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In Youth With ADHD, New-Onset Psychosis Up With Amphetamines

New-onset psychosis occurred in about one in 660 teens, young adults with ADHD receiving stimulants

depressed teen

THURSDAY, March 21, 2019 (Pharmacist's Briefing) -- For adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD), new-onset psychosis occurs more often with amphetamine use versus methylphenidate use, according to a study published in the March 21 issue of the New England Journal of Medicine.

Lauren V. Moran, M.D., from Brigham and Women's Hospital in Boston, and colleagues examined whether the risk for psychosis in adolescents and young adults with ADHD differs among various stimulants. The authors used data from two commercial insurance claims databases for 337,919 patients aged 13 to 25 years who had received a diagnosis of ADHD and started taking methylphenidate or amphetamine. Propensity scores were used to match 110,923 patients who received methylphenidate with 110,923 patients who received amphetamine; the incidence of psychosis was compared between the stimulant groups.

The researchers identified 343 episodes of psychosis in the matched populations (2.4 per 1,000 person-years): 106 and 237 episodes in the methylphenidate and amphetamine groups, respectively (0.1 versus 0.21 percent; hazard ratio with amphetamine use, 1.65).

"The risk of new-onset psychosis was approximately one in 660 patients who received a prescription for stimulants for ADHD, but the risk was about twice as high among patients who started amphetamine as among patients who started methylphenidate," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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