Mr. H. G., aged fifty-eight, presents to the healthcare setting with the chief complaint of having trouble concentrating on tasks and becoming increasingly forgetful. The patient remembers having memory and concentration issues throughout his life; however, lately, the symptoms have exacerbated. The patient’s difficulty getting organized causes him to be quite messy, forgetting to put on shoes or socks, leaving his phone at home, as well as being morally absent from his work routines.
The patient does not have a history of hospitalizations, self-harm, psychotropic medication use, or being diagnosed with psychiatric conditions. Mr. H. G. admits to having a glass of scotch and a cigar on the weekends; he also consumes drinks containing caffeine but denies having any symptoms of withdrawal. In terms of family history, there are no substance use disorders, mental health disorders, or suicide. Mr. H. G. lives in Atlanta on his own, dating men from time to time. With a Bachelor’s in engineering, the patient reports working for a large architectural company. Current medications include Losartan 100 mg once a day, ASA 81 mg once a day, Metoprolol 25 mg two times a day, Fenofibrate 160 mg once a day, and Tamsulosin. The patient has an anaphylactic reaction to morphine and denies having any other allergies.
Objective and Assessment
The patient’s blood pressure is 134/88 mmHg, his pulse is 86, and his body temperature is 98.8; he is 5’11 and weighs 180 lbs. There is no need to perform a systemic physical examination. Diagnostic results point to ADHD drawing from clinical evaluation. The patient presents in a well-kempt condition and with good nutritional status. He is not confused, maintains adequate eye contact, and has a normal gait and posture. His voice volume is higher than average, and despite having clear speech, Mr. H. G. has issues staying on one topic as he gets easily distracted and loses concentration when answering specific questions. He has a slightly elevated effect and reports sleeping between four to six hours a day. The patient denies having delusions and hallucinations, scoring 27 out of 30 with attention difficulty and delayed recall based on the MOCA score, with a 20/24 scale for the ASRS-5 screening.
The three differential diagnoses applied to Mr. H. G.’s case include attention deficit hyperactivity disorder (ADHD), anxiety disorder, and dysthymic disorder. ADHD is usually diagnosed in the early years and is among the most common neurodevelopmental conditions that can last into adulthood and even elderly years. Individuals with the disorder tend to struggle to concentrate, control impulsive behaviors, and can be excessively active (CDC, 2021). Even though ADHD has no cure, it can be successfully managed through medication and behavioral therapy to improve the adverse symptoms. The diagnosis applies to Mr. H. G. due to his history of hyperactivity, being easily distracted, forgetful, unorganized, and lacking concentration. Besides, the patient avoids tasks that require prolonged mental activity. Mr. H. G. mostly likely has inattentive ADHD based on his history mentioned above.
Anxiety disorder is a mental health condition that extends beyond nervousness, with the feeling of anxiety interfering with people’s ability to function. It often occurs when external or internal factors trigger negative emotions, causing a person to overreact and experience anxiety (Knight & Depue, 2019). Most importantly, individuals dealing with anxiety disorder cannot control their responses to stressful situations. The diagnosis applies to the case of Mr. H. G. because he has complained of worrying about minor issues, difficulty maintaining attention, as well as having trouble mentally concentrating.
Dysthymic disorder is characterized by persistent depressive disorder, which is a continuous and chronic form of depression. Individuals with the disorder tend to lose interest in everyday activities, and experience feelings of hopelessness and a lack of productivity, as well as feelings of inadequacy and low self-esteem. Because of the chronic nature of the disorder, coping with depressive symptoms is a great challenge; the combination of psychotherapy and drug therapy can be effective in treating the disorder.
Among the differential diagnoses, Mr. H. G. meets the criteria for ADHD, which presents significant challenges to adults across different areas of life, including physical and mental health as well as personal relationships. It is recommended that the patient avoids using caffeinated drinks and vigorous physical activity. Instead, he should practice mindfulness, get a lot of sleep, develop a healthy and nutritious diet, as well as get organized. The support of Mr. H. G.’s family members is imperative to facilitate the effective treatment of the patient, both in terms of physical and mental health. When it comes to behavioral interventions such as CBT, it is imperative to obtain informed consent from the patient as well as ensure confidentiality during therapy sessions.
To summarize, ADHD is a mental health condition that can affect individuals in their adult years, causing severe distress and preventing them from completing everyday tasks. Because of the persistence of the patient’s condition, Mr. H. G. will likely get treated by combining medication with behavioral treatment and a self-help strategy. The case of the patient has allowed promoting awareness of the impact of ADHD on adults and revealed ways in which it can get treated effectively and efficiently. It is important to be accepting of the condition and develop holistic and health-conscious ways to treat it.
CDC. (2021). Attention-deficit/hyperactivity disorder (ADHD).
Knight, L. K., & Depue, B. E. (2019). New frontiers in anxiety research: The translational potential of the bed nucleus of the stria terminalis. Frontiers in Psychiatry.