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Stimulant psychosis

Stimulant psychosis is a mental disorder characterized by psychotic symptoms (such as hallucinations, paranoid ideation, delusions, disorganized thinking, grossly disorganized behaviour) which involves and typically occurs following an overdose or several day 'binge' on psychostimulants;[1] however, it has also been reported to occur in approximately 0.1% of individuals, within the first several weeks after starting amphetamine or methylphenidate therapy.[2][3][4] Methamphetamine psychosis, or long-term effects of stimulant use in the brain (at the molecular level), depend upon genetics and may persist for some time.[5]

Stimulant psychosis
Other namesStimulant-induced psychotic disorder[1]
SpecialtyPsychiatry, addiction psychiatry

The most common causative agents are substituted amphetamines, including substituted cathinones, as well as certain dopamine reuptake inhibitors such as cocaine and phenidates.

Signs and symptoms

The symptoms of stimulant psychosis vary depending on the drug ingested, but generally involve the symptoms of organic psychosis such as hallucinations, delusions, or paranoia.[2][3][4] Other symptoms may include mania, erratic behavior, agitation and/or aggression.

Cause

Substituted amphetamines

Drugs in the class of amphetamines, or substituted amphetamines, are known to induce "amphetamine psychosis" typically when chronically abused or used in high doses.[6] In an Australian study of 309 active methamphetamine users, 18% had experienced a clinical level psychosis in the past year.[7] Commonly abused amphetamines include methamphetamine, MDMA, 4-FA, as well as substituted cathinones like a-PVP, MDPV, and mephedrone, though a large number of other closely related compounds have been recently synthesized. Methylphenidate is sometimes incorrectly included in this class, although it is nonetheless still capable of producing stimulant psychosis.

The symptoms of amphetamine psychosis include auditory and visual hallucinations, grandiosity, delusions of persecution, and delusions of reference concurrent with both clear consciousness and prominent extreme agitation.[8][9] 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.[10] However it has been suggested that around 5–15% of users fail to make a complete recovery in the long term.[11] Furthermore, even at a small dose, the psychosis can be quickly reestablished.[10] Psychosocial stress has been found to be an independent risk factor for psychosis relapse even without further substituted amphetamine use in certain cases.[12]

The symptoms of acute amphetamine psychosis are very similar to those of the acute phase of schizophrenia[6] although in amphetamine psychosis visual hallucinations are more common and thought disorder is rare.[13] Amphetamine psychosis may be purely related to high drug usage, or high drug usage may trigger an underlying vulnerability to schizophrenia.[6] 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.[14] The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis, while schizophrenia is more likely to follow a chronic course.[15]

Although rare and not formally recognized,[16][17] 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.[18]

Cocaine

Cocaine has a similar potential to induce temporary psychosis[19] with more than half of cocaine abusers reporting at least some psychotic symptoms at some point.[20] Typical symptoms include paranoid delusions that they are being followed and that their drug use is being watched, accompanied by hallucinations that support the delusional beliefs.[20] Delusional parasitosis with formication ("cocaine bugs") is also a fairly common symptom.[21]

Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.[20][22]

Phenidates

Methylphenidate and its analogues (such as ethylphenidate, 4F-MPH, and isopropylphenidate) share similar pharmacological profiles as other norepinephrine-dopamine reuptake inhibitors.[23][24][25] Chronic abuse of methylphenidate has the potential to lead to psychosis.[26][27] Similar psychiatric side effects have been reported in a study of ethylphenidate.[28] No studies regarding psychosis and 4F-MPH or isopropylphenidate have been conducted, but given their high DAT binding and cellular uptake activity,[29][30] the possibility of stimulant psychosis remains.

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.[31][32][33]

Diagnosis

Differential diagnosis

Though less common than stimulant psychosis, stimulants such as cocaine and amphetamines as well as the dissociative drug phencyclidine (PCP, angel dust) may also cause a theorized severe and life-threatening condition known as excited delirium. This condition manifests as a combination of delirium, psychomotor agitation, anxiety, delusions, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature, and hysterical strength.[34] Despite some superficial similarities in presentation excited delirium is a distinct (and more serious) condition than stimulant psychosis. The existence of excited delirium is currently debated.

Transition to schizophrenia

A 2019 systematic review and meta-analysis by Murrie et al. found that the pooled proportion of transition from amphetamine-induced psychosis to schizophrenia was 22% (5 studies, CI 14%–34%). This was lower than cannabis (34%) and hallucinogens (26%), but higher than opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.[35]

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. However, the benzodiazepines, temazepam and triazolam at 30 mg and 0.5 mg, respectively, are highly effective if aggression, agitation, or violent behaviour is apparent.[6] In the instance of persistent psychosis after repeated use of stimulants, there are cases in which electroconvulsive therapy has been beneficial.[36] This is followed by abstinence from psychostimulants supported with counselling or medication designed to assist the individual preventing a relapse and the resumption of a psychotic state.

