Varied Presentations and Specific Treatment of Adult Attention-deficit Hyperactivity Disorder: Is There a Learning Lesson?

Abstract

Abstract The importance of diagnosing and treating adult attention-deficit hyperactivity disorder (ADHD) effectively is accepted nowadays. However, significant numbers of ADHD adults are missed because of variability in presentations that impede diagnosis. Complex presentations occur due to many factors such as individual variations in neurodevelopmental deficits, impact of comorbidities, genetic load, coping mechanism, and intelligence. With this background, four outpatient department cases are selected. The objective is to describe variability in presentations/symptoms, diagnostic dilemma, and partial recovery and discuss the effectiveness of treatment which is not reported before. Cases presenting with comorbidities/unsuspecting presentations/relapses that created diagnostic conundrum are selected. Uncommon varied presentations, not reported before such as persistent dysphoria, unremitting childhood insomnia, nonresponding obsessive rumination, pathological sense of morality, inappropriate behavior, and paresthesias are described. Combination of suboptimal dose of Atmoxetine (ATX) and that of sustained release Methylphenidate (MPH) which is not reported before is described in this series. Use of symptomatic pharmacotherapy along with specific psychotherapy that brought lasting relief is unfolded here.