Risk Factors for Psychosis and Mania with Prescription Amphetamine Use

使用处方安非他明导致精神病和躁狂症的危险因素

• 批准号: 10188647
• 负责人: LAUREN V MORAN
• 金额: $ 69.41万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-10 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188647
• 关键词: Address; Adolescent; Adolescent and Young Adult; Adult; Affective; Age; Amphetamine Users; Amphetamines; Antipsychotic Agents; Area; Attention deficit hyperactivity disorder; Big Data; Bipolar Disorder; Boston; Case-Control Studies; Child; Clinical; Clinical Practice Guideline; Clinical Practice Patterns; Cohort Studies; Complement; Computerized Medical Record; Data; Data Set; Data Sources; Databases; Diagnosis; Disease; Dose; Ethnic Origin; Family; Family history of; First Degree Relative; Future; Goals; Gold; Healthcare; Hospitalization; Hospitals; Immigration; Interdisciplinary Study; Intervention; Journals; Knowledge; Label; Lead; Manic; Measurement; Medicine; Mental disorders; Modification; Mood stabilizers; National Institute of Mental Health; Natural Language Processing; New England; Outcome; Patients; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Pharmacy facility; Positioning Attribute; Practice Guidelines; Prevention; Principal Investigator; Provider; Psychiatric Hospitals; Psychoses; Public Health; Publishing; Race; Recording of previous events; Relative Risks; Reporting; Research; Research Design; Risk; Risk Factors; Ritalin; Sampling; Socioeconomic Status; Symptoms; Testing; Translating; Woman; adverse outcome; amphetamine use; base; comorbidity; comparative; cost effective; data warehouse; first episode psychosis; high risk; innovation; marijuana use; patient subsets; practice setting; prescription stimulants; prevent; provider factors; stimulant use; treatment risk; university student

ABSTRACT: The use of prescription amphetamines for the treatment of attention-deficit hyperactivity disorder (ADHD) has markedly increased in the last fifteen years, with the greatest increase in adolescents and young adults. In 2007, the FDA mandated changes to stimulant labels to warn of increases in psychosis and mania in patients without pre-existing conditions. Our multidisciplinary research team from Brigham and Women's Hospital and McLean Hospital recently published a landmark cohort study demonstrating an increased risk of psychotic episodes in new users of amphetamine compared to methylphenidate in adolescents and young adults with ADHD. Alarmingly, the use of amphetamines increased four-fold over the study period (2004 – 2015). In addition, our data show that prescription amphetamine use has dramatically increased in patients with pre-existing bipolar disorder. Thus, there is an urgent need to accelerate knowledge about prescriber-level factors, patient-level factors and disease states that potentiate the risk of psychosis and mania with prescription amphetamines. Large-scale studies using real-world data are the only option to study the risk of infrequent and serious adverse outcomes. In Aim 1, using incident-user cohort study designs, we will utilize data from two national administrative claims databases to identify prescriber dosing strategies that increase the risk of first-episode psychosis in ~220,000 adolescents and adults with ADHD initiating amphetamines. We hypothesize that there will be a dose-dependent increase in the risk of psychosis. The goal of Aim 2 is to identify patient subgroups at heightened risk of psychosis/mania with prescription amphetamine use. To accomplish this goal, we will perform a case control study using electronic medical records (EMR) from McLean Hospital in ~1,650 patients hospitalized for an initial episode of psychosis or mania compared to ~3,300 controls with a first psychiatric hospitalization for reasons other than psychosis or mania. We will apply natural language processing to unstructured narrative notes to capture detailed patient data not available in claims data. We hypothesize that patients with a family history of psychiatric illness will have an increased risk of psychosis/mania with amphetamines compared to patients without a family history. We also hypothesize that patients with concurrent cannabis use will have an increased risk of psychosis/mania with amphetamines compared to patients without cannabis use. Aim 3 compares the risk of treatment-emergent mania in ~52,000 new users of amphetamine versus methylphenidate in a cohort study of patients with pre-existing bipolar disorder, an urgent issue given the known risk of mania with stimulant use. Combined, these studies will provide actionable evidence to be incorporated into clinical practice guidelines with the goal of mitigating the risk of psychosis and mania with prescription stimulants. The proposed research agenda aligns with NIMH Strategic Objective 3.3 “Striving for Prevention and Cure” on testing interventions in real-world practice settings to evaluate the impact of patient- and provider-level factors on clinical outcomes.

摘要：使用处方安非他明治疗注意缺陷多动障碍