Lecture – Risk of Psychosis With Prescription Stimulants in Youths With ADHD

Available with English captions.

Presented by Lauren V. Moran, MD, McLean Hospital – McLean Forum lecture

The use of stimulants like methylphenidate, such as Ritalin, and amphetamine, including Adderall, to treat attention-deficit/hyperactivity disorder (ADHD) has been increasing. In fact, prescribing of amphetamines has risen four-fold since 2005.

With this rise in prescriptions has come reports of increases of new-onset psychosis. Based on these findings, the Food and Drug Administration mandated changes to drug labels for stimulants in 2007.

Despite these concerns, no studies have investigated whether the risk of psychosis in patients with ADHD differs among various stimulants.

In this lecture, Moran looks at prescribing trends in methylphenidate and amphetamine in adolescents and young adults. She describes the relative risk of psychosis in new users of these drugs. Also, she examines the relative risk of psychosis by provider type, including family practitioners, pediatricians, and psychiatrists.

Watch now to learn more about:

  • Trends in methylphenidate and amphetamine prescribing in adolescents and young adults
  • The relative risk of psychosis with amphetamines compared to methylphenidate in youth with ADHD
  • The relative risk of psychosis in patients with ADHD treated by family practitioners, pediatricians, and psychiatrists

Moran details her research into the risk of psychosis with amphetamine versus methylphenidate prescriptions in adolescents and young adults with ADHD.

Moran and her team used data from two commercial insurance claims databases to assess patients 13 to 25 years of age who received a diagnosis of ADHD. The study subjects started taking methylphenidate or amphetamine between January 1, 2004 and September 30, 2015.

The study found that the rate of psychosis was greater in those prescribed amphetamines than in those prescribed methylphenidates. Findings also revealed that patients treated by family practitioners and pediatricians had higher relative risk of psychosis with amphetamines compared to methylphenidate than patients treated by psychiatrists.

In this talk, Moran discusses how the research findings could impact clinical practice. She says that while psychotic events are rare, it is important to identify sub-groups of patients and prescribing practices to better assess risks. Also, a deeper understanding of patient characteristics, such as family psychiatric history or overlapping prescriptions, could inform clinical practice.