ATTENTION-DEFICIT HYPERACTIVITY DISORDER AND COMORBID PSYCHOSIS - A REVIEW AND 2 CLINICAL PRESENTATIONS

Background: A review of literature relating attention-deficit hyperact ivity disorder (ADHD) to adult-onset psychosis suggests that cases of comorbid ADHD and atypical neuroleptic-refractory psychosis may respon d to psychostimulants. Method: Two patients are described who presente d to the authors for clinical care. Data were gathered by reviewing ho spital 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 charact erized 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 therap y. The patients were then observed by the authors to be free of psycho sis for many weeks, both while taking neuroleptics and psychostimulant s concurrently, as well as while taking only psychostimulants after ne uroleptics had been withdrawn. Conclusion: When integrated with report s of five similar cases and a review of the literature, the above resu lts suggest that further attention be given to the evaluation, treatme nt, and eventual classification of a potentially distinct patient grou p with ADHD and atypical psychotic episodes.