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. 2017 Apr;56(4):336-343.
doi: 10.1016/j.jaac.2017.01.016. Epub 2017 Feb 4.

Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder: An Analysis of the MTA Database

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Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder: An Analysis of the MTA Database

Benedetto Vitiello et al. J Am Acad Child Adolesc Psychiatry. .
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Objective: To assess the prevalence of psychotic symptoms among youths (14-25 years of age) with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) combined type.

Method: Participants in the Multimodal Treatment Study of Children with ADHD (MTA) and a local normative comparison group (LNCG) were systematically assessed 6, 8, 10, 12, 14, and 16 years after the original enrollment at a mean age of 8.5 years. Trained research assistants administered a psychosis screener, and positive screens were referred to study clinicians to confirm or exclude psychosis. Possible associations between screening positive and alcohol or substance use were assessed.

Results: Data were available from 509 MTA participants (88% of original MTA sample; mean age 25.1 years) and 276 LNCG participants (96% of original sample; mean age 24.6 years) at year 16. Twenty-six MTA participants (5%; 95% CI 3-7) and 11 LNCG participants (4%; 95% CI 2-6) screened positive for at least 1 psychotic symptom (p = .60). Most psychotic symptoms were transient. The prevalence of clinician-confirmed psychotic symptoms was 1.1% (95% CI 0.2-2.1) in the MTA group and 0.7% (0-1.7) in the LNCG (p = .72). Greater cannabis use was reported by those who screened positive (p < .05) and were confirmed positive (p < .01).

Conclusion: There was no evidence that ADHD increased the risk for psychotic symptoms. In the ADHD and normative comparison groups, more frequent cannabis use was associated with a greater likelihood of experiencing psychotic symptoms, thus supporting the recommendation that youth should not use cannabis.

Keywords: attention-deficit/hyperactivity disorder; cannabis; psychosis; screening.


Figure 1
Figure 1
Frequency of cannabis use among the positive (n=37) and negative screens (n=748) for psychotic experiences. Note: Frequency is expressed as the reported number of times that cannabis was used in past 12 months.

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