Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood

Abstract

Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population—the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.

• ADHD
• Conduct disorder
• Forensic
• Psychosis
• Schizophrenia
• Substance abuse

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Notes

¹ The DSMIII criteria of ADHD were based on clinical descriptions of children infected by the von Economo influenza type virus during the epidemic of 1915–1926 in Europe and North America, Encephalitis lethargica. The clinical syndromes, which differed in children and adults, were probably caused by auto-immune mechanisms in vulnerable individuals (cf. 10). Such a mechanism, targeting the basal ganglia, is probably involved in the recent 10-fold increase in narcolepsy in Sweden associated with Swine flu and the corresponding vaccine. Treatment by central stimulants for “minimal CP children” was found to be effective in the mid-1930s (Bradley C, The behaviour of children receiving Benzedrine. Am J of Psychiatry1937;94:577–585).