Psychostimulants in the Treatment of Adults with Psychosis and Attention Deficit Disorder

Opler, Lewis A.; Frank, Denise M.; Ramírez, Paul

doi:10.1111/j.1749-6632.2001.tb05786.x

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…Interestingly, case reports on ADHD and comorbid neuroleptic-refractory adult-onset psychosis presenting with delusions and hallucinations observed improvement of schizophrenic symptoms when adding psychostimulants to ongoing antipsychotic treatment and even after withdrawal of the antipsychotics (Pine et al, 1994). It has been suggested that ADHD psychosis favourably responding to psychostimulants constitutes a distinct entity with key symptoms like brief hallucinations, delusions with evident compensatory functions concerning low self-esteem, poor impulse control, aggression and impaired judgement whereas interest in social life maintains and disorganization of thoughts is rare (Opler et al, 2001). Psychotic symptoms usually disappear quickly after administration of psychostimulants, however, long-term prognosis of recurring psychotic episodes and social adjustment is poor (ibid.).…”

Section: Adhdmentioning

confidence: 97%

Dopaminergic dysbalance in distinct basal ganglia neurocircuits: Implications for the pathophysiology of parkinson’s disease, schizophrenia and attention deficit hyperactivity disorder

Riederer²,

2006

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The basal ganglia form a forebrain system that collects signals from a large part of the neocortex, redistributes these cortical inputs both with respect to one another and with respect to inputs from the limbic system, and then focuses the inputs of this redistributed, integrated signals into particular regions of the frontal lobes and brainstem involved in aspects of motor planning and motor memory. Movement disorders associated with basal ganglia dysfunction comprise a spectrum of abnormalities that range from the hypokinetic disorder (from which Parkinson's disease, PD, is the best-known-example) at one extreme to the hyperkinetic disorder (exemplified by Huntington's disease and hemiballism) at the other. In addition to disorders of movement, major mental disorders including schizophrenic-like states and attention deficit hyperactivity disorder (ADHD) have been linked to abnormalities in the basal ganglia and their allied nuclei. In this paper we discuss recent evidence indicating that a dopamine-induced dysbalance of basal ganglia neurocircuitries may be an important pathophysiological component in PD, schizophrenia and ADHD. According to our model, the deprivation of dopaminergic nigro-striatal input, as in PD, reduces the positive feedback via the direct system, and increases the negative feedback via the indirect system. The critical consequences are an overactivity of the basal ganglia output sites with the resulting inhibition of thalamo-cortical drive. In schizophrenia the serious cognitive deficits might be partly a result of a hyperactivity of the inhibitory dopamine D(2) transmission system. Through this dysinhibition, the thalamus exhibits hyperactivity that overstimulates the cortex resulting in dysfunctions of perception, attention, stimulus distinction, information processing and affective regulation (inducing hallucinations and delusions) and motor disabilities. Recent studies have strongly suggested that a disturbance of the dopaminergic system is also involved in the pathophysiology of ADHD. The most convincing evidence comes from the demonstration of the efficacy of psychostimulants such as the dopamine transporter (DAT) blocker methylphenidate in the symptomatic treatment of ADHD. Genetic studies have shown an association between ADHD and genes involved in dopaminergic neurotransmission (for example the dopamine receptor genes DRD4 and DRD5, and the DAT gene DAT1). DAT knockout mice display a phenotype with increased locomotor activity, which is normalized by psychostimulant treatment. Finally, imaging studies demonstrated an increased density of DAT in the striatum of ADHD patients. Which system is disturbed and whether this system is hyper- or hypoactive is not unambiguously known yet.

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Section: Adhdmentioning

confidence: 97%

Dopaminergic dysbalance in distinct basal ganglia neurocircuits: Implications for the pathophysiology of parkinson’s disease, schizophrenia and attention deficit hyperactivity disorder

Riederer²,

2006

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“…The cited studies show no worsening of psychotic symptoms but an amelioration of both attentional deficits and psychotic symptoms, probably by increasing perfusion to the frontal lobes [112] .…”

Section: Environmental Risk Factorsmentioning

confidence: 99%

“…In fact, there are case studies demonstrating that stimulants have been well tolerated in subjects with psychosis, with or without concomitant antipsychotic treatment [105109] , with positive effects on cognition [110,111] . It has been suggested that the positive effect of methylphenidate, described in some studies, may be due to a regulation of frontal hypodopaminergic state [110,112] . In fact, methylphenidate affects dopamine D1 receptors in frontal regions improving cognition, whereas antipsychotics block D2 receptors in mesolimbic systems, without influencing D1 receptors [110] .…”

