ADHD psychosis

Definition
ADHD psychosis (or ADD psychosis) is a distinctive form of psychosis, identified by Leopold Bellak and his colleagues, which accompanies attention-deficit hyperactivity disorder (ADHD).

Treatment
ADHD psychosis tends to be treatable with typical ADHD medication such as stimulants, antidepressants, or a combination of the two. ADHD psychosis can also be treated with psychotherapy, which is often an adjunct to the pharmaceutical treatment of ADHD. ADHD psychosis responds to neither conventional neuroleptics, such as Haldol or Thorazine, or atypical antipsychotic medications, such as Seroquel, Zyprexa or Risperdal, currently the most commonly prescribed antipsychotic.

Prevalence
Although this condition does not appear in DSM-IV, and is not widely recognized, it has been detailed in several academic papers which give a number of case examples1, 2, 3.

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 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.

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 or suffers from a mental illness, such as 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, 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.

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, 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

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; the effects of such reactions from others can have a negative impact on the patient's psyche, and sometimes patients begin to believe themselves that they actually are psychotic.