Stimulant psychosis

Stimulant psychosis
Classification and external resources
ICD-10	F15.5
ICD-9	292.1

Stimulant psychosis is a psychotic disorder that appears in some people who use stimulant drugs. Most commonly, stimulant psychosis occurs in drug abusers who take large stimulant doses but, in rare cases, it can also appear in patients taking therapeutic doses under medical supervision.^[1] The most common stimulants involved are amphetamines and cocaine, though others have also been reported.

Amphetamine psychosis

Amphetamines, typically when abused heavily and/or chronically, are well-known to cause psychosis in individuals. The amphetamines include amphetamine, methamphetamine, methcathinone, etc.

A 2007 article^{[citation needed]} examined the limited amount of documentation and research currently available on methamphetamine-induced psychotic syndromes. In nearly every case, the symptoms of methamphetamine-induced psychosis (as well as stimulant psychosis in general) will stop within 7–10 days of discontinuing the drug, however, in some cases discontinuation symptoms have been reported to last for months.

Furthermore, a small percentage of long-term or "heavy" users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence.^[2]

Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term methamphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.

Spontaneous and long-term recurrences (akin to "flashbacks") are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.

The key distinction between this condition and e.g. a psychotic disorder or schizophrenia, is that the symptoms of a methamphetamine-induced psychotic disorder are not considered to be permanent and will eventually subside with abstinence and proper treatment.^{[citation needed]}

Cocaine

Cocaine is known to induce psychosis as well, and more than half of cocaine abusers report having experienced at least some psychotic symptoms at some point.^{[citation needed][3]}} Typical symptoms of sufferers include paranoid delusions that they are being followed, and that their drug use is being watched, often with hallucinations to match. Delusional parasitosis with formication ("cocaine bugs") is also fairly common. Cocaine-induced psychosis shows sensitization in that psychosis tends to become more severe and occur more rapidly with repeated use of the drug.^[4][5]

Methylphenidate

Methylphenidate, a central nervous system stimulant with the same mechanism of action as cocaine,^[6][7] can also lead to a psychosis from chronic use. Although the safety profile of short-term methylphenidate therapy in clinical trials has been well established, repeated use of psychostimulants such as methylphenidate is less clear. The long term effects of methylphenidate such as drug addiction, withdrawal reactions and psychosis has received very little research and thus the long term effects of using stimulants for ADHD are largely unknown.^[8] Short term clinical trials show a very low incidence of methylphenidate induced psychosis of 0.01%.^[9] A study published in 1999 showed that 6 of 98 children prescribed methylphenidate in an outpatient clinic developed psychosis, but the study was naturalistic, and the lack of a control makes it impossible to determine if this was an effect of the medication.^[10] The long term effects on mental health disorders in later life of chronic use of methylphenidate is unknown.^[11] Concerns have been raised that long-term therapy might cause drug dependence, paranoia, schizophrenia and behavioral sensitisation, similar to other stimulants.^[12] Psychotic symptoms from methylphenidate can include, hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, mania, grandiosity, paranoid delusions, confusion, increased aggression and irritability. Methylphenidate psychosis is unpredictable in whom it will occur. Family history of mental illness does not predict the incidence of stimulant toxicosis in ADHD children.

The withdrawal or rebound symptoms of methylphenidate can include psychosis and depression.^[13] Stimulant withdrawal or rebound reactions can occur and should be minimized in intensity, i.e. via a gradual tapering off of medication.^[14][15][16] A very small study of abrupt withdrawal of stimulants suggests that withdrawal reactions are not typical. Nonetheless withdrawal reactions may still occur in susceptible individuals.^[17]

Caffeine

There is evidence that caffeine, in extreme acute doses or when severely abused for long periods of time, may induce psychosis in some individuals.^[18][19][20] This infrequently reported and somewhat controversial effect has not been very well studied, however, and it is not clear whether it proceeds by a similar mechanism as other stimulant psychoses or whether it is an entirely different phenomenon. However, like other stimulants, caffeine is now known to increase dopamine levels as one of its effects, albeit indirectly.^[21][22]

Treatment

Typical (haloperidol) and atypical antipsychotics (olanzapine, risperidone) have been found to be helpful in the initial treatment of amphetamine induced psychosis.^[23]

See also

• Amphetamine
• Delusional parasitosis
• Dopamine hypothesis of psychosis
• Psychosis

