View Full Version : Article: ADHD and Psychosis


Matt S.
11-01-07, 09:01 AM
This was interesting


Definition

ADHD psychosis (or ADD psychosis) is a distinctive form of psychosis (http://psychology.wikia.com/wiki/Psychosis), identified by Leopold Bellak (http://psychology.wikia.com/index.php?title=Leopold_Bellak&action=edit) and his colleagues, which accompanies attention-deficit hyperactivity disorder (http://psychology.wikia.com/wiki/Attention-deficit_hyperactivity_disorder) (ADHD).

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Treatment

ADHD psychosis tends to be treatable with typical ADHD medication such as stimulants (http://psychology.wikia.com/wiki/Stimulants), antidepressants (http://psychology.wikia.com/wiki/Antidepressants), or a combination of the two. ADHD psychosis can also be treated with psychotherapy (http://psychology.wikia.com/wiki/Psychotherapy), which is often an adjunct to the pharmaceutical treatment of ADHD (http://psychology.wikia.com/wiki/ADHD). ADHD psychosis responds to neither conventional neuroleptics (http://psychology.wikia.com/wiki/Neuroleptics), such as Haldol (http://psychology.wikia.com/wiki/Haloperidol) or Thorazine (http://psychology.wikia.com/wiki/Thorazine), or atypical antipsychotic (http://psychology.wikia.com/wiki/Antipsychotic) medications, such as Seroquel (http://psychology.wikia.com/wiki/Quetiapine), Zyprexa (http://psychology.wikia.com/wiki/Olanzapine) or Risperdal (http://psychology.wikia.com/wiki/Risperidone), currently the most commonly prescribed antipsychotic.

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Prevalence

Although this condition does not appear in DSM-IV (http://psychology.wikia.com/wiki/DSM-IV), and is not widely recognized, it has been detailed in several academic papers which give a number of case examples1 (http://psychology.wikia.com/wiki/ADHD_psychosis#References), 2 (http://psychology.wikia.com/wiki/ADHD_psychosis#References), 3 (http://psychology.wikia.com/wiki/ADHD_psychosis#References).

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Possible Symptoms

Among the many symptoms that an ADHD patient may experience are impulsivity, the inability to organize thoughts, difficulty keeping track of time, remembering important events or tasks, the inability to complete tasks, and the tendency to delay tasks that require more concentration. Commonly a perceived psychotic episode (http://psychology.wikia.com/wiki/Psychosis) in a patient could reasonably be attributed to the patient's inability to properly organize thoughts and information. If, for example, a patient consistently consciously spends more money than he or she earns, the behavior could be considered psychotic based on the assumption that the patient believes that he or she earns more money than is obviously the case. The patient usually knows about this situation, but is unable to control it effectively, due to ADHD symptoms. Another example would be a patient who consistently and knowingly does not keep appointments or appears late to events or meetings to which the patient had explicitly agreed to be attending on time.

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Reactions and Diagnosis

If the patient's ADHD condition is not known to an observer, the observer may reasonably assume that the patient is undergoing a psychotic episode (http://psychology.wikia.com/wiki/Psychosis) or suffers from a mental illness (http://psychology.wikia.com/wiki/Mental_illness), such as schizophrenia (http://psychology.wikia.com/wiki/Schizophrenia), based on the patient's erratic behavior and statements that are obviously and demonstrably false, even to the patient himself. These symptoms would, from a psychological standpoint, not be considered a psychosis (http://psychology.wikia.com/wiki/Psychosis), but rather a behavioral or thought disorder that is related to the pre-existing ADHD condition; if the patient was actually psychotic, he would hold a false belief, even if it can be disproven, but an ADHD patient is usually aware, at least on a subconscious level, that his actions are not always consistent with reality, but nonetheless exhibits the behavior due to a lack of control of his impulses.

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Possible Causes

The ADHD patient is often unaware of an appointment or task that needs to be completed, or grossly over- or underestimates the amount of time or effort that is required to complete a project, and therefore can be observed to have an extremely chaotic lifestyle. Often ADHD patients will simply forget a task because it does not interest them, and it is simply no longer part of their conscious memory, no matter how important it is (i.e. taking an exam, driving the kids to school, going to an interview, doctor's appointment, etc). In such cases, the patient may perhaps be considered delusional (http://psychology.wikia.com/wiki/Delusion), because his perception of reality is severely distorted without his knowledge. Most patients, however, learned to live with the fact that they are very forgetful, and therefore do not consider themselves delusional on a conscious level, although their behavior may mimic that of a person who actually is suffering from a psychosis (http://psychology.wikia.com/wiki/Psychosis)

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Perception

It is important for ADHD patients that others recognize that their seemingly irrational behavior is not necessarily due to a severe mental illness that requires immediate treatment and that could even present a danger to the patient himself or others, but are rather normal, relatively benign traits of the patient's personality; the behavior usually does not increase in scope, severity or recurrence, and with the proper background information can be identified as ADHD.

