BACKGROUND Use of psychostimulants and relative drugs has increased worldwide in treatment of attention-deficit hyperactivity disorder (ADHD) in adolescents and adults. Recent studies suggest a potential association between use of psychostimulants and psychotic symptoms. The risk may not be the same between different psychostimulants. OBJECTIVE To assess whether amphetamine or atomoxetine use is associated with a higher risk of reporting symptoms of psychosis than methylphenidate use in adolescents and adults, particularly in patients with ADHD. METHODS Using VigiBase, the WHO's pharmacovigilance database, disproportionality of psychotic symptoms reporting was assessed among adverse drug reactions related to methylphenidate, atomoxetine and amphetamines, from January 2004 to December 2018, in patients aged 13-25 years. The association between psychotic symptoms and psychostimulants was estimated through the calculation of reporting OR (ROR). FINDINGS Among 13 863 reports with at least one drug of interest, we found 221 cases of psychosis with methylphenidate use, 115 with atomoxetine use and 169 with a prescription of an amphetamine drug. Compared with methylphenidate use, amphetamine use was associated with an increased risk of reporting psychotic symptoms (ROR 1.61 (95% CI 1.26 to 2.06)]. When we restricted the analysis to ADHD indication, we found a close estimate (ROR 1.94 (95% CI 1.43 to 2.64)). No association was found for atomoxetine. CONCLUSION Our study suggests that amphetamine use is associated with a higher reporting of psychotic symptoms, compared with methylphenidate use. CLINICAL IMPLICATIONS The prescription of psychostimulants should consider this potential adverse effect when assessing the benefit-risk balance.

中文翻译：

---

青少年和成人使用安非他明药物、哌醋甲酯和托莫西汀引起的精神病。


背景技术世界范围内精神兴奋剂和相关药物在治疗青少年和成人注意力缺陷多动障碍(ADHD)方面的使用有所增加。最近的研究表明，使用精神兴奋剂与精神病症状之间存在潜在关联。不同精神兴奋剂之间的风险可能不同。目的 评估在青少年和成人中，尤其是 ADHD 患者中，使用苯丙胺或托莫西汀是否比使用哌醋甲酯与报告精神病症状的风险更高相关。方法 使用世界卫生组织药物警戒数据库 VigiBase，对 2004 年 1 月至 2018 年 12 月期间 13-25 岁患者中与哌醋甲酯、托莫西汀和安非他明相关的药物不良反应中精神症状报告的不成比例进行评估。通过计算报告 OR (ROR) 来估计精神病症状和精神兴奋剂之间的关联。结果 在 13 863 份至少涉及一种感兴趣药物的报告中，我们发现 221 例因使用哌醋甲酯而出现精神病，115 例因使用托莫西汀而出现精神病，169 例因服用安非他明药物而出现精神病。与哌醋甲酯的使用相比，安非他明的使用与报告精神病症状的风险增加相关（ROR 1.61（95% CI 1.26 至 2.06）]。当我们将分析限制在 ADHD 适应症时，我们发现了一个接近的估计值（ROR 1.94（95% CI 1.26 至 2.06））。 CI 1.43 至 2.64)) 结论 我们的研究表明，与哌醋甲酯的使用相比，使用安非他明与更高的精神病症状相关。 精神兴奋剂的处方在评估时应考虑这种潜在的副作用。利益-风险平衡。