References

1. ^ Curran, Catherine et al., Stimulant psychosis: systematic review, The British Journal of Psychiatry (2004) 185: 196-204
2. ^ Zoric, Rim, Rad, Tsuang et al. (2007) Overview of Methamphetamine-Induced Psychotic Syndromes. UCLA Semel Institute for Neurosciences and Human Behavior
3. ^ Thirthalli, Jagadisha; Vivek Benegal Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. "MD". Psychosis Among Substance Users. National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore. http://www.medscape.com/viewarticle/528487_5. Retrieved 8 August 2011. 
4. ^ http://www.medscape.com/viewarticle/528487_5 Psychosis Among Substance Users: Cocaine, Medscape
5. ^ http://psy.psychiatryonline.org/cgi/reprint/22/10/845 Drug-induced psychosis: Emergency diagnosis and management, Psychosomatics. DiSCLAFANI et al. 22 (10): 845. 1981 Accessed 5-20-2010
6. ^ Auriel E, Hausdorff JM, Giladi N (October 2008). "Methylphenidate for the Treatment of Parkinson Disease and Other Neurological Disorders". Clin Neuropharmacol 32 (2): 75–81. doi:10.1097/WNF.0B013E318170576C. PMID 18978488. 
7. ^ Abramowicz MJ, Van Haecke P, Demedts M, Delcroix M (September 2003). "Primary pulmonary hypertension after amfepramone (diethylpropion) with BMPR2 mutation". Eur. Respir. J. 22 (3): 560–2. doi:10.1183/09031936.03.00095303. PMID 14516151. http://erj.ersjournals.com/cgi/content/full/22/3/560. 
8. ^ Ashton H, Gallagher P, Moore B (September 2006). "The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder". J. Psychopharmacol. (Oxford) 20 (5): 602–10. doi:10.1177/0269881106061710. PMID 16478756. http://jop.sagepub.com/cgi/pmidlookup?view=long&pmid=16478756. 
9. ^ "Ritalin & Ritalin-SR Prescribing Information" (PDF). Novartis. April 2007. http://www.pharma.us.novartis.com/product/pi/pdf/ritalin_ritalin-sr.pdf. 
10. ^ Cherland E, Fitzpatrick R (October 1999). "Psychotic side effects of psychostimulants: a 5-year review". Can J Psychiatry 44 (8): 811–3. PMID 10566114. 
11. ^ Kimko HC, Cross JT, Abernethy DR (December 1999). "Pharmacokinetics and clinical effectiveness of methylphenidate". Clin Pharmacokinet 37 (6): 457–70. doi:10.2165/00003088-199937060-00002. PMID 10628897. 
12. ^ Dafny N; Yang PB. (15). "The role of age, genotype, sex, and route of acute and chronic administration of methylphenidate: A review of its locomotor effects.". Brain research bulletin. 68 (6): 393–405. doi:10.1016/j.brainresbull.2005.10.005. PMID 16459193. 
13. ^ Rosenfeld AA (February 1979). "Depression and psychotic regression following prolonged methylphenidate use and withdrawal: case report". Am J Psychiatry 136 (2): 226–8. PMID 760559. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=760559. 
14. ^ Cohen D, Leo J, Stanton T, et al (2002). "A boy who stops taking stimulants for "ADHD": commentaries on a Pediatrics case study". Ethical Hum Sci Serv 4 (3): 189–209. PMID 15278983. 
15. ^ Schwartz RH, Rushton HG (May 2004). "Stuttering priapism associated with withdrawal from sustained-release methylphenidate". J. Pediatr. 144 (5): 675–6. doi:10.1016/j.jpeds.2003.12.039. PMID 15127013. http://linkinghub.elsevier.com/retrieve/pii/S0022347604000228. 
16. ^ Garland EJ (1998). "Pharmacotherapy of adolescent attention deficit hyperactivity disorder: challenges, choices and caveats". J. Psychopharmacol. (Oxford) 12 (4): 385–95. doi:10.1177/026988119801200410. PMID 10065914. 
17. ^ Nolan EE, Gadow KD, Sprafkin J (April 1999). "Stimulant medication withdrawal during long-term therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder". Pediatrics 103 (4 Pt 1): 730–7. doi:10.1542/peds.103.4.730. PMID 10103294. 
18. ^ Hedges, D. W.; F. L. Woon, S. P. Hoopes (September 2009). "Caffeine-induced psychosis.". CNS Spectrums 14 (3): 127–9. PMID 19407709. 
19. ^ Cerimele, J. M.; A. P. Stern, D. Jutras-Aswad (September 2010). "Psychosis following excessive ingestion of energy drinks in a patient with schizophrenia.". American Journal of Psychiatry 167 (3): 353. doi:10.1176/appi.ajp.2009.09101456. PMID 20194494. 
20. ^ Broderick, P.; Benjamin, A. B. (2004). "Caffeine and psychiatric symptoms: A review". The Journal of the Oklahoma State Medical Association 97 (12): 538–542. PMID 15732884.  edit
21. ^ Solinas, Marcello; Sergi Ferre,Zhi-Bing You, Marzena Karcz-Kubicha,Patrizia Popoli, and Steven R. Goldberg (August 2002). "Caffeine Induces Dopamine and Glutamate Release in the Shell of the Nucleus Accumbens". The Journal of Neuroscience 14 (3): 127–9. http://www.jneurosci.org/content/22/15/6321.full.pdf. Retrieved 2010-05-16. 
22. ^ http://health.howstuffworks.com/caffeine4.htm How Caffeine Works
23. ^ Shoptaw SJ, Kao U, Ling WW (2008). Shoptaw, Steven J. ed. "Treatment for amphetamine psychosis". Cochrane Database Syst Rev (4): CD003026. doi:10.1002/14651858.CD003026.pub2. PMID 18843639. 

Further reading

• Connell, P.H. (1961) Amphetamine Psychosis. Oxford University Press.

External links

• Chronic amphetamine use and abuse - Review published in 2000.