A growing number of patients are developing psychosis, including paranoia and hallucinations, after taking medication to treat ADHD, psychiatrists have warned.
asserted
psychiatrists → grow → ADHD
While the drugs can be transformative for people with ADHD, psychiatrists say stimulant medication can, in rare cases, trigger psychosis.
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medication → say → psychosis
It is estimated that between 2 and 6 per cent of Australian adults have ADHD.
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cent → estimate → ADHD
Rates of diagnosis have skyrocketed due to increased awareness of the disorder, and the number of Australians using stimulant medication to treat the neurodevelopmental condition is surging.
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number → skyrocket → condition
Stimulant-induced psychosis was rare 10 years ago, Australian Society of Psychiatrists executive director Dr Pramudie Gunaratne said.
“This is more of a regular presentation now,” Dr Gunaratne said.
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Gunaratne → induce → presentation
“If you’ve increased the number of people being prescribed this medication, there’s going to be a certain proportion of those people that will develop psychosis,” she said.
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she → increase → psychosis
“If you take more than prescribed, if you take it without medical supervision, if people are accessing stimulants from friends, that can put them at particularly high risk.”
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that → take → risk
The number of adults being treated for ADHD has increased more than sixfold since 2017, research by the University of NSW found.
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research → treat → NSW
Gunaratne said stimulant medications could alter brain chemistry.
uncertain
medications → say → chemistry
“Like all medications, they carry significant risks,” she said.
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she → carry → risks
“Even when stimulants are taken exactly as prescribed in people without known risk factors, there is a rare but real risk of psychosis.”
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stimulants → take → psychosis
Symptoms of psychosis can include paranoia, hallucinations or delusional beliefs.
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Symptoms → include → paranoia
“Sometimes the person themselves might not have insight or recognise that this is happening, and it will be the people around them that notice that their behaviour or thinking is out of character,” Gunaratne said.
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Gunaratne → have → character
Sydney psychiatrist Dr Matthew Large, a conjoint professor at UNSW, is treating an increasing number of patients for psychosis linked to ADHD medication.
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Large → treat → medication
Large has seen four cases in the past year, including a young patient who experienced psychosis after she was prescribed stimulant medication to treat her inattention.
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she → see → inattention
He said the patient’s inattention was linked to trauma.
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inattention → say → trauma
“The patient instead needed treatment for post-traumatic stress disorder,” he said.
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he → need → disorder
In another case, a high-achieving student feigned ADHD symptoms to secure medication to improve their academic performance.
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student → achieve → performance
This patient experienced psychosis after increasing the dose.
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patient → experience → dose
Too few patients were informed of the risk of psychosis before starting treatment, Large said.
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Large → inform → treatment
He said that while safety studies of stimulants in children indicated only a small proportion developed psychosis, it was unclear whether the drugs carried the same low risk in adults.
uncertain
drugs → say → adults
“The practice has outstripped safety evidence, in my view,” he said.
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he → outstrip → view
Psychosis is thought to be caused by excessive dopamine transmission in the brain.
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Psychosis → think → brain
Large said this dopamine transmission is increased by stimulant medication.
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transmission → say → medication
People experiencing psychosis are usually admitted to hospital, where they receive anti-psychotic medication, therapy and social support.
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they → experience → medication
“Even treatment of one psychotic episode is a very significant event in a person’s life,” Large said.
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Large → say → life
“They lose contact with reality.
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They → lose → reality
They often do things that are deeply embarrassing to themselves, and they can get in trouble with the law.”
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they → do → law
Associate Professor Mark Putland, Victoria branch chair of the Australasian College for Emergency Medicine, said misuse of ADHD medication was triggering psychosis in some patients, but some people using the medication as directed had developed psychosis.
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people → say → psychosis
“It is a real health problem from an addiction and mental health point of view,” he said.
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he → say → view
He said combining ADHD medication with other substances was also fuelling psychosis.
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combining → say → psychosis
“They might be abusing prescribed stimulants and also using some amphetamines they bought on the street, and they might also have some mental health conditions.
uncertain
they → abuse → conditions
It’s often messy.”
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It → ’ → ?
ADHD Australia chief executive Melissa Webster, who was diagnosed with ADHD while at university, knows at least four people who have experienced psychosis while using stimulant medication.
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who → diagnose → medication
She said these people also had pre-existing mental health conditions, so it was difficult to determine what led to the psychosis.
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what → say → psychosis
Better communication of side effects was needed, she said.
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she → need → effects
Some psychiatrists relied on patients reading the paperwork tucked into their boxes of medication, she said, while others outlined potential side effects in great detail.
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others → rely → detail
But serious side effects were rare and many people found the medication life changing for the better.
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medication → find → better
More states are allowing GPs to diagnose, treat and prescribe ADHD medication.
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GPs → allow → medication
Last week, 150 Victorian GPs started diagnosing and prescribing the medication, following NSW, South Australia and Queensland.
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GPs → start → NSW
…and 1 more, not listed.
The Aporia
