Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults
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...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Mental Health |
| Online Access: | https://ebmh.bmj.com/content/27/1/e300876.full |
| _version_ | 1797210184532099072 |
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| author | François Montastruc Vanessa Rousseau Agnes Sommet Alexis Revet Genevieve Durrieu Jacques Hamard Philippe Garcia Antoine Yrondi |
| author_facet | François Montastruc Vanessa Rousseau Agnes Sommet Alexis Revet Genevieve Durrieu Jacques Hamard Philippe Garcia Antoine Yrondi |
| author_sort | François Montastruc |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T10:06:34Z |
| format | Article |
| id | doaj.art-ab211f33f6d046b6a2a60204977efd04 |
| institution | Directory Open Access Journal |
| issn | 2755-9734 |
| language | English |
| last_indexed | 2024-04-24T10:06:34Z |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj.art-ab211f33f6d046b6a2a60204977efd042024-04-13T01:40:07ZengBMJ Publishing GroupBMJ Mental Health2755-97342024-04-0127110.1136/bmjment-2023-300876Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adultsFrançois Montastruc0Vanessa Rousseau1Agnes Sommet2Alexis Revet3Genevieve Durrieu4Jacques Hamard5Philippe Garcia6Antoine Yrondi7Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France5 Clinical Investigation Center, Centre Hospitalier Universitaire de Toulouse, Toulouse, FranceCIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, FranceDepartment of Child and Adolescent Psychiatry, University Hospital Centre Toulouse, Toulouse, France2Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine, Toulouse, France1 Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France1 Department of Medical and Clinical Pharmacology, CHU Toulouse, Toulouse, Occitanie, France4 Department of Medical Psychiatry, CHU Toulouse, Toulouse, Occitanie, FranceBackground 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.https://ebmh.bmj.com/content/27/1/e300876.full |
| spellingShingle | François Montastruc Vanessa Rousseau Agnes Sommet Alexis Revet Genevieve Durrieu Jacques Hamard Philippe Garcia Antoine Yrondi Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults BMJ Mental Health |
| title | Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults |
| title_full | Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults |
| title_fullStr | Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults |
| title_full_unstemmed | Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults |
| title_short | Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults |
| title_sort | psychosis with use of amphetamine drugs methylphenidate and atomoxetine in adolescent and adults |
| url | https://ebmh.bmj.com/content/27/1/e300876.full |
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