Raising attention to attention deficit hyperactivity disorder in schizophrenia

Abstract

Schizophrenia and attention deficit hyperactivity disorder (ADHD) are two psychiatric disorders with a negative impact on quality of life of individuals affected. Although they are classified into distinct disorders categories, attentional dysfunction is considered as a core feature in both conditions, either at the clinical then pathophysiological level. Beyond the obvious clinical overlap between these disorders, the Research Domain Criteria approach might offer an interesting perspective for disentangling common circuits underpinning both disorders. Hence, we review evidences regarding the overlap between schizophrenia and ADHD, at the clinical level, and at the level of underlying brain mechanisms. The evidence regarding the influence of environmental risk factors in the emergence of both disorders, and their developmental trajectories is also reviewed. Among these, we will try to elucidate the complex relationship between stimulants use and psychotic symptoms, discussing the potential role of ADHD medication in inducing psychosis or in exacerbating it. We aim that, taken together, these findings may promote further investigation with important implications both for clinicians and research. In fact, considering the amounting evidence on the overlap between schizophrenia and ADHD, the delineation of their boundaries might help in the decision for diagnosis and treatment. Moreover, it may help to promote interventions focused on the prevention of both schizophrenia and ADHD, by the reduction of recognized environmental risk factors.

Keywords: Attention deficit disorder with hyperactivity; Central nervous system stimulants; Psychotic disorders; Schizophrenia; Toxic psychoses

Core tip: In line with the translational approach of viewing disorders in terms of dysregulation of brain basic mechanisms, there is increasing evidence of overlap between different mental disorders. Here, we explore relationships between attention deficit hyperactivity disorder and schizophrenia, in light of recent insights into potential common etiological mechanisms explaining some of the observed overlap in both disorders. Using evidence from clinical epidemiology and neuropsychology, we propose a biologically-based reconsideration of these brain diseases. We have also summarized environmental risk factors for both disorders, aiming to promote awareness regarding the need of appropriate interventions to prevent the onset and development of these diseases.