PDF(Pubmed)
Abstract：
UNASSIGNED: Individuals with attention-deficit/hyperactivity disorder (ADHD) often have comorbid psychiatric conditions. Relatively little is known about how specific ADHD medications are associated with overall treatment outcomes among these patients.
UNASSIGNED: To investigate the association of the use of specific ADHD medications with hospitalization outcomes and work disability among adolescents and adults with ADHD.
UNASSIGNED: This nationwide register-based cohort study identified individuals (aged 16-65 years) with ADHD from Swedish nationwide registers of inpatient health care, specialized outpatient health care, sickness absence, and disability pension during the years 2006 to 2021. Data analysis was performed from November 2022 to August 2023.
UNASSIGNED: Use of specific ADHD medications.
UNASSIGNED: The main outcome measure was psychiatric hospitalization, and secondary outcomes were suicide attempt and/or death by suicide, nonpsychiatric hospitalization, and work disability (ie, sickness absence or disability pension). The risk of outcomes between use vs nonuse periods of ADHD medications was compared in a within-individual design, where a person acts as their own control, and was analyzed with stratified Cox models.
UNASSIGNED: A total of 221 714 persons with ADHD were included in the study cohort (mean [SD] age, 25.0 [11.2] years; 120 968 male individuals [54.6%]). Methylphenidate was the most commonly used ADHD medication (151 837 individuals [68.5%]), followed by lisdexamphetamine (78 106 individuals [35.2%]) during the follow-up (mean [SD], 7.0 [4.7] years). The following medications were associated with a decreased risk of psychiatric hospitalization: amphetamine (adjusted hazard ratio [aHR], 0.74; 95% CI, 0.61-0.90), lisdexamphetamine (aHR, 0.80; 95% CI, 0.78-0.82), ADHD drug polytherapy (aHR, 0.85; 95% CI, 0.82-0.88), dexamphetamine (aHR, 0.88; 95% CI, 0.83-0.94), and methylphenidate (aHR, 0.93; 95% CI, 0.92-0.95). No associations were found for modafinil, atomoxetine, clonidine, and guanfacine. Decreased risk of suicidal behavior was associated with the use of dexamphetamine (aHR, 0.69; 95% CI, 0.53-0.89), lisdexamphetamine (aHR, 0.76; 95% CI, 0.68-0.84), and methylphenidate (aHR, 0.92; 95% CI, 0.86-0.98). None of the medications was associated with increased risk of nonpsychiatric hospitalization; instead, use of amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine were associated with decreased risk of nonpsychiatric hospitalization. The results regarding work disability were significant only for the use of atomoxetine (aHR, 0.89; 95% CI, 0.82-0.97), especially among adolescents and young adults aged 16 to 29 years, (aHR, 0.82; 95% CI, 0.73-0.92).
UNASSIGNED: In this nationwide cohort study of adolescents and adults with ADHD, the use of ADHD medication was associated with fewer hospitalizations for both psychiatric and nonpsychiatric morbidity and lower suicidal behavior.
UNASSIGNED: To investigate the association of the use of specific ADHD medications with hospitalization outcomes and work disability among adolescents and adults with ADHD.
UNASSIGNED: This nationwide register-based cohort study identified individuals (aged 16-65 years) with ADHD from Swedish nationwide registers of inpatient health care, specialized outpatient health care, sickness absence, and disability pension during the years 2006 to 2021. Data analysis was performed from November 2022 to August 2023.
UNASSIGNED: Use of specific ADHD medications.
UNASSIGNED: The main outcome measure was psychiatric hospitalization, and secondary outcomes were suicide attempt and/or death by suicide, nonpsychiatric hospitalization, and work disability (ie, sickness absence or disability pension). The risk of outcomes between use vs nonuse periods of ADHD medications was compared in a within-individual design, where a person acts as their own control, and was analyzed with stratified Cox models.
UNASSIGNED: A total of 221 714 persons with ADHD were included in the study cohort (mean [SD] age, 25.0 [11.2] years; 120 968 male individuals [54.6%]). Methylphenidate was the most commonly used ADHD medication (151 837 individuals [68.5%]), followed by lisdexamphetamine (78 106 individuals [35.2%]) during the follow-up (mean [SD], 7.0 [4.7] years). The following medications were associated with a decreased risk of psychiatric hospitalization: amphetamine (adjusted hazard ratio [aHR], 0.74; 95% CI, 0.61-0.90), lisdexamphetamine (aHR, 0.80; 95% CI, 0.78-0.82), ADHD drug polytherapy (aHR, 0.85; 95% CI, 0.82-0.88), dexamphetamine (aHR, 0.88; 95% CI, 0.83-0.94), and methylphenidate (aHR, 0.93; 95% CI, 0.92-0.95). No associations were found for modafinil, atomoxetine, clonidine, and guanfacine. Decreased risk of suicidal behavior was associated with the use of dexamphetamine (aHR, 0.69; 95% CI, 0.53-0.89), lisdexamphetamine (aHR, 0.76; 95% CI, 0.68-0.84), and methylphenidate (aHR, 0.92; 95% CI, 0.86-0.98). None of the medications was associated with increased risk of nonpsychiatric hospitalization; instead, use of amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine were associated with decreased risk of nonpsychiatric hospitalization. The results regarding work disability were significant only for the use of atomoxetine (aHR, 0.89; 95% CI, 0.82-0.97), especially among adolescents and young adults aged 16 to 29 years, (aHR, 0.82; 95% CI, 0.73-0.92).