See also

References

  1. ^ a b "ICD-11 for Mortality and Morbidity Statistics: 6C46.6 Stimulant-induced psychotic disorder including amphetamines, methamphetamine or methcathinone". who.int. World Health Organization. 2018. Retrieved 7 April 2019.
  2. ^ a b "Adderall XR Prescribing Information" (PDF). FDA.gov. US Food and Drug Administration. December 2013. Retrieved 30 December 2013. Treatment-emergent psychotic or manic symptoms, e.g. hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. ... In a pooled analysis of multiple short-term, placebo controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.
  3. ^ a b Shoptaw, Steven J; Kao, Uyen; Ling, Walter (21 January 2009). "Treatment for amphetamine psychosis". Cochrane Database of Systematic Reviews. 2009 (1): CD003026. doi:10.1002/14651858.CD003026.pub3. PMC 7004251. PMID 19160215.
  4. ^ a b Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R (February 2009). "Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children". Pediatrics. 123 (2): 611–616. doi:10.1542/peds.2008-0185. PMID 19171629. S2CID 22391693.
  5. ^ Greening, David W.; Notaras, Michael; Chen, Maoshan; Xu, Rong; Smith, Joel D.; Cheng, Lesley; Simpson, Richard J.; Hill, Andrew F.; van den Buuse, Maarten (10 December 2019). "Chronic methamphetamine interacts with BDNF Val66Met to remodel psychosis pathways in the mesocorticolimbic proteome". Molecular Psychiatry. 26 (8): 4431–4447. doi:10.1038/s41380-019-0617-8. PMID 31822818. S2CID 209169489.
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  28. ^ Robertson, Roy (2017). "Prolonged mental health effects of ethylphenidate beyond cessation of use". Addiction. 112 (1): 183–184. doi:10.1111/add.13630. PMID 27936504.
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  30. ^ Markowitz, John S.; Zhu, Hao-Jie; Patrick, Kennerly S. (December 2013). "Isopropylphenidate: An Ester Homolog of Methylphenidate with Sustained and Selective Dopaminergic Activity and Reduced Drug Interaction Liability". Journal of Child and Adolescent Psychopharmacology. 23 (10): 648–654. doi:10.1089/cap.2013.0074. hdl:2027.42/140321. PMID 24261661.
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External links