To those who are not familiar with the symptoms that are experienced by an ADHD patient, which is the case for most non-professsionally trained people who do not have ADHD, it may be difficult or impossible to believe that the patient is not actually insane (http://psychology.wikia.com/wiki/Insane); the effects of such reactions from others can have a negative impact on the patient's psyche (http://psychology.wikia.com/wiki/Psyche), and sometimes patients begin to believe themselves that they actually are psychotic.
http://psychology.wikia.com/wiki/ADHD_psychosis

hollyduck
11-01-07, 10:10 AM
I'm not sure what to think about this. On the one hand, it looks more or less accurate. On the other hand I think "psychosis" is a word that's not likely to be helpful.

Explaining why I haven't done X, Y or Z has been a lifelong problem for me (big surprise). When I know I NEED to do the task, or have promised to do it, this actually makes it more likely it will be forgotten. An invisible force field suddenly stands between me and the promised task.

If I had MS or needed dialysis or was being treated for cancer, any of these problems would be sufficient to explain why something didn't get done. Even something like chronic fatigue or fibromyalgia would be better than pure ADHD for the purpose of making excuses which would be believed.

Not having a real reason to put forward, I have become highly skilled at contriving believable excuses each based on the situation, or even devising white lies which covered up the lapse. (Usually the white lies are to cushion lapses towards people I care about, so they won't feel that I do not care. Probably this doesn't work very well.)

Another approach is to embrace my inner scatterbrain, learn to apologise constantly, present myself as unreliable and forgetful so people don't expect too much from me, or even present myself as a fool. (Not usually very difficult).

I still struggle with making promises and volunteering help for tasks which ought to be well within my abilities. When I enter a new community, people percieve me as being capable, smart and (because I downplay my abilities) even modest! The difficult thing is learning to NOT offer to do volunteer things-- to force myself to decline and button my lip. If this makes me look selfish and lazy, so be it -- it's better than inevitably failing at the task and leaving my friends in the lurch. Many are the community groups I value which have been weakened or even disabled by my failures.

Looking back over this letter, it looks like I've been whipping myself with the wet noodles more than I deserve. But actually, I'm fairly cheerful, especially because of the possibility of treatment and finally being able to volunteer help which will actually be helpful.

Sorry for the bablbing post. Back to you,

Ducky

Tylerlee17
11-01-07, 12:24 PM
I don't like the use of the words: Psychosis, Delusional, etc. IMO It's more like just extremely forgetful and unorganized... I always associate anti-psychotics with folks having delusions / schizophrenia, etc. Probably my #1 issue with ADHD is difficulty concentrating on task at hand which is paticularly a problem in school not so much anywhere else. #2 is my behavior being a bit hyperactive, and #3 is my forgetfulness.. but I definately don't associate what my symptoms are like to any kind of psychosis. I once had an ex girlfriend who was diagnosed with extreme depression. From time to time she would look up and ask me if I could see the clown that was standing in the corner of her room.... [yikes] that's what I associate with psychosis.

Matt S.
11-01-07, 03:37 PM
It was an article I bumped into by accident, honestly, and since I have never heard of it myself I guess I decided to share it. It seems odd but if it exists and is related to ADHD I guess why not post it.

The fact is though, there may be people labelled with schizophrenia who actually have this issue and may not be getting the proper treatment.

QueensU_girl
11-01-07, 04:03 PM
This has to be a spoof. (And I don't see a journal publication citation.)
;)

Skully
11-01-07, 04:43 PM
Wow. That certainly puts an interesting spin on things.

watts
11-02-07, 12:27 AM
This has to be a spoof. (And I don't see a journal publication citation.)
;)
Spoof meaning not legit? It's Wikepedia. Go to the bottom of the screen that comes up first, near the bottom click on ADHD Psychosis, then the Wikepedia comes up.

Myself, I've never heard of it till now, and found it very informative. I am an information nut, especially with anything related to ADHD. Thanks for providing this information.

Matt S.
11-02-07, 09:31 AM
The only other related thing I had access to, there were some full-text journal articles but I had to pay for them so I had no access.


