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Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review

Stefania Chiappini, Pietro Domenico Gramuglia, Alessio Mosca, Clara Cavallotto, Andrea Miuli, John Martin Corkery, Amira Guirguis Orcid Logo, Fabrizio Schifano, Giovanni Martinotti

Frontiers in Psychiatry, Volume: 15, Start page: 1508732

Swansea University Author: Amira Guirguis Orcid Logo

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DOI (Published version): 10.3389/fpsyt.2024.1508732

Abstract

Background: Methylphenidate (MPH), a central nervous system stimulant primarily prescribed for attention-deficit/hyperactivity disorder (ADHD), has seen increasing rates of misuse and abuse, particularly in patients with dual diagnosis (co-occurring psychiatric disorders and substance use disorders/...

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Published in: Frontiers in Psychiatry
ISSN: 1664-0640
Published: Frontiers Media SA 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa68125
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The heightened risk of dependence and adverse effects in these vulnerable populations warrants a systematic review to assess the prevalence and pattern of abuse/misuse of MPH among patients within this population and to understand potential risk factors, patterns of misuse, and outcomes, including the impact on psychiatric symptoms and overall mental health, the effects on SUD (e.g., exacerbation or mitigation of symptoms), and the incidence of adverse events and complications (e.g., cardiovascular issues, psychological effects). Methodology: A systematic review was conducted in August-September 2024 using both PubMed and Scopus databases. The following search strategy was used: TITLE-ABS-KEY (methylphenidate OR Ritalin OR Concerta) AND TITLE-ABS-KEY (abuse OR misuse OR dependency OR addiction) AND TITLE-ABS-KEY (dual diagnosis OR comorbid psychiatric disorder OR psychiatric disorder AND substance use disorder). The systematic review was structured in accordance with the PRISMA guidelines and identified studies were assessed by title/abstract and full text screening against eligibility criteria. Results: A total of 12 studies were selected for analysis after screening for relevance, quality, and adherence to inclusion criteria. Findings indicated that individuals with psychiatric disorders, particularly conduct disorder (N=593/1551 individuals), mood disorder (N=90/1551 individuals), anxiety disorder (N=66/1551 individuals), personality disorder (N=44/1551 individuals) and major depression disorder (N=40/1551 individuals), were more likely to misuse MPH. Co-occurring SUD, especially involving Alcohol Use Disorder (N=475/1551 individuals), Cannabis Use Disorder (N=371/1551 individuals), Nicotine Use Disorder (N=343/1551 individuals), Cocaine Use Disorder (N=68/1551 individuals), significantly elevated the risk. Misuse often involved higher doses than prescribed (N=84/1551 individuals) or using non-oral routes of administration (N=20/1551 individuals; e.g., snorting). Adverse outcomes included heightened risk of gastrointestinal events (N=201/1551 individuals), cardiovascular events (N=108/1551 individuals), psychosis (N=69/1551 individuals), and exacerbation of psychiatric symptoms (N=1082/1551 individuals). Conclusion: MPH misuse and abuse are significant concerns in patients with psychiatric disorders and SUD. Risk factors include impulsivity, history of substance abuse, and access to prescription stimulants. Integrated therapeutic approaches and stricter prescription monitoring are recommended to mitigate misuse risks. 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spelling 2024-12-12T13:12:24.3595464 v2 68125 2024-10-31 Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review b49270b9a0d580cf4f31f9a1b6c93f87 0000-0001-8255-0660 Amira Guirguis Amira Guirguis true false 2024-10-31 MEDS Background: Methylphenidate (MPH), a central nervous system stimulant primarily prescribed for attention-deficit/hyperactivity disorder (ADHD), has seen increasing rates of misuse and abuse, particularly in patients with dual diagnosis (co-occurring psychiatric disorders and substance use disorders/SUDs). The heightened risk of dependence and adverse effects in these vulnerable populations warrants a systematic review to assess the prevalence and pattern of abuse/misuse of MPH among patients within this population and to understand potential risk factors, patterns of misuse, and outcomes, including the impact on psychiatric symptoms and overall mental health, the effects on SUD (e.g., exacerbation or mitigation of symptoms), and the incidence of adverse events and complications (e.g., cardiovascular issues, psychological effects). Methodology: A systematic review was conducted in August-September 2024 using both PubMed and Scopus databases. The following search strategy was used: TITLE-ABS-KEY (methylphenidate OR Ritalin OR Concerta) AND TITLE-ABS-KEY (abuse OR misuse OR dependency OR addiction) AND TITLE-ABS-KEY (dual diagnosis OR comorbid psychiatric disorder OR psychiatric disorder AND substance use disorder). The systematic review was structured in accordance with the PRISMA guidelines and identified studies were assessed by title/abstract and full text screening against eligibility criteria. Results: A total of 12 studies were selected for analysis after screening for relevance, quality, and adherence to inclusion criteria. Findings indicated that individuals with psychiatric disorders, particularly conduct disorder (N=593/1551 individuals), mood disorder (N=90/1551 individuals), anxiety disorder (N=66/1551 individuals), personality disorder (N=44/1551 individuals) and major depression disorder (N=40/1551 individuals), were more likely to misuse MPH. Co-occurring SUD, especially involving Alcohol Use Disorder (N=475/1551 individuals), Cannabis Use Disorder (N=371/1551 individuals), Nicotine Use Disorder (N=343/1551 individuals), Cocaine Use Disorder (N=68/1551 individuals), significantly elevated the risk. Misuse often involved higher doses than prescribed (N=84/1551 individuals) or using non-oral routes of administration (N=20/1551 individuals; e.g., snorting). Adverse outcomes included heightened risk of gastrointestinal events (N=201/1551 individuals), cardiovascular events (N=108/1551 individuals), psychosis (N=69/1551 individuals), and exacerbation of psychiatric symptoms (N=1082/1551 individuals). Conclusion: MPH misuse and abuse are significant concerns in patients with psychiatric disorders and SUD. Risk factors include impulsivity, history of substance abuse, and access to prescription stimulants. Integrated therapeutic approaches and stricter prescription monitoring are recommended to mitigate misuse risks. