Year: 2014
Type: article
Study design: Observational Study
Abstract: Background: The prescribing of stimulants for Attention Defi cit Hyperactivity Disorder (ADHD) has increased dramatically over the past decade.Case reports suggest that these drugs may precipitate psychosis, as might be expected based upon their pharmacology.We examined whether treatment with prescription stimulants is associated with hospitalization for psychosis.Methods: We conducted a population based case-crossover study in Ontario, Canada, from October 1, 1999 to March 31, 2013.We studied Ontario residents aged 25 years and younger whose prescription costs were reimbursed by the provincial government.All subjects were hospitalized for psychosis within 180 days of commencing treatment with a prescription stimulant.We estimated the risk of hospitalization for psychosis within 60 days of commencing treatment, relative to a corresponding 60-day reference interval four months earlier.Under the case-crossover design, each patient served as his or her own control, thereby controlling implicitly for fi xed patient characteristics.Odds ratios were calculated using McNemar's test, with 95% confi dence intervals for binomial proportions.Results: We identifi ed 219 patients hospitalized with psychosis within 180 days of a fi rst stimulant prescription.Hospitalization for psychosis was associated with stimulant initiation in the preceding 60 days (odds ratio [OR] 1.70; 95% confi dence interval [CI] 1.31 to 2.27).The risk was greater among patients with a history of antipsychotic drug treatment (OR 2.00; 95% CI 1.36 to 3.11), but persisted in patients with no such history (OR 1.48; 95% CI 1.03 to 2.19).More than a third of patients hospitalized for psychosis resumed stimulant therapy after hospital discharge; of these, 38% (30 of 78) were readmitted for psychosis shortly thereafter.Interpretation: The initiation of prescription stimulants is associated with hospitalization for psychosis in young people.Following discharge, resumption of therapy and subsequent readmission for psychosis are common.These fi ndings strengthen the argument for causation, and suggest a lack of awareness of the potential for prescription stimulants to cause psychosis in young people.
Source: Clinical Toxicology
Authors: Hahn, A., Begemann, K
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2535939852