<TABLE cellSpacing=0 cellPadding=0 width=570 border=0><TBODY><TR vAlign=top><TD colSpan=2><TABLE cellSpacing=0 cellPadding=0 width=410 border=0><TBODY><TR vAlign=top><TD width=570>From Medscape Psychiatry & Mental Health
http://images.medscape.com/pi/global/ornaments/spacer.gif Treating Comorbid ADHD and Psychosis

</TD></TR></TBODY></TABLE>http://images.medscape.com/pi/global/ornaments/spacer.gif Question What should I know about the treatment of comorbid ADHD and psychosis? Is it possible to use a stimulant medication if the psychosis is actually not acute? Should any specific ADHD medications be avoided in this setting?

Dr. Herbert Leherr, Switzerland

http://images.medscape.com/pi/global/ornaments/spacer.gif
Response from Craig Surman, MD
Instructor in Psychiatry, Harvard Medical School; Scientific Coordinator, Adult ADHD Research Program, Massachusetts General Hospital, Cambridge, Massachusetts


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Attention-deficit/hyperactivity disorder (ADHD) treatments are contraindicated for patients with current psychosis or a history of psychosis. This is because ADHD treatments could potentially exacerbate an underlying psychotic condition. Psychosis is a well documented but rare side effect of stimulant and bupropion treatments. Atomoxetine and desipramine, which are also effective ADHD treatments, have been reported as activators of manic symptoms, and psychosis can be a feature of mania. There are no data that I am aware of to suggest that any of these agents would be safer than any other to give to a patient with psychosis history.

There is little scientific evidence to guide treatment of patients with ADHD and psychosis. I would never start an ADHD treatment on someone who currently has untreated psychotic symptoms. I would consider adding an ADHD treatment to the treatment regimen for a patient with psychosis history, however, if the potential benefits greatly outweighed the risks. In such a case, I would first optimize antipsychotic treatment because the thought disorganization of untreated psychosis can mimic ADHD traits. Psychological testing could be helpful to determine the presence of residual psychosis.

In the case of an untreated patient with remote psychosis history but no residual psychosis, I would consider starting a prophylactic neuroleptic agent before initiating an ADHD treatment. I would also advise third-party observation or even hospitalization when possible to improve identification of emergent psychotic symptoms. I would not start an ADHD treatment with such a patient if I had any concern that their compliance or feedback to me would be inadequate to allow a safe treatment trial. I would also recommend starting ADHD treatment at lower doses than usual and very cautiously increasing the dose in such cases.


http://images.medscape.com/pi/global/ornaments/spacer.gif Posted 11/16/2005
http://images.medscape.com/pi/global/ornaments/spacer.gif <CENTER><HR width="75%"></CENTER>Suggested Readings

<TABLE><TBODY><TR><TD>

Cherland E, Fitzpatrick R. Psychotic side effects of psychostimulants: a 5-year review. Can J Psychiatry. 1999;44:811-813.
Surles LK, May HJ, Garry JP. Adderall-induced psychosis in an adolescent. J Am Board Fam Pract. 2002;15:498-500.
Tossell JW, Greenstein DK, Davidson AL, et al. Stimulant drug treatment in childhood-onset schizophrenia with comorbid ADHD: an open-label case series. J Child Adolesc Psychopharmacol. 2004;14:448-454.
</TD></TR></TBODY></TABLE>
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Funding Information
Supported by an independent educational grant from Shire.


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</TD></TR><TR><TD colSpan=2>
http://images.medscape.com/pi/global/ornaments/spacer.gif Disclosure: Craig B.H. Surman, MD, has disclosed that he has received grants for educational research from McNeil Pharmaceuticals. Dr. Surman has also disclosed the he serves as an advisor to Shire Pharmaceuticals.

http://images.medscape.com/pi/global/ornaments/spacer.gif
http://images.medscape.com/pi/global/ornaments/spacer.gif
http://images.medscape.com/pi/global/buttons/btn-backtotop.gif (http://www.medscape.com/viewarticle/516378#top)

Medscape Psychiatry & Mental Health. 2005;10(2) ©2005 Medscape


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hollyduck
11-02-07, 10:16 AM
Spoof meaning not legit? It's Wikepedia. Go to the bottom of the screen that comes up first, near the bottom click on ADHD Psychosis, then the Wikepedia comes up.
Well, when I went to the page, the article was preceded by: "This article is in need of attention from an expert on the subject. Please help recruit one, or improve this page yourself if you can."