UNASSIGNED: In this nationwide cohort study of adolescents and adults with ADHD, the use of ADHD medication was associated with fewer hospitalizations for both psychiatric and nonpsychiatric morbidity and lower suicidal behavior.
摘要：
■患有注意力缺陷/多动障碍（ADHD）的人通常患有并存的精神疾病。关于特定的ADHD药物如何与这些患者的整体治疗结果相关，人们知之甚少。
旨在调查特定ADHD药物的使用与青少年和成人ADHD患者的住院结局和工作障碍之间的关系。
■这项基于全国注册的队列研究从瑞典全国住院医疗保健登记册中确定了患有ADHD的个体（16-65岁），专门的门诊保健，疾病缺席,2006年至2021年期间的残疾抚恤金。数据分析于2022年11月至2023年8月进行。
■使用特定的ADHD药物。
■主要结局指标是精神病住院，次要结果是自杀未遂和/或自杀死亡，非精神病住院,和工作残疾(即，病假或残疾养恤金)。在个体内部设计中比较了使用与未使用ADHD药物之间的结果风险，一个人作为自己的控制，并采用分层Cox模型进行分析。
■总共221714名ADHD患者被纳入研究队列(平均[SD]年龄，25.0[11.2]岁；120968名男性[54.6%]）。哌醋甲酯是最常用的ADHD药物（151837例[68.5%]），随访期间其次是右苯丙胺(78106例[35.2%])(平均值[SD]，7.0[4.7]年)。以下药物与精神病住院风险降低相关：苯丙胺（调整后的危险比[aHR]，0.74；95%CI，0.61-0.90），利德苯丙胺(AHR，0.80；95%CI，0.78-0.82），多动症药物综合疗法(aHR，0.85；95%CI，0.82-0.88），右旋苯丙胺(AHR，0.88；95%CI，0.83-0.94），和哌醋甲酯(AHR，0.93；95%CI，0.92-0.95）。没有发现莫达非尼的关联,托莫西汀,可乐定,和胍法辛。自杀行为风险降低与使用右旋苯丙胺相关(aHR，0.69；95%CI，0.53-0.89），利德苯丙胺(AHR，0.76；95%CI，0.68-0.84），和哌醋甲酯(AHR，0.92；95%CI，0.86-0.98）。这些药物都没有增加非精神病住院的风险；相反，使用安非他明，利德苯丙胺，综合疗法,右旋苯丙胺,哌醋甲酯，和托莫西汀与非精神病住院风险降低相关.关于工作残疾的结果仅在使用托莫西汀(aHR，0.89；95%CI，0.82-0.97），特别是在16至29岁的青少年和年轻人中，(AHR,0.82；95%CI，0.73-0.92）。
■在这项全国性的青少年和成人多动症队列研究中，使用ADHD药物与精神病和非精神病发病率的住院次数减少以及自杀行为降低相关.
旨在调查特定ADHD药物的使用与青少年和成人ADHD患者的住院结局和工作障碍之间的关系。
■这项基于全国注册的队列研究从瑞典全国住院医疗保健登记册中确定了患有ADHD的个体（16-65岁），专门的门诊保健，疾病缺席,2006年至2021年期间的残疾抚恤金。数据分析于2022年11月至2023年8月进行。
■使用特定的ADHD药物。
■主要结局指标是精神病住院，次要结果是自杀未遂和/或自杀死亡，非精神病住院,和工作残疾(即，病假或残疾养恤金)。在个体内部设计中比较了使用与未使用ADHD药物之间的结果风险，一个人作为自己的控制，并采用分层Cox模型进行分析。
■总共221714名ADHD患者被纳入研究队列(平均[SD]年龄，25.0[11.2]岁；120968名男性[54.6%]）。哌醋甲酯是最常用的ADHD药物（151837例[68.5%]），随访期间其次是右苯丙胺(78106例[35.2%])(平均值[SD]，7.0[4.7]年)。以下药物与精神病住院风险降低相关：苯丙胺（调整后的危险比[aHR]，0.74；95%CI，0.61-0.90），利德苯丙胺(AHR，0.80；95%CI，0.78-0.82），多动症药物综合疗法(aHR，0.85；95%CI，0.82-0.88），右旋苯丙胺(AHR，0.88；95%CI，0.83-0.94），和哌醋甲酯(AHR，0.93；95%CI，0.92-0.95）。没有发现莫达非尼的关联,托莫西汀,可乐定,和胍法辛。自杀行为风险降低与使用右旋苯丙胺相关(aHR，0.69；95%CI，0.53-0.89），利德苯丙胺(AHR，0.76；95%CI，0.68-0.84），和哌醋甲酯(AHR，0.92；95%CI，0.86-0.98）。这些药物都没有增加非精神病住院的风险；相反，使用安非他明，利德苯丙胺，综合疗法,右旋苯丙胺,哌醋甲酯，和托莫西汀与非精神病住院风险降低相关.关于工作残疾的结果仅在使用托莫西汀(aHR，0.89；95%CI，0.82-0.97），特别是在16至29岁的青少年和年轻人中，(AHR,0.82；95%CI，0.73-0.92）。
■在这项全国性的青少年和成人多动症队列研究中，使用ADHD药物与精神病和非精神病发病率的住院次数减少以及自杀行为降低相关.
