Thoughts on the Neuro-Psychology Exam

[Alternate title, “Ritalin: It’s not what you think.”]

It’s now been about a year or so since I did the post-TBI Neurology/Psychology battery of tests — the Neuro/Psych exam. I think I’d said before that these things were often performed prior to returning to work, but because I’m so determined (and somewhat narrow-minded) and was chomping at the bit to get back to the people I knew, I just resumed work as best I could then worried about the Neuro/Psych tests later.

Last March, I’d shared, very vaguely, the way Neuro/Psych exams are performed. I’d also used the abbreviation “PSE” and I frankly have no idea how or why I’d used that, so… meh. Jump back there for a review of the very generalized review of how the Neuro/Psych exam works.

The intention was, of course, to baseline the patient and compare his performance to — a big question mark. There is, of course, nothing to compare the patient’s current mental state to his pre-TBI mental state, so it’s instead very much working in averages based upon the statistics and trends of other people in the same age- and education-range.

I’d made it rather clear at the off that I have limitations and they’re almost entirely mental focus-related. Sure, there were other issues — gross neurological-related.

Ultimately, the report from the psychologist said…

…nothing that I didn’t already know.

I’d never read it, and it was relayed to me by the neurologist. He suggested, “I think we should try Ritalin.”

Ritalin? Well, Methylphenidate, actually — Ritalin is, of course, a trade-name.

So, sure. It doesn’t hurt to give it a go. A couple of concerns with it, but they have nothing at all to do with the social, dosage, or cost.

We’ll take those in reverse order:

Cost: trivial. In fact, I’d wager that somebody could shuffle around in the couch cushions to find enough to cover a three-month supply. I think it was US$3 or $4.

Dosage: it’s actually the smallest possible dosage. 5 mg. We’ll do it once per day and see if there is any impact.

Social: ADHD. This isn’t. I suppose that Ritalin is often thought to be a sedative to calm down hyperactive children. It doesn’t do what you think, nor is it anywhere near the dosage level that people would assume. It’s actually a stimulant, not a sedative.

“You’re giving stimulants to hyperactive children?!? What kind of monster are you!?!”

hammy the squirrel

“The last thing you need is caffeine.”

As much as you’d think caffeine will make a hyperactive child more hyperactive (mega-active?), it actually won’t. What you consider to be “hyper-activity” is actually the result of boredom coupled with rapid, unfocused task-switching.

Also, as long as I’ve been on it, I’ve not had any psychological awareness of stimulation (or addictiveness) — but it does help improve task focus.

So, where’s the problem?

It’s inconvenient.

You’ll need

  1. an actual printed prescription, and
  2. only a 90-day supply, and
  3. there are no refills.

That’s somewhat inconvenient. Methylphenidate is on the Schedule II controlled-substance list and laws. Other things like Hydrocodone, Opium, and Morphine (among others) are on the list! No wonder there are such strong social beliefs about being in a culture that drugs children. And, yet, Methylphnidate is nowhere nearly as physiologically (or socially) impactful as those substances are.

So, every three months, I’ll need to get a printed prescription from the doctor who is 110 miles away. I suppose I should investigate having a local doctor here in Moses Lake do the needful rather than a neurologist or physiologist in Spokane.

Are there alternatives? Well, caffeine, at an appropriate level, will help provide the additional mental focus, but it has several other rather unwelcome side effects: tremors, elevated blood pressure and heart-rate, digestive issues, insomnia.

Ritalin is far more agreeable. Inconvenient, yes. But far more agreeable by not incurring any of those other side effects.

Right, so where are we one-year on?

I’d say that now there’s something more realistic to compare last year’s exam to. Rather than compare to the global averages of people at the rough age and education level, it’s going to be more meaningful to compare my current state to the previous state.

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