Hallusinosis due to methylphenidate overdose in an eight-year-old child: a case report

Abstract

Methylphenidate, which blocks the presynaptic norepinephrine and dopamine transporters, is the most common used medication and offered as first choice in the treatment guidelines of attention deficit hyperactivity disorder (ADHD). One of its rarely seen adverse effects is, hallucinations that can be formed idiosyncratically, which can be correlated with increased dopaminergic functioning in synaptic cleft. We will present an eight year old boy diagnosed with ADHD-combined type, and oppositional defiant disorder (ODD) with no previous medical and family history who has impulsively taken extra dose of methylphenidate in the course of usual drug treatment. The acute hallucinosis presentation which has subsided the next day completely with the cessation of drug treatment will be discussed. Keywords:Methylphenidate, Hallucinosis, Attention deficit hyperactive disorder ÖZPresinaptik norepinefrin ve dopamin taşıyıcılarını bloke eden metilfenidat, dikkat eksikliği hiperaktivite bozukluğu (DEHB) tedavisinde en sık kullanılan ve tedavi rehberlerinde birinci tercih olarak sunulan ilaçtır. Nadir karşılaşılan yan etkilerinden biri de, sinaptik aralıktaki artmış dopaminerjik işleyiş ile ilişkilendirilen, idiosenkratik oluşabilen varsanılardır. Polikliniğimizde DEHBbileşik tip ve karşıt olma karşı gelme bozukluğu (KOKGB) teşhisi konularak metilfenidat tedavisine başladığımız, özgeçmiş ve soygeçmişinde herhangi bir hastalık öyküsü bulunmayan sekiz yaşındaki erkek bir çocukta, olağan ilaç tedavisi sırasında impulsif bir şekilde aldığı fazladan bir doz kısa etkili metilfenidat ile gelişen ve ilacın kesilmesiyle birlikte ertesi gün tümüyle gerileyen halüsinoz tablosunu tartışacağız.Anahtar kelimeler: Metilfenidat, Halüsinoz, Dikkat eksikliği hiperaktivite bozukluğu IntroductionAttention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorder in school age children. It is a heterogeneous disorder which is composed of core symptoms including hyperactivity, attention deficit and impulsivity. Short and long acting methylphenidate (MPH), amphetamine, mixed amphetamine salts, and atomoxetine are utilized for the pharmacologic treatment [1]. Methylphenidate is the most commonly used agent and it is the first option in treatment. MPH acts via specifically blocking presynaptic norepinephrine and dopamine transporters, impedes their reuptake thereby increases their levels in synaptic cleft [2,3]. MPH is safely used in children, adolescents and adults due to its low adverse effect profile. Among the most common adverse effects; sleeplessness, stomachache, headache, loss of appetite, irritability and anxiety can be considered. Relatively less commonly, tics and emotional fluctuations also can be seen [4]. In addition, in 1971 Lucas and Weiss, mentioned short lasting psychotic symptoms in patients who utilize methylphenidate [5]. In the current literature, "hallucinosis" and "toxicosis" terms are particularly used in order to differentiate temporary symptoms related to stimulants in contrast to perma...

Efficacy and Safety of Medication for Attention-Deficit Hyperactivity Disorder in Children and Adolescents with Common Comorbidities: A Systematic Review

“…For safety, there were four meta-analyses/pooled analyses [ 16 , 18 , 19 , 39 ], 33 RCTs and associated extension studies [ 28 – 34 , 36 , 38 , 40 , 41 , 43 – 46 , 48 , 50 , 52 , 55 , 56 , 60 – 63 , 66 – 68 , 70 – 73 , 76 , 84 ], 11 cohort studies [ 53 , 54 , 58 , 69 , 74 , 79 , 83 , 86 , 87 , 90 , 91 ], and 16 case reports or case series [ 47 , 49 , 51 , 57 , 59 , 64 , 65 , 75 , 77 , 78 , 80 – 82 , 85 , 88 , 89 ]. Most of the meta-analyses and RCTs were conducted in patients with ADHD and autism spectrum disorders or ODD, and more information was available on treatment with MPHs and ATX in these patients, with very few studies on AMPs or GXR (Table 1 ).…”

“…Adverse events reported in case reports of patients receiving MPHs included exacerbation of obsessive behavior [ 82 ], visual and/or auditory hallucinations [ 47 , 49 , 51 , 64 ], severe agitation, and hyperactivity and/or irritability in three patients with ODD after switching from risperidone to MPHs [ 85 ]. Adverse events reported in case reports of patients receiving ATX included Raynaud’s phenomenon [ 65 ] and onset of mania and auditory hallucinations when a patient titrated up to 40 mg/day [ 78 ].…”

“…There were no reports of treatment-emergent suicidal ideation in patients with comorbid anxiety [34] or comorbid MDD [29] and no exacerbation of depressive symptoms in patients with comorbid MDD [29] who were treated with ATX. Adverse events reported in case reports of patients receiving MPHs included exacerbation of obsessive behavior [82], visual and/or auditory hallucinations [47,49,51,64], severe agitation, and hyperactivity and/or irritability in three patients with ODD after switching from risperidone to MPHs [85]. Adverse events reported in case reports of patients receiving ATX included Raynaud's phenomenon [65] and onset of mania and auditory hallucinations when a patient titrated up to 40 mg/day [78].…”