Psychostimulants in the academic context: Neuropsychiatric and metabolic repercussions of misuse

The non-medical use of prescription psychostimulants for cognitive enhancement has become increasingly prevalent in higher education, particularly among medical students exposed to intense academic pressure. This integrative review aimed to critically analyze the neuropsychiatric and metabolic consequences of off-label psychostimulant misuse in healthy university populations. A search was conducted in PubMed/MEDLINE, Scopus, and Web of Science, including peer-reviewed studies published within the last ten years, prioritizing meta-analyses, randomized controlled trials, longitudinal cohorts, and translational neurobiological research. Epidemiological data indicate misuse rates of approximately 17% among undergraduates, reaching up to 47.4% in some medical student cohorts. The evidence demonstrates that supratherapeutic catecholaminergic stimulation induces oxidative stress, neuroinflammation, cortical structural alterations, sleep architecture disruption, affective dysregulation, and increased risk of stimulant-induced psychosis. Systemically, chronic misuse is associated with hypertension, tachycardia, elevated cardiomyopathy risk, hypothalamic–pituitary–adrenal axis dysregulation, appetite suppression, and reduced bone integrity. Importantly, controlled trials show minimal objective improvement in complex cognition among healthy individuals, despite strong subjective perceptions of enhanced performance. Overall, the findings indicate that the biological and psychiatric risks of psychostimulant misuse substantially outweigh any perceived academic benefit, underscoring the need for institutional preventive strategies and evidence-based education within academic environments.