Treatment with psychostimulants and atomoxetine in people with psychotic disorders: Reassessing the risk of clinical deterioration in a real-world setting

Olivier Corbeil, Sébastien Brodeur, Josiane Courteau, Laurent Béchard, Maxime Huot-Lavoie, Elaine Angelopoulos, Samanta Di Stefano, Erica Marrone, Alain Vanasse, Marie Josée Fleury, Emmanuel Stip, Alain Lesage, Ridha Joober, Marie France Demers, Marc André Roy

Research output: Contribution to journalArticlepeer-review

Abstract

Background Although attention-deficit hyperactivity disorder (ADHD) is often comorbid with schizophrenia spectrum and other psychotic disorders (SZSPD), concerns about an increased risk of psychotic events have limited its treatment with either psychostimulants or atomoxetine. Aims To examine whether the risk of hospital admission for psychosis in people with SZSPD was increased during the year following the introduction of such medications compared with the year before. Method This was a retrospective cohort study using Quebec (Canada) administrative health registries, including all Quebec residents with a public prescription drug insurance plan and a diagnosis of psychotic disorder, defined by relevant ICD-9 or ICD-10 codes, who initiated either methylphenidate, amphetamines or atomoxetine, between January 2010 and December 2016, in combination with antipsychotic medication. The primary outcome was time to hospital admission for psychosis within 1 year of initiation. State sequence analysis was also used to visualise admission trajectories for psychosis in the year following initiation of these medications, compared with the previous year. Results Out of 2219 individuals, 1589 (71.6%) initiated methylphenidate, 339 (15.3%) amphetamines and 291 (13.1%) atomoxetine during the study period. After adjustment, the risk of hospital admission for psychosis was decreased during the 12 months following the introduction of these medications when used in combination with antipsychotics (adjusted HR = 0.36, 95% CI 0.24-0.54; P < 0.0001). Conclusions These findings suggest that, in a real-world setting, when used concurrently with antipsychotic medication, methylphenidate, amphetamines and atomoxetine may be safer than generally believed in individuals with psychotic disorders.

Original languageEnglish
JournalBritish Journal of Psychiatry
DOIs
Publication statusAccepted/In press - 2023

Keywords

  • Attention-deficit hyperactivity disorders
  • CNS stimulants
  • comorbidity
  • drug or substance interactions and side-effects
  • psychotic disorders/schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health

Fingerprint

Dive into the research topics of 'Treatment with psychostimulants and atomoxetine in people with psychotic disorders: Reassessing the risk of clinical deterioration in a real-world setting'. Together they form a unique fingerprint.

Cite this