MHM Magazine

12 | MENTAL HEALTH MATTERS | 2022 | Issue 4 MHM OPTIMAL TRANSITION Less that 5% of individuals with ADHD experienced optimal transition from child to adult mental health services. Most children don’t want to be medicated during this transition. Psychoeducation is crucial – for both parents and patients. Teens who understand and accept their diagnosis and treatment are far more likely to adhere to pharmacotherapy. ADHD treatment should be reassessed at school-leaving age (by age 18) to determine the need for treatment continuation in adulthood. “Psychosocial interventions play a particularly important role during key life transitions, including the transition from adolescence to adulthood.” COMORBIDITIES & ADHD Across the lifespan, psychiatric comorbidities are common in individuals with ADHD. These comorbidities, both diagnosed and undiagnosed, can complicate treatment. ADHD can cause disruption at school, work, and in relationships. Adults with ADHD may also experience a range of financial difficulties and have compulsive spending habits. RISK TAKING & IMPULSIVITY ADHD may also be associated with increased risk-taking behaviour. One study of 5–10-year-old children (ADHD group, n=103; non-ADHD group, n=100) showed a significant correlation (p<0.001) between symptoms of ADHD and greater risk-taking and reduced sensitivity to punishment. A Norwegian study found that while children with ADHD are not particularly risk-prone, children with ADHD (n=36) showed significantly poorer risk-adjustment (p<0.01) and significantly more delay-aversion (p<0.01) during the Cambridge Gambling Task. (https://adhd- institute.com) THE STIMULANT MYTH It’s important for clinicians to remember that pharmacotherapy for ADHD varies from person to person. Pharmacological treatments for ADHD such as methylphenidate, amphetamine, atomoxetine and guanfacine appear to have distinct effects on dopamine and noradrenaline signalling pathways in the brain. Stimulants such as methylphenidate and amphetamine target the DAT and NET and inhibit DA or NA reuptake. PRODRUGS & ADDICTION Prodrugs are pharmacologically inactive molecules that are activated only after being absorbed by the intestinal tract. Lisdex is one such drug that is converted to dextroamphetamine (active) and l-lysine (inactive) over a period of hours. The ‘slow release’ of lisdex eliminates the pleasure-seeking point of misuse. Even if injected intravenously the molecules don’t release any differently – “a drug that doesn’t peak within half-an-hour isn’t going to be abused.” This is an important part too of patient/ parent/caregiver psychoeducation. The myths and stigmas of stimulant use in ADHD are misconceptions. Once thought of as a childhood disorder, ADHD is now acknowledged to persist into adulthood. Factors like the severity of symptoms, psychosocial adversity, and psychiatric comorbidity all contribute to persistence and impact. The aetiology of ADHD is complex and its treatment must be multi-modal and individual. Therapies ideally involve psychoeducation as well as behavioural, psychological, social, educational and lifestyle interventions that are modified as the patient’s level of understanding and symptoms change. Lisdexamfetamine dimesylate is a ProDrug: lysine only becomes active after lysine is cleaved by enzymes in the bloodstream. Lisdexamfetamine dimesylate is a ProDrug: lysine only becomes active after lysine is cleaved by enzymes in the bloodstream.