Skip to main content

Research Repository

Advanced Search

Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study

Hollis, Chris; Chen, Qi; Chang, Zheng; Quinn, Patrick D; Viktorin, Alexander; Lichtenstein, Paul; D'Onofrio, Brian; Landén, Mikael; Larsson, Henrik

Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study Thumbnail


Authors

CHRIS HOLLIS chris.hollis@nottingham.ac.uk
Professor of Child and Adolescent Psychiatry and Digital Mental Health

Qi Chen

Zheng Chang

Patrick D Quinn

Alexander Viktorin

Paul Lichtenstein

Brian D'Onofrio

Mikael Landén

Henrik Larsson



Abstract

Background: There is a clinical concern that prescribing methylphenidate, the most common pharmacological
treatment for attention-deficit hyperactivity disorder (ADHD), might increase the risk of psychotic events, particularly in young people with a history of psychosis. We aimed to determine whether the risk of psychotic events increasesimmediately after initiation of methylphenidate treatment or, in the longer term, 1 year after treatment initiation in adolescents and young adults with and without a previously diagnosed psychotic disorder.
Methods: In this cohort study, we used population-based observational data from the Swedish Prescribed Drug Register, the National Patient Register, and the Total Population Register, three population-based registers containing data on all individuals in Sweden, to attain data on sex, birth, death, migration, medication use, and psychotic events for all eligible participants. We screened individuals on these registers to identify those receiving methylphenidate treatment, and who were aged 12–30 years at the start of treatment, for their inclusion in the study. We used a within-individual design to compare the incidence of psychotic events in these individuals during the 12-week periods immediately before and after methylphenidate initiation. Longer term risk was assessed by comparing the incidence of psychotic events 12 weeks before methylphenidate initiation and during a 12-week period one calendar year before the initiation of methylphenidate with the incidence of these events during the 12-week period one calendar year after
methylphenidate initiation. We estimated the incidence rate ratios (IRR) and 95% CIs of psychotic events after the initation of methylphenidate treatment, relative to the events before treatment, which were defined as any hospital visit (inpatient admission or outpatient attendance, based on data from the National Patient Register) because of psychosis, using the International Classification of Diseases version 10 definition. Analyses were stratified by whether
the individual had a history of psychosis.
Findings: We searched the Swedish Prescribed Drug Register to find eligible individuals who had received methylphenidate between Jan 1, 2007 and June 30, 2012. 61 814 individuals were screened, of whom 23 898 (38·7%) individuals were assessed and 37 916 (61·3%) were excluded from the study because they were outside of the age
criteria at the start of treatment, they had immigrated, emigrated, or died during the study period, or because they were administered other ADHD medications. The median age at methylphenidate initiation was 17 years, and a history of psychosis was reported in 479 (2·0%) participants. The IRR of psychotic events in the 12-week period after initiation of methylphenidate treatment relative to that in the 12-week period before treatment start was 1·04 (95% CI
0·80–1·34) in adolescents and young adults without a history of psychosis and 0·95 (0·69–1·30) among those with a history of psychosis.
Interpretation: Contrary to clinical concerns, we found no evidence that initiation of methylphenidate treatment increases the risk of psychotic events in adolescents and young adults, including in those individuals with a history of psychosis. Our study should reassure clinicians considering initiating methylphenidate treatment for ADHD in adolescents and young adults, and it challenges the widely held view in clinical practice that methylphenidate should be avoided, or its use restricted, in individuals with a history of psychosis.

Citation

Hollis, C., Chen, Q., Chang, Z., Quinn, P. D., Viktorin, A., Lichtenstein, P., …Larsson, H. (2019). Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study. Lancet Psychiatry, 6(8), 651-658. https://doi.org/10.1016/s2215-0366%2819%2930189-0

Journal Article Type Article
Acceptance Date Jun 17, 2019
Online Publication Date Jun 17, 2019
Publication Date Aug 1, 2019
Deposit Date Aug 27, 2019
Publicly Available Date Aug 27, 2019
Journal The Lancet Psychiatry
Print ISSN 2215-0366
Electronic ISSN 2215-0374
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 6
Issue 8
Pages 651-658
DOI https://doi.org/10.1016/s2215-0366%2819%2930189-0
Public URL https://nottingham-repository.worktribe.com/output/2507256
Publisher URL https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30189-0/fulltext
Contract Date Aug 27, 2019

Files





You might also like



Downloadable Citations