Russell E. Scheffer, MD
Chart Review: Adult ADHD
PATIENT INFO
37
Age: _____________________________________________________________________________________________
Male
Sex: _____________________________________________________________________________________________
Masters degree in health care administration, works for an
Background: _____________________________________________________________________________________
insurance company. Has been responsible for member and
__________________________________________________________________________________________________
physician recruitment. Recently became section chief and
__________________________________________________________________________________________________
has 10 direct reports. Had some marijuana use in college
__________________________________________________________________________________________________
Has always been easily distractible. Uses “peripheral brain”
__________________________________________________________________________________________________
notes, etc., to keep organized. Good student (Bs mostly)
but has 135 IQ and always felt he should do better.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Never treated with stimulants.
Medical History: __________________________________________________________________________________
Mom states some teachers thought he was a behavioral
Other: ___________________________________________________________________________________________
problem and may have had attention problems
__________________________________________________________________________________________________
Presenting Complaint:
Is coming unglued as he tries to keep
up with people other than himself.
BEST PRACTICES
List three best practices agreed to by the group in your chart review session:
1. Careful assessment—concentrate on the actual diagnosis, does he meet the criteria for ADHD.
2. Ruling out other disorder—bipolar disorder, substance abuse—other things that could potentially mimic
ADHD.
3. Collateral information—i.e. family, teachers (if student).
4. Use longer-acting stimulants or non-stimulants in adults.
Adult ADHD
Chart Review
Russell E. Scheffer, MD
University of Kansas
School of Medicine-Wichita
Russell E. Scheffer, MD
Disclosures
 Research/Grants: Wyeth Pharmaceuticals
 Speakers Bureau: None
 Consultant: AstraZeneca Pharmaceuticals LP
 Stockholder: None
 Other Financial Interest: None
 Advisory Board: None
Learning
Objective
Develop an
assessment and
treatment plan for an
adult presenting with
symptoms of ADHD
Patient Information
 37-year-old male, Masters degree in health
care administration, works for an insurance
company
 Has been responsible for member and
physician recruitment
 Recently became section chief and has 10
direct reports
 Had some marijuana use in college
Additional Information
 Has always been easily distractible
 Uses “peripheral brain” notes, etc., to keep organized
 Good student (B’s mostly) but has 135 IQ and always
felt he should do better
 Never treated with stimulants
 Is coming unglued as he tries to keep up with people
other than himself
 Mom states some teachers thought he was a
behavioral problem and may have had attention
problems
Audience Response
Diagnosis and Treatment Choice
Option
Diagnosis
Treatment
Treatment 2
1
None
“Peter Principle”
None
Get a different
job
2
ADHD NOS
Atomoxetine
Stimulant
3
ADHD
Stimulant
Atomoxetine
4
ADHD
None
He did alright until now
Get a different
job
Summary
 FDA-approved medications for adult ADHD include
dexmethylphenidate-XR, OROS methylphenidate,
mixed amphetamine salts-XR, lisdexamfetamine,
and atomoxetine
 ADHD is often comorbid with SUD and mood and
anxiety disorders
 Minimal evidence about pharmacotherapy for ADHD
and comorbid disorders in the adult population
 CBT can be an effective adjunctive treatment for
some patients
Adler LA. J Clin Psychiatry 2009;70:e12.
an educational series offered by
CME Outfitters, LLC
This CME/CE activity is
co-sponsored by
Adult ADHD
Russell E. Scheffer, MD
Adler LA. Pharmacotherapy for adult ADHD J Clin Psychiatry. 2009;70:e12.