Using a combined approach of CBT and pharmacologic management, his dose of MPH was initially reduced to 200mg/day; however, he continued to experience pronounced symptoms of ADHD, which affected his family relationships. While his signs of OCD diminished with fluoxetine, his ADHD symptoms only improved dramatically after he began treatment extended-release MPH (378mg/day). His Global Assessment of Functioning scale score increased from 43 to 68, and he began to care for his child several days a week and reestablish interpersonal relationships at home.

During treatment, he was carefully monitored for cardiac side effects (e.g., tachycardia and hypertension), as well as manic symptoms, suicidal ideation, and psychosis, all of which were absent. Symptoms such as agitation and irritability, which can be signs of MPH abuse, were likewise absent. Moreover, there was no return to the excessive use of MPH.

The authors conclude, “To our knowledge, this is the first reported case of high-dose treatment in a patient with adult ADHD. We therefore suggest that clinicians consider these findings in their work with patients when ADHD symptoms do not improve sufficiently with currently recommended dosages of stimulants.” They advise close monitoring of clinical symptoms for potential adverse effects when using these higher dosages.

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