ArticleBMJ mental health2025
Risk of hospitalisation for first-onset psychosis or mania within a year of ADHD medication initiation in adults with ADHD.
Article in BMJ mental health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Occurrence of Psychosis and Bipolar Disorder in Individuals With Attention-Deficit/Hyperactivity Disorder Treated With Stimulants: A Systematic Review and Meta-Analysis.JAMA psychiatry · 2025Pooled it
- Methylphenidate Treatment and Risk of Psychotic Disorder.JAMA psychiatry · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe prevalence of attention-deficit hyperactivity disorder (ADHD) drug treatment for youth and adults has been rising exponentially in Iceland over the past 15 years. The efficacy of ADHD drugs is not as strongly supported for adults as for children and adolescents, and adult use has been reported to increase the risk of psychosis or mania.
objectiveTo assess the absolute risk of hospitalisation for first-onset psychosis or mania in adults diagnosed with ADHD within 1 year of being prescribed ADHD drugs and to examine the proportional attributable risk.
methodsThis study included all adults prescribed ADHD drugs in Iceland between 1 January 2010 and 31 December 2022. Records from the Icelandic Prescription Drug Register were linked to the Hospital Discharge Register to identify individuals who were admitted due to psychosis or mania. This risk was compared with the risk of all other first-onset hospitalisations for psychosis, mania or mixed episodes between 1 January 2018 and 31 December 2020.
findings16 125 individuals aged 18 or older initiated ADHD drug therapy during the study period. Of those, 61 were hospitalised due to first-onset psychosis or mania within a year. This corresponds to an absolute risk of 0.38% for such an admission. The general population risk for all other first-onset hospitalisations for psychosis or mania from 2018 through 2020 for Icelanders aged 18-67 was 0.048%. The estimated relative risk was 7.99 (95% CI 6.06, 10.54), the proportional attributable risk 87.5% and the number needed to harm 302 (95% CI 271, 340). Within 1 year of hospital discharge, 69% (42/61) had been represcribed their ADHD medication, and 26.2% (11/42) of these had to be readmitted for psychosis or mania
conclusionsThe risk of hospitalisation for psychosis or mania with prescription ADHD drugs is small but real among adults, and represcription is strongly associated with readmission. CLINICAL IMPLICATIONS: Clinicians and adults diagnosed with ADHD should be aware of the association between ADHD drugs and the risk of developing psychosis or mania requiring hospitalisation in adults with ADHD.
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