Risk of Incident Psychosis and Mania With Prescription Amphetamines.

IF 15.1 1区 医学 Q1 PSYCHIATRY
Lauren V Moran,Joseph P Skinner,Ann K Shinn,Kathryn Nielsen,Vinod Rao,S Trevor Taylor,Talia R Cohen,Cemre Erkol,Jaisal Merchant,Christin A Mujica,Roy H Perlis,Dost Ongur
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Abstract

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.
处方安非他明引发精神病和狂躁症的风险。
目的近年来,美国的苯丙胺处方量有所增加。以前的研究发现,处方苯丙胺类药物会增加发生精神病的风险。本研究旨在探讨处方安非他明的剂量水平对这一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,比较过去一个月暴露于处方安非他明的情况下发生精神病或躁狂症的几率。病例对象是 2005 年至 2019 年期间因精神病或躁狂症而在麦克林医院住院的 16-35 岁患者。对照组受试者是因其他原因(最常见的是抑郁症和/或焦虑症)而首次住院治疗的精神病患者。苯丙胺剂量被转换为右旋苯丙胺当量,并分为三等分。结果在1,374名病例受试者和2,748名对照受试者中,与未使用苯丙胺相比,过去一个月使用过苯丙胺处方药的人患精神病和躁狂症的几率增加(调整后的几率比=2.68,95% CI=1.90-3.77)。观察到一种剂量-反应关系;高剂量苯丙胺(>30 毫克右旋苯丙胺当量)与精神病或躁狂症几率增加 5.28 倍相关。结论虽然使用住院对照受试者排除了病情较轻的患者,导致了选择偏差,但研究结果表明,在开具大剂量苯丙胺类药物时应谨慎,并定期筛查精神病或躁狂症状。
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来源期刊
American Journal of Psychiatry
American Journal of Psychiatry 医学-精神病学
CiteScore
22.30
自引率
2.80%
发文量
157
审稿时长
4-8 weeks
期刊介绍: The American Journal of Psychiatry, dedicated to keeping psychiatry vibrant and relevant, publishes the latest advances in the diagnosis and treatment of mental illness. The journal covers the full spectrum of issues related to mental health diagnoses and treatment, presenting original articles on new developments in diagnosis, treatment, neuroscience, and patient populations.
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