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Detecting and treating adult attention deficit hyperactivity disorder in a patient with schizophrenia

Diagnostik und Behandlung von ADHS bei einem erwachsenen Patienten mit Schizophrenie

  • case report
  • Published:
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Summary

Background

The comorbidity of attention deficit hyperactivity disorder (ADHD) and schizophrenia poses a considerable diagnostic challenge due to significant symptom overlap, and represents a highly debilitating condition for the patient. This case report aims to present the history of a 19-year-old patient suffering from these two diagnostic entities, and thereby seeks to elucidate diagnostic and therapeutic approaches for this condition.

Methods

The Diagnostic and Statistical Manual of Mental Disorders (fourth edition) criteria for ADHD and schizophrenia were used to establish clinical diagnoses. Furthermore, an in-depth clinical interview with the patient’s mother was carried out. Finally, a clinical interview was conducted with the patient and the Wender Utah Rating Scale was applied to assess ADHD symptoms retrospectively.

Results

Outcomes of the mentioned diagnostic approaches confirmed the diagnosis of ADHD in the patient suffering from schizophrenia. As amphetamines would be contraindicated in the described patient, atomoxetine, a drug approved for the treatment of ADHD due to its efficacy as a selective norepinephrine reuptake inhibitor, was chosen. Following a 6-week interval after treatment initiation, a clinical re-evaluation was carried out, which showed an improvement of symptoms according to the International Classification of Diseases (tenth revision) criteria.

Conclusion

The present case report indicates that atomoxetine may be effective in treating symptoms of ADHD in patients with schizophrenia, without increasing psychotic symptoms. Results are discussed in terms of diagnostic and therapeutic implications.

Zusammenfassung

Hintergrund

Die Komorbidität von ADHS und Schizophrenie stellt aufgrund von Symptomüberlappung eine erhebliche diagnostische Herausforderung dar und ist für den Patienten eine stark beeinträchtigende Bedingung. Der vorliegende Fallbericht setzt sich zum Ziel, die Anamnese eines neunzehnjährigen Patienten, der unter den erwähnten zwei diagnostischen Entitäten leidet, darzustellen und dadurch diagnostische und therapeutische Herangehensweisen darzulegen.

Methoden

DSM-IV Kriterien für ADHD und Schizophrenie wurden herangezogen, um die klinischen Diagnosen zu erstellen. Überdies wurde ein klinisches Interview mit der Mutter des Patienten durchgeführt. Schließlich wurde auch mit dem Patienten ein klinisches Interview durchgeführt sowie die Wender Utah Rating Scale angewandt, um retrospektiv ADHD Symptome zu erfassen.

Ergebnisse

Die Ergebnisse der erwähnten diagnostischen Zugänge bekräftigten die Diagnose von ADHD bei jenem Patienten mit Schizophrenie. Da die Verabreichung von Amphetaminen bei beschriebenem Patienten kontraindiziert ist, wurde Atomoxetin, ein Medikament, das für die Behandlung von ADHD aufgrund seiner Wirksamkeit als selektiver Noradrenalin-Wiederaufnahme-Hemmer zugelassen ist, verwendet. Nach einem sechswöchigen Intervall nach Behandlungsbeginn wurde eine klinische Re-evaluierung durchgeführt, die eine Symptomverbesserung nach ICD 10 Kriterien zeigte.

Schlussfolgerung

Der vorliegende Fallbericht beschreibt, dass Atomoxetin in der Behandlung von ADHD Symptomen bei Patienten mit Schizophrenie wirksam sein kann, ohne psychotische Symptome zu steigern. Die Ergebnisse werden in Bezug auf diagnostische und therapeutische Implikationen diskutiert.

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Acknowledgments

The authors thank the patient for allowing them to publish his case report. The authors are grateful for the proof reading of the manuscript by Anne Unger.

Conflict of interest

Julia Huemer and Ingrid Sibitz report no conflict of interest.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Julia Huemer MD

  2. Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

    Ingrid Sibitz

Authors
  1. Julia Huemer MD
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  2. Ingrid Sibitz
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Correspondence to Julia Huemer MD.

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Huemer, J., Sibitz, I. Detecting and treating adult attention deficit hyperactivity disorder in a patient with schizophrenia. Neuropsychiatr 28, 92–96 (2014). https://doi.org/10.1007/s40211-014-0103-0

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  • DOI: https://doi.org/10.1007/s40211-014-0103-0

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