Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
BMJ Ment Health. 2024 Sep 19;27(1):e301003. doi: 10.1136/bmjment-2024-301003.
Psychiatric comorbidity is frequent among persons with attention-deficit/hyperactivity disorder (ADHD). Whether pharmacological treatment of ADHD influences the incidence of psychiatric comorbidity is uncertain.
To investigate associations and causal relations between pharmacological treatment of ADHD and incidence of subsequent comorbid psychiatric diagnoses.
We employed registry data covering all individuals aged 5-18 years in Norway who were diagnosed with ADHD during 2009-2011 (n=8051), followed until 2020. We used linear probability models (LPM) and instrumental variable (IV) analyses to examine associations and causal effects, respectively, between pharmacological treatment and subsequent comorbidity.
From time of ADHD diagnosis to 9 years of follow-up, 63% of patients were registered with comorbid psychiatric disorders. For males, LPM showed associations between ADHD medication and several incident comorbidities, but strength and direction of associations and consistency over time varied. For females, no associations were statistically significant. IV analyses for selected categories isolating effects among patients 'on the margin of treatment' showed a protective effect for a category of stress-related disorders in females and for tic disorders in males for the first 2 and 3 years of pharmacological treatment, respectively.
Overall, LPM and IV analyses did not provide consistent or credible support for long-term effects of pharmacological treatment on later psychiatric comorbidity. However, IV results suggest that for patients on the margin of treatment, pharmacological treatment may initially reduce the incidence of certain categories of comorbid disorders.
Clinicians working with persons with ADHD should monitor the effects of ADHD medication on later psychiatric comorbidity.
ISRCTN11891971.
精神共病在注意力缺陷/多动障碍（ADHD）患者中很常见。ADHD 的药物治疗是否会影响精神共病的发生率尚不确定。
研究 ADHD 药物治疗与随后共患精神诊断之间的关联和因果关系。
我们使用了涵盖挪威所有在 2009-2011 年间被诊断为 ADHD 的 5-18 岁个体的登记数据（n=8051），并对其进行了随访直至 2020 年。我们分别使用线性概率模型（LPM）和工具变量（IV）分析来检验药物治疗与随后共病之间的关联和因果效应。
从 ADHD 诊断到 9 年的随访期间，63%的患者被诊断为共患精神障碍。对于男性，LPM 显示 ADHD 药物治疗与几种新发共病之间存在关联，但关联的强度、方向和随时间的变化有所不同。对于女性，没有关联具有统计学意义。针对治疗边缘患者的特定类别进行的 IV 分析显示，对于女性，药物治疗的前 2 年和前 3 年，应激相关障碍的一个类别以及男性的抽动障碍有保护作用。
总体而言，LPM 和 IV 分析并未为药物治疗对后期精神共病的长期影响提供一致或可信的支持。然而，IV 结果表明，对于处于治疗边缘的患者，药物治疗最初可能会降低某些共患疾病类别的发生率。
与 ADHD 患者合作的临床医生应监测 ADHD 药物治疗对后期精神共病的影响。
ISRCTN82475704。
