Moran LV, et al. - Researchers investigated if the risk of psychosis in adolescents and young adults with attention deficit–hyperactivity disorder (ADHD) varies with respect to stimulants prescribed. Findings suggest that approximately 1 in 660 patients suffer new-onset psychosis among adolescents and young adults with ADHD who were receiving prescription stimulants. A greater risk of psychosis was observed in correlation with amphetamine vs methylphenidate.

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).