Moran LV, Ongur D, Hsu J, Castro VM, Perlis RH, Schneeweiss
S. Psychosis with Methylphenidate or Amphetamine in Patients with ADHD. N Engl
J Med. 2019 Mar 21;380(12):1128-1138.
Abstract
BACKGROUND:
The prescription use of the stimulants methylphenidate and
amphetamine for the treatment of attention deficit-hyperactivity disorder
(ADHD) has been increasing. In 2007, the Food and Drug Administration mandated
changes to drug labels for stimulants on the basis of findings of new-onset
psychosis. Whether the risk of psychosis in adolescents and young adults with
ADHD differs among various stimulants has not been extensively studied.
METHODS:
We used data from two commercial insurance claims databases
to assess patients 13 to 25 years of age who had received a diagnosis of ADHD
and who started taking methylphenidate or amphetamine between January 1, 2004,
and September 30, 2015. The outcome was a new diagnosis of psychosis for which
an antipsychotic medication was prescribed during the first 60 days after the
date of the onset of psychosis. To estimate hazard ratios for psychosis, we
used propensity scores to match patients who received methylphenidate with
patients who received amphetamine in each database, compared the incidence of
psychosis between the two stimulant groups, and then pooled the results across
the two databases.
RESULTS:
We assessed 337,919 adolescents and young adults who
received a prescription for a stimulant for ADHD. The study population
consisted of 221,846 patients with 143,286 person-years of follow up; 110,923
patients taking methylphenidate were matched with 110,923 patients taking
amphetamines. There were 343 episodes of psychosis (with an episode defined as
a new diagnosis code for psychosis and a prescription for an antipsychotic medication)
in the matched populations (2.4 per 1000 person-years): 106 episodes (0.10%) in
the methylphenidate group and 237 episodes (0.21%) in the amphetamine group
(hazard ratio with amphetamine use, 1.65; 95% confidence interval, 1.31 to
2.09).
CONCLUSIONS:
Among adolescents and young adults with ADHD who were
receiving prescription stimulants, new-onset psychosis occurred in
approximately 1 in 660 patients. Amphetamine use was associated with a greater
risk of psychosis than methylphenidate. (Funded by the National Institute of
Mental Health and others.).
Methods
Researchers assessed patients 13 to 25 years of age who were
diagnosed with ADHD and who started taking methylphenidate or amphetamine
between January 1, 2004 and September 30, 2015 using data from two commercial
insurance claims databases.
A new diagnosis of psychosis for which an antipsychotic
medication was prescribed during the first 60 days after the date of the onset
of psychosis was the assessed outcome.
They estimated hazard ratios for psychosis using propensity
scores to match patients who received methylphenidate with patients who
received amphetamine in each database, comparing psychosis incidence between
the two stimulant groups, and then pooling the results across the two
databases.
Results
A prescription for a stimulant for ADHD was received by
337,919 adolescents and young adults.
Researchers analyzed 221,846 patients with 143,286
person-years of follow up; they matched 110,923 patients taking methylphenidate
with 110,923 patients taking amphetamines.
In the matched populations, 343 episodes of psychosis (with
an episode defined as a new diagnosis code for psychosis and a prescription for
an antipsychotic medication) were reported (2.4 per 1000 person-years): 106
episodes (0.10%) in the methylphenidate group and 237 episodes (0.21%) in the
amphetamine group (hazard ratio with amphetamine use, 1.65; 95% confidence
interval, 1.31 to 2.09).
https://www.mdlinx.com/journal-summaries/psychosis-methylphenidate-amphetamine-adhd/2019/03/22/7561460?spec=neurology
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