Although attention-deficit hyperactivity disorder (ADHD) is often comorbid with schizophrenia spectrum and other psychotic disorders (SZSPD), concerns about an increased risk of psychotic events have limited its treatment with either psychostimulants or atomoxetine.

To examine whether the risk of hospital admission for psychosis in people with SZSPD was increased during the year following the introduction of such medications compared with the year before.

This was a retrospective cohort study using Quebec (Canada) administrative health registries, including all Quebec residents with a public prescription drug insurance plan and a diagnosis of psychotic disorder, defined by relevant ICD-9 or ICD-10 codes, who initiated either methylphenidate, amphetamines or atomoxetine, between January 2010 and December 2016, in combination with antipsychotic medication. The primary outcome was time to hospital admission for psychosis within 1 year of initiation. State sequence analysis was also used to visualise admission trajectories for psychosis in the year following initiation of these medications, compared with the previous year.

Out of 2219 individuals, 1589 (71.6%) initiated methylphenidate, 339 (15.3%) amphetamines and 291 (13.1%) atomoxetine during the study period. After adjustment, the risk of hospital admission for psychosis was decreased during the 12 months following the introduction of these medications when used in combination with antipsychotics (adjusted HR = 0.36, 95% CI 0.24–0.54; P < 0.0001).

These findings suggest that, in a real-world setting, when used concurrently with antipsychotic medication, methylphenidate, amphetamines and atomoxetine may be safer than generally believed in individuals with psychotic disorders.

尽管注意力缺陷多动障碍（ADHD）通常与精神分裂症谱系和其他精神障碍（SZSPD）共存，但对精神病事件风险增加的担忧限制了精神兴奋剂或托莫西汀的治疗。

旨在检查 SZSPD 患者在引入此类药物后一年内因精神病入院的风险是否比前一年有所增加。

这是一项使用魁北克（加拿大）行政健康登记处的回顾性队列研究，包括所有拥有公共处方药保险计划并诊断为精神障碍（由相关 ICD-9 或 ICD-10 代码定义）的魁北克居民，他们开始使用哌醋甲酯、 2010 年 1 月至 2016 年 12 月期间，安非他明或阿托莫西​​汀与抗精神病药物联合使用。主要结局是开始后一年内因精神病入院的时间。状态序列分析还用于可视化开始使用这些药物后一年与前一年相比的精神病入院轨迹。

在 2219 名受试者中，有 1589 名（71.6%）在研究期间开始使用哌醋甲酯，339 名（15.3%）名安非他明和 291 名（13.1%）名阿托莫西汀。调整后，在引入这些药物与抗精神病药联合使用后的 12 个月内，因精神病入院的风险降低（调整后 HR = 0.36，95% CI 0.24–0.54；P < 0.0001）。

这些发现表明，在现实世界中，当与抗精神病药物同时使用时，哌醋甲酯、安非他明和阿托莫西汀可能比人们普遍认为的精神障碍患者更安全。