If you have felt like you may have ADHD, it is crucial to get an accurate diagnosis. People are often told they have ADHD when they have another condition that can be mistaken for ADHD. Conditions such as hypomania, psychosis, depression, and anxiety can all look similar to ADHD. This is why it is essential to see a psychiatric clinician for diagnosis.
After lifestyle modifications and executive functioning coaching, the first-line treatment of ADHD is stimulant medication therapy. However, these medications pose a danger if given for the wrong diagnosis. They can exacerbate mania, cause psychosis, and even lead to addictive behavior.
A typical new psychiatric evaluation takes sixty minutes performed by a psychiatrist, psychiatric mental health nurse practitioner, or prescribing psychologist.
It includes the duration of symptoms, signs throughout childhood, how they present in adulthood, ruling out possible medical comorbidities, and, very importantly, a thorough assessment of family psychiatric history. In addition, we look at good and poor responses to previous medications for cues into your diagnosis.
Some believe treating ADHD is easy, that it could be done by any prescriber, especially after some continuing education courses or a week of training. Though online screeners may aid in the diagnostic process or monitor symptoms, the psychiatric evaluation needs a competent provider to ask the right follow-up questions to those screeners. For example, we look at family history of mental and substance abuse issues, history of having harmful effects on medications, possible history of psychosis, and many other questions. These things might help predict response to medications or have us watch closer to monitor potential side effects and educate the patient about the side effects.
Let’s give a common scenario. A person has a strong family history of bipolar, but they present as ADHD inattentive type. This patient has no mood swings, no depressive episodes, and a positive yet incomplete response to a non-stimulant medication for ADHD. Though they show no symptoms, they might be at higher risk for stimulant-induced hypomania or mania. In this case, the psychiatric nurse practitioner would discuss what hypomania looks like. We’d look for symptoms of spending to improve after therapy, not worsen, for focus to improve, not worsen, signs of hypersexuality, subtle signs of psychotic symptoms, thoughts, sleep, and energy patterns.
If bad symptoms develop, the patient has a safety plan with their initial trusted psychiatric provider, and they are already set in that comprehensive initial visit. They have the lifeline to the provider. And most importantly, the initial provider knows how to treat side effects, hypomania, or psychosis. If harmful effects occur, that is not the time to pass the patient onto a psychiatric provider skilled in diagnosing and treating mental health conditions.
Seeing a board-certified psychiatric clinician or physician should be done at the very first visit to prevent the wrong diagnosis inappropriate treatment and be there if there are side effects.
The treatment of ADHD is fulfilling but potentially dangerous if not done right. It requires years in the field, specialized diagnostic ability, and the ability to land the plane if it goes off trajectory.
For this reason, we only have board-certified psychiatric specialists on staff through At Your Service Psychiatry.