Background or Objective Maladaptive daydreaming (MD) is a proposed clinical syndrome characterized by excessive, compulsive immersion in vivid fantasy leading to functional impairment. Despite high rates of comorbidity with attention-deficit/hyperactivity disorder (ADHD), no pharmacological treatment specifically targeting MD has been established. We report a case of comorbid treatment-resistant ADHD and MD treated with naltrexone targeting reward-system dysregulation.Methods A 19-year-old woman presented with inattention, impulsivity, academic decline, and intense, uncontrollable daydreaming episodes. ADHD was assessed using the Diagnostic Interview for ADHD in Adults, Version 2.0 (DIVA 2.0), and MD was assessed using the Structured Clinical Interview for Maladaptive Daydreaming (SCIMD) and the 16-item Maladaptive Daydreaming Scale (MDS-16). ADHD symptoms were evaluated with the Adult ADHD Self-Report Scale-5 (ASRS-5). The patient had previously undergone multiple pharmacological trials, including SSRIs, an SNRI, atypical antipsychotics, and psychostimulants, with minimal benefit or intolerable adverse effects. Naltrexone was titrated to 100 mg/day and combined with low-dose methylphenidate 10 mg twice daily.Results After four weeks of treatment, the patient reported approximately 50% subjective improvement. MD severity showed a clinically meaningful reduction, with the MDS-16 score decreasing from 85 to 60, although the post-treatment score remained above the clinical threshold. ADHD symptom scores showed minimal change, with the ASRS-5 score decreasing from 19 to 18. No adverse effects were observed.Conclusions Naltrexone targeting reward-system dysregulation may represent a promising strategy for treatment-resistant ADHD with comorbid MD, particularly for reducing MD-related symptoms. Controlled studies are needed to confirm this approach.
Eren et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: