How to treat patients with adult attention-deficit/hyperactivity disorder (ADHD) comorbid with psychosis? a case report

Abstract

Introduction

It is not uncommon that patients suffering from psychosis reveal a comorbidity of attention-deficit/hyperactivity disorder (ADHD). There is lack of evidence how to treat these patients as amphetamines are considered contraindicated for patients with psychosis.

Objective/aims/methods

To provide the case history of such a comorbid patient.

Results

A 21 year old male patient is committed to the psychiatric clinic displaying massive assaultive behavior. He has been consuming cannabis heavily over the last few years; for a couple of days now he has been displaying psychotic features. Occasional aggressive outbursts have been known to occur since childhood. The patient’s own accounts and those of his relatives also make an ADHD highly probable. During inpatient stay there are massive, dangerous aggressive assaults without detectable reasons along with complete disorganized behavior and massive thought disorders on three different occasions. Medication with very high doses of antipsychotics, benzodiazepines as well as mood stabilizers could not prevent the patient from his aggressive outbursts. The lack of efficacy of conventional treatment led us to propose to the patient a trial dose of methylphenidate, which calmed the patient instantly. Psychotic symptom, aggression and symptoms of ADHD improved during further treatment with methylphenidate, which was replaced by atomoxetine later. The patient was dismissed on a regimen of atomoxetine, Risperidone and Valproate and was well at a follow-up investigation 2 months later.

Conclusions

The use of methylphenidate in patients with adult ADHD comorbid with psychosis seems to be possible and helpful on some occasions.