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Hamard J, Rousseau V, Durrieu G, Garcia P, Yrondi A, Sommet A, Revet A, Montastruc F. Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults. BMJ MENTAL HEALTH 2024; 27:e300876. [PMID: 38609318 PMCID: PMC11029235 DOI: 10.1136/bmjment-2023-300876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/13/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Use of psychostimulants and relative drugs has increased worldwide in treatment of attention-deficit hyperactivity disorder (ADHD) in adolescents and adults. Recent studies suggest a potential association between use of psychostimulants and psychotic symptoms. The risk may not be the same between different psychostimulants. OBJECTIVE To assess whether amphetamine or atomoxetine use is associated with a higher risk of reporting symptoms of psychosis than methylphenidate use in adolescents and adults, particularly in patients with ADHD. METHODS Using VigiBase, the WHO's pharmacovigilance database, disproportionality of psychotic symptoms reporting was assessed among adverse drug reactions related to methylphenidate, atomoxetine and amphetamines, from January 2004 to December 2018, in patients aged 13-25 years. The association between psychotic symptoms and psychostimulants was estimated through the calculation of reporting OR (ROR). FINDINGS Among 13 863 reports with at least one drug of interest, we found 221 cases of psychosis with methylphenidate use, 115 with atomoxetine use and 169 with a prescription of an amphetamine drug. Compared with methylphenidate use, amphetamine use was associated with an increased risk of reporting psychotic symptoms (ROR 1.61 (95% CI 1.26 to 2.06)]. When we restricted the analysis to ADHD indication, we found a close estimate (ROR 1.94 (95% CI 1.43 to 2.64)). No association was found for atomoxetine. CONCLUSION Our study suggests that amphetamine use is associated with a higher reporting of psychotic symptoms, compared with methylphenidate use. CLINICAL IMPLICATIONS The prescription of psychostimulants should consider this potential adverse effect when assessing the benefit-risk balance.
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Affiliation(s)
- Jacques Hamard
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Department of Psychiatry, Centre Hospitalier Gérard Marchant, Toulouse, France
| | - Vanessa Rousseau
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Geneviève Durrieu
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Philippe Garcia
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Department of Medical Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
| | - Antoine Yrondi
- Department of Medical Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
- Treatment Resistant Depression Expert Center, FondaMental, Toulouse, France
- ToNIC Toulouse NeuroImaging Center, University Paul Sabatier Toulouse INSERM, Toulouse, France
| | - Agnès Sommet
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, CHU Toulouse, Toulouse, Occitanie, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France
- Centre d'Investigation Clinique INSERM 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanque), CHU de Toulouse, Toulouse, France
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Muacevic A, Adler JR, Abbas MS, Nassar ST, Tasha T, Desai A, Bajgain A, Ali A, Dutta C, Elshaikh AO. Psychosis Induced by Methylphenidate in Children and Young Patients With Attention-Deficit Hyperactivity Disorder. Cureus 2023; 15:e34299. [PMID: 36860219 PMCID: PMC9970721 DOI: 10.7759/cureus.34299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders diagnosed in children of this era. ADHD in children and adults is challenging but highly manageable. Children with ADHD cannot focus, are hyperactive, and appear withdrawn. These symptoms make them endure difficulties in learning and create academic challenges. Methylphenidate (MPH) is one of the psychostimulants used as a first-line therapy for ADHD. In this literature review, we have gathered information that describes the evidence of psychotic symptoms in children and young patients with ADHD as a side effect of MPH. We used articles from the National Library of Medicine (PubMed) and Google Scholar to gather the relevant information. Our findings concluded that MPH can increase the risk of psychosis, particularly when taken in high doses. It is still unclear whether the psychotic range of symptoms occurred due to an increased dopamine (DA) level caused by MPH or as a predominant feature of ADHD or if there was another comorbid feature in the history of the patient that led to psychosis. However, a necessary step for every medical practitioner prescribing psychostimulants is that they enlighten the patient and caregiver that this rare but threatening side effect is a possibility.
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Björkenstam E, Pierce M, Björkenstam C, Dalman C, Kosidou K. Attention Deficit/Hyperactivity Disorder and risk for non-affective psychotic disorder: The role of ADHD medication and comorbidity, and sibling comparison. Schizophr Res 2020; 218:124-130. [PMID: 32001080 DOI: 10.1016/j.schres.2020.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in childhood. It is unclear whether ADHD increases the risk of non-affective psychotic disorder (NAPD). The study included a matched cohort, drawn from all born in Sweden 1987-1991 (n = 548,852). ADHD was defined as ICD diagnosis and/or prescription of ADHD medication. We distinguished between stimulants and non-stimulants, and usage duration (<1 year, 1-2 years and ≥2 years). We calculated odds ratios (OR) with 95% confidence intervals (CI) for NAPD, adjusted for confounders, comorbid autism spectrum disorder (ASD) and substance abuse. ADHD cases were also compared to their unaffected full siblings. We analyzed 18,139 ADHD cases and 72,437 sex and birth year matched controls. NAPD was more common in cases than controls (2.7 and 0.4%, respectively). After adjustment for confounders, ADHD cases had markedly high risk for NAPD (OR: 6.99; 95% CI 6.03-8.10), which attenuated further after adjustment for ASD and substance abuse (OR: 2.57; 95% CI 2.09-3.16). Utilization of ADHD medication increased the risk for NAPD (ORs for change in odds of NAPD for every 5 extra prescriptions of stimulants 1.06 (95% CI 1.02-1.10) and, non-stimulants 1.15 (95% CI 1.01-1.30)). There was no association between usage length of medication and risk for NAPD. The risk was higher in individuals with ADHD than their unaffected siblings (OR: 2.95 (95% CI 2.07-4.20)). Overall, ADHD was associated with elevated risk for NAPD, which is not entirely explained by shared familial factors. The clinical severity leading to medical treatment may also increase NAPD risk. Ethics approval: Approved by the ethical committee in Stockholm, Sweden (dnrs: 2010-1185-31/5 and 2013/1118-32).
