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Some ADHD drugs can increase psychosis more than others



aAdolescents and young adults who are treated for hearing impairment and hyperactivity disorder may be at increased risk for psychotic outbreaks if provided with amphetamine drugs such as Adderall and Vyvanse instead of compounds such as Ritalin or Concerta methylphenidate, according to a study published on Wednesday .

According to a study published in the New England Journal of Medicine, the risk of mental illness is generally found in one out of 660 people.

Dr. Lauren Moran, the lead author of the study, said that "this risk is so low that it can not be said that it does not just prescribe Adderall. "But from a public health point of view, many people are actually getting this medication and getting to thousands of people who are at increased risk of mental illness." Moran is an assistant professor at Harvard Medical School and a psychiatrist treating patients with inpatient schizophrenia. Patients with bipolar disorder at McLean Hospital.

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This study does not affect which drugs are used in most cases, but when prescribing medicines for ADHD, you can carefully observe potential risk factors for other mental illnesses. Researchers used the term "evidence of the real world", which is the term used to refer to data collected during a medical practice, not a golden standard for randomized and controlled clinical trials.

The study was conducted with Aetion, a New York City health data venture founded by another Harvard researcher. Moran does not have a financial relationship with Aetion.

"I do not think it was a shocking discovery," he points out that the small risk of mental illness is attached to all stimulant prescriptions, "Dr. Anthony L. Rostain, a psychiatrist and pediatric professor at the Perelman School of Medicine at the University of Pennsylvania, It will be important to mention to people that there is a risk. I think I should tell everyone when I start taking medicines like psychosis. "Rostain Vyvanse and a consultant to Shire who developed Adderall, which is now part of Japanese pharmaceutical company Takeda and other amphetamines It belongs to manufacturer Arbor Pharmaceuticals.

The study used an insurance claim database assembled by Aetion (a notice of what the payment system uses to the patient). The study began by looking for patients between the ages of 13 and 26 who were diagnosed with ADHD and started taking methylphenidate or amphetamine between January 2005 and September 2015. A factor of 110,923 who received each type of drug that could be matched based on age and other risks. Patients with existing signs of psychosis, such as antipsychotic prescriptions, were excluded.

The researchers then confirmed that each patient was serious enough to warrant a psychotic drug within 60 days of being diagnosed with psychosis. In that group, there were 343 episodes of psychosis, 106 of the methylphenidate group, 0.1% of the group, 237 of the amphetamine group, and 0.21%. Amphetamine users increased the risk of psychotic events that could include delusions or hallucinations by 65%.

Moran and Rostain said it could be one of the reasons why drugs work differently in the brain. Both increase the level of dopamine, a neurotransmitter involved in the host of brain function. Methylphenidate works by blocking the removal of dopamine from the brain. In contrast, amphetamines block the removal of dopamine and increase the production of dopamine. They also pointed out that one of the risk factors for psychosis is drug use in a way that is different from drug abuse. Rostain saw amphetamine drugs as a potential risk.

Moran became interested in this issue. Because she was interested in this problem because young patients, many of them college students, used psychiatric wards after they used stimulants. She initially undertook this project as part of a project run by Sebastian Schneeweiss, a professor of medicine and epidemiology at Harvard Medical School and a core advisor to Aetion. The results are very interesting and we decided to work with larger, more rigorous studies.

Schneeweiss said in an interview that Aetion was founded because "Harvard could not work together with such a huge demand for practical evidence leading to a causal conclusion" and a need for a paid software engineer. The company works with the KFDA to ensure that the patient's database can replicate the results of randomized clinical trials that randomly assign patients to one treatment or other treatment. Aetion's software platform "provides audit trails with all the bells and whistles that regulators need to make regulatory decisions based on these studies," says Aetion McKesson Ventures, Sanofi and UCB, according to Pitchbook.

The next steps, Moran and Schneeweiss, said the doctors would do additional research to help them identify which patients are at increased risk for psychotic episodes.


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