Methylphenidate and Somatic Hallucinations

Hallucinations and other psychotic symptoms in response to methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder: a Cochrane systematic review with meta-analysis and trial sequential analysis#

“…In the 12 patient reports describing 18 patients (Table 4), 57.9% had ADHD combined subtype, 10.5% had the inattentive subtype and 5.3% had the hyperactive-impulsive subtype. Sixteen patients developed new psychotic symptoms during methylphenidate treatment and two patients experienced exacerbation of preexisting psychotic symptoms, that is, chronic pattern of partial somatic hallucinations (83) and comorbid schizotypal personality disorder and infantile psychosis (77). The newly developed psychotic symptoms reported were primarily hallucinations, including visual, auditory and tactile hallucinations.…”

“…We included 10 randomized clinical trials [four parallel group trials (46-50) and six cross-over trials (51)(52)(53)(54)(55)(56)(57)] totalling 1103 participants, 17 nonrandomized studies (49,58-75) totalling 76,237 participants and 12 patient reports or small series describing 18 patients (76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88).…”

“…In two of four patients, a re-challenge with methylphenidate was followed by the recurrence of symptoms (80,81). Furthermore, eight patients were reported to be followed up between 3 months and 3 years after the occurrence of psychotic symptoms (77,79,80,82,83,88), and only one patient continued to have symptoms (77). At follow-up, he was still receiving methylphenidate and was diagnosed with schizophrenia.…”

Methylphenidate Induction of Complex Visual Hallucinations

“…11 It is possible that in vulnerable patients who receive methylphenidate, the failure to downregulate the dopamine transporter combined with chronic dopamine flooding of the prefrontostriatal circuitry leads to concurrent somatic hallucinations. 7 According to Mehler-Wex and colleagues, 14 a dopamineinduced imbalance in the basal ganglia neurocircuitry may be an important pathophysiological component of ADHD and schizophrenia. This model suggests that deprivation of the dopaminergic nigrostriatal input reduces the positive feedback via the direct system and increases the negative feedback via the indirect system.…”

Methylphenidate-Induced Visual Hallucinations

“…Several hypotheses could explain the mechanism of action that may underlie toxic eff ects. Individual variation in the response to MPH may exist, and it is possible that in vulnerable patients who receive MPH, the failure to down-regulate the dopamine transporter combined with chronic dopamine fl ooding of the prefrontostriatal circuitry leads to the occurrence of complex visual hallucinations [7] .…”