Impaired Concentration

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of decreased concentration

Described as ‍difficulty focusingtrouble rememberinginability to stay engaged

Severity is ‍mildmoderatesevere

Negative impact on ‍workacademic performancedaily tasks

Concentration difficulties are ‍persistentintermittent

Recent source of stress: ‍, ‍work-related issues, ‍personal issues

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍decreased productivity

‍difficulty making decisions

‍forgetfulness

‍poor attention span

‍feelings of frustration or irritability

‍mental fatigue

‍lack of motivation

‍anxiety

‍depressed mood

‍sleep disturbances

‍social withdrawal or isolation



Contributing factors:

‍work-related stress

‍recent life changes

‍sleep deprivation

‍substance use

no history of: ‍attention deficit hyperactivity disorder (ADHD), ‍depression, ‍anxiety, ‍sleep disorders, ‍head injury, ‍neurological disorders

no use of: ‍antidepressants, ‍sedatives, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍ADHD ‍likelysuspectedpossible

DDx: ADHD, adjustment disorder, major depressive disorder, anxiety disorders, insomnia, sleep apnea, substance use disorders, neurocognitive disorders, Alzheimer's disease, thyroid disease, anemia, chronic illness, medication side effect, electrolyte imbalance, nutritional deficiencies, chronic pain syndrome, head trauma, brain tumors, post-traumatic stress disorder, chronic fatigue syndrome, fibromyalgia, pregnancy, long Covid





PLAN:

Investigations:

- ADHD auto-questionnaire

- Mini-mental state exam

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍creatinine, ‍glucose, ‍vitamin B12

- CT scan of the brain

- MRI of the brain

- Sleep study

Treatments:

- Lifestyle modifications: ‍healthy diet, ‍regular exercise, ‍good sleep hygiene, ‍stress management techniques

- ‍Antidepressants

- ‍Stimulants

- Discontinuation of medications that may cause decreased concentration (antidepressants, sedatives)

- Avoidance of alcohol and recreational drugs

- Cognitive behavioral therapy

- Occupational therapy for cognitive assessment

Further care:

- Referral to psychologist

- Referral to psychiatrist

- Follow-up in ‍ ‍weeksmonths

- Return if concentration does not improve or if new symptoms develop such as memory loss, confusion, or difficulty with daily activities