IDENTIFYING DATA:,  The patient is a 36-year-old Caucasian male.,CHIEF COMPLAINT:,  The patient relates that he originally came to this facility because of failure to accomplish task, difficulty saying what he wanted to say, and being easily distracted.,HISTORY OF PRESENT ILLNESS:,  The patient has been receiving services at this facility previously, under the care of ABC, M.D., and later XYZ, M.D.  Historically, he has found it very easy to be distracted in the "cubicle" office setting where he sometimes works.  He first remembers having difficulty with concentration in college, but his mother has pointed out to him that at some point in his early education, one teacher commented that he may have problems with attention-deficit hyperactivity disorder.  Symptoms have included difficulty sustaining attention (especially in reading), not seeming to listen one spoke into directly, failure to finish task, difficulty with organization, avoiding task requiring sustained mental effort, losing things, being distracted by extraneous stimuli, being forgetful.  In the past, probably in high school, the patient recalled being more figidity than now.  He tensed to feel anxious.  Sleep has been highly variable.  He will go for perhaps months at a time with middle insomnia and early morning awakening (3:00 a.m.), and then may sleep well for a month.  Appetite has been good.  He has recently gained about 15 pounds, but notes that he lost about 30 pounds during the time he was taking Adderall.  He tends to feel depressed.  His energy level is "better now," but this was very problematic in the past.  He has problems with motivation.  In the past, he had passing thoughts of suicide, but this is no longer a problem.,PSYCHIATRIC HISTORY:,  The patient has never been hospitalized for psychiatric purposes.  His only treatment has been at this facility.  He tried Adderall for a time, and it helped, but he became hypertensive.  Lunesta is effective for his insomnia issues.  Effexor has helped to some degree.  He has been prescribed Provigil, as much as 200 mg q.a.m., but has been cutting it down to 100 mg q.a.m. with some success.  He sometimes takes the other half of the tablet in the afternoon.nan