Methylphenidate psychosis

[Dapplegrey]

Advertisement - Members don't see this ad

Got a new patient this week on methylphenidate with paranoid delusions. Has been on methylphenidate for a few years and new onset psychosis, within the last year, getting worse. Middle aged man, previously high functioning. Anybody with experience on the topic??

 

[billypilgrim37]

What's specifically the question? I have seen a handful of teenagers/young kids in similar situations in inpatient/emergency room, several resolved with discontinuation of methylphenidate, some required risperdal. I haven't been around long enough to see long-term how these folks do.

 

[Dapplegrey]

The literature I've read reports only a 0.1% chance of developing methylphenidate induced psychosis (in children and adolescents) with 85-90% of cases remitting within a few weeks following discontinuing of the stimulant. However, there are no studies on adults. My question is have you had any adult patients with suspected stimulant induced psychosis?? How did you treat it, outcomes, etc??

 

[billypilgrim37]

The literature I've read reports only a 0.1% chance of developing methylphenidate induced psychosis (in children and adolescents) with 85-90% of cases remitting within a few weeks following discontinuing of the stimulant. However, there are no studies on adults. My question is have you had any adult patients with suspected stimulant induced psychosis?? How did you treat it, outcomes, etc??

Surprised the rate is that low. But as the tertiary care center for a fairly large area, I guess it makes some sense the rate we see, given how many kids are on stimulants. I've only had one 30ish yo adult develop psychosis on 25mg of Adderall (wound up in forensic unit, some pretty terrible things happened--and he's a very high functioning, very calm guy otherwise). Since all this happened, his PCP had put him back on a lower dose of Adderall and he was doing okay, but seemed like not a great idea. We've been trying Strattera for a while, which has been helpful for his anxiety, but not for his ADHD. I think he briefly received an antipsychotic while he was inpatient last year when all of this happened, but was not on it long term. More palliative given how dangerous/miserable things were at the time. He's back to being a high-functioning guy.

 

[heyjack70]

I've never seen an rx stimulant psychosis, i've certainly seen people on methamphetamine, which has the same mech of action, come into the ED psychotic and persist for a few days on the inpatient unit with psychosis with rapid response to sobriety and d2 blockade drugs.

 

[RedPakotaSea]

I treated a patient last year with suspected methylphenidate-induced psychosis. He was taking up to 200 mg/day, and presented with anxiety, paranoia, and disorganized thinking. He improved over a couple days, but was still a bit disorganized at the time of discharge. I was just notified by his primary psychiatrist that he will be returning to a top university (which I will leave unnamed) to complete his undergraduate education, so I assume he has recovered quite well. IIRC, he was treated with Abilify, but I think stopping stimulant use was probably the key element in his recovery.

 

[nitemagi]

I've had a handful. Mixed results with discontinuation alone, and I usually don't wait too long before starting a low dose antipsychotic. The biggest hurdle is usually getting them to give up the stimulant. FYI wellbutrin has a similar risk of psychosis. I often emphasize the risk of psychosis during informed consent of a stimulant of WBT if I want to scare them a bit, and try to mention it at least in all medication consent forms.