Behavioral disorders in emergencies. Differential diagnosis and treatment

Introduction The clinical case has been submitted because it presents a number of difficulties in diagnosis. After seven psychiatric hospitalizations, it does not present a definitive diagnosis, poor prognosis and multiple relapses. Objectives Both analyze clinical, psychopathological and epidemiological characteristics of behavioral disorders in relation to a clinical case and review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of an appropriate differential diagnosis to reach a correct therapeutic approach. Methods Review of the impact literature for the last five years concerning behavioral disorders: prevalence, incidence, pathogenesis and its relationship with psychiatric disorders encoded in DSM-V. Results It is evident that the patient has behavioral disorders and psychotic symptoms in the context of cocaine intoxication. Although sometimes the dose of cocaine has been very small and probably not justifies in all cases a toxic psychosis, it is true that withdrawal periods have been short; therefore difficult to assess. Also mania-like symptoms have been discussed because the patient has an increased activity, dysphoric mood, anxiety and decreased need for sleep. Conclusions Response to treatment and hyperactivity, impulsivity and inattention characteristics make us consider the diagnosis of adult Attention Deficit Hyperactivity Disorder (ADHD). ADHD in adults and adolescents have significant comorbidity with substance abuse, particularly cocaine, amphetamines and psychostimulants, also alcohol, tobacco and cannabis, and with other psychiatric disorders: oppositional defiant, personality (especially cluster B: antisocial, etc), anxiety (generalized anxiety, phobias, panic..), affective or eating disorders.