There was no evidence of publication bias.
In meta-regression analyses, sex, and study quality did not moderate the association. The median prevalence of psychotic disorder in the cohort studies was 0.5% for controls and 2.7% for the ADHD population, corresponding to an approximately 5-fold increased risk of subsequent psychotic disorder in children with ADHD (relative effect = 4.74, 95% CI 4.11-5.46).įindings were similar in subgroup analyses (including schizophrenia versus other psychotic disorders, as well as the presence or absence of follow-up after aged 18 years). After review, 15 studies (1 case-control and 14 cohorts) were included in the systematic review and 12 studies (1.85 million unique participants) were included in the meta-analysis. The authors screened 3782 records and assessed 45 full-text articles for eligibility. Subgroup and meta-regression analyses were performed for study design, sex, treatment, relevant psychiatric comorbidities, and type of outcome, but data were not available regarding substance use comorbidity. Egger’s test and funnel plots were used to assess for potential publication bias. Pooled measures of relative effects (eg, RR, OR, HR) were calculated using random-effects meta-analysis. An assessment of risk of bias and study quality was performed for each included study. Relevant data-including relative risks (RR), odds ratios (OR), hazard ratios (HR), and 95% confidence intervals-were extracted for each study. They excluded studies with attention deficits or impulsivity without any ADHD diagnosis or adult ADHD diagnosis, or psychotic disorders that were diagnosed before or concurrently with ADHD. The primary outcome was occurrence of any psychotic disorder (also using any recognized diagnostic criteria including schizophrenia, schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, delusional disorder, psychotic disorder not otherwise specified, or schizotypal personality disorder) at or after aged 18 years following a diagnosis of ADHD. They included peer-reviewed case-control and cohort studies of children younger than 18 with ADHD (using any recognized diagnostic criteria) with a comparison group. The authors searched MEDLINE, Scopus, PsycInfo, and Web of Science from inception through November 2015. Nourredine and colleagues 5 performed a systematic review and meta-analysis of the association between ADHD during childhood and the subsequent risk of developing a psychotic disorder.
3 There are also abnormalities in overlapping dopaminergic brain circuits in schizophrenia and ADHD.4 However, epidemiologic evidence for the association between psychotic disorders and ADHD remains inconsistent. There are overlapping environmental risk factors for both disorders, including obstetric complications, preterm birth, and low birth weight. There is also an added risk of psychosis in patients with comorbid cannabis use. There is evidence for shared genetic susceptibility to both conditions, 1 and first-degree relatives of people with ADHD have twice the risk of having schizophrenia compared with healthy controls. Attention-deficit/hyperactivity disorder (ADHD) is frequently associated with other psychiatric conditions, including psychotic disorders.
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