Case Study 5

CASE STUDY 5

At age 17, this single, white male was referred by his mother for evaluation of attention deficit hyperactivity disorder. During the mother’s interview, she reported a history of temper outbursts with breaking things, low frustration tolerance, impulsivity, moodiness, poor concentration, distractibility in class, being easily overwhelmed and symptoms that existed since childhood. The patient admits to forgetfulness, misplacing things, disorganization, taking longer to complete tasks, needing to reread because of drifting thoughts, fidgeting, procrastination and missing assignment deadlines. The patient describes his moods as very immediate, reactive and volatile. He denies feeling sad, depressed or exuberant. These moods are short-lived. He also denies panic, social anxiety, hypomania, ritualistic behavior, obsessive thoughts, or psychosis.

The patient was first diagnosed with ADHD at age 9 and treated with methylphenidate for two years with benefit. At age 12, because of declining grades, disruptive behavior in school, and oppositional and occasionally violent outbursts at home, he was admitted to an in-patient psychiatric unit. This was precipitated by suspension from school for three days because of a fight. Discharged back on methylphenidate, the family engaged in family therapy. In his mid-teens, he was off psychotropic medication for 1-2 years while he attended a military school for a year. Nine months ago, the patient was started on bupropion for ADHD and dysthymia. Risperidone was added one month later for anxiety and emotional reactivity. On this medication combination of bupropion SR 150 mg bid and risperidone 0.5 mg bid, he stated “I’m 50% better,” referring to cognitive and mood improvement and an ADHD Rating Scale score of 17.

His past medical history is unremarkable and he denies substance abuse or caffeine, alcohol and tobacco use.

His family history is positive for his mother being treated with venlafaxine and a stimulant for anxiety and ADHD. His maternal grandmother had a “nervous breakdown,” but the patient states no other information available.

His childhood history is unremarkable for pregnancy/delivery difficulties, or delayed developmental milestones.

Thought Provoking Questions

Would you diagnose this patient with adult ADHD alone or adult ADHD with comorbid depression and anxiety disorder?
Based on your diagnosis of this patient, how would you initiate treatment?


For a deeper analysis of these clinical cases and to gain further practical insights into the treatment of adult ADHD, submit your e-mail address and CME LLC will send you a summary of important discussion points from each clinical case. Additionally, we will notify you when video synopses of a live meeting are available online.

CASE STUDY 1 | CASE STUDY 2 | CASE STUDY 3 | CASE STUDY 4 | CASE STUDY 5