ADHD in a 19-year-old male :: PLAB 2 Case Scenario

Summary:

This case involves a 19-year-old male presenting with symptoms suggestive of Attention Deficit Hyperactivity Disorder (ADHD). The scenario emphasizes data gathering, differential diagnosis, ruling out psychiatric conditions, and a structured management plan focused on patient education and support.

Key Points:

Main Topic: ADHD

Symptoms: Inattention, loss of concentration, fidgeting, hyperactivity.
Data Gathering: Focus on inattention (careless mistakes, forgetfulness) and hyperactivity (restlessness, fidgeting).

Differential Diagnosis:

Depression: Must rule out mood changes and anhedonia (loss of interest in usual activities).
Schizophrenia: Assess for hallucinations or delusions.
Suicidal Thoughts: Essential to check for self-harm ideation in psychiatric assessments.

Important Considerations:

Age-appropriate diagnosis: Focus on psychiatric conditions relevant to a 19-year-old male.
Differentiation: ADHD vs. other psychiatric conditions like depression or schizophrenia.
Symptom Clarity: While hyperactivity is key, avoid extensive questioning that veers into pediatric issues like birth history.

Diagnostic Approach:

Presenting Complaint: Start by clarifying the symptoms, focusing on inattention and hyperactivity.
Structured Data Gathering: Apply mnemonics (Socrates for pain, Odipara for others).
Differential Diagnosis: Ensure to cover depression, schizophrenia, and suicide risk.
Specific ADHD Symptoms: Confirm by asking about forgetfulness, fidgeting, difficulty focusing.

Management:

Diagnosis: Always refer to a specialist for ADHD diagnosis; never give a definitive diagnosis as a GP.
Patient Support: Explain ADHD as suspected, focusing on loss of concentration and hyperactivity.
Educational Support: Address the patient's concerns about how ADHD might affect his studies. Discuss potential educational adjustments.
Safety Netting: Recommend a follow-up with mental health services and explain the role of the specialist in confirming the diagnosis and treatment.

Communication Skills:

Clarity: Use language the patient understands; explain ADHD simply.
Empathy: Acknowledge the patient’s concern about their studies and provide reassurance about available support.
Signposting: When discussing self-harm or other sensitive issues, introduce the topic gently (e.g., explaining why you're asking).

Ethical Considerations:

Non-diagnosis: As a GP, it is critical to state "suspected ADHD" rather than giving a formal diagnosis.
Confidentiality: Follow the appropriate standards for discussing sensitive psychiatric issues without unnecessary alarm.

Additional Resources:

Good Medical Practice Guidelines: Emphasize clear patient communication, partnership in care, and structured diagnosis.
PLAB 2 Examiner Tips: Manage time effectively, focus on the immediate task, and don’t over-promise.