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The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder.

Artikel i vetenskaplig tidskrift
Författare Alexander Viktorin
Eleonore Rydén
Michael E Thase
Zheng Chang
Cecilia Lundholm
Brian M D'Onofrio
Catarina Almqvist
Patrik K E Magnusson
Paul Lichtenstein
Henrik Larsson
Mikael Landén
Publicerad i The American journal of psychiatry
Volym 174
Nummer/häfte 4
Sidor 341-348
ISSN 1535-7228
Publiceringsår 2017
Publicerad vid Institutionen för neurovetenskap och fysiologi
Sidor 341-348
Språk en
Länkar dx.doi.org/10.1176/appi.ajp.2016.16...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Psykiatri

Sammanfattning

The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder.Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment. To adjust for individual-specific confounders, including disorder severity, genetic makeup, and early environmental factors, Cox regression analyses were used, conditioning on individual to compare the rate of mania (defined as hospitalization for mania or a new dispensation of stabilizing medication) 0-3 months and 3-6 months after medication start following nontreated periods.Patients on methylphenidate monotherapy displayed an increased rate of manic episodes within 3 months of medication initiation (hazard ratio=6.7, 95% CI=2.0-22.4), with similar results for the subsequent 3 months. By contrast, for patients taking mood stabilizers, the risk of mania was lower after starting methylphenidate (hazard ratio=0.6, 95% CI=0.4-0.9). Comparable results were observed when only hospitalizations for mania were counted.No evidence was found for a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD. Given the markedly increased hazard ratio of mania following methylphenidate initiation in bipolar patients not taking mood stabilizers, careful assessment to rule out bipolar disorder is indicated before initiating monotherapy with psychostimulants.

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