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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4032
Experience:  MD Psychiatry
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Schizotypy and ADHDIm diagnosed with Schizotypal disorder

Customer Question

Schizotypy and ADHD
I’m diagnosed with Schizotypal disorder and comorbid ADHD. I’ve read that changes in cortico-subcortical DA neurotransmission occur in both disorders. But schizotypy, which, I guess, is the subclinical expression of schizophrenia is also associated with increased risk of psychosis and thus theoretically associated with excessive DA activation whereas ADHD theoretically is associated with deficient DA activation. I’m in treatment with both an atypical antipsychotic and a stimulant and I’m rather confused about the relationship between ADHD and schizotypy. To me it seems as if the two conditions are the opposite of each other. Try to explain it for me please.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Anna replied 5 years ago.
They are separate disorders. The treatments that you're on may have connections, but that doesn't mean the disease does.
Customer: replied 5 years ago.

Try to explain

Expert:  Dr. Kaushik replied 5 years ago.
Hi there ,

Welcome to Juts answer !

Since you have opted out on the previous expert , i would like to field your question.

Do you mean to say that you are diagnosed with Schizotypal personality disorder ?

Kindly confirm this and i shall get back to you with an appropriate reply.

Regards...
Customer: replied 5 years ago.

No, I'm diagnosed with Schizotypal disorder (schizotypy) according to ICD-10. In ICD-10, schizotypal disorder is classified together with the schizophrenias rather than with the personality disorders. ICD-10 schizotypy represents a milder, less psychotic, variant of schizophrenia but there is no clear-cut division between the two disorders.

Customer: replied 5 years ago.

To summarize:
I'm diagnosed with Schizotypal disorder (schizotypy) according to the ICD-10 and comorbid ADHD. In the ICD-10, schizotypal disorder is classified together with the schizophrenias rather than with the personality disorders. ICD-10 schizotypy represents a milder, less psychotic, variant of schizophrenia but there is no clear-cut division between the two disorders. I've read that changes in cortico-subcortical DA neurotransmission occur in both schizotypy and ADHD. But schizotypy, which, I suppose, is the subclinical or even prototypic expression of schizophrenia-like features is also associated with increased risk of psychosis and thus theoretically associated with excessive DA activation whereas ADHD theoretically is associated with deficient DA activation. The first line treatment of psychosis or schizophrenia-like features is dopamine blockade, while the first line treatment for ADHD is dopamine enhancement. I'm in treatment with both an atypical antipsychotic and a stimulant and I'm rather confused about the relationship between ADHD and schizotypy. To me it seems as if the two conditions to some extent are the opposite of each other. But anyway, I am a living example of the two disorders occurring at the same time. Try to explain it for me, please.

Expert:  Dr. Kaushik replied 5 years ago.
Thanks for the reply and i must say that i am quite impressed by your research on these 2 disorders , and i shall try my best to explain to you the 2 disorders in question, and how they are not opposite to each other.

I Agree to the point made by you that in Schizotypy which is a variant of schizophrenia , and along with it is included in Schizophreniform disorders , THERE IS excessive dopamine activity while in ADHD there is decreased dopamine activity , if we look at these 2 disorders this way , then we wil think that they are opposite to each other , but if we further dwell on the mechanism of causation of the 2 disorders , we wil get to know that the 2 disorders are different from each other and not opposite to each other.

Well, to support my explanation , let me tell you the most significant point , and that is in Schizophrenia like disorders it is the Dopamine D2 receptors in the mesolimbic system which are involved , at which there is excessive dopamine activity is seen , and it is these Dopamine D2 receptors which are aimed at by the anti psychotics to block them , thereby decreasing the dopamine activity , and thus controlling psychosis . While , IN CONTRAST TO THIS , in ADHD , it is the Dopamine D4 RECEPTORS PLUS THE DOPAMINE TRANSPORTERS WHICH ARE EFFECTED , due to which the there is decreased dopamine activity , and so the psychostimulants aim at these dopamine D4 receptors and incrase the dopamine activity .

So, you see , in a simple manner we look at this , it is the Dopamine D2 receptors whch are involved in schizophrenia like disorders while itis the Dopmaine D4 Receptors and dopamine transportes that are involved in ADHD , so since there are 2 different receptors involved we consider them different disorders , as, only the same receptor had been involved then we could have considered the 2 disorders opposite to each other, but this is not the case.

Also, in ADHD , besides the dopamine receptors D4 and dopamine transporters , other receptors such as 5HT2A AND 5HT1B , monoamine oxidase , and serotonin transporter promoter are also involved ,while in schizophrenia these receptors have no role to play.

Also, some theories also claim that ADHD occurs due to reduction in brain volume , but no theory claiming increase in brain volume which is opposite to the ADHD theory is made to reason the cause of schizophrenia.

sO, I BELIEVE if you get into depth of these two disorders then you will realise that actually the mechanisms involved in the causaion of these disorders is very differnt , and also let me clarify that since anti psychotics that you are using for schizotypy will be acting on only D2 dopamine receptors and not effecting Dopmaine D4 receptors , on which psychostimulants will be acting for ADHD , so there will be no cross interaction between Anti psychotics and psychostimulants ,and so you shall continue on them without any apprehension.

I am MENTIONING BELOW A few links which will throw more light on these 2 disorders .

http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder#Causes

http://en.wikipedia.org/wiki/Schizophrenia

I hope this helps in clearing your doubts .

I wish you all the best. Take care..

Please press the ACCEPT button if you are satisfied with the answer as only then will i be credited for my service.

Regards...
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4032
Experience: MD Psychiatry
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