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Affiliation(s)
- Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, United States; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Matthias Pierce
- Center for Women's Mental Health, School of Health Sciences, University of Manchester, UK
| | | | - Christina Dalman
- Department of Public Health Sciences, Division Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Public Health Sciences, Division Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden; Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Abstract
For children and adolescents with uncomplicated psychiatric disorders, pediatricians are often the first prescriber of psychiatric medications. Mental health disorders commonly treated by pediatricians include attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. There are several safe and effective first-line medications for these disorders. For ADHD, stimulants and nonstimulants can be used as first-line interventions. For anxiety and depression, selective serotonin reuptake inhibitors are well-established treatments and often well-tolerated. With appropriate support and training, pediatricians can increase access for children to necessary mental health treatments. [Pediatr Ann. 2018;47(8):e311-e316.].
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Reiersen AM. Occurrence of psychotic symptoms during treatment of ADHD with methylphenidate: Clinical significance and the need for further research. Scand J Child Adolesc Psychiatr Psychol 2018; 6:1-3. [PMID: 33520746 PMCID: PMC7750696 DOI: 10.21307/sjcapp-2018-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Groenman AP, Schweren LJS, Dietrich A, Hoekstra PJ. An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder. Expert Opin Drug Saf 2017; 16:455-464. [PMID: 28277842 DOI: 10.1080/14740338.2017.1301928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Methylphenidate is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear. Areas covered: Physical adverse effects, psychiatric adverse events and brain development Expert opinion: Some physical adverse events have been described (e.g. sleep disturbances, growth reduction, loss of appetite), although most are of transient nature. Psychiatric adverse events seem more related to the diagnosis ADHD itself, and not stimulant treatment. Concluding, short-to-mid-term use (i.e., up to 2 years) stimulants are relatively safe, but much less is known about longer-term efficacy and safety of these drugs.
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Affiliation(s)
- Annabeth P Groenman
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | | | - Andrea Dietrich
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Pieter J Hoekstra
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
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Research Domain Criteria versus DSM V: How does this debate affect attempts to model corticostriatal dysfunction in animals? Neurosci Biobehav Rev 2016; 76:301-316. [PMID: 27826070 DOI: 10.1016/j.neubiorev.2016.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/03/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
For decades, the nosology of mental illness has been based largely upon the descriptions in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). A recent challenge to the DSM approach to psychiatric nosology from the National Institute on Mental Health (USA) defines Research Domain Criteria (RDoC) as an alternative. For RDoC, psychiatric illnesses are not defined as discrete categories, but instead as specific behavioral dysfunctions irrespective of DSM diagnostic categories. This approach was driven by two primary weaknesses noted in the DSM: (1) the same symptoms occur in very different disease states; and (2) DSM criteria lack grounding in the underlying biological causes of mental illness. RDoC intends to ground psychiatric nosology in those underlying mechanisms. This review addresses the suitability of RDoC vs. DSM from the view of modeling mental illness in animals. A consideration of all types of psychiatric dysfunction is beyond the scope of this review, which will focus on models of conditions associated with frontostriatal dysfunction.
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Abstract
PURPOSE OF REVIEW The study reviews publications on the use of methamphetamine and amphetamine in relation to psychotic symptoms, substance-induced psychosis, and primary psychosis published between July 2014 and December 2015. The databases MEDLINE, Embase, and PsycINFO were searched using the terms 'amphetamine psychosis' and 'methamphetamine psychosis' for the time period 1 July 2014 to 31 December 2015. RECENT FINDINGS There were 37 studies published on the subject during this time period. Risk factors for psychotic symptoms, substance-induced psychosis, and primary psychosis included patterns of drug use, but results also pointed to the importance of nondrug-related vulnerability. Cognitive impairment is associated with both amphetamine use and psychosis, and the impairment among those with amphetamine-induced psychosis resembles that of schizophrenia. At the neuronal level, GABAergic mechanisms may offer some understanding about the association between stimulant use and psychosis. Several different types of antipsychotic medication are effective for treating agitation and psychosis, but drugs with high DRD2 blockade should be used with caution. Some novel treatments are described, but are not sufficiently repeated to be recommended. SUMMARY During the past 18 months, studies have been published that cover risk factors, neuronal mechanisms, and treatment. These recent results do not differ from previous understandings, but the role of cognition and GABAergic dysfunction should be further investigated, and knowledge about resilience factors is still scarce. Also, a clearer evidence base for medical treatment of psychosis with concurrent amphetamine use is warranted. VIDEO ABSTRACT.
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