation, self-harm, or substance use. Patient has a history of mild anxiety, well-managed with non-pharmacological strategies. Protective factors include a supportive family environment and stable employment. Impulsivity-related risks are low. Plan for risk mitigation includes regular follow-up and monitoring of mood and anxiety symptoms. Mental State Examination: Patient was well-groomed and cooperative throughout the interview. Speech was of normal rate and rhythm. Mood was euthymic, and affect was congruent. Thought form was linear and logical, with no evidence of thought disorder. No perceptual disturbances reported. Cognitive function appeared intact. Insight into condition and treatment was good, and judgement was sound. Treatment Plan: - Increase Methylphenidate ER to 54mg once daily in the morning to address the reported wearing-off effect in the late afternoon. This aims to provide extended symptom control. - Advise patient to monitor for any new side effects with the dosage increase, particularly appetite and sleep disturbances. - Explore non-pharmacological strategies for evening routine management, such as setting timers or breaking down tasks into smaller steps. - Referral to occupational therapy to further develop organisational skills and executive functioning strategies. - Follow-up appointment scheduled in 4 weeks to review medication efficacy and side effects.