Methamphetamine Psychosis: Epidemiology and Management

Abstract

Psychotic symptoms and syndromes are frequently experienced among individuals who use methamphetamine, with recent estimates of up to approximately 40% of users affected. Though transient in a large proportion of users, acute symptoms can include agitation, violence, and delusions, and may require management in an inpatient psychiatric or other crisis intervention setting. In a subset of individuals, psychosis can recur and persist and may be difficult to distinguish from a primary psychotic disorder such as schizophrenia. Differential diagnosis of primary versus substance-induced psychotic disorders among methamphetamine users is challenging; nevertheless, with careful assessment of the temporal relationship of symptoms to methamphetamine use, aided by state-of-the art psychodiagnostic assessment instruments and use of objective indicators of recent substance use (i.e., urine toxicology assays), coupled with collateral clinical data gathered from the family or others close to the individual, diagnostic accuracy can be optimized and the individual can be appropriately matched to a plan of treatment. The pharmacological treatment of acute methamphetamine-induced psychosis may include the use of antipsychotic medications as well as benzodiazepines, although symptoms may resolve without pharmacological treatment if the user is able to achieve a period of abstinence from methamphetamine. Importantly, psychosocial treatment for methamphetamine dependence has a strong evidence base and is the optimal first-line treatment approach to reducing rates of psychosis among individuals who use methamphetamines. Prevention of methamphetamine relapse is the most direct means of preventing recurrence of psychotic symptoms and syndromes. Long-term management of individuals who present with recurrent and persistent psychosis, even in the absence of methamphetamine use, may include both behavioral treatment to prevent resumption of methamphetamine use and pharmacological treatment targeting psychotic symptoms. In addition, treatment of co-occurring psychiatric disorders including depression and anxiety is important as a means of preventing relapse to methamphetamine use, which is often triggered by associated symptoms.

Aspects of Methamphetamine Abuse in Adolescents and Young Adults in a Thuringian County

“…With longer duration of abuse addiction will develop, neurocognitive performance, memory, self-monitoring and non-verbal reasoning decrease (Cuzen et al[2]), cardiovascular symptoms, arrhythmia, weight loss besides other symptoms (Courtney and Ray [3]) and psychotic and depressive symptoms may occur (Rusyniak [4]; Glasner-Edwards and Mooney [5]). Methamphetamine has a high addiction liability (Nutt et al[6]).…”

NRG1 Types Down Regulate in Methamphetamine and Heroin Dependent Patients

“…In the other hand same results in correlation studies between schizophrenia and Methamphetamine abusers could explain the high frequency of Meth-psychosis with schizophrenic like symptoms among the Methamphetamine abusers. 2 Prevalence of smoking in schizophrenic patients is higher than general population as well as patients with other psychiatric conditions. In the other hand while neuregulin signaling pathway were indicated as involved pathway in etiology of schizophrenia, genes from the same pathway such as NRG3 were found associated with smoking behavior tendency.…”

“…2 Methamphetamine may cause a highly psychological dependence along with structural and functional abnormalities in brain. Psychotic symptoms in chronic abusers of methamphetamine and less frequently in chronic abusers of Heroin are previously reported.…”

Update on methamphetamine: an old problem that we have recently encountered

“…Therefore, cases with transient psychotic symptoms do not constitute a diagnosable psychotic disorder. However, these patients may still require pharmacological management when their state is accompanied by acute agitation, violent behavior, or otherwise severe distress and impairment in functioning (47). Generally, the psychotic state can be resolved with dopamine receptor antagonists (43).…”

“…However, some patients with methamphetamine psychosis do not remit psychotic symptoms for weeks or months, exhibiting the so-called "prolonged type of methamphetamineinduced psychosis" (44). A rigid 1-month cut-off may not be applicable in cases of methamphetamine-related psychosis that might be longer in duration, yet not appropriate for a diagnosis of schizophrenia-spectrum disorder (47).…”