ADHD and Psychosis Risk: Who Needs Close Follow-Up?

"Psychosis" is one of those words that makes something stir inside a person with ADHD, or someone close to them, as they read. I want to calm that right away, but without lying: the subject is real, and the paper does not hide it. The same paper also says openly that the transition is seen in only a portion of people with ADHD. Both have to be held together.

In this post I explain what I learned, and what I could not learn, from the abstract of a paper listed on Nature's ADHD page on 14 October 2026. All I have is the paper's abstract. I have not read the full text, so I do not know the authors' detailed discussion, and I will not write as if I know what I do not.

Who the study comes from and where

The paper is titled "Attention deficit hyperactivity disorder: transition to psychotic disorders". Its authors are Anita Thapar, Charlotte A. Dennison, Ali Kandeğer and Michael J. Owen. It was published in 2026 in the journal Molecular Psychiatry.

This is not an experimental study collecting new data. The authors describe it as a "perspective", that is, an opinion and appraisal paper: it takes up hypotheses and the existing evidence and discusses what they mean clinically. This is why the abstract gives no number of participants. No age range is given either; the subject is people with ADHD in general.

This post is a Turkish-language summary of the paper published open access in Molecular Psychiatry. The paper was published under the Creative Commons Attribution 4.0 (CC BY 4.0) license. The findings belong to the authors of the paper; the account and appraisal here are mine.

What the paper says

The starting point is this: it is well known that ADHD raises the risk of common mental health conditions such as depression and anxiety, and it is thought that recognizing and treating ADHD early may reduce part of this risk. According to the authors, though, the increased risk for bipolar disorder, psychosis and schizophrenia is often overlooked. The paper calls these three together "psychotic disorders" and gives the risk as an odds ratio between 4.7 and 8.9.

The second emphasis concerns how the health system works. Because ADHD is so common, there is pressure for primary care services (such as family medicine) to take on more responsibility, especially for its less complex forms. The authors do not oppose this; they set one condition: those at highest risk of transition to a psychotic disorder should be kept as a priority in secondary care, that is, in specialist follow-up.

The third point, and in my view the most honest one, is this: today there is no method to tell who among people with ADHD is at higher risk. The authors say that why only some people develop a psychotic disorder is not known either.

What these numbers mean and what they do not

An odds ratio is a statistic that compares how differently often something occurs in two groups. A value of 1 means "no difference". Values between 4.7 and 8.9 show that the odds of these disorders in the ADHD group are roughly five to nine times higher than in people without ADHD. The abstract gives a single range and does not say which value corresponds to which disorder.

This has two limits. First, an odds ratio is a relative measure, not absolute risk. Several times something very rare can still be rare. The abstract gives no absolute figure, so I cannot answer the question "what percent of people with ADHD experience psychosis" from this abstract. Second, this is an association. The number itself does not say whether this association comes from ADHD itself, from a shared foundation, or from something else. The rest of the paper is in fact dealing with exactly this question.

Why only a portion: four explanations

The authors take up, one by one, the main hypotheses that could explain why the transition occurs in a subgroup. As far as I can gather from the abstract, they are these:

ADHD symptoms may be an early form of psychosis. That is, some features that resemble ADHD may actually be the early appearance of a psychotic disorder that will emerge later. The authors note that direct support for this idea is limited.

ADHD treatment may play a role. I explain this separately in the next section.

Environmental conditions produced by ADHD may mediate. That is, the experiences that come with having ADHD (the abstract does not list which ones are meant here) may be a step on the way to psychosis. The authors discuss this mediation but say that evidence for mediation is lacking.

The two may arise from the same neurodevelopmental processes. That is, ADHD and psychotic disorders may have a shared, developmental origin. The paper also evaluates the evidence for this. The abstract does not say whether it reaches a conclusion on this point.

The abstract does not present any of these explanations as settled. Direct support for the first is limited, evidence for the third is lacking, and on medication the picture is clear in one respect and uncertain in another. For the fourth the abstract gives no verdict. In my view, being able to write this openly is the trustworthy side of the paper.

The medication question: methylphenidate and amphetamine

This is the place readers will be most curious about, because the first question that comes to mind is "does the medication trigger this". The answer given in the abstract has two parts. According to the authors, the available data show that the therapeutic use of methylphenidate is not associated with an increase in the risk of psychotic disorder. For the amphetamine group, uncertainty continues.

The phrase "uncertainty continues" should not be read as "there is a risk" or as "there is no risk". It means the data are not clear enough. The abstract does not say which studies this conclusion rests on or how many people were looked at. Which medication can be used in which country also varies. In the methylphenidate article on this site I explained how this medication works. There is also a register study from Sweden close to the same subject: it reports that in adults with a history of psychosis, psychotic events did not increase after a stimulant medication was started. I summarized it in a separate article. It is a study independent of this paper, and I do not know whether its abstract cites this perspective paper.

In either case, whether to use medication or to change it is not a decision to be made on the abstract of a single paper. What to expect from medication treatment and its side effects are separate topics, carried out together with a doctor.

Follow-up and screening: what is recommended, what is not known

Near the end of the abstract, the authors emphasize the clinical implications for screening and monitoring individuals with ADHD for psychotic disorders, and say they take up which factors may be useful in weighing the risk. The honest side of the matter is this: the abstract does not say what these factors are, how many months apart to check, or which scale to use. I do not know these, and I will not make them up.

As general information I can say this: psychosis is a condition that can come with symptoms such as a weakened tie to reality, hearing or seeing things that are not there, or holding baseless suspicions. In bipolar disorder, periods such as energy overflowing on very little sleep for days stand out. These are not from this paper but from general medical knowledge. I described the places where ADHD's own difficulties and these can get mixed up in the article ADHD or bipolar.

What this finding means for me

If you have ADHD: this abstract gives no reason for panic, but at the first appointment I think it is a good habit to tell your doctor whether there is a history of bipolar disorder, psychosis or schizophrenia in your family, and whether you have had such periods before. This is not something the paper recommends; it is my view. The abstract does not count something like a family history as a risk weight.

If you have a relative with ADHD: if you notice something out of the ordinary in them (very little sleep for a long time, beliefs that do not match reality), it is reasonable to share it with the treating doctor rather than counting it as an ordinary part of ADHD. Not to raise an alarm, but so that the full picture is in the doctor's hands.

If you are a doctor or work within the health system, the paper's main message is for you: this risk should be kept in mind in a patient with ADHD, and those at higher risk should be followed as a priority in secondary care.

What it does not say

This is a perspective paper, that is, not a new cohort or experiment. It does not offer a scale that separates who is at risk; on the contrary, it says there is no such scale. It does not show that ADHD leads to psychosis. It does not declare the safety of medications with certainty: the picture is more reassuring for methylphenidate and uncertain for amphetamine. And we cannot derive individual risk from average risk: an average that is 4.7-8.9 times higher does not tell you or me what will happen.

What is left for me

I liked this paper because it prevents two mistakes at once. One is the comfort of "ADHD is only a matter of attention, nothing else happens". The other is the fear that "people with ADHD go on to psychosis". The paper says neither: the risk is real and higher on average, but not for everyone, and we do not yet know in whom it will occur.

What comes out of it for me is this: a person with ADHD deserves to be asked the same questions, with the same seriousness, as someone without ADHD, but asking these questions needs to be a form of care, not of fear. Talking openly with your doctor, telling them how the medication is going, your sleep, your mood. Without having read the full text, it would not be right for me to say more than this.