Stimulant psychosis

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Stimulant psychosis is a psychotic disorder that occurs in some people who use stimulant drugs. Stimulant psychosis commonly occurs in people who abuse stimulants, but it also occurs in some patients taking therapeutic doses of stimulant drugs such as methylphenidate under medical supervision.[1]

The most common causative agents are substituted amphetamines, cathinones and cocaine.

Signs and symptoms

The symptoms of stimulant psychosis may vary slightly depending on the drug ingested but generally include the symptoms of organic psychosis including external hallucinations, delusions, thought disorder, environmental alterations, object activation, and, in extreme cases, autonomous entities such as shadow people and catatonia.

In cases of stimulant psychosis, not organic psychosis, patients tend to also present with the physical symptoms of prolonged stimulant abuse or acute overdose. These additional symptoms may include aggression, arrhythmia, dilated pupils, diarrhea, hypertension, hyperthermia, nausea, rapid breathing, restlessness, seizures, sleep deprivation, tremor, and vomiting.[2]

Stimulants

The following stimulants are known to cause psychosis.

Substituted amphetamines

Drugs in the class of amphetamines are known to induce "amphetamine psychosis" typically when chronically abused or used in high doses.[3] Common examples include DOM, ephedrine, MDMA, and methamphetamine.

The symptoms of amphetamine psychosis include auditory and visuals, delusions of persecution and delusions of reference concurrent with both clear consciousness and prominent extreme agitation.[4][5] A Japanese study of recovery from methamphetamine psychosis reported a 64% recovery rate within 10 days rising to an 82% recovery rate at 30 days after methamphetamine cessation.[6] However, it has been suggested that around 5–15% of users fail to make a complete recovery in the long-term.[7] Furthermore, even at a small dose, the psychosis can be quickly re-established.[8]

Symptoms of acute amphetamine psychosis are very similar to those of the acute phase of schizophrenia[3] although in amphetamine psychosis visual hallucinations are more common and thought disorder is rare.[9] Amphetamine psychosis may be purely related to high drug usage, or high drug usage may trigger an underlying vulnerability to schizophrenia.[3] There is some evidence that vulnerability to amphetamine psychosis and schizophrenia may be genetically related. Relatives of methamphetamine users with a history of amphetamine psychosis are five times more likely to have been diagnosed with schizophrenia than relatives of methamphetamine users without a history of amphetamine psychosis.[10] The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis, while schizophrenia is more likely to follow a chronic course.[11]

Although rare and not formally recognized,[12][13] a condition known as Amphetamine Withdrawal Psychosis (AWP) may occur upon cessation of substituted amphetamine use and, as the name implies, involves psychosis that appears on withdrawal from substituted amphetamines. However, unlike similar disorders, in AWP, substituted amphetamines reduce rather than increase symptoms, and the psychosis or mania resolves with resumption of the previous dosing schedule.[12]

Cocaine

Cocaine has a similar potential to induce temporary psychosis[14] with more than half of cocaine abusers reporting at least some psychotic symptoms at some point.[15] Typical symptoms of sufferers include paranoid delusions that they are being followed and that their drug use is being watched accompanied by hallucinations that support the delusional beliefs.[16] Delusional parasitosis with formication ("cocaine bugs") is also a fairly common symptom.[16]

Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.[17]

Methylphenidate

Chronic abuse of methylphenidate can also lead to psychosis.[18][19] The safety profile of short-term methylphenidate therapy has been well-established, with short-term clinical trials revealing a very low incidence (0.1%) of methylphenidate-induced psychosis at therapeutic dose levels.[20] Psychotic symptoms from methylphenidate can include hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, mania, grandiosity, paranoid delusions, confusion, increased aggression, and irritability.

Caffeine

There is limited evidence that caffeine, in high doses or when chronically abused, may induce psychosis in normal individuals and worsen pre-existing psychosis in those diagnosed with schizophrenia.[21][22]

Treatment

Treatment consists of supportive care during the acute intoxication phase: maintaining hydration, body temperature, blood pressure, and heart rate at acceptable levels until the drug is sufficiently metabolized to allow vital signs to return to baseline. Typical and atypical antipsychotics have been shown to be helpful in the early stages of treatment.[3] This is followed by abstinence from psychostimulants supported with counseling or medication designed to assist the individual preventing a relapse and the resumption of a psychotic state.

