7 Steps for Optimization in Adult ADHD Treatment From Dr Rakesh Jain

Psych Congress Steering Committee Member, Rakesh Jain, MD, MPH, gives 7 questions to add into practice to improve the treatment of adult attention deficit/hyperactivity disorder. The questions help to gauge what is working, what is not working, and where there is room for improvement.

Dr Jain will be on-site at Psych Congress in New Orleans, Louisiana from September 16-20. In addition, a range of distinguished faculty will be sharing more psychiatry updates to improve patient outcomes through education. For more information or to register, visit the website by clicking here.

Read the transcript:

It is very important not to assume anything. Let's ask important questions about exactly what is better and what is not better. Where is the room for improvement?

I've got 7 suggestions.

Number 1, a basic question, are you taking your medication? Pseudo resistance to medications is very common in psychiatry. And you can imagine with someone who has ADHD, adherence can be a problem. So please check that first.

Number 2, any side effects? How are you responding to it? How are the side effects doing? I know you had trouble with X, Y, and Z for the first two days, is it still a problem or is it gone?

Number 3, really important, are we covering, are we treating what was bothering you, but are we treating it for enough hours in the day? It's not enough to control hypertension. As an example, between 10:00 in the morning and 3:00 in the afternoon. It's just not. So why would it be okay just to cover ADHD from 9:00 in the morning to 4:00; why would that be okay? It's not okay. So this question number 3 is really important, are you, dear patient, getting coverage of symptoms for adequate number of hours in your day.

Number 4, side effects. I really go after side effects, I really do. And you might say, but you're looking for trouble. Well, I might as well look for it so that it doesn't become a cause of poor adherence. And most often I can solve it. It's when I don't know the side effects is when I can't solve it.

Number 5, if they already had a comorbidity, how is that doing? Another new comorbidity develop? I need to know that. I want to know that. If you've been using a lot of cannabis, how is that use? If you've been using quite a bit of alcohol, how are you doing with that? I know you've been very anxious about not being able to complete your school assignments, assuming it's a college student, how is your anxiety now that your attention problems are better? See, we can look, we should explore that. It's not enough just to talk about ADHD.

Number 6, I come back to my theme, how's functionality? I know I've helped you with the symptoms. I know, dear college student, you're getting your exam papers back in time and you're getting good grades, but how's your social life? How's your functioning? How is your quality of life? What do we need to do? Or shall we talk about to help you with that? Often these 2 are lagging and they're often lagging because the symptom control is inadequate.

Number 7, a very honest question, a very humble question, don't you think that the sign of a really competent, confident clinician is humbleness? Don't you think so? Don't you think sometimes saying you are the expert, dear patient, you not me, is a sign of both respect and clinical humility? I think it is.

So, as you can see I'm ending the 7 question list with treating you, dear patient, as the real expert in your disorder. What is it that still is a source of concern that we haven't addressed? What can we do to make things even better for you?

I don't know if you like my Magnificent 7 list. It's tongue in cheek. Obviously, there's nothing magnificent about it. This is just a logical, good approach to helping our patients with adult ADHD.