Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults.
Child & adolescent psychiatry
Schizophrenia & psychotic disorders
Journal
BMJ mental health
ISSN: 2755-9734
Titre abrégé: BMJ Ment Health
Pays: England
ID NLM: 9918521385306676
Informations de publication
Date de publication:
12 Apr 2024
12 Apr 2024
Historique:
received:
05
09
2023
accepted:
13
01
2024
medline:
15
4
2024
pubmed:
13
4
2024
entrez:
12
4
2024
Statut:
epublish
Résumé
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. 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. 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). 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. Our study suggests that amphetamine use is associated with a higher reporting of psychotic symptoms, compared with methylphenidate use. The prescription of psychostimulants should consider this potential adverse effect when assessing the benefit-risk balance.
Sections du résumé
BACKGROUND
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
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
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
RESULTS
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
CONCLUSIONS
Our study suggests that amphetamine use is associated with a higher reporting of psychotic symptoms, compared with methylphenidate use.
CLINICAL IMPLICATIONS
CONCLUSIONS
The prescription of psychostimulants should consider this potential adverse effect when assessing the benefit-risk balance.
Identifiants
pubmed: 38609318
pii: bmjment-2023-300876
doi: 10.1136/bmjment-2023-300876
pii:
doi:
Substances chimiques
Amphetamine
CK833KGX7E
Methylphenidate
207ZZ9QZ49
Atomoxetine Hydrochloride
57WVB6I2W0
Central Nervous System Stimulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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