Reports of Perceived Adverse Events of Stimulant Medication on Cognition, Motivation, and Mood: Qualitative Investigation and the Generation of Items for the Medication and Cognition Rating Scale

Abstract

Objective: There is no questionnaire to specifically monitor perceived adverse events of methylphenidate (MPH) on cognition, motivation, and mood. The current study therefore had two goals. First, to harvest accounts of such putative events from transcripts of interviews in samples enriched for such potential experiences. Second, to use the derived data to generate items for a new questionnaire that can be used for monitoring such events in medication trials or routine clinical care.Methods: Following a literature search aimed at identifying associations between MPH and cognition and/or motivation, a qualitative semistructured interview was designed to focus specifically on the domains of cognition (i.e., reasoning, depth/breadth of thinking, intellectual capacity, and creativity) and motivation (i.e., drive, effort, and attitudes toward rewards/incentives). Interviews were conducted with 45 participants drawn from the following four groups: (a) clinicians, child and adolescent psychiatrists, and pediatricians specializing in attention-deficit/hyperactivity disorder (ADHD) (n = 15); (2) teachers, with experience of teaching at least 10 medicated children with ADHD (n = 10); (3) parents of children with ADHD (n = 8) treated with MPH; and (4) adolescents/adults with ADHD (n = 12). Purposeful sampling was used to selectively recruit ADHD participants whose histories suggested a degree of vulnerability to MPH adverse events. Data were analyzed using a deductive approach to content analysis.Results: While we probed purposefully for cognitive and motivational adverse events, a third domain, related to mood, emerged from the reports. Therefore, three domains, each with a number of subdomains, were identified from the interview accounts: (i) Cognition (six subdomains; attention/concentration, changes in thinking, reduced creativity, sensory overload, memory, slower processing speed); (ii) motivation (four subdomains; loss of intrinsic motivation for goal-directed activities, external locus of control, lack of effort/engagement in daily tasks, increased focus on incentives); and (iii) mood (three subdomains; dampening of spontaneity/flat affect, mood dysregulation, increased anxiety/edginess). On the basis of these reports, 34 items were specified and incorporated into a prototype questionnaire, which was piloted and refined on the basis of field-testing.Conclusions: Items were identified that capture potential/perceived cognitive, motivational, and mood-related adverse events of MPH. The items generated will allow us to further develop and psychometrically examine their prevalence, and the extent to which they are associated with medication adherence, treatment outcome, impairment, and other reported adverse events (e.g., loss of appetite/cardiovascular effects).

Optimising treatment strategies for ADHD in adolescence to minimise ‘lost in transition’ to adulthood

“…Finally, it is unclear whether adolescents are more sensitive to and suffer more from common (such as loss of appetite, insomnia, irritability, abdominal pain, headache for stimulants and decreased appetite, dizziness, abdominal pain, fatigue, somnolence and vomiting for atomoxetine and clonidine or guanfacine) or less common (moodiness, dysphoria, loss of creativity) side effects of ADHD medication, or are better able to observe these effects. Results of prospective studies to document side-effects of ADHD medication using newly developed instruments are pending Kovshoff et al 2016).…”

Safety Profile of Methylphenidate Under Long-Term Treatment in Adult ADHD Patients – Results of the COMPAS Study

“…Our findings emphasize the need to thoroughly inform and monitor patients under MPH treatment for effects of cardiovascular and neuropsychiatric stimulation as well as weight loss, caused by reduced appetite [5][6][7][27][28][29][30].…”

“…However, they emphasize that the effects of long-term MPH treatment on the cardiovascular system have not been sufficiently researched yet. Focusing on neuropsychiatric side effects of stimulants, Kovshoff et al [7] reported possible adverse effects presenting on the cognitive, emotional, and motivational level. However, these findings were based on interviews with clinicians, patients, parents, and teachers and have so far not been further verified in clinical studies.…”

Adverse drug event‐related hospitalisation in persons with neurodevelopmental disorders: a state‐wide retrospective cohort study

“…The term ADEs used in this study includes unintended injuries resulting from medication use at usual therapeutic doses (Nebeker et al 2004), excluding those due to overdose and medication errors. Previous studies reported higher incidence of ADEs in PwNDD compared with those without (McCracken 2005;Mahan et al 2010;Aagaard & Hansen 2011;Fahoum et al 2016;Scheifes et al 2016b;Sheehan et al 2017), with a variety of ADEs being reported during the use of psychotropic medications, e.g., cardiovascular complications (Vigod et al 2016), cognitive and emotional disorders (Kovshoff et al 2016) and metabolic disorders (Aagaard & Hansen 2011;Vigod et al 2016). Despite this, epidemiological profile analysis regarding ADEs serious enough to warrant hospital acute care is scarce in the extended group of NDD.…”

“…), cognitive and emotional disorders (Kovshoff et al . ) and metabolic disorders (Aagaard & Hansen ; Vigod et al . ).…”