See also

External links

References

  1. ↑ Curran, C., Byrappa, N., McBride, A. (September 2004). "Stimulant psychosis: systematic review". British Journal of Psychiatry. 185 (3): 196–204. doi:10.1192/bjp.185.3.196. ISSN 0007-1250. 
  2. ↑ http://www.drugs.com/amphetamine.html | Amphetamine
  3. ↑ 3.0 3.1 3.2 3.3 Shoptaw, S. J., Kao, U., Ling, W. W. (8 October 2008). "The Cochrane Database of Systematic Reviews (Complete Reviews)". In The Cochrane Collaboration. Treatment for amphetamine psychosis. John Wiley & Sons, Ltd. pp. CD003026.pub2. doi:10.1002/14651858.CD003026.pub2. 
  4. ↑ McKetin, R., McLaren, J., Lubman, D. I., Hides, L. (October 2006). "The prevalence of psychotic symptoms among methamphetamine users". Addiction. 101 (10): 1473–1478. doi:10.1111/j.1360-0443.2006.01496.x. ISSN 0965-2140. 
  5. ↑ Dore, G., Sweeting, M. (March 2006). "Drug-Induced Psychosis Associated with Crystalline Methamphetamine". Australasian Psychiatry. 14 (1): 86–89. doi:10.1080/j.1440-1665.2006.02252.x. ISSN 1039-8562. 
  6. ↑ Sato, M., Numachi, Y., Hamamura, T. (1 January 1992). "Relapse of Paranoid Psychotic State in Methamphetamine Model of Schizophrenia". Schizophrenia Bulletin. 18 (1): 115–122. doi:10.1093/schbul/18.1.115. ISSN 0586-7614. 
  7. ↑ Hofmann, F. G. (1983). "A Handbook on Drug and Alcohol Abuse: The Biomedical Aspects. 2nd edition". British Journal of Psychiatry. 145 (6): 677–677. doi:10.1192/S0007125000119701. ISSN 0007-1250. 
  8. ↑ Yui, K., Ikemoto, S., Goto, K. (24 January 2006). "Factors for Susceptibility to Episode Recurrence in Spontaneous Recurrence of Methamphetamine Psychosis". Annals of the New York Academy of Sciences. 965 (1): 292–304. doi:10.1111/j.1749-6632.2002.tb04171.x. ISSN 0077-8923. 
  9. ↑ Schatzberg, A. F., Nemeroff, C. B. (2009). The American Psychiatric Publishing Textbook of Psychopharmacology. American Psychiatric Pub. ISBN 9781585623099. 
  10. ↑ Chen, C.-K., Lin, S.-K., Sham, P. C., Ball, D., Loh, E.-W., Murray, R. M. (5 July 2005). "Morbid risk for psychiatric disorder among the relatives of methamphetamine users with and without psychosis". American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 136B (1): 87–91. doi:10.1002/ajmg.b.30187. ISSN 1552-4841. 
  11. ↑ Mclver, C., McGregor, C., Baigent, M., Spain, D., Newcombe, D., Ali, R. (2006), Guidelines for the medical management of patients with methamphetamine-induced psychosis: Drug & Alcohol Services South Australia (PDF) 
  12. ↑ 12.0 12.1 Hegerl, U., Sander, C., Olbrich, S., Schoenknecht, P. (September 2009). "Are Psychostimulants a Treatment Option in Mania?". Pharmacopsychiatry. 42 (05): 169–174. doi:10.1055/s-0029-1220888. ISSN 0176-3679. 
  13. ↑ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). 1 (4th ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890423349. ISBN 9780890423349. 
  14. ↑ Brady, K. T., Lydiard, R. B., Malcolm, R., Ballenger, J. C. (December 1991). "Cocaine-induced psychosis". The Journal of Clinical Psychiatry. 52 (12): 509–512. ISSN 0160-6689. 
  15. ↑ Psychosis Among Substance Users 
  16. ↑ 16.0 16.1 Elliott, A., Mahmood, T., Smalligan, R. D. (March 2012). "Cocaine Bugs: A Case Report of Cocaine-Induced Delusions of Parasitosis: Cocaine Bugs". The American Journal on Addictions. 21 (2): 180–181. doi:10.1111/j.1521-0391.2011.00208.x. ISSN 1055-0496. 
  17. ↑ DiSclafani, A., Hall, R. C. W., Gardner, E. R. (1 October 1981). "Drug-induced psychosis: Emergency diagnosis and management". Psychosomatics. 22 (10): 845–855. doi:10.1016/S0033-3182(81)73092-5. ISSN 0033-3182. 
  18. ↑ Morton, W. A., Stockton, G. G. (1 October 2000). "Methylphenidate Abuse and Psychiatric Side Effects". The Primary Care Companion for CNS Disorders. 2 (5): 25507. doi:10.4088/PCC.v02n0502. ISSN 2155-7780. 
  19. ↑ Spensley, J., Rockwell, D. A. (20 April 1972). "Psychosis during Methylphenidate Abuse". New England Journal of Medicine. 286 (16): 880–881. doi:10.1056/NEJM197204202861607. ISSN 0028-4793. 
  20. ↑ Ritalin & Ritalin-SR Prescribing Information | http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf
  21. ↑ Hedges, D. W., Woon, F. L., Hoopes, S. P. (March 2009). "Caffeine-induced psychosis". CNS spectrums. 14 (3): 127–129. doi:10.1017/s1092852900020101. ISSN 1092-8529. 
  22. ↑ Cerimele, J. M., Stern, A. P., Jutras-Aswad, D. (March 2010). "Psychosis Following Excessive Ingestion of Energy Drinks in a Patient With Schizophrenia". American Journal of Psychiatry. 167 (3): 353–353. doi:10.1176/appi.ajp.2009.09101456. ISSN 0002-953X. 
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