Stimulant Treatment for ADHD Associated With Psychosis and BD
Stimulant use for the treatment of attention-deficit/hyperactivity disorder (ADHD) was associated with higher occurrence of psychotic symptoms, psychotic disorders, and bipolar disorder (BD), particularly in those treated with amphetamines, according to a systematic review published in JAMA Psychiatry.
“We found that 2.8%, 2.3%, and 3.7% of individuals with ADHD who had been prescribed stimulants developed psychotic symptoms, a psychotic disorder, and BD, respectively,” reported Gonzalo Salazar de Pablo, PhD, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom, and coauthors.
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The findings came from an analysis of 16 studies (N=391,043) that evaluated psychosis or BD outcomes in ADHD populations exposed to stimulants.
“Although not remarkably high, a 2.8% development of psychotic symptoms represents a nonnegligible figure and lends further meta-analytic support to the 2007 US Food and Drug Administration (FDA) change in the drug label for stimulants, alerting on the possible occurrence of psychotic symptoms,” the authors explained.
The researchers noted that the risk of psychosis was significantly higher in those treated with amphetamines than in those treated with methylphenidate (odds ratio [OR], 1.57, 95% CI, 1.15-2.16; k = 3, n = 231,325). Additional subgroup analyses showed that populations with a higher proportion of females, smaller sample sizes, and a higher stimulant dose were also associated with an increased likelihood of psychotic symptoms.
“Our results underscore the crucial need for comprehensive psychoeducation, careful monitoring (for all psychostimulants), and discussion with patients and their caregivers about management strategies,” the researchers wrote. However, they cautioned that the included studies could not establish causality and highlighted the need for future randomized clinical trials to better establish the relationship between stimulant exposure and psychosis/BD outcomes.
