ADHD Review Template

Current Medication

• Lisdexamfetamine (Elvanse®) 50 mg PO OM (adherent; increased from 30 mg PO OM on 12/03/2026 due to suboptimal mid-afternoon symptom control).
• Melatonin 2 mg PO ON PRN for sleep onset insomnia.
• Omega-3 fish oil 1,000 mg PO OD (over-the-counter supplement).

Response to Medication

The patient reports a marked improvement in core ADHD symptoms since increasing the lisdexamfetamine dose to 50 mg. Task initiation and sustained attention at work have significantly improved, allowing him to complete complex data analysis reports ahead of deadlines. Socially, he feels more present during conversations and interrupts others less frequently. However, he notes that executive functioning remains somewhat impaired during the late evening when attempting household chores.

Current Symptoms

Residual inattentive symptoms are currently mild and primarily manifest after 19:00, presenting as difficulty organising evening routines and occasional misplacement of personal items. Hyperactivity is well controlled during working hours, reduced to mild subjective inner restlessness in the evenings. Impulsivity has decreased markedly, with a cessation of impulsive online spending and improved emotional regulation during workplace disagreements.

Side Effects

He experiences mild xerostomia beginning approximately two hours post-dose and lasting throughout the afternoon, which he manages effectively with frequent sips of water. Mild appetite suppression occurs during the middle of the day, though he compensates by eating a substantial breakfast prior to dosing and a larger evening meal. He denies any cardiovascular symptoms, tics, or increased anxiety.

Physical Monitoring

• Weight: 76.5 kg (stable; baseline 77.2 kg on 01/02/2026).
• Blood pressure: 122/78 mmHg.
• Heart rate: 76 bpm, regular.
• Sleep: Averaging 7 hours per night; sleep latency improved with PRN melatonin.
• Appetite: Reduced midday, normal in the morning and evening.
• Cardiovascular screen: No chest pain, palpitations, syncope, or exertional dyspnoea.

Duration of Action

The medication takes effect approximately 60 minutes after ingestion at 07:30, providing robust symptom coverage until roughly 18:30. After this point, he experiences a gradual return of distractibility and mental fatigue, though he denies any abrupt mood crash or rebound irritability. This 11-hour duration covers his core occupational demands adequately.

Investigations

• Adult ADHD Self-Report Scale (ASRS v1.1): Score 22/72 (reduced from baseline 54/72 prior to titration).
• Baseline ECG (28/01/2026): Normal sinus rhythm, QTc 412 ms, NAD.
• Blood tests (28/01/2026): FBC, U&Es, LFTs, and TFTs all within normal reference ranges.

Risk Assessment

The patient has a past psychiatric history of mild Adjustment Disorder in 2022, now fully resolved. He denies any current or historical suicidal ideation, intent, or self-harm behaviours. Alcohol consumption is limited to 2–4 units at weekends, and he denies illicit substance use; he has been advised to avoid excessive caffeine intake while taking stimulants. Risks associated with ADHD-related impulsivity, specifically previous reckless driving and financial overspending, have substantially mitigated on treatment. Protective factors include stable employment, a supportive partner, and strong engagement with clinical care. He was provided with crisis contact numbers and advised to seek prompt review if he develops any mood destabilisation.

Mental State Examination

The patient presented as casually dressed and well-groomed. His behaviour was cooperative and engaged, with no evidence of psychomotor agitation or fidgeting. Speech was of normal rate, rhythm, and volume. His mood was described as "good" and his affect was euthymic and reactive. Thought form was linear and goal-directed, with no formal thought disorder, delusions, or thoughts of harm to self or others. There were no perceptual abnormalities. Attention and concentration were sustained throughout the 30-minute consultation, and both insight and judgement regarding his condition and pharmacological management are intact.

Treatment Plan

The patient is now stabilised on lisdexamfetamine (Elvanse®) 50 mg PO OM, which provides an optimal balance of efficacy and tolerability, and this regimen will be maintained. A shared care agreement request will be sent to his GP today to transition ongoing prescribing and six-monthly physical health monitoring (BP, HR, and weight). He was advised to continue utilising structured digital planners to manage evening executive tasks after the medication wears off. A routine annual specialist ADHD review has been scheduled in 12 months, with instructions to contact the clinic sooner if efficacy wanes or adverse effects emerge.