Beyond the basics management of complex ADHD patients. When GPs should decline shared care.
Beyond the basics management of complex ADHD patients. When GPs should decline shared care.  
Podcast: Primary Care Masterclass Podcast
Published On: Sat Aug 08 2026
Description: Dr. Vicki Nahamkes presents a guide for General Practitioners on managing complex ADHD patients, emphasizing that while treatment is rewarding, it requires rigorous monitoring and boundary setting. She introduces a "3C Rule" for patient reviews, assessing **Mental Clarity** (organized thinking), **Calm** (mood regulation), and **Consistency** (sleep, diet, and exercise).Cardiovascular safety is a primary concern, particularly for older patients. Dr. Nahamkes advises a cardiovascular risk assessment before starting stimulants, aiming for a risk score below 5%. Regular blood pressure checks are mandatory, as stimulants can increase pressure by 2–4 mmHg; hypertension must be managed or the stimulant withdrawn.A significant portion of the talk addresses special populations and comorbidities:* **Women’s Health:** Hormonal fluctuations during menopause can severely destabilize ADHD control. Dr. Nahamkes shares a case where a patient required increased stimulant dosage and Hormone Replacement Therapy to regain stability.* **Binge Eating Disorder:** She notes that Vyvanse is the only stimulant evidence-based for this comorbidity.* **Bipolar Disorder:** There is a risk of stimulants unmasking mania. A detailed case study describes a patient who developed hypersexuality and reckless behavior upon starting stimulants, eventually requiring a transition to mood stabilizers like Lamotrigine instead of ADHD medication.Dr. Nahamkes concludes with clinical pearls, noting that successful treatment often results in *decreased* steps on fitness trackers, indicating less chaotic movement and better organization. Finally, she empowers GPs to decline "shared care" for patients with complex presentations—such as those with Cluster B personality traits or unstable bipolar disorder—stating these cases often require psychiatrist-led management.This podcast was recorded live at the ADHD, Binge and Other Eating Disorders Symposium in Melbourne hosted by ADHD-BED Integrated. adhd-bed.events-------------------------------------------------------------------------------If you are a General Practitioner who gets invited to dozens of webinars a month. The General Practice Clinical Sessions Podcast is designed for you.Instead of giving up an evening with your family for a live webinar or your weekend for a conference, you can listen to it here whenever it's convenient, in half the time and while you are commuting, exercising or even walking the dog.It's the same education, without interrupting your life.GPs can also earn CPD hours.Earn Educational Activity (EA) CPD without sacrificing time with your family.Listen to your Clinical Sessions Podcasts on your commute or while you exercise. Then each week, calculate the amount of time you invest listening and count that as self claimed Educational Activities (EA).Earn Reviewing Performance (RP) CPD without sacrificing time with your family.After each podcast, pause for a few minutes and identify and summarise 3 key points relevant to your scope of practice.Identify the key clinical learnings that may be incorporated into the clinical assessment, work-up and/or management plan for appropriate patients.If relevant, would you change any of your management strategies for those patients identified by appropriate screening, examination and investigation.Invest 10 minutes per podcast mentally reviewing your practice. When you listen to 6 podcasts per week, you have earned an hour of Reviewing Performance CPD you can self claim.Remember to document your learning!Earn Measuring Outcomes (MO) CPD without sacrificing time with your family.To claim MO, you need:A baseline measurementA change in practiceA re-measurementReflection on the outcome1. Identify a measurable change. After the podcast, ask:“What will I do differently on Monday?”Example:Start using a screening toolChange prescribing habitsIncrease documentation of a risk factor2. Measure your baseline (quick audit). Do a small, realistic auditExamples:Review last 10 patients with condition X% who had guideline-based management% with documented counselling3. Implement the change. Apply the idea from the podcast for 2–4 weeksCould be as simple as a checklist, template, or reminder4. Re-measure. Repeat the same audit:Same sample sizeSame criteria5. Reflect & Document:What changed?Did outcomes improve?What will you keep doing?If you enjoy learning through podcasts and video podcasts then you can also access thousands of premium podcasts with PowerPoint Slides at https://www.armchairmedical.tv/podcastsEnjoying the episode?⭐ Rate this episode➕ Follow the podcast💬 Share it with a colleague who’d value conference learning without the time awayDisclaimer: Content is for health professionals and general educational purposes only. It is not medical advice or a substitute for independent clinical judgement. Always consult current guidelines, product information and local protocols. Views expressed are those of the presenters and not necessarily ArmchairMedical. ArmchairMedical accepts no responsibility or liability for any loss or harm resulting from reliance on the information provided.Visit https://www.armchairmedical.tv/podcasts for more information.