How do you approach stimulant prescribing for ADHD in a patient with auditory hallucinations, that can be command in nature (suicide), who will not take an antipsychotic medication?  

Without knowing more history, I would never prescribe stimulants for such a patient. I respectfully disagree with Dr. Gill. Stimulants can cause and do exacerbate psychosis. And I’m not sure what Dr. Gill means when he says Wellbutrin is the culprit? A patient with Chronic Schizophrenia with A...

The first order of business is diagnostic clarity. Is the disorder causing hallucinations also causing symptoms that are being mistaken for ADHD? Is ADHD pre-existing, and now the patient is presenting with hallucinations? Are the hallucinations secondary to existing ADHD treatment (stimulants can c...

It’s important to remember that our psychiatric diagnostic process is not a simple checklist, and a hierarchical approach must not be forgotten. In lieu of psychosis, suicide, and command hallucination, inattention must be considered within that psychopathology system. A diagnosis of ADHD is n...

While I generally try to work with patients who refuse the ideal medications (in this case, the antipsychotics), I also would not give them a stimulant (which could exacerbate their condition). I once had a patient who had very high blood pressure tell me I was “Required” to give him Add...

I would not prescribe a stimulant medication for a patient with auditory hallucinosis, especially one with command hallucinations of suicidal content. You mentioned that the patient will not take an antipsychotic. At least where I live, if a patient presents a danger to themselves, which I would ass...

I will not prescribe a stimulant to this patient. More than likely, their ADHD is caused by their psychotic process. I will wait to treat them with appropriate antipsychotic involuntarily and keep evaluating the MS.

1. Clarify the diagnosis. ADHD will not cause hallucinations. Stimulants may worsen hallucinations, cause hallucinations at high doses, and should NOT be prescribed when active hallucinations are present.  Is the AH a true hallucination? If so, what is the cause? Considering organic causes a...