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Various toxicities: case report A 37-year-old man developed paradoxical reaction leading to an increase in psychomotor restlessness and progressive confusional profile during treatment with clonazepam for attention deficit hyperactivity disorder (ADHD). Additionally, he exhibited paroxetine abuse [dosages, routes, time to reactions onset and outcomes not stated]. The man, who had ADHD, was admitted to the dual pathology unit for the study polysubstance abuse and profile of unspecified motor hyperactivity. His family history included alcoholic paternal grandfather, alcoholic father and son in child psychiatry study for behavioural disorders. His personal history included hiatus hernia, appendectomy, polysubstance abuse, hyperuricaemia, alcohol dependence, cocaine dependence (primary) and opiate dependence. He had been on methadone replacement therapy, and he had been abusing paroxetine. he had two previous admissions at a substance abuse day centre. At the current admission, a differential diagnosis was requested for his hyperactivity profile in the context of toxic substance withdrawal. He was admitted to the dual pathology unit because of difficulty in continuing abstain from the substances, despite visit to the day centre and due to abstinencerelated hyperactivity, which was difficult to evaluate due to active intake of high doses of cocaine and paroxetine. At admission, alcohol and cocaine consumption predominated along with frequent episodes of aggression against the others during acute intoxication. He had delusions of recovery and control regarding most of the toxic substance he consumed, which minimised his alcohol and cannabis intake, but he had good awareness of hyperactivity and cocaine addiction. Behavioural disorders were no observed, based on which borderline personality disorder was ruled out. He attended psychoeducational groups and group therapy, in which he actively participated. During individual interviews and group therapies, he constantly moved his chair, got up and interrupted therapist and other attendees. He received clonazepam, and he had paradoxical reactions to clonazepam, which led to an increase in psychomotor restlessness and progression to a confusional profile. He also reported other paradoxical effects such as he reported that heroin made him more nervous and cocaine calmed him down. Since childhood, he had been very active, like his son and father to the extent that he was nicknamed as "Speedy Gonzalez" by his classmates. In the total abstinence from paroxetine and cocaine, high impulsivity and motor hyperactivity was still observed. He was started on treatment with methylphenidate [methylphenidate hydrochloride], following which a marked improvement was noted in his symptoms without increasing the tic disorder (which was diagnosed at admission). During discharge procedure, he reported of spending the day tidying the house. His psychopathological examination revealed his rituals of order, cleaning, checking and collecting, all of which had started in childhood and which were c