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024576724. Journal Article Frontiers in Psychiatry 15 1508732 Frontiers Media SA 1664-0640 Methylphenidate, MPH, ADHD, dual diagnosis, SUD, drug misuse, pharming 18 11 2024 2024-11-18 10.3389/fpsyt.2024.1508732 Systematic Review COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article. 2024-12-12T13:12:24.3595464 2024-10-31T12:06:09.8474665 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Pharmacy Stefania Chiappini 1 Pietro Domenico Gramuglia 2 Alessio Mosca 3 Clara Cavallotto 4 Andrea Miuli 5 John Martin Corkery 6 Amira Guirguis 0000-0001-8255-0660 7 Fabrizio Schifano 8 Giovanni Martinotti 9
title Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
spellingShingle Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
Amira Guirguis
title_short Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
title_full Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
title_fullStr Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
title_full_unstemmed Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
title_sort Methylphenidate abuse and misuse in patients affected with a psychiatric disorder and a substance use disorder: a systematic review
author_id_str_mv b49270b9a0d580cf4f31f9a1b6c93f87
author_id_fullname_str_mv b49270b9a0d580cf4f31f9a1b6c93f87_***_Amira Guirguis
author Amira Guirguis
author2 Stefania Chiappini
Pietro Domenico Gramuglia
Alessio Mosca
Clara Cavallotto
Andrea Miuli
John Martin Corkery
Amira Guirguis
Fabrizio Schifano
Giovanni Martinotti
format Journal article
container_title Frontiers in Psychiatry
container_volume 15
container_start_page 1508732
publishDate 2024
institution Swansea University
issn 1664-0640
doi_str_mv 10.3389/fpsyt.2024.1508732
publisher Frontiers Media SA
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Pharmacy{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Pharmacy
document_store_str 0
active_str 0
description Background: Methylphenidate (MPH), a central nervous system stimulant primarily prescribed for attention-deficit/hyperactivity disorder (ADHD), has seen increasing rates of misuse and abuse, particularly in patients with dual diagnosis (co-occurring psychiatric disorders and substance use disorders/SUDs). The heightened risk of dependence and adverse effects in these vulnerable populations warrants a systematic review to assess the prevalence and pattern of abuse/misuse of MPH among patients within this population and to understand potential risk factors, patterns of misuse, and outcomes, including the impact on psychiatric symptoms and overall mental health, the effects on SUD (e.g., exacerbation or mitigation of symptoms), and the incidence of adverse events and complications (e.g., cardiovascular issues, psychological effects). Methodology: A systematic review was conducted in August-September 2024 using both PubMed and Scopus databases. The following search strategy was used: TITLE-ABS-KEY (methylphenidate OR Ritalin OR Concerta) AND TITLE-ABS-KEY (abuse OR misuse OR dependency OR addiction) AND TITLE-ABS-KEY (dual diagnosis OR comorbid psychiatric disorder OR psychiatric disorder AND substance use disorder). The systematic review was structured in accordance with the PRISMA guidelines and identified studies were assessed by title/abstract and full text screening against eligibility criteria. Results: A total of 12 studies were selected for analysis after screening for relevance, quality, and adherence to inclusion criteria. Findings indicated that individuals with psychiatric disorders, particularly conduct disorder (N=593/1551 individuals), mood disorder (N=90/1551 individuals), anxiety disorder (N=66/1551 individuals), personality disorder (N=44/1551 individuals) and major depression disorder (N=40/1551 individuals), were more likely to misuse MPH. Co-occurring SUD, especially involving Alcohol Use Disorder (N=475/1551 individuals), Cannabis Use Disorder (N=371/1551 individuals), Nicotine Use Disorder (N=343/1551 individuals), Cocaine Use Disorder (N=68/1551 individuals), significantly elevated the risk. Misuse often involved higher doses than prescribed (N=84/1551 individuals) or using non-oral routes of administration (N=20/1551 individuals; e.g., snorting). Adverse outcomes included heightened risk of gastrointestinal events (N=201/1551 individuals), cardiovascular events (N=108/1551 individuals), psychosis (N=69/1551 individuals), and exacerbation of psychiatric symptoms (N=1082/1551 individuals). Conclusion: MPH misuse and abuse are significant concerns in patients with psychiatric disorders and SUD. Risk factors include impulsivity, history of substance abuse, and access to prescription stimulants. Integrated therapeutic approaches and stricter prescription monitoring are recommended to mitigate misuse risks. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024576724.
published_date 2024-11-18T08:30:03Z
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score 11.263136

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