ADHD and Schizophrenia: Decoding the Connection
Understand overlapping symptoms, risk factors, and treatment approaches for this rare, and serious, comorbidity.
Q: Schizophrenia is a rare brain disorder, but its prevalence rate among adults with ADHD is about double that of the general population – 0.9 percent versus 0.45 percent. Likewise, rates of ADHD among people with schizophrenia range from 10 percent to 47 percent, compared with 3 percent to 6 percent in the general population.
ADHD and schizophrenia are distinct neurodevelopmental disorders with some overlapping symptoms, such as inattention, impulsivity, weak working memory, and emotional dysregulation. Symptoms of schizophrenia may also include hallucinations, delusions, and paranoia. Understanding how ADHD fits into this diagnostic picture, and untangling overlapping symptoms, leads to better treatment approaches and outcomes.
While most people with ADHD will never develop schizophrenia, these factors increase risk: family history of schizophrenia, adverse childhood experiences or trauma, and abuse of psychoactive substances, such as marijuana that contains elevated levels of THC.
Schizophrenia typically emerges in the late teens through early thirties. ADHD can be diagnosed at any age, though it usually emerges in the early grade school years.
[Watch: “Understand How ADHD and Schizophrenia Overlap”]
ADHD and Schizophrenia: Treatment Options
When treating comorbid schizophrenia and ADHD, a priority must be to treat any psychosis with first-generation antipsychotics such as Haldol and Trilafon, or second-generation antipsychotics such as Abilify and Risperdal. Antipsychotics can be taken orally in the form of daily pills or as injectables. Recent innovations have yielded exciting new medications, such as injectables effective for as long as three months, and other promising new interventions are on the horizon. Antidepressants, mood stabilizers, or anti-anxiety drugs may also help in treating associated symptoms of schizophrenia, as do adjunctive therapies such as cognitive behavioral therapy and family therapy.
Only after the psychosis is under control can clinicians clearly identify symptoms associated with ADHD and prescribe treatment. ADHD is associated with low dopamine levels in the brain, and most ADHD medications are intended to increase these. Patients with schizophrenia tend to have high dopamine levels, so doctors must exercise caution when prescribing stimulants to them. If medication increases dopamine levels further, this may exacerbate schizophrenia by worsening psychosis.
[Read: Why ADHD Brains Crave Stimulation]
Under the consistent care of a clinician, patients with schizophrenia who adhere to their medication regimen tend to do very well. No matter a condition’s treatment challenges, I understand a patient and their symptoms more fully every time I see them. I learn from what we’ve tried, bringing us closer to getting a medication combination just right. This kind of treatment takes trial and error, thoughtfulness, and time spent with a doctor.
ADHD and Schizophrenia: Next Steps
- Read: When It’s Not Just ADHD – Symptoms of Comorbid Conditions
- Read: ADHD Comorbidity – An Overview of Dual Diagnoses
- Read: A Clinician’s Guide to Impulsive Aggression
Napoleon B. Higgins, Jr., M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.
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