OBJECTIVE Amphetamine prescribing has increased in the United States in recent years. Previous research identified an increased risk of incident psychosis with prescription amphetamines. The purpose of this study was to examine the impact of dose levels of prescription amphetamines on the risk of this rare but serious adverse outcome. METHODS A case-control study using electronic health records was conducted to compare the odds of incident psychosis or mania with past-month exposure to prescription amphetamines. Case subjects were patients ages 16-35 hospitalized at McLean Hospital for incident psychosis or mania between 2005 and 2019. Control subjects were patients with an initial psychiatric hospitalization for other reasons, most commonly depression and/or anxiety. Amphetamine doses were converted to dextroamphetamine equivalents and divided into terciles. Secondary analyses evaluated the odds of psychosis or mania with methylphenidate use. RESULTS Among 1,374 case subjects and 2,748 control subjects, the odds of psychosis and mania were increased for individuals with past-month prescription amphetamine use compared with no use (adjusted odds ratio=2.68, 95% CI=1.90-3.77). A dose-response relationship was observed; high doses of amphetamines (>30 mg dextroamphetamine equivalents) were associated with 5.28-fold increased odds of psychosis or mania. Past-month methylphenidate use was not associated with increased odds of psychosis or mania compared with no use (adjusted odds ratio=0.91, 95% CI=0.54-1.55). CONCLUSIONS Although use of hospitalized control subjects excludes individuals with less severe disease, leading to selection bias, the study results suggest that caution should be exercised when prescribing high doses of amphetamines, with regular screening for symptoms of psychosis or mania.

中文翻译：

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处方苯丙胺有发生精神病和躁狂症的风险。


目的 近年来，美国的苯丙胺处方有所增加。先前的研究发现，处方苯丙胺会增加发生精神病的风险。本研究的目的是检查处方苯丙胺剂量水平对这种罕见但严重的不良后果风险的影响。方法 进行了一项使用电子健康记录的病例对照研究，以比较发生精神病或躁狂症的几率与过去一个月暴露于处方苯丙胺的几率。病例对象是 2005 年至 2019 年间因事件精神病或躁狂症在麦克莱恩医院住院的 16-35 岁患者。对照受试者是因其他原因（最常见的是抑郁和/或焦虑）而初次接受精神病住院治疗的患者。苯丙胺剂量转换为右旋苯丙胺当量并分为三分位数。二次分析评估了使用哌醋甲酯时精神病或躁狂症的几率。结果 在 1,374 例病例受试者和 2,748 例对照受试者中，与未使用相比，过去一个月使用处方苯丙胺的个体发生精神病和躁狂的几率增加 （校正比值比=2.68,95% CI =1.90-3.77）。观察到剂量 - 反应关系;高剂量的苯丙胺 （x3E30 mg 右旋苯丙胺当量） 与精神病或躁狂症的几率增加 5.28 倍相关。与不使用相比，过去一个月使用哌醋甲酯与精神病或躁狂症的几率增加无关 （校正比值比 =0.91,95% CI =0.54-1.55）。 结论 尽管使用住院对照受试者排除了病情较轻的个体，导致选择偏倚，但研究结果表明，在开具高剂量的苯丙胺处方时应谨慎，并定期筛查精神病或躁狂症的症状。