Psychosis Requiring Hospitalization in an Adult ADHD Patient on a Therapeutic Stimulant: A Case Report and Review of Treatment Alternatives

Abstract

Introduction: This is a case of a patient on therapeutic dextroamphetamine for adult ADHD who developed severe psychotic symptoms requiring hospitalization and anti-psychotic medication. While there are case reports of patients who abuse stimulants or do not take them as directed, there is little in the literature describing those who take moderate doses as prescribed, particularly over a short duration, and develop florid psychosis. Case Presentation: A 26 year old male who suffered from adult attention-deficit hyperactivity disorder (ADHD) was brought to the attention of the psychiatric consult-liaison service as he suddenly developed psychotic symptoms after taking a prescribed stimulant three times per day for a short duration. He ultimately required a four-day hospitalization in inpatient psychiatry with medication management lasting nearly two weeks before complete symptom resolution was achieved. Conclusion: Patients taking stimulants as prescribed for the treatment of ADHD may be at risk of developing psychosis. It is essential that patients be monitored closely on initiation of treatment and during induction for behavioral changes. Fortunately, there are a variety of pharmacologic and behavioral treatment modalities that do not include stimulants, but that are proven effective and can be used as alternatives in such cases.

Psychosis Induced by Methylphenidate in Children and Young Patients With Attention-Deficit Hyperactivity Disorder

“…In a case report, Gable and Depry outlined a 26-year-old patient with ADHD who required hospital admission after taking the prescribed dose of a stimulant [ 24 ]. The report points out that patients taking stimulants to treat ADHD may be at risk of developing psychosis [ 24 ].…”

“…In a case report, Gable and Depry outlined a 26-year-old patient with ADHD who required hospital admission after taking the prescribed dose of a stimulant [ 24 ]. The report points out that patients taking stimulants to treat ADHD may be at risk of developing psychosis [ 24 ]. Until the underlying risk factors become apparent, all practitioners need to have a complete psychiatric and family history of schizophrenia before prescribing the medication [ 24 ].…”

“…The report points out that patients taking stimulants to treat ADHD may be at risk of developing psychosis [ 24 ]. Until the underlying risk factors become apparent, all practitioners need to have a complete psychiatric and family history of schizophrenia before prescribing the medication [ 24 ]. It is also important for patients to carefully monitor behavioral changes at the start of treatment and during induction while emphasizing the importance of taking prescribed medications to avoid the development of psychosis [ 24 ].…”