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A randomised controlled trial to evaluate the clinical and cost-effectiveness of stimulant compared with non-stimulant medication for adults with attention-deficit/hyperactivity disorder and a history of Psychosis or biPolar disordER: SNAPPER

Loi, Shrushma
; 
Joshee, Paras
; 
Ottridge, Ryan
; 
Woolley, Rebecca
; 
Gkini, Eleni
; 
Asherson, Philip
; 
Young, Allan H
; 
Al-Janabi, Hareth
; 
Broome, Matthew
; 
Roberts, Anya
... show 9 more
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder involving inattention, hyperactivity and impulsivity, which starts in childhood and frequently persists into adulthood. Stimulant and non-stimulant medication are the mainstay of treatment in adults. ADHD in adults is commonly comorbid in people with severe mental illness (SMI) such as bipolar disorder (bipolar) and psychosis. There is substantial uncertainty over the effectiveness of stimulant and non-stimulant medication in adult ADHD comorbid with SMI. There is also concern that they could trigger or worsen psychotic or manic symptoms. Whilst National Institute of Health and Care Evidence (NICE) ADHD guidelines indicate available evidence does not justify a deviation from their main recommendations of using stimulants first line, this is based on limited studies within this comorbid population. A randomised controlled trial (RCT) is needed to address this evidence gap. We present a protocol for a pragmatic, observer-blind, multi-centre, two-arm, RCT called SNAPPER that aims to investigate the clinical and cost-effectiveness of stimulant compared with non-stimulant medication for adults with ADHD and a history of SMI.
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Date
2025
Type
Article
Subject
Attention deficit disorder with hyperactivity
 Psychosis
 Bipolar disorder
 Pharmacology
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NottsHC Attention Deficit Disorder
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Citation
A randomised controlled trial to evaluate the clinical and cost-effectiveness of stimulant compared with non-stimulant medication for adults with attention-deficit/hyperactivity disorder and a history of Psychosis or biPolar disordER: SNAPPER
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https://mider.dspace7.openrepository.com/handle/20.500.12904/20049
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Springer Nature
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© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
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