Attention-deficit hyperactivity disorder and comorbid psychosis: a review and two clinical presentations.
BACKGROUND
A review of literature relating attention-deficit hyperactivity disorder (ADHD) to adult-onset psychosis suggests that cases of comorbid ADHD and atypical neuroleptic-refractory psychosis may respond to psychostimulants.


METHODS
Two patients are described who presented to the authors for clinical care. Data were gathered by reviewing hospital charts from previous admissions and by conducting serial mental status examinations over many weeks. Subjects chosen for presentation herein met DSM-III-R criteria for ADHD and atypical psychosis characterized by delusions or hallucinations.


RESULTS
After each subject had suffered multiple neuroleptic-refractory psychotic episodes, both had been treated by adding psychostimulants to ongoing neuroleptic therapy. The patients were then observed by the authors to be free of psychosis for many weeks, both while taking neuroleptics and psychostimulants concurrently, as well as while taking only psychostimulants after neuroleptics had been withdrawn.


CONCLUSIONS
When integrated with reports of five similar cases and a review of the literature, the above results suggest that further attention be given to the evaluation, treatment, and eventual classification of a potentially distinct patient group with ADHD and atypical psychotic episodes.
Pine
D S
DS
Department of Psychiatry, New York State Psychiatric Institute, NY 10032.
Klein
R G
RG
Lindy
D C
DC
Marshall
R D
RD
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D015897:Comorbidity; D003702:Delusions / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants