Psychosis Induced by Methylphenidate Misuse.

Objectives: This paper deals with the methylphenidate (MPH) misuse by adults in Germany. Results of a survey among primary care physicians/internists have been supplemented by a comparison with the literature. Methods: In the period from October 5-20, 2015, a survey was sent to 414 primary care physicians/internists in four German cities (n = 10 were undeliverable). The response rate was 58% (n = 235). 34 original works on MPH abuse worldwide were found in the literature and are used in the analysis of the present data situation. The literature published before November 9, 2015 is considered in this paper. Results: 14% of the doctors who took part in the survey said that they had been asked for MPH prescriptions without any medical indication. The most frequent reason given for the request (42%) was adult attention deficit/hyperactivity disorder (ADHD) not verified by documents. According to the comparison with the literature, university students had a lifetime prevalence of MPH misuse ranging from 0.8% to 16.6% and school children had a misuse rate of 4.0%. In the civilian US population, the misuse rate was 4.2%. Among patients in possession of a current MPH prescription due to a diagnosis, the lifetime prevalence was 29% and among adolescents with suspected alcohol and/or drug problems 20%. Conclusions: MPH misuse is a major problem which has not been studied sufficiently. MPH misuse not only plays a role in the field of psychiatry, but also in other disciplines. Misuse particularly following a therapeutic prescription should be taken into account.

A steady growth in the use of medication for the treatment of attention-deficit hyperactivity disorder (ADHD) has been evident over the past few decades. While growth attests to increased awareness of ADHD and improved access to diagnosis and treatment, concerns have been raised about poor adherence to treatment and diversion of medication. This current study explored the seasonal and/or temporal use of methylphenidate (MPH) in South Africa. The study was conducted in South Africa. A retrospective database analysis was conducted to examine unit sales of MPH over a 9-year period. The unit sales of MPH were compared to those of atomoxetine for the same period. Unit sales for MPH peaked in May and October, which coincided with the academic high-pressure periods for school learners and university students. This was most evident for MPH immediate release 10 mg. There was a noticeable decrease in unit sales for MPH during December. Atomoxetine demonstrated much less seasonal variation. The seasonal and/or temporal use of MPH fluctuates following the academic calendar. These changes are driven by both temporary interruptions of treatment, such as 'drug holidays', and the misuse and diversion of MPH for non-medical use. This holds significant implications for interventions to improve ADHD outcomes. It is crucial to balance accessibility to treatment with the prevention of misuse of MPH. Our findings highlight the need to reconsider current policies and regulations regarding the appropriate diagnosis and management of ADHD and the scripting, dispensing and monitoring of MPH.

Objective: Misuse of methylphenidate (MPH) has been found to be highly prevalent in young individuals. MPH misuse is more frequent among college students. In the present study, we aimed to evaluate the frequency of misuse of MPH and knowledge level about this agent among resident physicians.Method: A group of 212 resident physicians working in Gaziantep University Medical Faculty Hospital were enrolled in our study. Of this group, 176 (83%) agreed to participate. Participants were asked to complete a twelve item questionnaire and a sociodemographic data sheet designed by the department of psychiatry.Results: Of the participants, 124 (70.5%) were male and 52 (29.5%) were female. Mean age was 29.25±3.04 (range: 24–44) years. Of the participants, 100 were resident physicians in internal medicine, whereas 57 were in surgical specialties and 19 in basic sciences. It was found that 39 participants (22.2%) had previously used MPH without a medical indication. Of the participants who reported misuse of MPH, 19 participants indicated that they started using MPH by recommendation of their colleagues, whereas 20 participants indicated that they started using MPH by their own decision. Twenty eight participants (15.9%) stated that they used MPH during the preparation period for the Medical Specialty Entrance Exam, while 11 participants (6.25%) stated that they used MPH in a period unrelated to the Medical Specialty Entrance Exam. No significant difference was detected between male (n=30; 24.2%) and female participants (n=9; 17.3%) regarding the frequency of misuse of MPH.Conclusion: This study shows that the frequency of misuse of MPH is high among resident physicians. Multi-centered studies are needed to generalize this conclusion.

This study determined the change in prevalence of methylphenidate misuse over the last four years in adolescents assessed at an outpatient substance abuse treatment facility. A review of 240 charts randomly selected from 1,183 patient records of assessments during 1992–1996 was done. Chi square and logistic regression were used in analysis. The sample was 74% male; 63% white, 36% African American; 11–20 years of age (mean 15.6 years). Five percent of the sample was assessed in 1992, 19% in 1993, 28% in 1994, 26% in 1995, and 22% in 1996. There was a significant increase in methylphenidate misuse over the last 2.5 years (2% 1992–1993, 12% 1994–1996) (p = 0.02). This increase was greatest in white adolescents (3% in 1992–1993, 20% in 1994–1996) (p = 0.009). There was no significant gender difference in methylphenidate misuse or association with a specific drug of choice. Misuse of other prescription or over-the-counter medications did not change. There has been a significant increase in methylphenidate misuse, especially in white adolescents. Treatment with methylphenidate in adolescents at risk of substance misuse should be considered carefully.

Introduction: Methylphenidate is a psychostimulant widely used to treat ADHD. However, its misuse is a growing concern due to potential neuropsychiatric repercussions. Many individuals use it recreationally or for cognitive enhancement, which can lead to adverse mental and physical effects. Objective: The aim of this study was to assess the neuropsychiatric repercussions of methylphenidate misuse, focusing on cognitive, behavioral, and emotional alterations. Methods: A systematic literature review was conducted following PRISMA guidelines. The SciELO, PubMed, and BVS databases were searched for studies published between 2015 and 2025 in Portuguese and English. The search terms included “methylphenidate misuse,” “neuropsychiatric effects,” “cognitive alterations,” “behavioral changes,” and “emotional disturbances.” Studies that focused solely on therapeutic use or lacked a neuropsychiatric focus were excluded. Results: Methylphenidate misuse is linked to cognitive, behavioral, and emotional changes. While some report improved concentration, evidence suggests benefits may result from placebo effects. Studies indicate no significant performance difference between users and non-users. Behavioral effects include increased irritability and aggression, requiring multidisciplinary monitoring. Emotional changes such as anxiety, depression, and mood swings were observed. Additionally, 50% of participants in one study reported tachycardia and anxiety, emphasizing the need for awareness campaigns. Conclusion: Methylphenidate misuse in individuals without a medical indication leads to cognitive, behavioral, and emotional disturbances. Despite its perceived cognitive benefits, the risks outweigh the potential advantages. Healthcare professionals must promote education and prevention to raise awareness of the dangers of unsupervised use.

Methylphenidate (MPH) is a prescription stimulant drug with known abuse potential; however, little is known about its patterns of misuse or the characteristics of its abusers. A sample of 50 university students reporting MPH misuse and 50 control subjects matched for age, sex, and ethnicity completed structured face-to-face interviews about their MPH and other drug use. For each substance ever used, they provided information regarding routes of administration and other substances ever coadministered, as well as details about the most recent administration. MPH users provided additional information about their reasons for use and, in 36 cases, about how they obtained the drug. Relative to control subjects, those who misused MPH were more likely to have used various other prescription and nonprescription stimulant drugs over their lifetime, and most MPH users reported mixing the drug with other psychoactive substances. Of the MPH sample, 70% reported recreational use of the drug, while 30% reported that MPH was used exclusively for study purposes. Relative to those using it exclusively for study, recreational users were more likely to report using MPH intranasally, as well as coadministering MPH with other substances. Most of those who reported their source of MPH obtained it from an acquaintance with a prescription. Those who misuse MPH are more likely than their peers to misuse various other substances, and MPH misuse frequently occurs in the context of simultaneous polydrug use. Because the primary supply of inappropriately used MPH appears to be prescribed users, efforts should be directed toward preventing its diversion.

Objective he misuse of methylphenidate is an important issue in the relevant literature. The abuse of these drugs for success, especially by high school and university students, is quite common at the international level. Young people consider these drugs as a savior in order to be successful in the exams and to sustain with their social life. It is possible that medical education is very hard and stressful for students in the world. The students feel too much pressure to succeed. So, this situation directs students towards alternatives that will reduce the pressure, stay awake and focus more. This study aims to understand the process and usage habits that direct medical students to methylphenidate. Material and Method The study was designed as a qualitative research method with an anthropological perspective. Medical students' experiences, thoughts, and observations on the illicit use of methylphenidate were collected by researcher, using the in-depth interviews. The study started with face-to-face interviews at the end of 2019. Due to the coronavirus pandemic, the negotiations were completed in February 2022, after a long break. The opinions of 17 volunteer students who participated in the study were evaluated with a descriptive approach. Results According to our research findings, medical students are positive about the non-medical use of methylphenidate to save the day, despite its side effects. The use of the drug increases especially during exam periods. It is seen that drugs are as an easy alternative for students. The medicines are mostly provided from other friends who still use them. In addition, the drug is also used for weight loss. It is a fact that its effects are exaggerated and advertised among non-prescription users. The results of our research are similar with international ones. Conclusion There are very few studies on the illicit use of psychomotor stimulants in our country. The findings prove that medical students need healthy and sustainable alternatives to cope with the stress and pressure on them. It is thought that this study will be a basis for determining the long-term negative effects of misuse of the drugs and taking precautions. The research is a preliminary assessment to explore the current situation. It is clear that there is a need for more information, quantitative and qualitative data in the field.

Introduction: Methylphenidate is a neuropsychotropic agent, indicated for the treatment of Attention Deficit / Hyperactivity Disorder (ADHD) and narcolepsy, and is commonly prescribed for school and university age patients. The growing prescription of the drug and the misuse of methylphenidate by academics without a diagnosis of ADHD and / or narcolepsy have raised concerns on the part of medical societies of psychiatry. The over-the-counter use of this substance causes potential dependence and adverse effects such as hallucinations, anxiety, dry mouth and visual disturbances. Unfortunately, there is a precarious amount of epidemiological data on the use of methylphenidate without prescription by university students. In view of this reality. Objectives: The present study proposed to review the assessment of the prevalence of methylphenidate consumption without medical prescription in university environments worldwide, with sources published between 2016-2021. Methods: To perform this research, the PubMed (https://pubmed.ncbi. nlm.nih.gov/) and Scielo (https://www.scielo.org/) databases were used as a search tool, using the Key words “non-medical”, “methylphenidate” and “university students”. Results: So far, 10 articles related to the study (carried out in China, Australia, Brazil, South Africa, Iran, Israel, Pakistan and the United States) have been identified, with 8 articles obtained from PubMed and 2 articles acquired from Scielo. The selected articles show that in 6 of these articles the groups of academics studied were undergraduate and graduate students in general areas, and 4 articles in medical students. The studies present cases of students who confirmed the use of methylphenidate without a prescription, with the justification that it improves academic performance even in healthy students. Conclusion: Therefore, further studies on epidemiology and effects on academic performance with the improper consumption of this drug are recommended.

In the last decades, several cognitive-enhancing drugs have been sold onto the drug market. Methylphenidate and analogs represent a sub-class of these new psychoactive substances (NPS). We aimed to review the use and misuse of methylphenidate and analogs, and the risk associated. Moreover, we exhaustively reviewed the scientific data on the most recent methylphenidate analogs (methylphenidate and ethylphenidate excluded). Literature search was performed on methylphenidate and analogs, using specialized search engines accessing scientific databases. Additional reports were retrieved from international agencies, institutional websites, and drug user forums. Methylphenidate/Ritalin has been used for decades to treat attention deficit disorders and narcolepsy. More recently, it has been used as a cognitive enhancer and a recreational drug. Acute intoxications and fatalities involving methylphenidate were reported. Methylphenidate was scheduled as an illegal drug in many countries, but NPS circumventing the ban and mimicking the psychostimulant effects of methylphenidate started being available: ethylphenidate, 3,4-dichloromethylphenidate, 3,4-dichloroethylphenidate, 4-fluoromethylphenidate, 4-fluoroethylphenidate, methylnaphthidate, ethylnaphthidate, isopropylphenidate, propylphenidate, 4-methylmethylphenidate, and N-benzylethylphenidate have been available in the past few years. Only little data is currently available for these substances. Many intoxications involving methylphenidate analogs were reported. To date, ethylphenidate was involved in 28 fatalities, although it was reportedly directly related to the cause of death in only 7 cases; 3,4-dichloroethylphenidate was involved in 1 death. The rapid expansion of methylphenidate analogs onto the drug market in the past few years makes likely the occurrence of intoxications and fatalities in the next years. Careful monitoring and systematic control of methylphenidate analogs should be undertaken to reduce the uprising threat, and education efforts should be made among high-risk populations.

