Stimulant psychosis

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Stimulant psychosis
Classification and external resources
ICD-10	F15.5

Stimulant psychosis is a psychotic disorder than appears in some people who use stimulant drugs. Most commonly, stimulant psychosis occurs in drug abusers who take large stimulant doses but it can also appear in patients taking theraputic doses under medical supervision.

Contents 1 Methamphetamine-induced psychotic syndromes 2 Methylphenidate 3 Treatment 4 Emergency Treatment 5 See also 6 References 7 Further reading 8 External links

[edit] Methamphetamine-induced psychotic syndromes

A 2007 article ^[1] examined the limited amount of documentation and research currently available on methamphetamine-induced psychotic syndromes.

In nearly every case, the symptoms of methamphetamine-induced psychosis will stop within 7–10 days of discontinuing the drug.

After discontinuing the drug, however, a small percentage of long-term or "heavy" users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence. The 2007 article by Zoric, Rim, Rad, Tsuang et al. looks at these cases a little more closely.

Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term methamphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.

Spontaneous and long-term recurrences (akin to "flashbacks") are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.

The key distinction between this condition and e.g. a psychotic disorder or schizophrenia, is that the symptoms of a methamphetamine-induced psychotic disorder are not considered to be permanent and will eventually subside with abstinence and proper treatment.

Anecdotally, the correlation of psychotic delusion with dopamine is confirmed by amphetamine use (a dopamine model for some schizophrenias). Very high and rare recreational use of amphetamine can produce Gender Identity Disorder delusions (which the DSM says are rare in schizophrenia),^[2][3][4] while low medical doses of amphetamine can produce more common morbid jealousy^[5]. Similarly, two cases reported using high doses in order to become transvestites (another Gender Identity Disorder);^[6] cases of which have been reported in schizophrenia^[7].

[edit] Methylphenidate

Methylphenidate, an amphetamine derivative^{[disputed – discuss]} and potent central nervous system stimulant,^[8][9] can also lead to a psychosis from chronic use. Although the safety profile of short-term methylphenidate therapy in clinical trials has been well established, repeated use of psychostimulants such as methylphenidate is less clear. The long term effects of methylphenidate such as drug addiction, withdrawal reactions and psychosis has received very little research and thus the long term effects of using stimulants for ADHD are largely unknown.^[10] Short term clinical trials show a very low incidence of methylphenidate induced psychosis of 0.01%.^[11] Longer term use of methylphenidate has a psychosis rate of 6% in children.^[12] The long term effects on mental health disorders in later life of chronic use of methylphenidate is unknown.^[13] Concerns have been raised that long-term therapy might cause drug dependence, paranoia, schizophrenia and behavioral sensitisation, similar to other stimulants.^[14] Psychotic symptoms from methylphenidate can include, hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, euphoria, grandiosity, paranoid delusions, confusion, increased aggression and irritability. Methylphenidate psychosis is unpredictable in who it will occur. Family history of mental illness does not predict the incidence of stimulant toxicosis in ADHD children. High rates of childhood stimulant use is found in patients with a diagnosis of schizophrenia and bipolar disorder independent of ADHD. Individuals with a diagnosis of bipolar or schizophrenia who were prescribed stimulants during childhood typically have a significantly earlier onset of the psychotic disorder and suffer a more severe clinical course of psychotic disorder.^[15][16][17]

The withdrawal or rebound symptoms of methylphenidate can include psychosis and depression.^[18] Stimulant withdrawal or rebound reactions can occur and should be minimized in intensity, i.e. via a gradual tapering off of medication.^[19][20][21] A very small study of abrupt withdrawal of stimulants suggests that withdrawal reactions are not typical. Nonetheless withdrawal reactions may still occur in susceptible individuals.^[22]

[edit] Treatment

Typical (haloperidol) and atypical antipsychotics (olanzapine, Risperidone) have been found to be helpful in the initial treatment of amphetamine induced psychosis.^[23] The atypical antipsychotics are more expensive, but have fewer side effects.

[edit] Emergency Treatment

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Severe paranoia and hallucinations should be treated as a medical emergency. A user who is tweaking, has been awake for a long time, and/or believes they are in immediate danger may put themselves (or others) at a grave risk for harm while trying to elude or respond defensively to a delusion or a hallucination (see Fight-or-flight response).

Some facilities may have sufficient funding, programs, and resources to address both mental health and substance abuse issues. This may be the most appropriate clinical setting for an amphetamine user who has presented with psychotic symptoms.

In other situations, facilities only address one or the other. In Chicago, for example, publicly funded substance abuse treatment providers commonly refuse to admit an amphetamine user before any psychiatric emergency (i.e. amphetamine-induced psychosis) is treated by a psychiatric provider.

Additionally, providers may fail to recognize the difference between amphetamine-induced psychosis and another mental illness.

Either situation typically results in a psychiatric commitment (which entails the administration of sedatives and observation over a period of several days) and discharge with little-to-no additional follow-up treatment for substance addiction (when applicable).

[edit] See also

• Amphetamine
• Delusional parasitosis
• Dopamine hypothesis of psychosis
• Psychosis

[edit] References

[edit] Further reading

• Connell, P.H. (1961) Amphetamine Psychosis. Oxford University Press.

[edit] External links

• Chronic amphetamine use and abuse - Review published in 2000.

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