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Adult ADHD in Schizophrenia Spectrum and Other Psychotic Disorders

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

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Abstract

Among disorders including psychotic symptoms, Schizophrenia is the most well known and it has been recognized as one of the top 25 leading causes of disability worldwide in 2013. A consistent proportion of people with schizophrenia present a lifetime history of substance use disorders, and the underlying neuropathology of schizophrenia may contribute to enhanced addiction vulnerability. Even though most cannabis users do not develop psychiatric disorders in adulthood, it is also well known that early and frequent cannabis use is linked to a higher risk of psychosis onset, and can trigger the disorder in vulnerable individuals.

Genetic studies found a correlation between schizophrenia and ADHD, suggesting the overlap of some risk alleles for the two conditions. Moreover, there is evidence regarding the presence of prodromal attentional deficit in people with schizophrenia. It is important to know that ADHD is the most common comorbid disorder in people with a childhood-onset schizophrenia, and that the presence of childhood ADHD is an important risk factor for the development of schizophrenia.

In consideration of the evidence showing the high frequency of ADHD in people with schizophrenia, a clinical assessment for ADHD in this population is mandatory. This is even more important when there is a history of substance/alcohol abuse. Indeed, higher ADHD scores have shown to predict a history of any abuse or dependence and to be implicated in poorer clinical outcomes and treatment compliance in people with schizophrenia.

When we consider the relationship between schizophrenia and ADHD, we have to take into account the fear regarding the potential of psychostimulants in producing psychosis or in increasing risk for developing schizophrenia. Evidence on this issue is controversial, but the ADD psychosis appeared somewhat different from psychosis characterizing schizophrenia.

Impaired attentional processing is a prominent feature of schizophrenia and it is—unfortunately—largely unresponsive to currently available medications. In this regard, an interesting trial with animal models found that low doses of cariprazine showed a potential for improving attentional impairment and other cognitive defects associated with schizophrenia.

For what concerns the comorbidity of ADHD and schizophrenia, there is evidence supporting the utility of stimulants in improving attentional deficits without worsening psychotic symptoms and in reducing the negative symptoms of schizophrenia.

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Pallanti, S., Salerno, L. (2020). Adult ADHD in Schizophrenia Spectrum and Other Psychotic Disorders. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_8

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