A study of 252 medical students found that 44 had used Ritalin or similar stimulants, even though only six had been diagnosed with attention deficit hyperactivity disorder, the condition for which it is prescribed. Thirty-three students said they had taken prescription stimulants in the past year. "Students possibly used stimulants to increase academic performance . with very few using it for reasons other than to increase concentration," said lead author Mari Retief, from the psychiatry department at Stellenbosch University. "The extreme academic pressure experienced by the medical fraternity, as well as high expectations to perform well, might be possible reasons for the higher prevalence of stimulant use in medical students compared with non-medical students," she said. A second-year medical student at Wits University told The Times: "I suppose I would think of it as cheating if I was the only person doing it, but our courses are so hectic and if others take something and you don't, it's almost a given that you will be left behind." According to the research, published in the South African Journal of Psychiatry, abuse of stimulant drugs can lead to anxiety, insomnia, cardiac problems, an upset stomach and "psychological and physiological dependence". It follows a recent study by the University of Pretoria, which found that one in six undergraduates across faculties were taking drugs such as Ritalin to enhance performance, when only 3% had been diagnosed with ADHD. Psychiatrist Jacques Malan said wealthy and "high-achieving families" often had suitable networks to gain stimulants along legal routes, and that students may know how to fake ADHD symptoms. Duke University in North Carolina, US, has banned non-medical use of prescription stimulants to enhance academic performance, classifying it as cheating. Dean of students Sue Wasiolek said it was the students themselves who had lobbied for it. "This raises the question whether South African universities and colleges should consider having a policy or protocol on the use of stimulants for cognitive enhancement," said Retief. UCT spokesman Elijah Moholola said the university had not considered banning stimulant use. Apart from Ritalin and Concerta, "caffeine is also a significant stimulant found in many forms, for example coffee and drinks such as Red Bull", he said. Source