Prescription Stimulant Use and Hospitalization for Psychosis or Mania: A Population-Based Study
Open accessAbstract
Small studies suggest that prescription stimulants can precipitate psychosis and mania. We conducted a population-based case-crossover study to examine whether hospitalization for psychosis or mania was associated with initiation of stimulant therapy. Between October 1, 1999 and March 31, 2013, we studied 12,856 young people who received a stimulant prescription and were subsequently hospitalized for psychosis or mania. Of these, 183 commenced treatment during 1 of 2 prespecified 60-day intervals (defined as the "risk interval" and "control interval," respectively) prior to admission. We found that stimulant initiation was associated with an increased risk of hospitalization for psychosis or mania in the subsequent 60 days (odds ratio, 1.86; 95% confidence interval, 1.39-2.56). The risk was marginally higher in patients treated with antipsychotic drugs (odds ratio, 2.06; 95% confidence interval, 1.38-3.28), but remained in patients with no such history (odds ratio, 1.66; 95% confidence interval, 1.09-2.66). One third of subjects received another stimulant prescription after hospital discharge. Of these, 45% were readmitted with psychosis or mania shortly thereafter. We conclude that initiation of prescription stimulants is associated with an increased risk of hospitalization for psychosis or mania. Resumption of therapy is common, which may reflect a lack of awareness of the potential causative role of these drugs.
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Almost all evidence for treating symptoms of psychosis from systematic reviews and meta-analyses is based on stimulant-induced or unspecified causes of psychosis.
“Almost all evidence for treating symptoms of psychosis from systematic reviews and meta-analyses is based on stimulant-induced or unspecified causes of psychosis.114,117,119,[150][151][152][153][154][155]”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [117]
The Results and Discussion examine whether starting prescription stimulants is associated with hospitalization for psychosis or mania. Our copy does not assess evidence for treating psychosis or the causes represented in systematic reviews and meta-analyses (searched: treatment evidence, systematic reviews, and unspecified psychosis). The supplied passages have no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThese studies generally noted a large beneficial effect of pharmacotherapy for both preexisting and stimulant-induced psychosis, as well as preexisting and stimulant-induced mania.
“These studies generally noted a large beneficial effect of pharmacotherapy for both preexisting and stimulant-induced psychosis, as well as preexisting and stimulant-induced mania.”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [117]
The Results and Discussion (page unavailable) examine the risk of hospitalization after starting prescription stimulants, not the effectiveness of pharmacotherapy for psychosis or mania. The Discussion says stimulant-induced episodes can resolve after discontinuing the stimulant, but reports no large beneficial effect of medication for either preexisting or stimulant-induced conditions. Searches for pharmacotherapy benefits and antipsychotic treatment effectiveness found no such finding in our copy. (LLM, conf=0.76)
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- Authors
- Cressman, A. M., Macdonald, E. M., Huang, A., Gomes, T., Paterson, M. J., Kurdyak, P. A., Mamdani, M. M., & Juurlink, D. N.
- Affiliations
- St. Michael's Hospital (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Li Ka Shing Foundation (CN)
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Cressman, Alex M.
- Macdonald, Erin M.
- Huang, Anjie
- Gomes, Tara
- Paterson, Michael J.
- Kurdyak, Paul A.
- Mamdani, Muhammad M.
- Juurlink, David N.
- ORCID
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2015-12
- Volume
- 35
- Issue
- 6
- Pages
- 667-671
- ISSN
- 0271-0749 (ISSN-L)
- PMC
- PMC4898903
- OpenAlex
- W1771889306
- Cited by
- 37
- References
- 42
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 6 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 2
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Institute for Clinical Evaluative Sciences
- Ontario Ministry of Health and Long-Term Care
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- stimulant medication, psychosis, mania, hospitalization, antipsychotic drugs, youth, hospital readmission, drug-induced psychosis, case-crossover
- MeSH terms
- Adolescent, Adult, Central Nervous System Stimulants, Bipolar Disorder, Female, Hospitalization, Humans, Male, Drug Prescriptions, Psychoses, Substance-Induced, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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