title: [Caffeine, cannabis and cocaine: from automedication to 'automutilation' in adults with ADHD].
abstract: Four patients whose automedication had attracted medical attention had signs compatible with adult attention deficit hyperactivity disorder (ADHD). Two of them, men aged 42 and 28, were seen with their hyperactive children in the outpatient department; they appeared to drink huge amounts of coffee, smoked heavily or used cannabis to facilitate sleep. The other two patients, a man aged 25 and a woman aged 35, were initially not diagnosed with ADHD; they had noticed that dopaminergic drugs like cocaine and an amphetamine-containing medication taken to lose weight made their behaviour much more 'normal', although the man was addicted. All experienced relief of their chaotic mental activity when they were treated with methylphenidate. Smoking and addiction due to undiagnosed ADHD may lead to 'automutilation'. Early recognition and awareness of the symptoms of ADHD is important; the clinical interview should also cover items like automedication and other ADHD symptoms in the family.
authors.affiliation: Medisch Centrum Rijnmond Zuid, locatie Clara, Olympiaweg 350, 3078 HT Rotterdam. pereirar@mcrz.nl
authors.forename: R Rodrigues
authors.initials: RR
authors.lastname: Pereira
authors.forename: B J M
authors.initials: BJ
authors.lastname: van de Wetering
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D002110:Caffeine / Q000008:administration & dosage; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse; D008774:Methylphenidate / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000209:etiology
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D002110:Caffeine