Attention deficit disorder psychosis as a diagnostic category.

Abstract

The hypothesis is advanced that certain psychoses in adults devolve from attention deficit disorder (ADD), which has a fundamental impact on cognitive and social development and thus affects personality structure and psychodynamics. This 'ADD psychosis' often masquerades as schizophrenia or an affective disorder and hence is frequently misdiagnosed, precluding appropriate clinical intervention. Based upon clinical evidence and empirical research involving phenomenological comparisons, premorbid history, high risk studies, neurodiagnostic evaluations, and pharmacotherapeutic response, it is suggested that ADD psychosis in adults be regarded as a separate diagnostic entity. Distinguishing symptomatology, anamnesis, family history, therapeutics, as well as prognosis, are discussed. The concept of attention deficit disorder (ADD), until recently referred to as minimal brain dysfunction (MBD), has been conceived as a childhood affliction with rather specific and circumscribed manifestations. The diverse features which embrace this syndrome, such as hyperactivity and dyslexia, were first identified and subsumed under the collective banner of MBD about 2 decades ago. The complex hypotheses concerning its possible etiology have been detailed elsewhere and need not be repeated here. Rutter, based on his extensive literature review and seminal studies, has come to regard MBD as a subclinical brain disorder developing from a genetically determined biochemical abnormality, which produces symptoms of hyperactivity, impulsivity, attention deficit, aggressivity, and conduct disturbance. Indeed, factor analytic studies reviewed by Rutter support the co-occurrence of these pathological features in children, yet the empirical evidence for a distinct syndrome and for a precise etiology has been admittedly weak, with some contending that MBD or ADD is simply a catch-all for disparate neurological symptoms of unknown and variable pathogenesis.