Attention-deficit/hyperactivity disorder in adult (ADHD), alcohol dependency, and combined personality disorder

The diagnostic problems and therapeutic strategies in a 28-year old psychiatric inpatient with a hyperkinetic syndrome, alcohol-dependency and a combined personality disorder were discussed. Without knowledge of his psychiatric history in childhood, we initially diagnosed a psychosis, cognitive disorder and a personality disorder. Because of a nor-response to fluoxetine and imipramine in the post, we started pharmacotherapy with moclobemid (900 mg/die). Within 5 weeks we observed a 50% improvement of the cognitive performance, psychomotoric activity and social behaviour. After an augmentation with methylphenidat (40 mg/die) further improvement occurred. Through concomitant behaviour therapy the goal of a better doily structuring, a more realistic self-concept and better psychosocial adaptation was only partially realized. During the follow-up period of 2 years the patient stopped the medication and relapsed into psychosocial impairment.