Stimulant Misuse in College for “Pseudo-Attention Deficit Disorder” During Schizophrenia Prodrome

“Mr. A,” a 20-year-old man, with normal childhood development and no behavioral or academic problems, graduated high school with honors despite regular marijuana use. During his sophomore year, he suddenly found it difficult to concentrate and demonstrated difficulty keeping up with his course work. These difficulties prompted him to try a friend’s prescription stimulant Adderall, which he found effective and continued to use it intermittently without a prescription for "cramming." Several months after starting Adderall, he became acutely psychotic after smoking phencyclidine-laced cannabis at a party. He required a lengthy hospitalization but was eventually stabilized and treated with aripiprazole 10 mg/daily. His request for stimulants “to concentrate better” was resisted, and after 6 months of treatment with aripiprazole, he made a full symptomatic and functional recovery without any objective or subjective residual psychotic or cognitive symptoms. His provisional diagnosis of schizophrenia was confirmed when he had a psychotic relapse 3 months after discontinuing his maintenance antipsychotic aripiprazole following 1 year of treatment.