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Methylphenidate and TBI in ADHD and co-occurring epilepsy and mental disorders: a self-controlled case series study

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Abstract

It is suggested that medication for attention-deficit hyperactivity disorder (ADHD) links to lower risk of traumatic brain injury (TBI). Little is known about whether the beneficial effect of methylphenidate is persistent in individuals with other comorbid mental disorders and epilepsy. We identified 90,634 participants who were less than 18 years old and diagnosed with ADHD from Taiwan’s National Health Insurance Research Database (NHIRD) from January 1, 2000 to December 31, 2013. Cox proportional hazards models with hazard ratio (HR) and 95% confidence interval were conducted to compare the risks of TBI event between groups of ADHD-only and ADHD with co-occurring other mental disorders. Within-individual comparisons using a self-controlled case series study design were conducted using conditional Poisson regression models with relative incidence (RR) and 95% CI to examine the effect of methylphenidate on TBI with adjustment for medication of psychotropics and anticonvulsants. For children and adolescents with ADHD, we found comorbid mental disorders and epilepsy increase the risk of TBI, with HRs ranged from 1.21 to 1.75. For the effect of MPH, we found reduced risks for TBI in ADHD (RR = 0.83, 95% CI = 0.70–0.98). Similar results were found among individuals with co-occurring oppositional defiant disorders or conduct disorder, MDD, tic disorders and epilepsy. Methylphenidate treatment was linked to lower risk for TBI in patients with ADHD and the inverse association was persistent among those with other comorbid mental disorders and epilepsy.

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These data were owned by the Taiwan Ministry of Health and Welfare. If researchers are interested in applying the data from Taiwan Ministry of Health and Welfare, information is available at www.mohw.gov.tw.

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Acknowledgements

The authors would also like to thank the Health Information and Epidemiology Laboratory (CLRPG6G0043) for their comments and assistance in data analysis.

Funding

This work was supported by grants from the Chang Gung Memorial Hospital (CLRPG6G0042, CLRPG6G0043).

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Authors and Affiliations

  1. Department of Psychiatry, Chiayi Branch, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Vincent Chin-Hung Chen

  2. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Vincent Chin-Hung Chen

  3. Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yao-Hsu Yang

  4. Department of Traditional Chinese Medicine, Chiayi Branch, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Yao-Hsu Yang

  5. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan

    Charles Tzu-Chi Lee

  6. Department of Healthcare Administration, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan

    Yi-Lung Chen

  7. Department of Psychology, Asia University, Taichung, Taiwan

    Yi-Lung Chen

  8. Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Michael E. Dewey

  9. National Addiction Centre, Institute of Psychiatry, King’s College London, London, UK

    Michael Gossop

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  1. Vincent Chin-Hung Chen
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Correspondence to Yi-Lung Chen.

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Conflict of interest

Author Vincent Chin-Hung Chen has been an investigator in a clinical trial from Orient Pharma. The other report no competing interests related to this work.

Ethical statement

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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Chen, V.CH., Yang, YH., Lee, C.TC. et al. Methylphenidate and TBI in ADHD and co-occurring epilepsy and mental disorders: a self-controlled case series study. Eur Child Adolesc Psychiatry 31, 361–368 (2022). https://doi.org/10.1007/s00787-020-01694-2

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