Prescription stimulant use is associated with earlier onset of psychosis.
Prescription stimulant use is associated with earlier onset of psychosis.
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DOI：
10.1016/j.jpsychires.2015.09.012
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发表时间：
2015-12
影响因子：
4.8
通讯作者：
Ongur D
中科院分区：
文献类型：
--
作者：
Moran LV;Masters GA;Pingali S;Cohen BM;Liebson E;Rajarethinam RP;Ongur D
注意力缺陷多动障碍 (ADHD) 的儿童期病史在精神障碍中很常见，但处方兴奋剂可能会对这些疾病的生理产生不利的相互作用。具体来说，接触兴奋剂会导致多巴胺释放的长期增加。因此，我们假设之前接触过处方兴奋剂的精神病患者会更早出现精神病。在控制潜在的混杂因素的同时，比较了之前接触过和未接触过处方兴奋剂的个体的精神病发病年龄（AOP）。在从住院精神病科招募的 205 名患者样本中，40% (n=82) 报告在精神病发作前使用过兴奋剂。大多数参与者在童年或青春期时因诊断患有多动症而服用兴奋剂。暴露于兴奋剂的人群中，AOP 显着提前（兴奋剂组为 20.5 年，无兴奋剂组为 24.6 年，p<0.001）。在控制了性别、智商、教育程度、大麻使用障碍或其他滥用药物的终生史以及患有精神病的一级亲属家族史后，兴奋剂暴露与早期 AOP 之间的关联仍然显着。性别与兴奋剂之间存在显着的相互作用，女性 AOP 降低幅度更大，而兴奋剂使用对男性 AOP 的较小影响并未达到统计学显着性。总之，接触处方兴奋剂的精神病患者的精神病发作较早，而且这种关系似乎不是由智商或大麻介导的。
A childhood history of attention deficit hyperactivity disorder (ADHD) is common in psychotic disorders, yet prescription stimulants may interact adversely with the physiology of these disorders. Specifically, exposure to stimulants leads to long-term increases in dopamine release. We therefore hypothesized that individuals with psychotic disorders previously exposed to prescription stimulants will have an earlier onset of psychosis. Age of onset of psychosis (AOP) was compared in individuals with and without prior exposure to prescription stimulants while controlling for potential confounding factors. In a sample of 205 patients recruited from an inpatient psychiatric unit, 40% (n=82) reported use of stimulants prior to the onset of psychosis. Most participants were prescribed stimulants during childhood or adolescence for a diagnosis of ADHD. AOP was significantly earlier in those exposed to stimulants (20.5 vs. 24.6 years stimulants vs. no stimulants, p<0.001). After controlling for gender, IQ, educational attainment, lifetime history of a cannabis use disorder or other drugs of abuse, and family history of a first-degree relative with psychosis, the association between stimulant exposure and earlier AOP remained significant. There was a significant gender x stimulant interaction with a greater reduction in AOP for females, whereas the smaller effect of stimulant use on AOP in males did not reach statistical significance. In conclusion, individuals with psychotic disorders exposed to prescription stimulants had an earlier onset of psychosis, and this relationship did not appear to be mediated by IQ or cannabis.