Section: Stimulants and Psychosismentioning

confidence: 99%

“…On the basis of case reports by Huey et al [120] , Bellak et al [119] , Pine et al [121] , Opler et al [112] suggested a trial of psychostimulants in patients presenting both ADD and psychosis, with a poor response to neuroleptics. The cited studies show no worsening of psychotic symptoms but an amelioration of both attentional deficits and psychotic symptoms, probably by increasing perfusion to the frontal lobes [112] .…”

Section: Environmental Risk Factorsmentioning

confidence: 99%

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Raising attention to attention deficit hyperactivity disorder in schizophrenia

Pallanti

Salerno

2015

WJP

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Schizophrenia and attention deficit hyperactivity disorder (ADHD) are two psychiatric disorders with a negative impact on quality of life of individuals affected. Although they are classified into distinct disorders categories, attentional dysfunction is considered as a core feature in both conditions, either at the clinical then pathophysiological level. Beyond the obvious clinical overlap between these disorders, the Research Domain Criteria approach might offer an interesting perspective for disentangling common circuits underpinning both disorders. Hence, we review evidences regarding the overlap between schizophrenia and ADHD, at the clinical level, and at the level of underlying brain mechanisms. The evidence regarding the influence of environmental risk factors in the emergence of both disorders, and their developmental trajectories is also reviewed. Among these, we will try to elucidate the complex relationship between stimulants use and psychotic symptoms, discussing the potential role of ADHD medication in inducing psychosis or in exacerbating it. We aim that, taken together, these findings may promote further investigation with important implications both for clinicians and research. In fact, considering the amounting evidence on the overlap between schizophrenia and ADHD, the delineation of their boundaries might help in the decision for diagnosis and treatment. Moreover, it may help to promote interventions focused on the prevention of both schizophrenia and ADHD, by the reduction of recognized environmental risk factors.Key words: Attention deficit disorder with hyperactivity; Central nervous system stimulants; Psychotic disorders; Schizophrenia; Toxic psychoses © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. Core tip:In line with the translational approach of viewing disorders in terms of dysregulation of brain basic mechanisms, there is increasing evidence of overlap between different mental disorders. Here, we explore relationships between attention deficit hyperactivity disorder and schizophrenia, in light of recent insights into potential common etiological mechanisms explaining some of the observed overlap in both disorders. Using evidence from clinical epidemiology and neuropsychology, we propose a biologically-based reconsideration of these brain diseases. We have also summarized environmental risk factors for both disorders, aiming to promote awareness REVIEW Submit a

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“…Though an addictive compound, amphetamine (AMPH) is a drug that has been used to treat a variety of diseases such as narcolepsy, obesity and ADHD [1,2]. Initially described as a potent sympathomimetic drug with cardiovascular and gastro-enteric effects, it soon became clear that AMPH has reinforcing properties leading to widespread abuse [3].…”

Section: Introductionmentioning

confidence: 99%

The Epigenetic Mechanisms of Amphetamine

2015

J Addict Prev

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Amphetamine (AMPH) is a psychostimulant and the most prescribed drug to treat attention deficit hyperactive disorder (ADHD). Although therapeutically used doses are generally well tolerated, numerous side effects are still known to occur, such as jitteriness, loss of appetite and psychosis. Moreover, AMPH is liable to be abused by users looking for increased alertness, weight loss or athletic performance. A growing body of evidence indicates that drugs of abuse, including AMPH, control gene expression through chromatin modifications. However, while numerous studies have investigated the molecular mechanisms of AMPH action, only a small number of studies have explored changes in gene expression caused by AMPH. This review examines the epigenetic changes induced by chronic and acute treatments with AMPH and includes, where relevant, data obtained with other psychostimulants such as methamphetamine and cocaine.

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Psychostimulants in the Treatment of Adults with Psychosis and Attention Deficit Disorder

Cited by 11 publications

References 9 publications

Dopaminergic dysbalance in distinct basal ganglia neurocircuits: Implications for the pathophysiology of parkinson’s disease, schizophrenia and attention deficit hyperactivity disorder

Dopaminergic dysbalance in distinct basal ganglia neurocircuits: Implications for the pathophysiology of parkinson’s disease, schizophrenia and attention deficit hyperactivity disorder

Raising attention to attention deficit hyperactivity disorder in schizophrenia

The Epigenetic Mechanisms of Amphetamine

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