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Attention Deficit Hyperactivity Disorder (ADHD)

 

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At CBD Doctors Melbourne we noticed increased demand for adult assessment for ADHD.  It is usually “a retrospective diagnosis” meaning that it may have started in childhood. In the past we had a lack of awareness, shortage of specialist psychiatrist and controversies surrounding the diagnosis of ADHD.We also experience strict and complex regulation of use of medications for ADHD medications (dexamfetamine, Ritalin and lisdexamfetamine), for “Schedule 8” medications.

Over the last 12 months we have referred increased number of patients from all around Victoria to different psychiatrists in order to be assessed for ADHD. Neither the diagnosis nor the treatment of ADHD is straightforward.

If you think you may have Attention Deficit Hyperactivity Disorder, we suggest:

  1. Conducting a home assessment first. A self assessment can be found here.
  2. Visit your GP
  3. Referral to a psychiatrist (please note this is only one option of treatment and the only one that gives you an access to ADHD medications)
  4. Return consultation to your GP for a prescription

The complexity of prescribing medications and monitoring outcomes is usually up to your GP and can be complex.

We asked Dr Manoj Ravindran, Psychiatrist Clinical Director at Rivendell Clinic North West Private Hospital:

“The incidence of ADHD is estimated at approximately 5%, which means that 1.3 million Australians are currently struggling with this condition. Undiagnosed and untreated ADHD can have a devastating impact on the lives of patients and their families. ADHD is associated with multiple physical and mental health comorbidities. A significant proportion of patients present with emotional dysregulation, anxiety and rejection sensitivity.

When ADHD is properly managed, Patients begin to live a more fulfilling life.

We at Fluence Clinic recognise the importance of managing this condition effectively and promptly in order to help patients live a more fulfilling life.

If you feel like you may have ADHD, please see your GP who will make a referral and you can soon start your journey of recovery”.

Once a patient has an assessment completed by a psychiatrist

Please ask your GP or a GP that is closer to your home to prescribe your medication.  Schedule 8 medications are restricted medications, and some GPs are not comfortable prescribing them.

During last two years more patients are seen by specialists due to high demand. And increased number of people diagnosed with ADHD. Having said that, many specialists are “delegating” prescribing to general practitioners. That means that psychiatrists are providing full education and support to these GPs, including doctors at CBD Doctors Melbourne.

Process:

  1. Book long appointment face to face at CBD Doctors Melbourne
    • select either “ADHD Initial Consultation (F2F)” or “ADHD Initial Consultation (Tele)” as the reason for seeing the doctor. Please note if you select the telehealth option (available Australia wide) you will no be eligible for a medicare rebate if you have not been to our clinic in person in the last 12 months.
  2. Your Doctor will prescribe you a medication, as per your psychiatrist’s letter. This prescription requires “an authority” which means that a doctor will need to talk to PBS (Pharmaceutical Benefit Scheme) to get an approval for a script . This is be required every time that you need a new script.
  3. Your Doctor will then have to apply for “a permit” which usually contains a maximal daily dose for the medication. It is usually valid for 2 years.
  4. ECG and routine blood tests are organised on the day of your appointment and then periodically.
  5. At CBD Doctors Melbourne we work closely with psychiatrists, and we are happy to titrate the dose. Unfortunately, every change of dose requires a new appointment, new script and authority from PBS).
  6. Once your daily dose is stable, you will only need one appointment every 6 months.
  7. Once your doctor gets a permit to prescribe (usually lasts 2 years), only that doctor and other doctors in that particular practice can prescribe that medication.
  8. If you want to change your practice, you will need an appointment and the licence has to be transferred to another practitioner, through the administrative process that requires input both your old and our new doctor.
  9. Doctor can hold a licence for only one medication or a certain combination that is in a psychiatrist’s letter. Please note: you are not allowed have two medications on hands “to try if one works and switch to another” Unfortunately, if one medication is not agreeing with you, or it is not effective enough, it requires to be stopped, script cancelled, permit cancelled and the doctor has to apply for a new permit for a different medication.
  10. Due to these complexities, we have a strict policy and the written consent. We require patients with ADHD under our care to keep their scripts in one usually local pharmacy. We discourage patients from keeping scripts with themselves due to legalities and complexities when you fill in your script in different pharmacies. With change of medications, we like to involve your pharmacist.
  11. You are obliged by the law to keep medications safe. That means out of reach for children. You are not allowed to share these medications with anyone- your family, friends, children.
  12. If you are driving a car, and using ADHD medications, you will test positive if subject to a drug test.
  13. If you are a patient of CBD Doctors Melbourne, we come under jurisdiction of Victoria Department of Health who issues a licence. The licence is not automatically transferred across the border to another jurisdiction (e.g NSW, Tas). That means that YOU CAN ONLY ACCESS MEDICATIONS IN VICTORIA.
  14. Cancelling the permit means: the doctor who holds the license to prescribe you ADHD medication will need to do that via Safe Script. Only once the permit cancellation is approved caan another doctor apply for a new permit.

    Please note: some practice administrators would tell you to submit the form known as “request for transfer of medical file”. This is a completely different purpose document and if you fill in this form, it doesn’t include the license to prescribe a schedule 8 medication.

    When you want to change a prescriber  of your Dexamphetamine Ritalin, Vyvanse, please send an email with the request to the reception@cbddocs.com.au

If you are from overseas and intend to stay in Victoria longer and you need medications, you would still need to go through the same process, requiring an assessment by an Australian trained psychiatrist.

We can’t provide any scripts for ADHD medications without a consultation. Please don’t try to order renewal of your prescriptions via “order a script” facility. Your request will be rejected.

If you are travelling, please make sure that you have enough tablets to cover your trip. If you are travelling overseas, you need to make sure that you know local government regulations on these medications. These medications may be BANNED in these countries, and you may be charged.

There is an ongoing shortage of lisdexamfetamine. Changing the dose may not be an option, ask your doctor at the appointment. That means that you may need an alternative medication (dexamfetamine).

If you think you have ADHD, please book an appointment with one of the Doctors at CBD Doctors Melbourne here.

 

Treatments of ADHD:

  • Lifestyle changes
  • Cognitive-behavioural intervention approaches
  • Parent/family training
  • Cognitive-behavioural interventions
  • Cognitive training
  • Neurofeedback
  • Organisation/school-based interventions
  • ADHD Coaching
  • Peer support workers

Useful links:

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