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randomdoc1

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Ok, I know we've talked a lot about this topic, especially regarding adults. There is still tons of people trying to establish care with me in the community because they want to continue their stimulants. Some certainly do not have ADHD, some are iffy, and some likely...they come in all shapes, colors, and sizes. Even if someone did have ADHD, what if they are in their 60's or 70's and still want stimulants? I question is, they are generally retired and not in school. Also, the stimulants come with their own risks, cardiovascular included. I am not quite sure what purpose these stimulants are supposed to serve in this age group, unless they are so severely disorganized that they cannot function in their everyday life without the meds. But in my experience, especially if someone has no children, is not in school, not working...life isn't that hard to hold together. Do you personally continue their stimulants in your own practice? I am more keen to weighing the risks and benefits with the patient and offering the opinion that the stimulants would likely offer limited benefit by this stage in their life, especially when weighed with the potential risks.

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I am more keen to weighing the risks and benefits with the patient and offering the opinion that the stimulants would likely offer limited benefit by this stage in their life, especially when weighed with the potential risks.

Do this and then see how capable they suddenly become. Stimulants have street value. The drug world has few roles; suppliers, distributors, and users. There may be some adults with solid documentation and clear benefit, but the prevalence is up a couple of orders of magnitude in the last few years. What ever you decide, word will get out about your management of this issue.
 
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I see no reason why someone in their 60's or above should need a stimulant for ADHD. They're likely not in school and about to retire, or already retired. For cancer? Sure. But not for ADHD.
 
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For most it may not be medically necessary, but come on. Legit benefit from stimulants for ADHD isn't isolated to school or work function. People have interactions with spouses, children, grandchildren, etc. They pay bills. They drive. They read books. Etc. There is still plenty of potential benefit, even life-changing benefit, for someone who is retired.

But this doesn't discount a risk/benefit discussion, which, in that situation, certainly shifts and perhaps often to the risk side.
 
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Retired and cannot maintain task puttering around in the workshop isn't a valuable reason for being placed on amphetamines.
 
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Funny--I just saw a 70 y o woman for intake with horrible ADHD, working full time and taking stimulants and need them. First rule in medicine: there are exceptions to every rule.
 
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True true, but the exceptions are becoming modal.
 
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Ok, I know we've talked a lot about this topic, especially regarding adults. There is still tons of people trying to establish care with me in the community because they want to continue their stimulants. Some certainly do not have ADHD, some are iffy, and some likely...they come in all shapes, colors, and sizes. Even if someone did have ADHD, what if they are in their 60's or 70's and still want stimulants? I question is, they are generally retired and not in school. Also, the stimulants come with their own risks, cardiovascular included. I am not quite sure what purpose these stimulants are supposed to serve in this age group, unless they are so severely disorganized that they cannot function in their everyday life without the meds. But in my experience, especially if someone has no children, is not in school, not working...life isn't that hard to hold together. Do you personally continue their stimulants in your own practice? I am more keen to weighing the risks and benefits with the patient and offering the opinion that the stimulants would likely offer limited benefit by this stage in their life, especially when weighed with the potential risks.

If I was a Psych, and someone of that age came in legitimately looking for stimulants the first thing I'd think to ask would be whether the person themselves really wanted the medication, or whether it was a spouse or other family member that was influencing their choice. If there were outside influences, then I'd probably be thinking along the lines of non pharmacological approaches, perhaps with an emphasis on psychoeducation for family members.
 
update: I echo what MacDonaldTriad said. Turned out the geriatric aged patient I had in question...was kicked out of multiple clinics. I got a hold of the DOB, looked up the drug monitoring program and found high cumulative doses of stimulants being dispensed by multiple prescribers. Looks like the individual may have gotten kicked out of the resident low cost clinic...which is a huge red flag...that answered that question for this specific case at least and helped some of my decision making for sure. Person was scheduled as a new patient, but I will not be accepting this individual now.
 
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New update! Another geriatric patient referred to be evaluated for "ADHD" for the first time ever. Turns out, without giving too much information, patient drinks tons of etoh and I recommended inpatient detox. What's with the ADHD over diagnosing?!
 
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New update! Another geriatric patient referred to be evaluated for "ADHD" for the first time ever. Turns out, without giving too much information, patient drinks tons of etoh and I recommended inpatient detox. What's with the ADHD over diagnosing?!

