Hello,
I have a complex pt. early-30s male with Bipolar 2 (diagnosed by me about 2 years ago), med compliance issues for bipolar meds (Lamictal 200mg, Abilify 2-5mg with trial of Latuda in past). I don't trust Qb test results since his Vanderbilt doesn't support childhood ADHD sx, has severe sleep apnea and reports consistent CPAP use but question his compliance, history of a fall from height in his late teens and childhood trauma environment (DV between parents, heavy ETOH/ SUD use in parents, undiagnosed bipolar in parent). I had referred him for Neuropsych testing last visit because he had stated he didn't remember having this level of focus, attention issues before his fall. I question if he has TBI.
Nowsent me Qb test results and a PA from an ADHD clinic suggesting Vyvanse for him. I don't typically Rx Amphetamine class Stims to bipolar pts due to concerns for higher chance of side effects and misuse.
I think his executive dysfunction is a related to sub therapeutic bipolar medication compliance, a new family stressor, sleep apnea, overwhelm due to hyper reactivity and TBI. I ve gotten some Neuropsych results back for other pts that diagnosed pt with TBI, bipolar and ADHD but they recommended brain training exercises and not stimulants that pt was seeking, which surprised me. So I don't automatically Rx Stims even if bipolar well controlled with TBI and ADHD dx now. Any thoughts? I tend to dig my heels in if Vanderbilt doesn't support ADHD childhood sx and bipolar history. I'm trying to be open minded though