Introduction
ADHD (attention deficit hyperactivity disorder) is a medical diagnosis that a neurologist or psychiatrist can make after a detailed examination of the child, questioning, and consultation with parents. According to Tsakiridou and Drigas (2022), 3 to 5% of the population suffers from ADHD. The disease is the most common cause of school failure and communication difficulties. In addition, if by adulthood, a person still learns to restrain their excessive activity, then absent-mindedness, impulsivity, and difficulty concentrating without timely therapy remain with the patient forever and can significantly affect his life.
Introduction to the Case
A Caucasian female patient, eight years old, was admitted to the office with the help of her parents. Their primary care physician referred them because the girl’s teachers suspected she might have ADHD. Accordingly, a psychiatric examination must confirm the fears or conclude that the patient is healthy. The girl’s teacher provided the Psychiatric-mental health nurse practitioner (PMHNP) evaluation sheet to help doctors determine the patient’s exact condition.
It was indicated that Katie could easily be distracted from the topic of the lesson; she is inattentive and quickly forgets what she has learned. In addition, the girl has difficulty with writing, counting, and reading. The patient pays attention only to what interests her, and her attention span is short. According to the patient’s teacher, she is constantly distracted and does not show interest in learning. Katie also often abandons the cases she takes on, does not follow instructions, and does not do well with school assignments. At the same time, the girl’s parents deny the possibility of ADHD and say they would have noticed if this were the case.
According to the patient, she is in perfect order and does not understand the problem. However, at the same time, she says that at school, all subjects seem boring to her, except art and recess. Because the patient cannot fully understand the objects, they seem complicated and boring to her, and she feels lost. Katie speaks only positively about family life; her relationship with her parents is good. The patient was instructed to take Ritalin 10 mg chewable tablets orally in the morning and requested to return in four weeks.
The First Decision
Ritalin 10 mg chewable tablet orally in the morning was prescribed in the first treatment decision. The main active ingredient is bupropion. This choice was made because it is well-suited for treating ADHD. The patient was prescribed long-acting bupropion, a slow-absorbing dosage form that can be taken only once daily. This simple dosage is suitable for people with ADHD, as the illness can cause them to forget to take their medications.
Ritalin may lead to a slight improvement in ADHD and reduce symptoms associated with ADHD. There were no more adverse effects with this medication than with a placebo. According to Ophir (2022), “Psychostimulant medications, such as methylphenidate (e.g., Ritalin), are prescribed to the majority of the children diagnosed with the disorder and are considered the pharmacological treatment of choice for ADHD” (p. 4). This will ensure a good result in the treatment of the patient.
No other solutions were selected because Intuniv does not positively affect ADHD symptoms. This drug’s active ingredient is guanfacine, a centrally-acting antihypertensive agent. This drug has several adverse side effects, due to which its use, especially for children, is undesirable. It can be drowsiness, insomnia, dizziness, fainting, or slow reaction time. Together, these factors can further exacerbate the symptoms of ADHD. This drug acts on the prefrontal cortex and may exacerbate “symptoms of inattentiveness, impulsivity, and excessive motor activity” (Ota et al., 2021, p. 1966).
All these factors make this option unacceptable for prescribing to a child. In addition, in the case of its use, the patient will generally not be able to wake up because drowsiness will increase, and attention and coordination may remain at the same level. As for Wellbutrin, this drug belongs to the group of non-amphetamine-type psychostimulants. It is also a bad option because it can be addictive, further worsening the disease.
By making such a decision, the goal is to reduce the symptoms of ADHD and, as a result, improve the patient’s mental health and academic performance. For ethical reasons, the prescribed treatment may not be the best, as Ritalin can negatively affect the patient’s thoughts. For example, a girl may have suicidal thoughts or intentions to harm herself. In this case, the treatment should be adjusted.
The Second Decision
Four weeks later, the client returned because the girl’s parents complained that she had thoughts of hurting herself. The decision was made to change to Ritalin LA 20mg orally daily in the morning. This option was chosen because the side effect manifested as a heart rate of 130 beats/minute of Ritalin and its low efficiency. If medical professionals do not react to this, then the patient may have had heart problems. Instead of Ritalin, Ritalin LA was prescribed, which is more careful about the psyche.
According to Weyandt et al. (2018), Ritalin LA positively affects palpitations and does not cause fits of laughter. In addition, this drug is safe if not taken in large doses. However, abuse can also lead to side effects such as slow heart rate, constriction of blood vessels, and fever.
