TEXT A: The GP’s role in the management of ADHD

It helps to remind patients that ADHD is not all bad. ADHD is associated with positive attributes such as being more spontaneous and adventurous. Some studies have indicated that people with ADHD may be better equipped for lateral thinking. It has been suggested that explorers or entrepreneurs are more likely to have ADHD. In addition, GPs can reinforce the importance of developing healthy sleep–wake behaviours, obtaining adequate exercise and good nutrition. These are the building blocks on which other treatment is based. For patients who are taking stimulant medication, it is helpful if the GP continues to monitor their blood pressure, given that stimulant medication may cause elevation. Once a patient has been stabilised on medication for ADHD, the psychiatrist may refer the patient back to the GP for ongoing prescribing in line with state-based guidelines. However, in most states and territories, the GP is not granted permission to alter the dose.

Text B: ADHD: Overview:

Contrary to common belief, ADHD is not just a disorder of childhood. At least 40 to 50% of children with ADHD will continue to meet criteria in adulthood, with ADHD affecting about one in 20 adults. ADHD can be masked by many comorbid disorders that GPs are typically good at recognising such as depression, anxiety and substance use. In patients with underlying ADHD, the attentional, hyperactive or organisational problems pre-date the comorbid disorders and are not episodic as the comorbid disorders may be. GPs are encouraged to ask whether the complaints are of recent onset or longstanding. Collateral history can be helpful for developing a timeline of symptoms (e.g. parent or partner interview). Diagnosis of underlying ADHD in these patients will significantly improve their treatment outcomes, general health and quality of life.

Text C: TABLE 2: Medications for attention deficit hyperactivity disorder and typical dosing

Immediate-release methylphenidate	5 to 10 mg in the morning the first day; add a second dose of 5 to 10 mg at lunch time for a week; then add further increments weekly	Total dose typically varies between 10 mg/day and 60 mg/day Doses of more than 80 mg/day are uncommon (maximum recommended dose in the NICE guidelines is 100 mg/day) 11 Transition to longer-acting formulations can occur after a month
Extended-release methylphenidate	18 or 36 mg/day taken once daily in the morning	Increase in 18 mg increments to a maximum of 72 mg/day Adjust dosage at weekly intervals
Long-acting methylphenidate	20 mg/day taken once daily in the morning	At dose wey in Dose usually would not exceed 60 mg/day
Dexamfetamine	2.5 to 5.0mg in the morning the first day; add a second dose of 2.5 to 5.0mg at lunch time for a week; then add further increments weekly	Total dose typically varies between 5 mg/day and 30 mg/day Doses over 40 mg/day are uncommon (maximum recommended dose in the NICE guidelines is 60 mg/day)11
Lisdexamfetamine	30 mg in the morning the first day; increase up to 70 mg according to response	Dose range typically 30 to 70 mg/ day
Atomoxetine	For those weighing less than 70 kg, start at 0.5 mg/kg taken once daily for three days then increase to 1.2 mg/kg once daily in the morning or as evenly divided doses in the morning and late afternoon/early evening. For those weighing more than 70kg, start at 40 mg/day taken once daily for three days then increase to target dose of 80 mga	Target dose 80 mg/day Maximum dose 100 mg

Text D: Treatment of ADHD

It is very important that the dosage of medication is individually optimised. An analogy may be made

with getting the right pair of glasses – you need the right prescription for your particular presentation with not too much correction and not too little. The optimal dose typically requires careful titration by a psychiatrist with ADHD expertise. Multiple follow-up appointments are usually required to maximise the treatment outcome. It is essential that the benefits of treatment outweigh any negative effects. Common side effects of stimulant medication may include:

• appetite suppression

• insomnia

• palpitations and increased heart rate

• feelings of anxiety

• dry mouth and sweating

In which text can you find information about…

1 different types of ADHD medication? __________

2 possible side effects of medication? ___________

3 conditions which may be present alongside ADHD? _____________

4 a doctor’s control over a patient’s medication? ____________

5 positive perspectives on having ADHD? ___________

6 when patients should take their ADHD medicine? _______________

7 figuring out a patient’s optimal dosage of medication? ________________

Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may

include words, numbers or both. Your answers should be correctly spelled.

8 What is the maximum recommended dose of Dexamfetamine?

9 What is typically needed to get the best results from ADHD treatment?

10 How can GP’s collect information about their patient’s collateral history?

11 What causes symptoms such as palpitations and anxiety in some patients?

12 What proportion of children with ADHD will carry symptoms into adulthood?

13 What positive personality traits are sometimes associated with ADHD?

14 Which medication has dose recommendations related to patient weight?

Questions 15-20. Complete each of the sentences, 15-20, with a word or short phrase.

• Sleep, exercise and nutrition comprise the (15) _______________of further ADHD treatment.
• When diagnosing ADHD, it is important to ask if the issues arose recently or are (16) ____________
• It is possible to move to (17) ______after one month of immediate-release methylphenidate.
• Signs of ADHD can be disguised by (18) _________________ which GPs are more likely to recognise.
• GPs should regularly check the (19) _________________ of patients prescribed stimulant medication.
• Establishing the ideal dose of ADHD medication needs (20) ________ by an expert psychiatrist.

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