ATTENTION DEFECIT HYPERACTIVITY DISORDER 2 Patient Chief Complaint Marty is a 23 year old male with a known history of ADHD. He cannot hold a steady job and has over a period of three years, switched jobs approximately four times on average per year. He loses focus quickly and is known among colleagues to be hyperactive rarely getting through with one task before he abruptly takes up another; he has his parents worried because he recently chocked his supervisor. This has him fired and facing assault charges. His family wants him to get back on his medicines which he refuses. His family has also noted that he is spending more time alone, he rarely eats, sleeps for the larger part of the day and has all but lost interest in playing his guitar which he loves .His brother also noted that he talks a lot about death and the family is concerned he might be slipping into depression. History Of Present Illness Marty was diagnosed with ADHD at age four. From infancy he was hyperactive and his parents attributed this to his gender assuming it to be a normal thing with boys, but in time the hyperactivity and dangerous play, had gotten out of hand, his parents resorted to physically restraining him until he settled down; he was impulsive, and would hardly maintain eye contact when communicating with family and friends. Social History In school he was regularly suspended for indiscipline and truancy. Within the community he was shunned by his peers and eventually branded a social outcast due to his continued
ATTENTION DEFECIT HYPERACTIVITY DISORDER 3 infractions with authority figures and local law enforcement. His parents were sidelined by the community who viewed Martyrs behavior as the hallmark of bad parenting; gradually he got into drug and substance abuse, starting with prescription drugs later moving on to marijuana. Family And Marty’s Past Medical History Genetics play a very huge role in ADHD, Marty’s family has a history of schizophrenia, his older brother, a former veteran committed suicide recently after decades of battling ADHD, depression and post traumatic stress disorder(Faraone, Et.Al.2019).This could also have trigger red the developing depression in Marty and the recent exhibition of violent behavior. Marty has only ADHD Medication He is currently on no medication. And has been as such for a while now Treatment Plan To counter the ADHD and suspected depression using integrative or holistic therapy approach, incorporating behavioral and psychological therapy with psychotropic medication. The medication: to counter his erratic behavior, hyperactive tendencies and increase concentration level. Through behavioral and psychological therapy the issue of depression will be addressed. How The Affordable Healthcare Acts Affect Behavioral Health Care, And My Patient. By allowing a child to benefit from their parents healthcare plan until they are 26 years old the ACA ensured that young people without jobs or insurance plans get access to mental
ATTENTION DEFECIT HYPERACTIVITY DISORDER 4 health care .The ACA ensured that people get access to mental health care by making, sure that of the cover included mental health and mental health prescription drugs. This helps the patient in my scenario who is currently unemployed and below 26 this means he is insured under his mother Community Resources Marty has a history of substance abuse, so I would first find out whether he has gone back to using recreational drugs or any other substance, then I would refer him to a rehabilitation centre, for drug abuse I would refer him to Community rehab center in free hold new jersey. Here he would also get urgent assessment and intervention. In my area there are church based organizations for someone who would not be able to afford behavioral therapy, I would also recommend him to go to support group therapy. Legal And Ethical Considerations On legal issues, in case Marty is completely unable to be fully re-integrated into the community and become a productive member of society, the doctor has to fully evaluate him before declaring him mentally disabled so he is entitled to Disability assistance from the government wrong diagnosis would have legal ramifications The ethical issue: A doctor is bound to be confidential about a patient’s condition, if he were to give it out to a third party without the patients consent law suits are bound to arise, in this case the doctor has a moral obligation to keep the information private but since the third party is the parent who will also be part of the therapy process he is obliged to share keep the parents in the loop.
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ATTENTION DEFECIT HYPERACTIVITY DISORDER 5 Marty needs routine follow up and monitoring to gauge the effectiveness of the therapy and medication on a weekly basis, this helps in controlling dosage by raising or reducing and changing the approach of the therapy, could be he isn’t as responsive to family group therapy and is better with individual therapy. As a primary care giver I should restore hope and instill resilience in my patient he needs to know that he can overcome whatever he is going through and have a normal life again should be empathetic and view him as more than just a patient but as a human being who has fears, hopes and ambitions. I should use my emotional intelligence when working with my patient.
ATTENTION DEFECIT HYPERACTIVITY DISORDER 6
ATTENTION DEFECIT HYPERACTIVITY DISORDER 7 Reference Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder.Molecular psychiatry,24(4), 562-575.