Psychosis methylphenidate

The development of psychosis is the most striking clinical characteristic of high-dose stimulant abuse. The amphetamines, methylphenidate, and phen-metrazine all produce psychosis (Ellinwood et al. 1973 Harris and Batki 2000 Iversen et al. 1978 Lucas and Weiss 1971 McCormick and McNeil 1962). 

Martin WR, Sloan JW, Sapira JD, et al Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenidate in man. Clin Pharmacol Ther 12 245-258, 1971 McCormick TC Jr, McNeil TW Acute psychosis and Ritalin abuse. Tex State J Med... 

The prescribing physician should be notified immediately if tics or psychosis (usually paranoia) develop. The medication should always be stopped when psychosis occurs. We once said the same about tics, but recent research suggests that stimulants may not worsen tics. Methylphenidate is now available in a controlled-release preparation (Concerta), which can be prescribed once daily. One key advantage to once-daily dosing is not pharmacological, but rather that it avoids the stigma children may experience when they need to go to the school nurse s office to receive their afternoon dose. Focalin is the active isomer of methylphenidate. 

Psychosis In psychotic children, administration of methylphenidate may exacerbate symptoms of behavior disturbance and thought disorder. 

Additional evidence comes from studies of increasing dopaminergic activity in patients with active psychosis. Small i.v. doses of methylphenidate (e.g., 0.5 mg/kg) can result in a marked exacerbation of an acute schizophrenic episode (18). By contrast, such doses usually do not produce psychotic symptoms in normal control... 

Exacerbation of psychosis Potentiation of hypertensive effects with phenylephrine, noradrenaline, methylphenidate Potentiation of effects of pheochromocytoma Can manifest as spurious hyperthyroidism, cardiac dysrhythmias, or, in some cases, enhanced therapeutic actions of tricyclics... 

DEXAMFET AMINE, METHYLPHENIDATE DISULFIRAM Risk of psychosis Additive effects these drugs interfere with dopamine metabolism Caution with co-administration. Warn patients and carers to watch for early features... 

Methylphenidate should not be used with monoamine oxidase inhibitors such as tranylcypromine. Symptoms of overdose may include euphoria, confusion, delirium, coma, toxic psychosis, agitation, headache, vomiting, dry mouth, mydriasis, self-injury, fever, diaphoresis, tremors, hyper-reflexia, muscle twitching, seizures, flushing, hypertension, tachycardia, palpitations, and arrhythmias. 

A 61-year-old man with major depression was prescribed sertraline 50 mg daily without response. Three months later the dose was increased to 100 mg daily and methylphenidate 2.5 mg daily was started. TEs symptoms improved and the dose of methylphenidate was increased to 2.5 mg twice daily and then 5 mg twice daily. After several days at the higher dose, the patient experienced visual hallucinations and confusion. The methylphenidate was discontinued and a day later the psychosis resolved. He was maintained on sertraline 100 mg daily and his mood and motivation remained good. ... 

Kraemer MK, Uekermann J, Wiltfang J, Kis B. Methylphenidate-induced psychosis in adult attention-deficit/hyperactivity disorder report of 3 new cases and review of the literature. Clin Neuropharmacol 2010 33 204-6. 

Psychiatric Psychosis is an important but unpredictable adverse effect of stimulant medications and can mimic the symptoms of ADHD. Four cases of stimulant-induced psychosis (three with methylphenidate and one with Concerta XL) resolved spontaneously on withdrawal of medication and... 

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