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Abstract

Stimulant medications are the most commonly used drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Reports of suicide attempts in ADHD cases with high dose longacting methylphenidate (MPH) are limited in the literature. In this case report, a 13-year-old boy who had attempted suicide by ingesting 1350 mg long-acting MPH and 2 mg risperidon is discussed. While the patient did not have life threatening symptoms, emergency medical intervention was necessary.

Keywords

• Suicidal attempt, Methylphenidate, Intoxication

Yüksek doz metilfenidat ile intihar girişimi: Bir olgu sunumu

Abstract

Stimülanlar, dikkat eksikliği hiperaktivite bozukluğu (DEHB) tedavisinde yaygın olarak kullanılan ilaçlardır. Literatürde, DEHB olgularında uzun etkili metilfenidat ile intihar girişimi olgu sunumları sınırlı sayıdadır. Bu olgu sunumunda 1350 mg uzun etkili metilfenidat ve 2 mg risperidon ile intihar girişiminde bulunan 13 yaşında erkek hasta tartışılmıştır. Hastada hayatı tehdit eden belirtiler olmamakla birlikte acil tıbbi müdahale gerekli olmuştur.

Keywords

• İntihar girişimi, Metilfenidat, İntoksikasyon

References

1. 1. Martin AM, Scahill L, Kratochvil C, (editors). Pediatric Psychopharmacology: Principle and Practice. 2nd ed. New York: Oxford University Press, 2011.
2. 2. Cooper WO, Habel LA, Sox CM, et al. ADHD drugs and serious cardiovascular events in children and young adults. N Engl J Med 2011; 365: 1896-904. doi: 10.1056/NEJMoa1110212.
3. 3. Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA 2011; 306: 2673-83. doi: 10.1001/jama.2011.1830
4. 4. Cascade E, Kalali AH, Weisler RH. Short-acting versus long-acting medications for the treatment of ADHD. Psychiatry (Edgmont) 2008; 5: 24–7.
5. 5. Scharman EJ, Erdman AR, Cobaugh DJ. Methylphenidate poisoning: An evidence-based consensus guideline for out-ofhospital management. Clin Toxicol (Phila). 2007;45 :737-52. doi: 10.1080/15563650701665175
6. 6. Klampfl K, Quattländer A, Burger R, et al. Case report: intoxication with high dose of long-acting methylphenidate (Concerta(®)) in a suicidal 14-year-old girl. Atten Defic Hyperact Disord 2010; 2:221-4. doi: 10.1007/s12402-010-0032-0.
7. 7. Fettahoglu EC, Satilmis A, Gokcen C, et al. Oral mega dose methylphenidate ingestion for suicide attempt. Pediatr Int (Japan Pediatric Society) 2009;51:844-5. doi: 10.1111/j.1442- 200X.2009.02929.x.
8. 8. Wong OF, Tsui KL, Fung HT. Acute coronary syndrome secondary to methylphenidate overdose. Hong Kong J Emerg Med 2010; 16:66-70.

9. 9. Özdemir E, Karaman M, Yurteri N, et al. A case of suicide attempt with long acting methylphenidate (Concerta). Atten Defic Hyperact Disord 2010; 2: 103-5. doi: 10.1007/s12402-010-0026-y.
10. 10. Challman TD, Lipsky JJ. Methylphenidate: Its pharmacology and uses. Mayo Clin Proc 2000; 75:711-21. doi:10.4065/75.7.711.
11. 11. Klein-Swartz W. Abuse and toxicity of methylphenidate. Curr Opin Pediatr 2002; 14:219-23. doi: 10.1097/00008480-200204000-00013
12. 12. Bruggisser M, Ceschi A, Bodmer M, Wilks MF, Kupferschmidt H, Liechti ME. Retrospective analysis of stimulant abuse cases reported to the Swiss Toxicological Information Centre during 1997–2009. Swiss Med Wkly 2010; 140: w13115. doi: 10.4414/smw.2010.13115.
13. 13. Foley R, Mrvos R, Krenzelok EP. A profile of methylphenidate exposures. Clin Tox 2000; 38: 625-30.
14. 14. Gandhi PJ, Ezeala GU, Luyen TT, et al. Myocardial infarction in an adolescent taking Adderall. Am J Health Syst Pharm 2005;62: 1494-7. doi:10.2146/ajhp040220
15. 15. Daly MW, Custer G, McLeay PD. Cardiac arrest with pulseless electrical activity associated with methylphenidate in an adolescent with normal baseline echocardiogram pharmacotherapy. Pharmacotherapy 2008; 28:1408-12. doi: 10.1592/phco.28.11.1408
16. 16. George AK, Kunwar AR, Awasthi A. Acute myocardial infarction in a young male on methylphenidate, bupropion, and erythromycin. J Child Adolesc Psychopharmacol 2005;15:693-5. doi:10.1089/ cap.2005.15.693
17. 17. Figueredo VM. Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart. Am J Med 2011;124:480-8. doi: 10.1016/j.amjmed.2010.11.031
18. 18. Singh K, Xiao L, Remondino A, et al. Adrenergic regulation of cardiac myocyte apoptosis. J Cell Physiol 2001; 189:257-65. doi:10.1002/ jcp.10024
19. 19. Hill SL, El-Khayat RH, Sandilands EA, et al. In our patient the vomiting may explain the reduced side effects of MPH, no matter whether the vomiting was due to a gastric irritation, or to higher levels of CNS dopamine. In such cases, the cause of vomiting needs to be investigated in depth in future studies.