ADHD and Schizophrenia

The report in the December 20, 2002, issue on a possible link between a diagnosis of ADHD when the patient has a close relative with schizophrenia and an increased risk of developing schizophrenia got my attention.

I want to use this opportunity to emphasize the importance of avoiding stimulant medications in close relatives of schizophrenia patients. This is relevant because, as the authors of the featured research study found out, relatives of persons with schizophrenia often have attention problems. That characteristic is the one that probably accounts for many misdiagnosed cases that we identify only when some of these youths come to us with a full-blown psychotic episode that followed a course of amphetamines.

Maybe we need to pay more attention to the findings of people like Dr. Nora Volkow, who presented PET scan images of how methylphenidate blocks the reuptake of dopamine with power similar to that of cocaine (Psychiatric News, January 18). If we think of methylphenidate as a wonderful drug for ADHD but also as a dangerous substance for people with anxiety, mania, or psychosis, we will be more careful at the time of diagnosing a person with ADHD. More important, we will never endorse allowing a teacher or a school counselor to make medical diagnoses like ADHD.

Dr. Keshavan’s study is interesting and eye-opening in many ways, but sadly the type of questions in the research instruments they use are not intended for use with little children. They are the ones who will get that Ritalin, Adderall, or Concerta prescription if their attention span is compromised or they appear to be hyperactive, which takes us to another important issue: hyperactivity can be more than just ADHD.