Navigating Adult ADHD and the Stimulant Shortage with Jake Behrens, MD

In this episode of Psychiatry Tomorrow, Dr. Jake Behrens shares his insights on navigating the complexities of diagnosing and treating adult ADHD. He discusses his comprehensive framework for ADHD assessments, the importance of psychoeducation, and strategies for medication management amidst the stimulant shortage. Dr. Behrens also explores the potential of digital health tools, the power of measurement-based care, and busts common myths about the condition. Throughout the conversation, he emphasizes the underrecognized dangers of ADHD underdiagnosis and undertreatment, and the importance of addressing it as a core issue that can open up profound possibilities for patients' lives.


Timestamps and Show Notes:

[00:01:00] Introduction: Adult ADHD is the second most prevalent adult psychiatric disorder, yet the U.S. lacks formal diagnostic guidelines, making it challenging for clinicians to properly diagnose and treat.

[00:03:00] How Dr. Behrens got into specializing in adult ADHD during his residency working with high-functioning patients who responded robustly to treatment.

[00:06:00] Dr. Behrens' framework for thorough ADHD assessments: Gathering detailed patient history, collateral information, using rating scales like the ASRS, and objective measures of executive function.

[00:11:00] The importance of devoting significant time in initial evaluations to psychoeducation, explaining ADHD neurobiology and the full range of treatment options.

[00:12:00] Navigating stimulant medication options and considering both effectiveness and affordability for patients.

[00:18:00] Strategies for dealing with stimulant medication shortages, including working with a virtual assistant to locate medications and establishing relationships with pharmaceutical reps.

[00:26:00] The benefits and challenges of working with pharmaceutical reps as a psychiatrist.

[00:29:00] The multifaceted reasons behind the current stimulant medication shortage.

[00:35:00] The potential impact of the DEA reinstating the Ryan Haight Act's in-person visit requirement for controlled substance prescriptions.

[00:36:00] How Dr. Behrens provides patients with blood pressure cuffs for remote monitoring.

[00:40:00] The exciting potential of digital health tools and wearables to passively track data that could enhance ADHD assessment and treatment.

[00:44:00] The power of measurement-based care and involving patients in tracking their own data.

[00:45:00] Busting common myths and misconceptions about adult ADHD, including that it's just about hyperactivity and that stimulant medications work like typical stimulants.

[00:47:00] The underrecognized dangers of ADHD underdiagnosis and undertreatment, including increased risk of car accidents, job loss, relationship issues, and other adverse outcomes.

[00:50:00] The importance of treating ADHD as a core issue that, when addressed, can remove barriers to other treatments and positive life changes.

[00:51:00] Conclusion and sharing of Dr. Behrens' favorite ADHD resources for clinicians and patients.

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