This chapter reviews methylphenidate misuse, abuse, dependence, diversion, and malingering associated with its use as a prescription medication for attention-deficit/hyperactivity disorder and the nonmedical use linked to its stimulant effects. Methylphenidate-induced regional elevations in brain dopamine appear to be integral to both efficacy in attention-deficit/hyperactivity disorder and potential for abuse, raising potential concerns for drug safety and prescription drug diversion costs associated with nonmedical use. Regardless, methylphenidate is an important treatment option, and detecting malingering for the purpose of illicit access to methylphenidate for subsequent misuse or diversion is a difficult challenge. Also discussed are the effects of methylphenidate in patients with comorbid substance use disorder and the potential linkage of methylphenidate use with subsequent substance abuse. The current data suggest that methylphenidate misuse and diversion are common health-care problems with a stimulant prescription drug diversion prevalence of approximately 5-10% of high school students and 5-35% of college students. The effectiveness and speed of action of methylphenidate are deemed desirable to enhance attention and focus performance for activities such as studying for exams, but methylphenidate is also misused recreationally. These data suggest a need for close screening and therapeutic monitoring of methylphenidate use in the treatment of attention-deficit/hyperactivity disorder.

PMH62 - Evidence for the off-label use of Methylphenidate for Cognitive Enhancement in Healthy individuals

Background: The Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) have recognized social media as a new data source to strengthen their activities regarding drug safety.Objective: Our objective in the ADR-PRISM project was to provide text mining and visualization tools to explore a corpus of posts extracted from social media. We evaluated this approach on a corpus of 21 million posts from five patient forums, and conducted a qualitative analysis of the data available on methylphenidate in this corpus.Methods: We applied text mining methods based on named entity recognition and relation extraction in the corpus, followed by signal detection using proportional reporting ratio (PRR). We also used topic modeling based on the Correlated Topic Model to obtain the list of the matics in the corpus and classify the messages based on their topics.Results: We automatically identified 3443 posts about methylphenidate published between 2007 and 2016, among which 61 adverse drug reactions (ADR) were automatically detected. Two pharmacovigilance experts evaluated manually the quality of automatic identification, and a f-measure of 0.57 was reached. Patient's reports were mainly neuro-psychiatric effects. Applying PRR, 67% of the ADRs were signals, including most of the neuro-psychiatric symptoms but also palpitations. Topic modeling showed that the most represented topics were related to Childhood and Treatment initiation, but also Side effects. Cases of misuse were also identified in this corpus, including recreational use and abuse.Conclusion: Named entity recognition combined with signal detection and topic modeling have demonstrated their complementarity in mining social media data. An in-depth analysis focused on methylphenidate showed that this approach was able to detect potential signals and to provide better understanding of patients' behaviors regarding drugs, including misuse.

Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, are frequently combined with medical psychostimulants such as methylphenidate (Ritalin), for example, in the treatment of attention-deficit hyperactivity disorder/depression comorbidity. Co-exposure to these medications also occurs with misuse of methylphenidate as a recreational drug by patients on SSRIs. Methylphenidate, a dopamine reuptake blocker, produces moderate addiction-related gene regulation. Findings show that SSRIs such as fluoxetine given in conjunction with methylphenidate potentiate methylphenidate-induced gene regulation in the striatum in rats, consistent with a facilitatory action of serotonin on addiction-related processes. These SSRIs may thus increase methylphenidate's addiction liability. Here, we investigated the effects of a novel SSRI, vilazodone, on methylphenidate-induced gene regulation. Vilazodone differs from prototypical SSRIs in that, in addition to blocking serotonin reuptake, it acts as a partial agonist at the 5-HT1A serotonin receptor subtype. Studies showed that stimulation of the 5-HT1A receptor tempers serotonin input to the striatum. We compared the effects of acute treatment with vilazodone (10-20mg/kg) with those of fluoxetine (5mg/kg) on striatal gene regulation (zif268, substance P, enkephalin) induced by methylphenidate (5mg/kg), by in situ hybridization histochemistry combined with autoradiography. We also assessed the impact of blocking 5-HT1A receptors by the selective antagonist WAY-100635 (0.5mg/kg) on these responses. Behavioral effects of these drug treatments were examined in parallel in an open-field test. Our results show that, in contrast to fluoxetine, vilazodone did not potentiate gene regulation induced by methylphenidate in the striatum, while vilazodone enhanced methylphenidate-induced locomotor activity. However, blocking 5-HT1A receptors by WAY-100635 unmasked a potentiating effect of vilazodone on methylphenidate-induced gene regulation, thus confirming an inhibitory role for 5-HT1A receptors. Our findings suggest that vilazodone may serve as an adjunct SSRI with diminished addiction facilitating properties and identify the 5-HT1A receptor as a potential therapeutic target to treat addiction.

Chapter 66 - The Impact of Methylphenidate on Circadian Rhythms and Clock Gene Expression

Book of the Month: Karch's Pathology of Drug Abuse