Differences in Clinical Features of Methamphetamine Users with Persistent Psychosis and Patients with Schizophrenia

Abstract

Background: Methamphetamine exerts neurotoxic effects and elicits psychotic symptoms. This study attempted to compare clinical differences between methamphetamine users with persistent psychosis (MAP) and patients with schizophrenia. In addition, we examined the discrimination validity by using symptom clusters to differentiate between MAP and schizophrenia. Methods: We enrolled 53 MAP patients and 53 patients with schizophrenia. The psychopathology of participants was assessed using the Chinese version of the Diagnostic Interview for Genetic Studies and the 18-item Brief Psychiatric Rating Scale. Logistic regression was used to examine the predicted probability scores of different symptom combinations on discriminating between MAP and schizophrenia. The receiver operating characteristic (ROC) analyses and area under the curve (AUC) were further applied to examine the discrimination validity of the predicted probability scores on differentiating between MAP and schizophrenia. Results: We found that MAP and schizophrenia demonstrated similar patterns of delusions. Compared to patients with schizophrenia, MAP experienced significantly higher proportions of visual hallucinations and of somatic or tactile hallucinations. However, MAP exhibited significantly lower severity in conceptual disorganization, mannerism/posturing, blunted affect, emotional withdrawal, and motor retardation compared to patients with schizophrenia. The ROC analysis showed that a predicted probability score combining the aforementioned 7 items of symptoms could significantly differentiate between MAP and schizophrenia (AUC = 0.77). Conclusion: Findings in the current study suggest that nuanced differences might exist in the clinical presentation of secondary psychosis (MAP) and primary psychosis (schizophrenia). Combining the symptoms as a whole may help with differential diagnosis for MAP and schizophrenia.

A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology

“…Additionally, Yamamuro et al ( 116 ) found similar PANSS results in their experimental study examining oxygenation changes in the prefrontal cortex in acute METH psychosis and schizophrenia during a verbal fluency task. Furthermore, Wang et al ( 115 ) examined the positive symptom profile of 52 individuals with chronic METH psychosis (who experienced psychosis and had been abstinent from METH for more than 1 month) and compared this to 53 participants with schizophrenia. They found no difference in the patterns of delusions experienced between those with chronic METH psychosis and schizophrenia and that auditory hallucinations were the most common type of hallucination experienced between groups.…”

“…When examining the individual symptoms, however, they found that ratings of avolition-apathy, anhedonia-asociality, and attentional impairment were similar between both groups, but those with schizophrenia demonstrated elevated symptoms of affective flattening and alogia. Additionally, Wang et al ( 115 ) found that schizophrenia was associated with greater frequency and severity of negative symptoms compared to those with chronic METH psychosis. Specifically, those with schizophrenia demonstrated elevated scores for blunted affect, emotional withdrawal and motor retardation.…”

Evidence-Based Guidelines for the Pharmacologic Management of Methamphetamine Dependence, Relapse Prevention, Chronic Methamphetamine-Related, and Comorbid Psychiatric Disorders in Post-Acute Settings

“…As is the case with depressive symptoms, in the first months of treatment it is difficult to distinguish between a primary schizophrenia and a methamphetamine-induced psychosis (MAP) [44]. (See the Keeping in mind that neuroleptics can promote craving and relapses in methamphetamine users because of their antidopaminergic effect [45,46], the indication for the continuation of neuroleptic therapy ought to be reviewed at the latest after 6 months of treatment in individuals presenting with a methamphetamineassociated psychosis (MAP) (LoE 5; ⇑⇑).…”

Demographic and clinical profile of patients utilising a transitional care intervention in the Western Cape, South Africa

“…The high rates of schizophrenia diagnosis may possibly be related to high rates of methamphetamine use as methamphetamine-induced psychosis has a similar clinical picture and could confound making the diagnosis. 31 Research has shown that the intensity, specificity and length of community-based psychosocial rehabilitation services were associated with superior functional outcomes for individuals diagnosed with schizophrenia. 4 Without community-based rehabilitation, mental healthcare users are likely to find it difficult to reintegrate into the community and have little support for their recovery.…”