Bingo. It's fashionable like calling mood swings - bipolar.
 
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New update! Another geriatric patient referred to be evaluated for "ADHD" for the first time ever. Turns out, without giving too much information, patient drinks tons of etoh and I recommended inpatient detox. What's with the ADHD over diagnosing?!

Come work in Australia, it's nigh on impossible to get a diagnosis of adult ADHD down this way. I had to jump through all sorts of hoops to get diagnosed back in the 90s (or re-diagnosed as the case was, because I'd already been diagnosed in early childhood) and they've since tightened the criteria up to be even more stringent. I know some people might say, "Oh, but that's not fair to people who would really benefit from a proper diagnosis if they make things too strict', but to that I say, "Okay, fine, if they're legit then they go through the correct process like everyone else'. If somebody has already been genuinely struggling throughout their adult life, then I don't see what difference an extra couple of weeks, and a battery of tests being performed to ensure the diagnosis is the correct one, is really going to make in the long run. The only people I know who've kicked up a fuss about the diagnostic guidelines here are the ones who don't legitimately have ADHD in the first place and are just looking to scam some stimulants. Seriously, from all that I've read and heard about how ADHD is diagnosed in the US, I think something has to change sooner rather than later.
 
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I thought of this forum the other day when I was looking up the contact info for a patient's psychiatrist. I found a statement, on the psychiatrist's home page, stating that the practice "specializes in the treatment of adults with ADHD," "primary prescribing... Adderall." I have never before seen a single brand-name drug mentioned on a psychiatrist's home page.
 
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I thought of this forum the other day when I was looking up the contact info for a patient's psychiatrist. I found a statement, on the psychiatrist's home page, stating that the practice "specializes in the treatment of adults with ADHD," "primary prescribing... Adderall." I have never before seen a single brand-name drug mentioned on a psychiatrist's home page.

You've got to meet Dr. Amen!
 
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I thought of this forum the other day when I was looking up the contact info for a patient's psychiatrist. I found a statement, on the psychiatrist's home page, stating that the practice "specializes in the treatment of adults with ADHD," "primary prescribing... Adderall." I have never before seen a single brand-name drug mentioned on a psychiatrist's home page.

Let me guess. Cash practice?
 
You've got to meet Dr. Amen!

A $20k SPECT scan and providing a consultation without ever having to see the patient again -- Adderall guy is an amateur indeed.
 
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But didn't you know that the latest in ADHD research shows that through SPECT scan, doctors can identify the specific subtype of ADHD allowing them to prescribe the best medication for that specific subtype. /s
 
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Let me guess. Cash practice?

No, quite the opposite - located outside the city in a working class community with few psychiatrists around. Not sure what kind of game he's running but it definitely involves being a Pez dispenser for Adderall and benzos.
 
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No, quite the opposite - located outside the city in a working class community with few psychiatrists around. Not sure what kind of game he's running but it definitely involves being a Pez dispenser for Adderall and benzos.

Sadly in my current neck of the woods the couple places where it is trivially easy to get scheduled substances are smallish community mental health agencies.
 
Sadly in my current neck of the woods the couple places where it is trivially easy to get scheduled substances are smallish community mental health agencies.

What a disservice to the patients and for those who aren't selling their spoils, when they decompensate into substance induced mood do, it won't be pretty. Around here in the past few years there has been a marked reduction in the benzo/stimulant gumball dispenser type prescribing. I attribute this to one being sanctioned and a few of the other ancient psychiatrists who had disintegrated into simply writing whatever the patients demanded finally retiring.
 
A $20k SPECT scan and providing a consultation without ever having to see the patient again -- Adderall guy is an amateur indeed.

I actually had a family come to our university clinic while I was still a resident there, showing me a "report" from Dr. Amen and how their adolescent kid had blah blah blah because the scan showed blah blah blah. I asked them how much they paid, and they said something like $3000. I wish I could show you the look on the parents faces when I told them that they essentially wasted their money...
 
I actually had a family come to our university clinic while I was still a resident there, showing me a "report" from Dr. Amen and how their adolescent kid had blah blah blah because the scan showed blah blah blah. I asked them how much they paid, and they said something like $3000. I wish I could show you the look on the parents faces when I told them that they essentially wasted their money...
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