Marmara Medical Journal 2013; 26:165-7 DOI: 10.5472/MMJ.2013.02663.1 REPORT / OLGU SUNUMU Suicidal attempt with high dose long-acting methylphenidate: A case report Yüksek doz metilfenidat ile intihar giri§imi: Bir olgu sunumu Duygu MURAT, Ayçe ARMAN 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 long- acting 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. Key words: Suicidal attempt, Methylphenidate, Intoxication ÖZET Stimiilanlar, dikkat eksikligi hiperaktivite bozuklugu (DEHB) tedavisinde yaygin olarak kullanilan ilaçlardir. Literatürde, DEHB olgulannda uzun etkili metilfenidat ile intihar giriçimi olgu sunumlan sinirli sayidadir. Bu olgu sunumunda 1350 mg uzun etkili metilfenidat ve 2 mg risperidon ile intihar giriçiminde bulunan 13 yaçinda erkek hasta tartiçilmiçtir. Hastada hayati tehdit eden belirtiler olmamakla birlikte acil tibbi müdahale gerekli olmuçtur. Anahtar kelimeler: Intihar giriçimi, Metilfenidat, intoksikasyon Introduction The role of stimulants in treatment of children with attention- deficit hyperactivity disorder (ADHD) was well-established by the 1970s. Since then, the database supporting the safety and efficacy of these stimulants has grown exponentially. Methylphenidate (MPH) increases dopamine andnoradrenalin in synapses and extracellular spaces of dopaminergic neurons in the central nervous system (CNS) [ 1 ]. Both short and long- acting MPH medications are widely used for the treatment of ADHD. The safety and tolerability of long-acting stimulants are similar to those of short-acting stimulants, appear to have a somewhat lower risk of abuse and diversion, and may be associated with significant improvements in medication adherence [2, 3]. Short-acting medications, in contrast may allow for more flexibility with the dosing frequency, titration, and determining the drug tolerability and can be taken on an as-needed basis when coverage is needed for a few hours [4]. As the therapeutic uses of long-acting MPH preparations in children and adolescents with ADHD are increasing, so does the risk of unintentional and intentional overdoses due to abuse, misuse, and suicidal inclinations. [4-6 ]. The intra-nasal and parenteral abuse of short-acting stimulants among teenagers has been reported in addition to mega dose ingestion for suicidal purposes among ADHD cases [7, 8]. Suicide attempts with long-acting MPH preparations have also been described in case reports [6, 9]. In the present report, we describe a suicide attempt involving a high dose (1350 mg) of long-acting MPH in a 13-year-old boy. Duygu Murat [ H ) . Ayçe Arman Department of Child and Adolescent Psychiatry. School ofMedicine. Marmara University. Istanbul, Turkey e-mail: duygucalisir44@yahoo.com Submitted/Baçvuru: 28.05.2013 - Accepted/Kabul: 23.06.2013 Case Report A 13-year-old boy, accompanied by his parents, was admitted to the emergency clinic approximately nine hours after ingesting 30 tablets of 27 mg long-acting MPH, 30 tablets of 18 mg long-acting MPH, and 2 tablets of 1 mg risperidone. Psychiatric history His mother had had no medical problem during the pregnancy; there were no complications in the course of the perinatal period. His developmental history and intellectual 165