stimulant, psychosis, mental, disorder, characterized, psychotic, symptoms, such, hallucinations, paranoid, ideation, delusions, disorganized, thinking, grossly, disorganized, behaviour, which, involves, typically, occurs, following, overdose, several, binge, . Stimulant psychosis is a mental disorder characterized by psychotic symptoms such as hallucinations paranoid ideation delusions disorganized thinking grossly disorganized behaviour which involves and typically occurs following an overdose or several day binge on psychostimulants 1 however it has also been reported to occur in approximately 0 1 of individuals within the first several weeks after starting amphetamine or methylphenidate therapy 2 3 4 Methamphetamine psychosis or long term effects of stimulant use in the brain at the molecular level depend upon genetics and may persist for some time 5 Stimulant psychosisOther namesStimulant induced psychotic disorder 1 SpecialtyPsychiatry addiction psychiatryThe most common causative agents are substituted amphetamines including substituted cathinones as well as certain dopamine reuptake inhibitors such as cocaine and phenidates Contents 1 Signs and symptoms 2 Cause 2 1 Substituted amphetamines 2 2 Cocaine 2 3 Phenidates 2 4 Caffeine 3 Diagnosis 3 1 Differential diagnosis 4 Transition to schizophrenia 5 Treatment 6 See also 7 References 8 External linksSigns and symptoms EditThe symptoms of stimulant psychosis vary depending on the drug ingested but generally involve the symptoms of organic psychosis such as hallucinations delusions or paranoia 2 3 4 Other symptoms may include mania erratic behavior agitation and or aggression Cause EditSubstituted amphetamines Edit Drugs in the class of amphetamines or substituted amphetamines are known to induce amphetamine psychosis typically when chronically abused or used in high doses 6 In an Australian study of 309 active methamphetamine users 18 had experienced a clinical level psychosis in the past year 7 Commonly abused amphetamines include methamphetamine MDMA 4 FA as well as substituted cathinones like a PVP MDPV and mephedrone though a large number of other closely related compounds have been recently synthesized Methylphenidate is sometimes incorrectly included in this class although it is nonetheless still capable of producing stimulant psychosis The symptoms of amphetamine psychosis include auditory and visual hallucinations grandiosity delusions of persecution and delusions of reference concurrent with both clear consciousness and prominent extreme agitation 8 9 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 10 However it has been suggested that around 5 15 of users fail to make a complete recovery in the long term 11 Furthermore even at a small dose the psychosis can be quickly reestablished 10 Psychosocial stress has been found to be an independent risk factor for psychosis relapse even without further substituted amphetamine use in certain cases 12 The symptoms of acute amphetamine psychosis are very similar to those of the acute phase of schizophrenia 6 although in amphetamine psychosis visual hallucinations are more common and thought disorder is rare 13 Amphetamine psychosis may be purely related to high drug usage or high drug usage may trigger an underlying vulnerability to schizophrenia 6 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 14 The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis while schizophrenia is more likely to follow a chronic course 15 Although rare and not formally recognized 16 17 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 18 Cocaine Edit Cocaine has a similar potential to induce temporary psychosis 19 with more than half of cocaine abusers reporting at least some psychotic symptoms at some point 20 Typical symptoms include paranoid delusions that they are being followed and that their drug use is being watched accompanied by hallucinations that support the delusional beliefs 20 Delusional parasitosis with formication cocaine bugs is also a fairly common symptom 21 Cocaine induced psychosis shows sensitization toward the psychotic effects of the drug This means that psychosis becomes more severe with repeated intermittent use 20 22 Phenidates Edit Methylphenidate and its analogues such as ethylphenidate 4F MPH and isopropylphenidate share similar pharmacological profiles as other norepinephrine dopamine reuptake inhibitors 23 24 25 Chronic abuse of methylphenidate has the potential to lead to psychosis 26 27 Similar psychiatric side effects have been reported in a study of ethylphenidate 28 No studies regarding psychosis and 4F MPH or isopropylphenidate have been conducted but given their high DAT binding and cellular uptake activity 29 30 the possibility of stimulant psychosis remains Caffeine Edit 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 31 32 33 Diagnosis EditDifferential diagnosis Edit Though less common than stimulant psychosis stimulants such as cocaine and amphetamines as well as the dissociative drug phencyclidine PCP angel dust may also cause a theorized severe and life threatening condition known as excited delirium This condition manifests as a combination of delirium psychomotor agitation anxiety delusions hallucinations speech disturbances disorientation violent and bizarre behavior insensitivity to pain elevated body temperature and hysterical strength 34 Despite some superficial similarities in presentation excited delirium is a distinct and more serious condition than stimulant psychosis The existence of excited delirium is currently debated Transition to schizophrenia EditA 2019 systematic review and meta analysis by Murrie et al found that the pooled proportion of transition from amphetamine induced psychosis to schizophrenia was 22 5 studies CI 14 34 This was lower than cannabis 34 and hallucinogens 26 but higher than opioid 12 alcohol 10 and sedative 9 induced psychoses Transition rates were slightly lower in older cohorts but were not affected by sex country of the study hospital or community location urban or rural