The Attitudes, Beliefs and Knowledge of Adult Psychiatrists and Child and Adolescent Psychiatrists About Methylphenidate and its Indicated, Off-Label, and Nonmedical Use

Abstract

Objective: Psychostimulants including methylphenidate (MPH) constitute first-line pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD). MPH is only indicated for ADHDand narcolepsy but its off-label use is common. The nonmedical use is also on rise especially amongstudents and physicians, because of the popular opinion that MPH provides cognitive improvement.However, to our knowledge, there is no previous study evaluating the off-label and nonmedical useof MPH among adult psychiatrists and child and adolescent psychiatrists. In this context, the studyaimed to evaluate the attitudes, beliefs, and knowledge of adult psychiatrists and child and adolescent psychiatrists about MPH and its indicated, off-label and nonmedical use among this population.Thus, in this particular population, it will be possible to identify realistic or unrealistic beliefs aboutMPH and to plan training for residents and specialists. Non-indications also will be identified and willcontribute to the literature on the identification of new indications.Material and Methods: Data for this study were collected via an Internet-based survey designed bythe researcher using Google forms®. Invitations to participate were shared in adult psychiatrists andchild and adolescent psychiatry occupational groups on social media platforms. Data were collectedduring August 2019.Results: Of the participants, 39.2% were adult psychiatrists and 60.8% were child and adolescentpsychiatrists. All physicians reported that they prescribed MPH at varying rates. The rate of prescribingoff-label MPH was 71.8%. The cases most commonly prescribed off-label MPH were autism, mentalretardation, and/or ADHD with uncontrolled hyperactivity and agitation under the age of 6 in thechildren and treatment-resistant depression in the adults, respectively. Nonmedical use was also highat 59.4%. The most common reason for nonmedical use was determined as cognitive improvementfor academic activities, followed by reducing sleep and increasing attention during night shifts. Theirknowledge about MPH and ADHD was sufficient in general. However, there were some doubts aboutthe diagnostic process.Conclusion: All participants had been prescribing MPH, both for indicated and off-label cases. Theyall had substantial knowledge about MPH. However, the adult psychiatrists were more concernedabout misuse and the probable adverse effects. The nonmedical use of MPH was also higher amongparticipants than the previously reported rates. New and more comprehensive studies are needed inthis context.