INTRODUCTION
Sluggish Cognitive Tempo (SCT) is a disorder characterized by a range of
symptoms such as mental slowness, daydreams, lack of energy, staring
with empty eyes (1). Although SCT and Attention-Deficit/ Hyperactivity
Disorder (ADHD) are often presented together, increasing current
evidence supports that SCT is a separate and independent diagnostic
entity differentiating from ADHD. Many researches highlight the overlap
between SCT and ADHD. 39% of individuals with ADHD were found to have
SCT; whereas 59% of individuals with SCT had ADHD as well (2). In
another study, it was stated that the proportion of patients with pure
SCT but not diagnosed with ADHD was 40% (3).
The literature on possible treatment modalities of SCT is very scarce.
It was detected that methylphenidate improves attention problems,
although it does not improve core SCT symptoms in limited studies (4).
There are also literature findings indicating that methylphenidate
therapy has not association with improving SCT symptom load (5, 6). A
current study also points out that Sluggish/sleepy symptoms of SCT do
not respond to methylphenidate, whereas SCT/Daydreamy symptoms have no
association with methylphenidate nonresponse (7). The results of a
study, in which atomoxetine was used, showed that SCT symptom scores
decreased as a result of 16 weeks of treatment of atomoxetine, and
academic improvement was observed (5). This study is important because
it was the first study to demonstrate improvements in SCT with
medication. On the other hand, another double-blind placebo-controlled
study suggested that atomoxetine provides control over ADHD symptoms but
has minimal effect on SCT symptoms (8).
When existing data are scrutinized, the lack of studies on SCT treatment
is noticeable. In addition, there are no case reports on the
differential diagnostic process and psychopharmacologic treatment
process in individuals with SCT. Exploring how the standard ADHD
treatment protocol affects SCT symptoms in a case with subthreshold
ADHD, and intense SCT symptoms, is very crucial for clinicians in terms
of shaping their treatment approaches about this kind of patients. For
these reasons, we aimed to investigate the differential diagnostic
procedure of a case with SCT and subthreshold ADHD symptoms and to
determine if there are improvements in SCT symptoms and to what extent
there has been improvement along with pharmacological treatment process.