The Wiki editor who originated the entry lists himself as Dr. Joe Kiff, as follows:

-------
This is the user page of Dr Joe Kiff. I previously worked under the title of Lifeartist (+20000 edits), but have decided, as this is a professional site, to use my full name.

I am a 55 year old clinical psychologist working in Dudley in the West Midlands,in England.

I am a strong believer in the wiki ideal and urge you to contribute to this site in any way you can. While the early structure exists I am sure we will find creative ways to expand it and make it immensely useful.


I founded this site in January 2006.


-------------

"This site" evidently being http://psychology.wikia.com , which is about 2 years old. I don't know if it is associated with Wikipedia proper, or just has the Wiki format.

No more time for research this morning, see you all later.

Ducky

kilted_scotsman
11-02-07, 04:18 PM
Run away run away..'sssss wikied maaan

Very very dubious line of argument.

kilt

speedo
11-03-07, 02:23 PM
This article is just some wiki that someone is using to stage their joke/misinformation/opinion. As far as I know there is no such thing as adhd psycosis and there is no way that a professional would confuse impusivity and distractability with psycosis. It would be like comparing chickens and Aardvarks then calling a chicken "disordered" because it does not look like an Aardvark.


ME :D


This was interesting


http://psychology.wikia.com/wiki/ADHD_psychosis

Matt S.
11-03-07, 02:25 PM
I totally agree, it's merit only came up in the second one that I had posted, where there is comorbidity.

ozchris
11-07-07, 03:19 AM
Spoof meaning not legit? It's Wikepedia. Go to the bottom of the screen that comes up first, near the bottom click on ADHD Psychosis, then the Wikepedia comes up.

Myself, I've never heard of it till now, and found it very informative. I am an information nut, especially with anything related to ADHD. Thanks for providing this information.Please be aware that anyone can post anything they want on wikipedia :) It should not be relied upon for accurate information just by itself.

Thanks for sharing it but it must be a hoax or something. It doesn't really make sense to call that psychosis and it even states that in the article:

"These symptoms would, from a psychological standpoint, not be considered a psychosis (http://psychology.wikia.com/wiki/Psychosis), but rather a behavioral or thought disorder that is related to the pre-existing ADHD condition; if the patient was actually psychotic, he would hold a false belief, even if it can be disproven, but an ADHD patient is usually aware, at least on a subconscious level, that his actions are not always consistent with reality, but nonetheless exhibits the behavior due to a lack of control of his impulses." Always check references and try and find out who is doing the study. That's my number 1 rule anyway. So many things claiming to be studies are either extremely bias or very misinformed (not all, but lots)

It would have tricked me too but I know psychosis is very scary and ADD symptoms not so much. I've been tricked by similar things before :o

Matt S.
11-07-07, 09:44 AM
You can have a comorbidity but this alleged condition which is helped by stimulants is bogus, my second post that was an article was pretty accurate.

Matt S.
11-07-07, 03:19 PM
Annals of the New York Academy of Sciences 931:297-301 (2001)
© 2001 New York Academy of Sciences (http://www.annalsnyas.org/misc/terms.shtml)




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

</NOBR><NOBR>LEWIS A. OPLER<SUP>a,b</SUP></NOBR>, <NOBR>DENISE M. FRANK</NOBR> AND <NOBR>PAUL M. RAMIREZ<SUP>b</SUP></NOBR>


<SUP>a</SUP>Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Research Division for the New York State Office of Mental Health, New York, New York 10032, USA<SUP> </SUP>
<SUP>b</SUP>Doctoral Program in Clinical Psychology, Long Island University (Brooklyn Campus), 1 University Plaza, Brooklyn, New York 11201, USA<SUP> </SUP>



Address for correspondence: Lewis A. Opler, M.D., Ph.D., 765 Gramatan Avenue, Mount Vernon, NY 10552. Voice: 914-668-4799; fax: 914-668-4814.<SUP> </SUP>
lao1@columbia.edu (lao1@columbia.edu)<SCRIPT type=text/javascript><!-- var u = "lao1", d = "columbia.edu"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//-->*********** <SUP></SUP>



<!-- ABS -->Whether conceptualized as comorbid ADD with psychosis or as<SUP> </SUP>a distinct diagnostic entity—ADD psychosis—patients<SUP> </SUP>with features of both ADD and psychosis benefit from treatment<SUP> </SUP>with psychostimulants. It is hypothesized that psychostimulants<SUP> </SUP>have their therapeutic effect via amelioration of frontal lobe<SUP> </SUP>dysfunction.<SUP> </SUP>
Key Words: Attention deficit disorder psychosis • Psychostimulants • Frontal lobe
http://www.annalsnyas.org/cgi/content/abstract/931/1/297

I might be wrong

ozchris
11-07-07, 05:43 PM
Look fine at first glance. I'll have a look later because it does seems interesting.

btw: love the tom cruise thing :D made me lol.

Electra2
11-07-07, 05:59 PM
Intersesting:cool:

speedo
11-07-07, 07:02 PM
yah, adhd AND psycosis I can understand, but "ADHD psycosis" is bogus.

The troible with wikipedia is that everything can be bogus, and it frequently is.

ME :D

Electra2
11-08-07, 05:30 AM
It would have tricked me too but I know psychosis is very scary and ADD symptoms not so much. I've been tricked by similar things before :oI think you have a good point there!I have read that psychosis is very scary and there is allways strong emotions detached to the confution.ADD-attacs are just annoing/irritating.

Matt S.
11-08-07, 10:04 AM
Well I don't honestly know because I don't have it but I found more than just a wiki article in regards to this first disaster I posted, two exactly. So just to make it more valid, maybe the moderator if it is speedo, for example can rename the thread ADHD and Psychosis so that way I don't have to keep looking for posts to validate it when I get defensive because people keep reposting the same comments in regards to the original thing which I beleive I said:

this looks interesting...
versus

this is fact

speedo
11-08-07, 08:50 PM
It's not you, you just posted what you found. It's wikipedia that is all awry. I can change the name of the thread per your request.

Me :D

Electra2
11-10-07, 03:34 PM
it was interesting anyway!:cool:

TygerSan
11-13-07, 09:31 AM
Interesting . . .

The second article is important because it highlights the fact that one can give psychostimulants to people suffering from psychosis and it can make them better. Common belief (and indeed one "animal model" of schizophrenia) is that since very high doses of amphetamine cause psychosis, giving psychostimulants to people who were psychotic to begin with would worsen their symptoms. . . soo this article is really saying that the common belief is not always correct, and that some people may be needlessly suffering from ADHD symptoms because Dr's refuse to prescribe psychostimulants to those with psychotic symptoms.

Fuse
02-10-08, 07:57 AM
It's not you, you just posted what you found. It's wikipedia that is all awry. I can change the name of the thread per your request.

Me :D

I disagree. Wikipedia is for the most part always at least in the ballpark when it comes to the validity and accuracy of its articles (unless they're extremely new for instance, or have been defaced - but many articles are locked in these days and defaced articles are quickly detected and reverted). It has improved a lot since its conception, which is a point hammered home by its founder in his recent attempts to allow wikipedia as a reference in undergrad essays and papers (previously he was against wikipedia as a reference). ADHD shouldn't be your sole source of information (nothing should be a sole source of information), but it's certainly not a bad way to quickly brush up on the basics of a topic - as a springboard to more technical information on that topic. Also, for articles with a bias or which lack sources, you will almost always see a message at the top of the page stating as much.

The host of the ADHD psychosis article is not wikipedia. It is a website using the wiki style of content dissemination. There is no other relationship.

My 2 pence.

Scattered
02-19-08, 10:01 PM
It seems to me if you are dealing with an actual psychosis you've moved beyond ADHD territory by definition into schiphrenia or bipolar, etc. I wouldn't call what he is describing psychosis -- there is no delusion present -- just poor follow through. Barkley talks about how with folks with ADHD it's not that they don't know, but that they have trouble acting on what they do know.

KurtG85
03-10-08, 09:00 AM
Defining this 'ADD-psychosis' as a specific disorder sounds pretty silly to me. It would be pretty confusing to call these symptoms 'psychosis' when they are actually just results of severe ADD. A defined label something along the lines of: 'ADD with psychotic-like (but not actually psychotic) symptoms' would probably be helpful though.
My first doctor mis diagnosed me as psychotic due to these exact same misperceptions.

justAwierd-o
03-19-08, 07:53 PM
I don't have ADHD. But the voices in my head do!

Kidding.

(not trying to insult anything, btw)

dotan
03-26-08, 05:21 PM
i can see why it might look like psychosis
the dissorgenized thought process . abstract mode of thinking . also when im tired and in deep need for stimuli i can easily look like in manic state but its never true psychosis . its intresting to see that schizophrenia and adhd both seem to have pathologys regarding dopamin .and the affect and emotional control seen in adhd seems at first glance like the flat affect of schizophrenia