The remaining options were not selected because they did not fit this scenario. It is unacceptable to tell the parents of a female patient that suicidal thoughts are every day and that medication should be continued. This will not give good results because the parents will be emotionally depressed, which will affect the patient’s condition. In addition, negative and suicidal thoughts may worsen and lead the patient as a child to harm herself.
Another indirect decision would be to prescribe Strattera (atomoxetine) 10 mg orally daily, a psychostimulant nootropic. This substance has several adverse side effects, such as abdominal pain and decreased appetite. Because of this, the patient may begin to lose weight, which will ultimately have a negative impact on the treatment process. In addition, Strattera (atomoxetine) “may have moderate or severe toxic effects such as drowsiness, agitation, hyperactivity, tremors, tachycardia, hyperreflexia, hypertension, and seizures” (Gün & Kocabay, 2020, p. 1). All of these effects would eventually lead to a re-prescribing of the remedy.
By approving such a decision, the goals are to eliminate the side effects of Ritalin and improve the patient’s condition. The effect of changing the treatment should be to improve the patient’s cognitive abilities and increase attention. Ethical issues strongly influence this case since Katie should not be allowed to have such a high pulse rate. Communication with parents should be more open, and it is worth explaining that they cannot change the course of treatment themselves without consulting a doctor.
The Third Decision
After starting Ritalin LA, the patient showed a beneficial effect on the patient’s heart rate, which returned to normal. Other indicators, such as the girl’s performance in school, improved, and the disease symptoms began to decrease. Therefore, the right decision is to maintain a current dose of Ritalin LA and evaluate side effects at the patient’s next visit in four weeks. The rest are not good options because the current drug works well, and it is irrational to cancel a drug that positively affects the disease.
Increasing the dosage of Ritalin LA is also not an option because the side effects may increase. According to Gonçalves et al. (2021), increasing the dosage of Ritalin LA can lead to increased heart rate, irritability, addiction, and adaptation to the drug. Because of this, it may turn out to be ineffective in the future, aggravating the situation.
By making this decision, the goal is to continue effective treatment and reduce side effects. Many of the studies cited above talk about the effectiveness of Ritalin LA, which makes it the best option. Ethical considerations may affect the treatment plan, and the physician should try every possible way to ensure that the patient is in excellent physical and mental condition.
Conclusion
The patient has been prescribed Ritalin 10 mg chewable tablet orally in the morning. However, the treatment had to be changed after side effects such as thoughts of self-harm appeared. The literature reviewed in this paper has helped form the opinion that Ritalin LA is the safest treatment for ADHD. After this medication was discontinued, Ritalin LA extended release of 20mg orally daily was started. This greatly improved the patient’s situation as the symptoms of the disease began to subside. However, there was a side effect in the form of a decrease in appetite. The decision was made to continue treatment with Ritalin LA and to monitor for symptoms and side effects, which should improve soon.
References
Gonçalves, C. Q., Do Nascimento, D. C., Anunciação, R. S., & de Almeida, A. C. G. (2021). The effectiveness of methylphenidate (ritalin) in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children: a systematic review/A eficácia do metilfenidato (ritalina) no tratamento do transtorno de déficit de atenção/hiperatividade (TDAH) em crianças: revisão sistemática. Brazilian Journal of Development, 7(12), 110880-110897. Web.
Gün, E., & Kocabay, K. (2020). Use of intravenous lipid emulsion therapy in a case of atomoxetine (Strattera®) toxicity. The Journal of Emergency Medicine, 59(2), e49-e51. Web.
Ophir, Y. (2022). ADHD is Not an Illness and Ritalin is Not a Cure: A Comprehensive Rebuttal of the (alleged) Scientific Consensus. Web.
Ota, T., Yamamuro, K., Okazaki, K., & Kishimoto, T. (2021). Evaluating guanfacine hydrochloride in the treatment of attention deficit hyperactivity disorder (ADHD) in adult patients: dDesign, development and place in therapy. Drug Design, Development and Therapy, 15, 1965. Web.
Tsakiridou, M., & Drigas, A. (2022). A review of stress on students with ADHD. The role of ICTs & mendal interventions to improve productivity. Technium Sustainability, 2(5), 39-57. Web.
Weyandt, L. L., White, T. L., Gudmundsdottir, B. G., Nitenson, A. Z., Rathkey, E. S., De Leon, K. A., & Bjorn, S. A. (2018). Neurocognitive, autonomic, and mood effects of Adderall: A pilot study of healthy college students. Pharmacy, 6(3), 58. Web.
