ADHD Diagnostic Outcome And Medication Plan Letter

Diagnosis

Following our comprehensive assessment today, I can confirm that Chloe Evans meets the diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD), combined presentation.

On the Diagnostic Interview for ADHD in Adults (DIVA-5), she endorsed 8 out of 9 symptoms of inattention and 6 out of 9 symptoms of hyperactivity-impulsivity in adulthood, alongside clear evidence of chronic impairment dating back to her primary school years.

Current Presentation

Chloe expressed a sense of relief upon receiving the diagnosis, noting that it helps make sense of her lifelong struggles with organisation and overwhelm, though she also felt some sadness regarding the late recognition of her difficulties.

She is currently experiencing significant pressure in her postgraduate studies, struggling particularly with initiating essays, sustaining focus during lectures, and managing her time effectively.

Her primary treatment aims are to improve her academic focus, establish sustainable daily routines, and reduce her day-to-day emotional reactivity, although she initially held some understandable worries about whether stimulant medication might increase her baseline anxiety.

Relevant Psychiatric And Medical Background

Chloe has a history of generalised anxiety and mild depressive episodes, which appear to be largely secondary to chronic academic burnout and executive dysfunction.

There is no personal history of bipolar disorder, psychosis, tics, obsessive-compulsive disorder, eating disorders, or seizures.

She has no personal history of cardiovascular disease, and there is no family history of sudden cardiac death or significant arrhythmias under the age of 40.

She does not use recreational substances, consumes minimal alcohol, and confirmed she is not currently pregnant or planning a pregnancy in the near future.

Current Medication

She currently takes sertraline (Lustral®) 50 mg PO OD, which has provided moderate relief for her generalised anxiety, and we agreed to keep this at a stable dose during the initial ADHD medication titration while monitoring for any potential interactions.

She also takes the combined oral contraceptive pill, Microgynon 30® 1 tablet PO OD, with no reported side effects or complications.

Treatment Discussion

We considered medication-based and non-medication approaches to managing ADHD.

Approaches including coaching, physical activity, regular sleep, changes to the environment, and external organisational aids continue to form an important part of care.

Medication may nevertheless assist with regulating attention, getting started on tasks, managing emotions, and putting supportive measures into practice.

We discussed first-line stimulant options, specifically lisdexamfetamine (Elvanse®) and modified-release methylphenidate (Concerta XL®), alongside the non-stimulant alternative atomoxetine (Strattera®).

Lisdexamfetamine was selected as our preferred initial option due to its smooth pharmacokinetic profile, extended duration of action suitable for her long university days, and once-daily convenience.

We discussed how stimulant medication may help with focus, task initiation, staying on track and reducing emotional reactivity, while recognising that medication has limitations and works best alongside supportive behavioural strategies and routines.

After weighing the options, Chloe chose to begin a trial of lisdexamfetamine (Elvanse®).

Medication Plan

She will commence lisdexamfetamine (Elvanse®) 30 mg PO OD each morning for the first 14 days.

If this initial dose is well tolerated, she will increase to lisdexamfetamine (Elvanse®) 50 mg PO OD each morning for the subsequent 14 days.

A private electronic prescription has been transmitted directly to our partnered online pharmacy for home delivery via secure courier.

I have provided a formal diagnostic confirmation letter to support her application for reasonable adjustments and Disabled Students' Allowance (DSA) at her university.

We discussed DVLA guidance, noting that she must ensure her medication does not impair her driving and only needs to notify the DVLA if her condition or treatment negatively affects her ability to drive safely.

She was advised that stimulant medication is generally not recommended during pregnancy, and she should inform us promptly if she plans to conceive so we can review her treatment.

Physical Monitoring

Her baseline blood pressure today is 116/74 mmHg.

Her baseline resting pulse rate is 72 bpm.

Her baseline weight is 64.5 kg, corresponding to a healthy BMI of 22.8 kg/m².

Safety And Monitoring Advice

We reviewed possible common effects such as reduced appetite, weight loss, headaches, palpitations, raised blood pressure, and disrupted sleep.

We also covered possible mood alteration, emotional dulling, increased anxiety, and the uncommon possibility of stimulant-related mania or psychosis.

Advised to take the medicine early in the day, preferably with breakfast.

Advised to keep a close watch on sleep, appetite, mood, and cardiovascular symptoms.

Advised to stop the medicine and contact me if sleep falls below 5.5 hours on two successive nights without feeling tired.

Advised to avoid recreational drugs and not to combine stimulant treatment with alcohol.

Encouraged to choose a trusted person who can help spot marked mood or behavioural changes while the dose is being adjusted.

Due to concurrent use of sertraline, we discussed the symptoms and risks of serotonin syndrome.

Mental State

Chloe presented as a neatly dressed young woman who engaged warmly and cooperatively throughout the consultation, though she exhibited mild fidgeting and restlessness in her seat.

Her speech was spontaneous and normal in tone and volume, though occasionally rapid when describing her academic pressures.

She described her mood as hopeful, and her affect was reactive and congruent with the conversation.

Her thought form was logical and goal-directed, with occasional tangentiality that was easily redirected, and there were no delusions or obsessional thoughts.

She reported no perceptual abnormalities, maintained intact cognition and orientation, and demonstrated good insight into her lifelong difficulties and the role of treatment.

Risk Assessment

Chloe denies any current suicidal ideation, intent, or history of deliberate self-harm, and she presents no risk of harm to others.

Dynamic risk factors include potential academic stress and the low risk of treatment-emergent anxiety or mood instability during stimulant titration.

She benefits from strong protective factors, including a supportive partner, stable accommodation, and high motivation to engage with both pharmacological and behavioural support.

Plan

Chloe will commence a four-week titration of lisdexamfetamine (Elvanse®) starting at 30 mg PO OD for two weeks and increasing to 50 mg PO OD for a further two weeks.

I will send her written information leaflets on lisdexamfetamine and digital resources regarding behavioural strategies for adult ADHD.

She will record her blood pressure, pulse rate, and weight weekly using a home monitor and submit these readings via our patient portal prior to her next review.

Once her dose is stabilised and shown to be safe and effective, I will write to you to formally request a shared-care prescribing arrangement in line with local guidelines.

She also plans to apply for specialist ADHD study skills coaching through her university's disability support service.

Recommendations For Primary Care

Please update her primary care record to reflect the diagnosis of ADHD, combined presentation.

No action is required regarding prescribing at this stage, as the clinic will issue private prescriptions until titration is complete, at which point I will write to invite you to enter a shared-care agreement.

Given her normal baseline cardiovascular findings and unremarkable medical history, a baseline ECG is not clinically indicated prior to starting treatment.

Please be aware of the theoretical risk of serotonin syndrome due to the co-prescription of lisdexamfetamine and sertraline, which we have counselled her to monitor closely.

Follow-Up

I have arranged a 30-minute video titration review with Chloe in four weeks' time to assess her response and tolerability.

She has been advised to contact the clinic via email or telephone for an earlier review if she experiences any troublesome side effects or clinical concerns before her scheduled appointment.

Repeat Prescription Requests

If a further private prescription is needed between planned appointments, the link below can be used:

https://portal.ukpsychiatryclinic.co.uk/repeat-prescriptions

Crisis Support

As an independent outpatient clinic, we do not operate an out-of-hours or emergency crisis service.

In the event of an urgent mental health concern, Chloe has been advised to contact her GP, call NHS 111 (selecting the mental health option), or reach out to the Samaritans on 116 123.

In an immediate medical or psychiatric emergency, she should attend her nearest hospital Emergency Department or dial 999.