Methamphetamine-Associated Psychosis and Treatment With Haloperidol and Risperidone: A Pilot Study

Abstract

BackgroundDifferent studies have suggested that antipsychotic medications of the first generation have better effectiveness for the treatment of psychotic symptoms compared with antipsychotic medications of the second generation.ObjectivesThe current study was the first pilot study in Iran that compared Haloperidol with Risperidone in the treatment of positive symptoms of psychosis among a group of methamphetamine-dependent patients.Materials and MethodsThis randomized clinical trial was designed and conducted in 2012. Overall, 44 patients who met the diagnostic and statistical manual of mental disorders, fourth edition-text revised (DSM.IV-TR) criteria for methamphetamine-associated psychosis (MAP) and were hospitalized at Razi psychiatric hospital in Tehran were selected. Patients (1: 1) were randomly divided to two groups. Overall, 22 subjects received Haloperidol (5 - 20 mg) and 22 subjects received Risperidone (2 - 8 mg). All subjects were assessed at baseline, during three consecutive weeks of treatment and one week after treatment (i.e., follow-up). Scale of assessment of positive symptoms (SAPS) was completed for each subject.ResultsThe study findings indicated that both Haloperidol (< 0.05) and Risperidone (< 0.05) were similarly applicable in the treatment of MAP but no differential effectiveness was found between the two medications. The treatment effects of both medications increased in the first two weeks of treatment and remained stable in the second two weeks.ConclusionsRisperidone and Haloperidol are two effective antipsychotic medications for the treatment of positive symptoms of MAP but other aspects of these two neuroleptic medications such as the long-term treatment effects should be studied. Further studies with more samples and longer follow-ups are suggested.

Methamphetamine‐associated psychosis: Clinical presentation, biological basis, and treatment options

“…Risperidone demonstrated a much higher tolerability, as 33% (7/21) of the aripiprazole treated patients dropped out before the end of the 22‐day trial (0% drop out for risperidone, 0/21). Treatment with aripiprazole resulted in significantly more akathisia and agitation in patients, contradicting biologically expected results, but consistent with a growing body of literature (Ono et al, ; Samiei et al, ). Surprisingly, although both risperidone and aripiprazole reduced cravings, the effect was significantly greater in risperidone‐treated subjects.…”

“…Furthermore, MAP and schizophrenia have been characterized by many of the same symptoms and comparisons between MAP and paranoid schizophrenia remain common (C. K. Chen et al, ). Antipsychotic medications used to treat schizophrenia have been popular and effective in treatment of the positive psychotic‐type symptoms of MAP (Glasner‐Edwards & Mooney, ; Samiei, Vahidi, Rezaee, Yaraghchi, & Daneshmand, ; Wang et al, ).…”

“…Antipsychotic medications used to treat schizophrenia have been popular and effective in treatment of the positive psychotic-type symptoms of MAP (Glasner-Edwards & Mooney, 2014; Samiei, Vahidi, Rezaee, Yaraghchi, & Daneshmand, 2016;Wang et al, 2016).…”

“…Another RCT comparing haloperidol ( n =22) and risperidone ( n =22) in MAP subjects found both medications to be equally effective at eliminating positive symptoms (i.e., delusions, hallucinations, and bizarre behaviors) following 1 month of treatment as measured by the Persian validated version of the Scale of Assessment of Positive Symptoms (SAPS; Samiei et al, ).…”

Chronic methamphetamine self-administration dysregulates 5-HT2A and mGlu2 receptor expression in the rat prefrontal and perirhinal cortex: Comparison to chronic phencyclidine and MK-801

“…Both cognitive impairments and psychotic symptoms produced by chronic meth are thought to arise from the dysregulation of several neurotransmitter systems within the frontostriatal circuit. Targeting aberrant dopamine transmission using D2 receptor antagonists is a standard-approach therapy of schizophrenia and more recently, also meth psychosis (Samiei et al, 2016; Verachai et al, 2014). However, D2 receptor antagonists do not typically improve cognitive dysfunction, and in some cases can even impair learning and memory performance in humans (Lustig and Meck, 2005; Saeedi et al, 2006; Xu, 2017) and animals (Abdel-Salam et al, 2012; Hou et al, 2006; Hutchings et al, 2013).…”