Man Kenneth K C, Coghill David, Chan Esther W, Lau Wallis C Y, Hollis Chris, Liddle Elizabeth, Banaschewski Tobias, McCarthy Suzanne, Neubert Antje, Sayal Kapil, Ip Patrick, Schuemie Martijn J, Sturkenboom Miriam C J M, Sonuga-Barke Edmund, Buitelaar Jan, Carucci Sara, Zuddas Alessandro, Kovshoff Hanna, Garas Peter, Nagy Peter, Inglis Sarah K, Konrad Kerstin, Häge Alexander, Rosenthal Eric, Wong Ian C K
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
JAMA Psychiatry. 2017 Oct 1;74(10):1048-1055. doi: 10.1001/jamapsychiatry.2017.2183.
Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear.
To investigate the association between methylphenidate and the risk of suicide attempts.
DESIGN, SETTING, AND PARTICIPANTS: A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients.
Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods.
Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95% CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95% CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95% CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35).
The incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study's results do not support a causal association between methylphenidate treatment and suicide attempts.
注意缺陷多动障碍（ADHD）患者自杀未遂风险增加。兴奋剂，如盐酸哌甲酯，是治疗ADHD最常用的药物，但其治疗用途与自杀之间的关联尚不清楚。
研究哌甲酯与自杀未遂风险之间的关联。
设计、设置和参与者：使用来自香港临床数据分析与报告系统的基于人群的电子病历数据库，识别2001年1月1日至2015年12月31日期间接受哌甲酯治疗的25629名6至25岁的个体。将有自杀未遂史的患者纳入分析。采用自我对照病例系列设计来控制患者的时间不变特征。
与未接触哌甲酯的时期相比，患者接触哌甲酯期间自杀未遂的相对发生率。
在25629例有哌甲酯处方的患者中，154例在研究期间首次记录到自杀未遂；其中，111例（72.1%）为男性；基线时的平均（标准差）年龄为7.15（2.19）岁。哌甲酯治疗期间自杀未遂发生率为每10000患者年9.27例。在开始使用哌甲酯前90天内，自杀未遂风险增加，发生率比（IRR）为6.55（95%CI，3.37 - 12.72）。在治疗的前90天内，IRR仍然升高（IRR，3.91；95%CI，1.62 - 9.42），然后在持续治疗期间恢复到基线水平（IRR，1.35；95%CI，0.77 - 2.38）。将治疗前90天的风险与首次治疗前90天的风险进行比较时，自杀未遂发生率并未升高（IRR，0.78；95%CI，0.26 - 2.35）。
在开始使用哌甲酯治疗前的时期，自杀未遂发生率更高。在开始使用哌甲酯治疗后，风险立即升高，并在继续使用哌甲酯治疗期间恢复到基线水平。治疗前观察到的较高自杀未遂风险可能反映了引发医疗咨询并导致决定开始ADHD治疗的新出现的精神症状。因此，本研究结果不支持哌甲酯治疗与自杀未遂之间存在因果关联。
