“I think I got ADHD.” I can never say what I think when someone says this. I think, “get out of here you drug seeking idiot.” The great majority of people who come into my office saying this are just that. Of course, I am not that blunt — at least not to their faces. But the tragedy is that they WILL find somebody to dash off a prescription (for a price).
Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
Ahh – 19 years old! It is a magical age. At least it has been my experience in public mental health clinics.
You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.
I don’t know what it is about 19.
One of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.
Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college. He wanted to be a performance artist.
I thought this person should be fired from the county clinic, but most counties don’t let me do that sort of thing. The state of California has a nice service, where I ask to see who else is prescribing this person the same abusable drugs that I am. I try to work with people who abuse drugs, I really do. In one sense, it is the purest of pharmacologies, in that things I usually think are parts of a physician-patient encounter, like conversation and logic, play little or no role. House said that patients lie. House is a Vicodin (opiate) addict. Some of my more intelligent substance abusers are House fans. The same way that “Cops” was the most watched TV show in prison, when I was a jailhouse doc.
This person, was getting weaned off amphetamines. After a lot of years, I am not very sure I believe in ADHD, or “Attention deficit disorder.” We all have problems of differential maturity. These are just people who learn to concentrate later. They may have other skills like class clowning that are way ahead. My book learning was ahead of my social skills for a lot of my life. Besides, most anybody brightens up when you give them amphetamines. Not that the effect lasts very long, mind you. Even kids who take Ritalin in a quest to do better on the Scholastic Aptitude Test seem to revert pretty quickly to their previous state of dullness. Read more on Getting Amphetamines In Other Places…