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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处方安非他明发生精神病和躁狂症的风险。


目的 近年来，美国的安非他明处方有所增加。先前的研究发现，处方安非他明会增加发生精神病的风险。本研究的目的是检查处方安非他明的剂量水平对这种罕见但严重的不良后果风险的影响。方法 使用电子健康记录进行病例对照研究，比较发生精神病或躁狂症与过去一个月接触处方安非他明的几率。病例受试者是 2005 年至 2019 年间因突发精神病或躁狂症而在 McLean 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）首次精神病住院的患者。安非他明剂量转换为右旋安非他明当量并分为三份。二次分析评估了使用哌醋甲酯导致精神病或躁狂症的可能性。结果 在 1,374 名病例受试者和 2,748 名对照受试者中，与未使用处方安非他明相比，过去一个月使用过处方安非他明的个体出现精神病和躁狂的几率增加（调整后比值比 = 2.68，95% CI = 1.90-3.77）。观察到剂量反应关系；高剂量的安非他明（>30 mg 右旋安非他明当量）与精神病或躁狂症的几率增加 5.28 倍相关。与不使用相比，过去一个月使用哌甲酯与精神病或躁狂的几率增加无关（调整后的比值比=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，在开出高剂量安非他明处方时应谨慎行事，并定期筛查精神病或躁狂症状。