Improvement in refractory psychosis after initiating management for underlying ADHD

Abstract

We report on a unique clinical case of psychosis precipitated by Attention Deficit Hyperactivity Disorder (ADHD) and explore its implications for clinical practice as well as our understanding of these conditions. We describe a clinical case of a 46-year-old male presenting with auditory, olfactory, tactile, and visual hallucinations. We reviewed the literature on reported cases in which psychotic symptoms were treated with stimulant medications for ADHD comorbidity. This case report reveals the potential for properly selected patients to benefit from a consideration of ADHD comorbidity and a trial of treatment with that focus. In addition, the literature reveals a pathophysiologic association between psychosis and ADHD supported by neurobiological data. However, far more research is required to fully understand these conditions and their relationship. We conclude that ADHD and psychosis have some related pathophysiologic mechanisms but their connection has not been adequately explored. This case adds support to literature suggesting that in refractory psychosis, clinicians should re-evaluate the diagnosis and one of the considerations should be ADHD. In certain cases, the presence of psychotic symptoms with ADHD should not exclude the use of stimulants.