Use of Psychostimulants and Risk of Bipolar Disorder in Children and Adolescents with Attention Deficit/Hyperactivity Disorder



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Objectives: The aim of our study is to compare effectiveness of psycho stimulants on risk of developing Bipolar Disorder in children and adolescents with ADHD diagnosis. Methods: This is an observational, retrospective cohort study with longitudinal follow-up of minimum 12 months and maximum up to 4 years and 6 months. The cohort consists of incident ADHD children and adolescents (6-18 years old) and prescription filled for Psychostimulants within 30 days of diagnosis were identified by using files from 2003-2007 from Medicaid Analytic Xtract (MAX). Children and adolescents with prior history of ADHD or/and BD or/and psycho stimulants were excluded. Time to development of bipolar disorder was conducted using survival analysis. Main outcome variable was time to bipolar and status variable was development of BD. Use of psycho stimulants was main independent dichotomous variable. All analysis was conducted using SAS 9.3 with significance level of 0.05. Results: Out of 3942935 children and adolescents without any history of ADHD and BD, 252388 children and adolescents developed ADHD during July 31, 2003 till December 31, 2006. Out of these Children and adolescents 68173 filled prescription for psycho stimulants within 30 days. Mean age of children and adolescents with ADHD diagnosis was 9.0 years (±3.12). Seventy two percent children were boys, majority (46% of cohort) of them were white by race, were from Texas (43.67%) region. Common co-morbidities were learning conduct disorder (7.8%) followed by adjustment disorder (5.4%) and depression (3.3%). 5029 were diagnosed with bipolar disorder which accounts for 7.37%. The age of onset of ADHD was found to be 9.0 years (±3.12) and that for BD was 10.49 years (± 3.44). Age of onset of BD for those who were exposed to stimulants and those who filled prescription of stimulants for just one time vs more than one time (12.11±3.60 vs 10.37±3.40 years p =<0.0001). The hazard ratio for children and adolescents with ADHD filled Rx for more than once for stimulant was more (HR 1.583; CI 1.418-1.768; p-<0.001) as compared to those who filled Rx only once for stimulants. Conclusion: Survival estimates for children and adolescents with ADHD were significantly different for patients filled Rx more than once for psycho stimulants vs patients with one Rx filled (HR 1.583, CI 1.418-1.768; p-<0.001). This study will help physicians to make better-informed decision.



Attention Deficit/Hyperactivity Disorder (ADHD), Bipolar disorder, Risk assessment, Psychostimulants, Stimulants, Mania, Early onset