A 20-Year-Old Man Comes for an Initial Visit for Treatment

A 20-year-old man comes for an initial visit for treatment of attention-deficit hyperactivity disorder.  He is currently in his third year of college and says that he is doing well, but his inattentive symptoms are causing significant problems.  Specifically, he frequently loses focus while studying and it takes him much longer than it should to complete assignments.  The patient describes a history of hyperactive and inattentive symptoms since second grade.  He says, "I could never sit still.  I was always running around and getting into trouble with teachers for not listening.  I have taken stimulants for most of my life and function better on medication."  The patient tolerates stimulants well and has never experienced side effects.  He has tried many different stimulant formulations of methylphenidate and amphetamines.  He usually needs a high dose, and immediate-release formulations work best.  The patient has no other psychiatric symptoms or history.  He takes no medications and does not use illicit drugs.  Physical examination is normal.  Before prescribing medication, which of the following is the most appropriate course of action?

A) Discuss abuse potential of stimulants and suggest starting at a low dose
B) Discuss possible adverse effects of decreased appetite and insomnia
C) Obtain cardiac history and perform an ECG
D) Obtain collateral information on history of attention-deficit hyperactivity disorder and prior stimulant treatment
E) Perform a urine drug test

Correct Answer:

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