Protocol for Treating Adhd in the Prison Population

Iowa Department of Corrections Psychiatric Guidelines ADHD

DIAGNOSIS  Meet DSM-IV-TR criteria for ADHD. Should rule out diagnoses that may better explain the symptoms, such as bipolar disorder, an anxiety disorder, borderline personality disorder, antisocial personality disorder, malingering, or other conditions. If applicable, consider medications that will target symptoms of these illnesses, for example mood stabilizer for mood lability. Should also rule out medical illnesses that may mimic ADHD symptoms such as hyperthyroidism.  Must have current symptoms that interfere with functioning in the classroom or at work, and/or problems interacting with other offenders/staff  Obtain prior medical records whenever possible.

NON-MEDICATION TREATMENT  The following should be employed during the course of treatment for ADHD: individual psychotherapy, anger management, anxiety reduction, sleep hygiene, abstinence from illegal drugs, minimizing caffeine intake, receiving additional help from staff (teachers, supervisors, etc.) in class or at work to assist with focus and staying on task.

TREATMENT – NON STIMULANT MEDICATIONS  Trial of bupropion lasting at least 6 weeks at a maximum dose with documented failure to respond; may terminate trial earlier due to medication side effects. If an offender chooses to stop medication early, he or she will need to wait for the duration of that medication trial before the next step will be considered. Offenders with a history of seizures should not receive bupropion; proceed with atomoxetine.  Use of medications such as fluoxetine, imipramine, clonidine may be considered at clinician’s discretion; again, need to ensure adequate trial of adequate dose.  Trial of atomoxetine lasting at least 6 weeks of using the medication at a maximum dose without response; may terminate trial earlier due to medication side effects.

TREATMENT – STIMULANT MEDICATIONS  Liquid methylphenidate: use if failure of adequate trials of non-stimulant medications and can document ongoing use of non-medication treatment modalities. Check baseline EKG and monitor pulse.  USE OF ANY OTHER STIMULANT MEDICATIONS: MUST DISCUSS WITH MENTAL HEALTH DIRECTOR; DR. SIELENI IS THE ONLY INDIVIDUAL WHO CAN CONSENT FOR USE OF THESE MEDICATIONS.

______Dr. Bruce Sieleni Mental Health Director Date

______Dr. Harbans Deol Medical Services Director Date

Origination Date: December 2009