Stimulant psychosis
Stimulant psychosis | |
---|---|
Other names | Stimulant-induced psychotic disorder[1] |
Specialty | Psychiatry, addiction psychiatry |
Stimulant psychosis is a
The most common causative agents are
Signs and symptoms
The symptoms of stimulant psychosis vary depending on the drug ingested, but generally involve the
Cause
Substituted amphetamines
Drugs in the
The symptoms of amphetamine psychosis include auditory and visual hallucinations, grandiosity,
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
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
Transition to schizophrenia
A 2019 systematic review and meta-analysis by Murrie et al. found that the pooled proportion of transition from
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.
See also
References
- ^ 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.
- ^ 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.
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