setting diagnostic methods or duration of follow up 35 Treatment EditTreatment 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 However the benzodiazepines temazepam and triazolam at 30 mg and 0 5 mg respectively are highly effective if aggression agitation or violent behaviour is apparent 6 In the instance of persistent psychosis after repeated use of stimulants there are cases in which electroconvulsive therapy has been beneficial 36 This is followed by abstinence from psychostimulants supported with counselling or medication designed to assist the individual preventing a relapse and the resumption of a psychotic state See also EditAimo Koivunen Amphetamine Delusional parasitosis Dopamine hypothesis of psychosis Excited delirium Psychosis Substance induced psychosis Neuroleptic malignant syndromeReferences Edit a b ICD 11 for Mortality and Morbidity Statistics 6C46 6 Stimulant induced psychotic disorder including amphetamines methamphetamine or methcathinone who int World Health Organization 2018 Retrieved 7 April 2019 a b Adderall XR Prescribing Information PDF FDA gov US Food and Drug Administration December 2013 Retrieved 30 December 2013 Treatment emergent psychotic or manic symptoms e g hallucinations delusional thinking or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses In a pooled analysis of multiple short term placebo controlled studies such symptoms occurred in about 0 1 4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses of stimulant treated patients compared to 0 in placebo treated patients a b Shoptaw Steven J Kao Uyen Ling Walter 21 January 2009 Treatment for amphetamine psychosis Cochrane Database of Systematic Reviews 2009 1 CD003026 doi 10 1002 14651858 CD003026 pub3 PMC 7004251 PMID 19160215 a b Mosholder AD Gelperin K Hammad TA Phelan K Johann Liang R February 2009 Hallucinations and other psychotic symptoms associated with the use of attention deficit hyperactivity disorder drugs in children Pediatrics 123 2 611 616 doi 10 1542 peds 2008 0185 PMID 19171629 S2CID 22391693 Greening David W Notaras Michael Chen Maoshan Xu Rong Smith Joel D Cheng Lesley Simpson Richard J Hill Andrew F van den Buuse Maarten 10 December 2019 Chronic methamphetamine interacts with BDNF Val66Met to remodel psychosis pathways in the mesocorticolimbic proteome Molecular Psychiatry 26 8 4431 4447 doi 10 1038 s41380 019 0617 8 PMID 31822818 S2CID 209169489 a b c d Shoptaw SJ Kao U Ling W 2009 Treatment for amphetamine psychosis Review Cochrane Database of Systematic Reviews 2009 1 1 doi 10 1002 14651858 cd003026 pub3 PMC 7004251 PMID 19160215 McKetin R McLaren J Lubman DI Hides L 2006 The prevalence of psychotic symptoms among methamphetamine users Addiction 101 10 1473 8 doi 10 1111 j 1360 0443 2006 01496 x PMID 16968349 Dore G Sweeting M 2006 Drug induced psychosis associated with crystalline methamphetamine Australasian Psychiatry 14 1 86 9 doi 10 1080 j 1440 1665 2006 02252 x PMID 16630206 S2CID 196398062 Srisurapanont M Ali R Marsden J Sunga A Wada K Monteiro M 2003 Psychotic symptoms in methamphetamine psychotic in patients International Journal of Neuropsychopharmacology 6 4 347 52 doi 10 1017 s1461145703003675 PMID 14604449 a b Sato M Numachi Y Hamamura T 1992 Relapse of paranoid psychotic state in methamphetamine model of schizophrenia Schizophrenia Bulletin 18 1 115 22 doi 10 1093 schbul 18 1 115 PMID 1553491 Hofmann FG 1983 A Handbook on Drug and Alcohol Abuse The Biomedical Aspects 2nd ed New York Oxford University Press p 329 Yui K Ikemoto S Goto K 2002 Factors for susceptibility to episode recurrence in spontaneous recurrence of methamphetamine psychosis Annals of the New York Academy of Sciences 965 1 292 304 Bibcode 2002NYASA 965 292Y doi 10 1111 j 1749 6632 2002 tb04171 x PMID 12105105 S2CID 25830663 Schatzberg Alan F Nemeroff Charles B 2009 The American Psychiatric Publishing Textbook of Psychopharmacology The American Psychiatric Publishing pp 847 48 ISBN 978 1 58562 309 9 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 136 1 87 91 doi 10 1002 ajmg b 30187 PMID 15892150 S2CID 25135637 McIver C McGregor C Baigent M Spain D Newcombe D Ali R 2006 Guidelines for the medical management of patients with methamphetamine induced psychosis South Australia Drug and Alcohol Services Sarampote CS Efron LA Robb AS Pearl PL Stein MA 2002 Can stimulant rebound mimic pediatric bipolar disorder J Child Adolesc Psychopharmacol 12 1 63 7 doi 10 1089 10445460252943588 PMID 12014597 Diagnostic and Statistical Manual of Mental Disorders Fourth ed Washington DC American Psychiatric Association Text Revision DSM IV TR 2000 Hegerl U Sander C Olbrich S Schoenknecht P August 2006 Are psychostimulants a treatment option in mania Prog Neuropsychopharmacol Biol Psychiatry 30 6 1097 102 doi 10 1016 j pnpbp 2006 04 016 PMID 16740350 S2CID 13239942 Brady KT Lydiard RB Malcolm R Ballenger JC 1991 Cocaine induced psychosis J Clin Psychiatry 52 12 509 512 PMID 1752853 a b c Thirthalli J Vivek B 2006 Psychosis Among Substance Users Curr Opin Psychiatry 19 3 239 245 doi 10 1097 01 yco 0000218593 08313 fd PMID 16612208 S2CID 13350537 Elliott A Mahmood T Smalligan R D 2012 Cocaine Bugs A Case Report of Cocaine Induced Delusions of Parasitosis The American Journal on Addictions 21 2 180 181 doi 10 1111 j 1521 0391 2011 00208 x PMID 22332864 DiSCLAFANI et al 1981 Drug induced psychosis Emergency diagnosis and management Psychosomatics 22 10 845 855 doi 10 1016 s0033 3182 81 73092 5 PMID 7313045 Robins Meridith T Blaine Arryn T Ha Jiwon E et al 2019 Repeated Use of the Psychoactive Substance Ethylphenidate Impacts Neurochemistry and Reward Learning in Adolescent 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repeated use of methylenedioxypyrovalerone bath salts The Journal of ECT 29 4 e59 60 doi 10 1097 YCT 0b013e3182887bc2 PMID 23609518 S2CID 45842375 External links Edit Retrieved from https en wikipedia org w index php title Stimulant psychosis amp oldid 1136144279, wikipedia, wiki, book, books, library,

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