Shibib 2009.

Methods	A report of 4 cases of psychosis during methylphenidate treatment
Participants	Diagnosis of ADHD: DSM‐IV (subtype: combined 100%) Age: 14, 8, 10, and 14 years old IQ: above 70 Sex: 1 female, 3 males Ethnicity: not stated Country: UK Comorbidity: conduct disorder (Case 4) Comedication: no, and no use of illicit substances Sociodemographics: not stated
Interventions	Case 1 Methylphenidate type: extended release (Equasym XL) Methylphenidate dosage: gradually increased to 30 mg over 4 weeks Administration schedule: once daily Duration of treatment: 1 month titration, hereafter 4 months treatment Treatment compliance: not stated Case 2 Methylphenidate type: immediate release (Ritalin) Methylphenidate dosage: gradually increased from 5 mg once daily to 10 mg twice daily Administration schedule: once/twice daily Duration of treatment: 7 days Treatment compliance: not stated Case 3 Methylphenidate type: immediate release and extended release (Concerta XL) Methylphenidate dosage: immediate release: gradually increased to 15 mg daily. Extended release: 36 mg, later increased to 54 mg daily Administration schedule: immediate release: not stated. Extended release: once daily Duration of treatment: immediate release: not stated. Extended release: 3 weeks Treatment compliance: because compliance became an issue treatment with immediate release methylphenidate was stopped, and extended release methylphenidate was initiated. No information about compliance during treatment with extended release methylphenidate Case 4 Methylphenidate type: extended release (Concerta XL) Methylphenidate dosage: 18 mg Administration schedule: not stated Duration of treatment: 24 hours Treatment compliance: because compliance became an issue treatment with immediate release methylphenidate was stopped, and extended release methylphenidate was initiated. No information about compliance during treatment with extended release methylphenidate
Outcomes	Serious adverse events: Case 1 Psychosis. Visual hallucinations. Paranoid Discontinuation: symptoms resolved spontaneously Case 2 Psychosis. Auditory and visual hallucinations. Suspicious Discontinuation: symptoms resolved spontaneously Case 3 Psychosis. Suspicious. Auditory hallucinations Discontinuation: symptoms resolved spontaneously Readministration of extended release methylphenidate (low dose) as an adjunct to atomoxetine, 5 weeks: "completely uncharacteristic behaviour", throwing furniture, making "silly" noises, and irritability. "Being unable to feel himself" Discontinuation: this behaviour resolved spontaneously within 72 hours Readministration of immediate release methylphenidate (15 mg, twice daily): no psychotic symptoms reported Case 4 Psychosis. Suspicious. Paranoid ideation. Denied any hallucinatory experiences although he was observed to be responding to possible auditory hallucinations Discontinuation: symptoms resolved spontaneously Re‐challenged with immediate release methylphenidate (10 mg 3 times daily): well tolerated Non‐serious adverse events Case 1 Extended release methylphenidate gradually increased to 30 mg over 4 weeks: loss of appetite Case 3 Immediate release methylphenidate gradually increased to 15 mg daily: poor appetite
Notes	Key conclusions of the study authors: psychosis is an important, unpredictable side effect of stimulant medication. Symptoms resolve with discontinuation of treatment. Reemergence of ADHD symptoms are rapid and re‐challenge is often indicated Comments from the study authors: it would be advisable for all professionals involved in the care and treatment of patients with ADHD to receive mental health training to aid the early recognition and appropriate management of such side effects Funding/vested interest/authors' affiliations: not stated Supplemental information regarding ADHD diagnostic criteria, ADHD subtype, and IQ received through personal email correspondence with the authors in August‐October 2013 (Shibib 2013 [pers comm])