Association of Risk of Suicide Attempts With Methylphenidate Treatment
Association of Risk of Suicide Attempts With Methylphenidate Treatment
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DOI：
10.1001/jamapsychiatry.2017.2183
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发表时间：
2017-10-01
期刊：
影响因子：
25.8
通讯作者：
Wong, Ian C. K.
中科院分区：
文献类型：
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作者：
Man, Kenneth K. C.;Coghill, David;Wong, Ian C. K.
注意缺陷/多动障碍（ADHD）患者企图自杀的风险增加。兴奋剂，如盐酸哌醋甲酯，是多动症最常见的治疗方法，但它们的治疗使用与自杀之间的关系尚不清楚。目的探讨哌醋甲酯与自杀未遂风险的关系。设计、环境和参与者使用来自香港临床数据分析和报告系统的以人群为基础的电子病历数据库，以确定2001年1月1日至2015年12月31日期间接受哌醋甲酯治疗的25 629名6至25岁的个体。那些曾试图自杀的人也被纳入了分析。采用自我控制的病例系列设计来控制患者的时不变特征。主要结局和测量：与未暴露期相比，患者暴露于哌甲酯期间自杀企图的相对发生率。结果在25629例服用哌醋甲酯的患者中，有154例在研究期间有过首次自杀企图；其中雄性111只（72.1%）；基线时平均（SD）年龄为7.15（2.19）岁。在哌甲酯治疗期间，自杀未遂的总发生率为9.27 / 10000患者年。在开始使用哌甲酯之前的90天内，发现自杀企图的风险增加，发病率比（IRR）为6.55 （95% CI, 3.37-12.72）。在治疗的前90天，IRR保持升高（IRR, 3.91; 95% CI, 1.62-9.42），然后在持续治疗期间恢复到基线水平（IRR, 1.35; 95% CI, 0.77-2.38）。将治疗前90天的风险与首次治疗前90天进行比较时，自杀企图发生率未升高（IRR, 0.78; 95% CI, 0.26-2.35）。结论及相关性在开始哌甲酯治疗前，自杀未遂的发生率较高。在开始哌甲酯治疗后，风险立即升高，并在继续哌甲酯治疗期间恢复到基线水平。在治疗前观察到的更高的自杀企图风险可能反映了新出现的精神症状，这些症状触发了医疗咨询，导致决定开始治疗多动症。因此，本研究结果不支持哌醋甲酯治疗与自杀企图之间的因果关系。
IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear.OBJECTIVE To investigate the association between methylphenidate and the risk of suicide attempts.DESIGN, SETTING, AND PARTICIPANTS A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients.MAIN OUTCOMES AND MEASURES Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods.RESULTS Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts duringmethylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35).CONCLUSIONS AND RELEVANCE The incidence of suicide attempts was higher in the period immediately before the start ofmethylphenidate treatment. The risk remained elevated immediately after the start ofmethylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.