Stimulants Linked to Psychotic Symptoms in Offspring of Parents with Psychiatric Illness

April 18, 2016 · Posted in Current Treatments, Risk Factors · Comment 

stimulants linked to psychotic symptoms

Stimulants are one of the most common medications prescribed to children and adolescents, typically for attention deficit hyperactivity disorder (ADHD). In children of parents with major depression, bipolar disorder, or schizophrenia, stimulant use may come with a risk of psychotic symptoms. A 2016 study by L.E. MacKenzie and colleagues in the journal Pediatrics reported that among children and youth whose parents had one of these psychiatric illnesses, 62.5% of those who had taken stimulants had current psychotic symptoms, compared to only 27.4% of those who had not taken stimulants. The participants with psychotic symptoms tended to have hallucinations that occurred while they were taking stimulants. Doctors may want to consider whether parents have a history of psychiatric illness when deciding whether to prescribe stimulants to children and adolescents with ADHD. Activation is a common side effect of antidepressants in children who have a parent with bipolar disorder. Young people taking stimulants for ADHD should be monitored for psychotic symptoms, particularly if they have a parent with a history of depression, bipolar disorder, or schizophrenia.

How Illness Progresses In The Recurrent Affective Disorders

December 12, 2012 · Posted in Peer-Reviewed Published Data, Risk Factors · Comment 

depressed man with woman

This editor (RM Post) in collaboration with Jacqueline Fleming and Flavio Kapczinski published the article “Neurobiological mechanisms of illness progression in the recurrent affective disorders” in the Journal of Psychiatric Research this year. The article built on several themes about the progression of bipolar illness that had been explored in previous research.

These themes include:

  1. The likely acceleration of repeated episodes as a function of the number of prior episodes (episode sensitization)
  2. The increased responsivity of the illness to repeated stressors (stress sensitization)
  3. The increased behavioral reactivity to repeated use of psychomotor stimulants such as cocaine (stimulant-induced behavioral sensitization)

Not only are these observations well documented in the scientific literature, but recent observations also suggest that each type of sensitization can show cross-sensitization to the other two types. That is, individuals exposed to repeated stressors are more likely both to experience affective illness episodes and to adopt comorbid substance abuse. In a similar way, episodes of an affective disorder and stressors may also be associated with the relapse into drug administration in those who have been abstinent.

In addition to these mechanisms of illness progression in the recurrent affective disorders, the new article reviews the literature showing that the number of affective episodes or the duration of the illness appear to be associated with a variety of other clinical and neurobiological variables.

The number of affective episodes a patient experiences is associated with the degree of cognitive dysfunction present in their bipolar illness, and experiencing more than 4 episodes of unipolar or bipolar depression is a risk factor for dementia in late life. A relative lack of response to most treatments is also correlated with the number of prior episodes, and this holds true for response to naturalistic treatment in general. While most of these data are correlational and the direction of causality cannot be ascertained for certain, it is likely that the number of affective episodes and/or their duration could account for and drive difficulties with treatment and with cognitive function.

If this were the case, one would expect to see a variety of neurobiological correlates with the number of prior episodes or duration of illness, and in the article we summarize those that have been found in unipolar and bipolar disorder. Considerable data indicate that cortical volume and degrees of prefrontal cortical dysfunction can vary as a function of number of prior episodes. There is evidence that increased activity of the amygdala and the nucleus accumbens are also related to episodes or duration of illness. In those with unipolar depression, the volume of the hippocampus is decreased with longer duration of illness. Read more

Guanfacine Augments Stimulants in ADHD

October 31, 2011 · Posted in Potential Treatments · Comment 

Tim Wilens of Massachusetts General Hospital presented a poster at the 57th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in October 2010 that showed that extended release guanfacine could augment incomplete responses to stimulants in children with attention deficit hyperactivity disorder (ADHD).  This double-blind, placebo-controlled study of children aged 6-17 used guanfacine doses of 4mg/day or less.  Those children who received guanfacine in addition to the psychomotor stimulant they were already taking were more likely to improve and more likely to reach a satisfactory remission than those taking a placebo in addition to their regular psychomotor stimulant.  These results suggest that adding an alpha 2 noradrenergic agonist compound like guanfacine to a psychomotor stimulant may bring about a more complete response in ADHD.