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 , DOM, ephedrine, MDMA, methamphetamine, and though a large number of such compounds have been synthesized.

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]

The symptoms of acute amphetamine psychosis are very similar to those of the acute phase of schizophrenia[9] although in amphetamine psychosis visual hallucinations are more common and thought disorder is rare.[10] Amphetamine psychosis may be purely related to high drug usage, or high drug usage may trigger an underlying vulnerability to schizophrenia.[11] 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.[12] The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis, while schizophrenia is more likely to follow a chronic course.[13]

Although rare and not formally recognized,[14][15] 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.[16]

Cocaine

Cocaine has a similar potential to induce temporary psychosis[17] with more than half of cocaine abusers reporting at least some psychotic symptoms at some point.[18] 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.[19] Delusional parasitosis with formication ("cocaine bugs") is also a fairly common symptom.[20]

Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.[21]

Methylphenidate

Chronic abuse of methylphenidate can also lead to psychosis.[22][23] 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.[24] 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.[25][26]

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.[27] 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. http://bjp.rcpsych.org/cgi/content/abstract/185/3/196 | Stimulant psychosis: systematic review, The British Journal of Psychiatry
  2. http://www.drugs.com/amphetamine.html | Amphetamine
  3. Shoptaw SJ, Kao U, Ling W. "Treatment for amphetamine psychosis (Review)". Cochrane Database of Systematic Reviews 2009: 1.
  4. McKetin R, McLaren J, Lubman DI, Hides L. The prevalence of psychotic symptoms among methamphetamine users. Addiction 2006;101(10):1473–8.
  5. Drug-Induced Psychosis Associated with Crystalline Methamphetamine | http://apy.sagepub.com/content/14/1/86
  6. Relapse of Paranoid Psychotic State in Methamphetamine Model of Schizophrenia | http://schizophreniabulletin.oxfordjournals.org/content/18/1/115
  7. Hofmann FG (1983). A Handbook on Drug and Alcohol Abuse: The Biomedical Aspects (2nd ed.). New York: Oxford University Press. p. 329.
  8. Factors for Susceptibility to Episode Recurrence in Spontaneous Recurrence of Methamphetamine Psychosis | [1]
  9. Shoptaw SJ, Kao U, Ling W. "Treatment for amphetamine psychosis (Review)". Cochrane Database of Systematic Reviews 2009: 1.
  10. Alan F. Schatzberg, Charles B. Nemeroff| The American Psychiatric Publishing Textbook of Psychopharmacology| http://books.google.com/?id=Xx7iNGdV25IC&pg=PP1%7Cyear 2009|publisher: The American Psychiatric Publishing|isbn: 978-1-58562-309-9|pages 847–48}}
  11. Shoptaw SJ, Kao U, Ling W. "Treatment for amphetamine psychosis (Review)". Cochrane Database of Systematic Reviews 2009: 1.
  12. >Chen CK, Lin SK, Pak CS, Ball D, Loh EW, Murray RM | 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 | volume 136 | issue 1 | pages 87–91 }}
  13. McIver C, McGregor C, Baigent M, Spain D, Newcombe D, Ali R. Guidelines for the medical management of patients with methamphetamine-induced psychosis. Drug and Alcohol Services: South Australia 2006.
  14. Hegerl U, Sander C, Olbrich S, Schoenknecht P (Aug 2006). "Are psychostimulants a treatment option in mania?". Prog Neuropsychopharmacol Biol Psychiatry 30 (6): 1097–102.
  15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.
  16. Hegerl U, Sander C, Olbrich S, Schoenknecht P (Aug 2006). "Are psychostimulants a treatment option in mania?". Prog Neuropsychopharmacol Biol Psychiatry 30 (6): 1097–102.
  17. Brady KT, Lydiard RB, Malcolm R, Ballenger JC (1991). "Cocaine-induced psychosis". J Clin Psychiatry 52: 509–512.
  18. Psychosis Among Substance Users | http://www.medscape.com/viewarticle/528487_5
  19. Cocaine Bugs: A Case Report of Cocaine-Induced Delusions of Parasitosis | [2]
  20. Cocaine Bugs: A Case Report of Cocaine-Induced Delusions of Parasitosis | [3]
  21. Drug-induced psychosis: Emergency diagnosis and management | http://www.psychosomaticsjournal.com/article/S0033-3182(81)73092-5/abstract
  22. Methylphenidate Abuse and Psychiatric Side Effects | http://www.psychiatrist.com/PCC/article/Pages/2000/v02n05/v02n0502.aspx
  23. http://www.nejm.org/doi/full/10.1056/NEJM197204202861607
  24. Ritalin & Ritalin-SR Prescribing Information | http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf
  25. Caffeine-induced psychosis | https://www.ncbi.nlm.nih.gov/pubmed/19407709
  26. Psychosis Following Excessive Ingestion of Energy Drinks in a Patient With Schizophrenia | http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2009.09101456
  27. Shoptaw SJ, Kao U, Ling W. "Treatment for amphetamine psychosis (Review)". Cochrane Database of Systematic Reviews 2009: 1.