• • • • DO NOT BELIEVE ANY OF THIS ENTRY***

I wrote most of it while high on amphetamines in a crazed attempt to convince my psychiatrist to give me more amphetamines. Then I was involuntarily hospitalised for amphetamine induced (not withdrawal) psychosis/mania. Funny stuff. Perhaps the editors could leave what I wrote below as a testament to an interesting period of my life ?

Amphetamine Withdrawal Psychosis (AWP) is a previously rare condition which is increasing in prevalence due to rises in medical and illicit stimulant

Stimulant

Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...

 use with concomitant high rates of withdrawal. This may lead to psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

 in vulnerable individuals, who may also have other psychiatric diagnoses.

Despite the above factors increasing prevalence of AWP in modern society, it is still often confused with the more common amphetamine

Amphetamine

Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...

 induced psychoses, schizoaffective and bipolar disorders. Its relatively low rate compared to the separate and distinct categories of the more general withdrawal or psychotic syndromes of amphetamine use mean that no general DSM IV category exists, and it is currently included under DSM IV code 292.9 - amphetamine-related disorder NOS (Not Otherwise Specified)DSM-IV Codes#Amphetamine (or amphetamine-like) related disorders. Its similarity to other conditions and the lack of a generally recognised diagnostic category may be a contributing factor to high rates of misdiagnosis, which can often lead to delays in appropriate treatment.

Symptoms emerge with sudden cessation of amphetamine use and can include insomnia, irritability, paranoid delusions, disordered thinking, agitated behaviour, somatic and auditory hallucinations, elevated or depressed mood and increased cravings for amphetamines.

However, unlike similar disorders, in AWP amphetamines reduce rather than increase symptoms, and the psychosis or mania resolves with resumption of the previous dosing schedule. Typically premorbid functioning is achieved with appropriate stimulant treatment – in fact, in the absence of clear biological markers, this clinical response is the primary diagnostic criteria for AWP.

There are some preliminary EEG markers for AWP, which relate to the vigilance hypothesis of bipolar disorder. Chronic underarousal is compensated for by increased physical and mental activity, which can manifest as both a mania acutely, or ADH/D in the long term – rebound effects from withdrawal can both unmask and precipitate episode.

These findings suggest that patients with severe Attention Deficit Disorder (ADD) are more susceptible to AWP with primarily manic as opposed to psychotic symptoms. There is however considerable overlap between genetic markers for psychotic and affective vulnerabilities.

At the neurotransmitter level of explanation, a variety of explanations have been proposed. Noradrenergic hyperactivity and "withdrawal-induced cholinergic overdrive and the cholinergic-monoaminergic system dysregulation" along with agonist-induced dopamine receptor hypersensitivity. Psychoscial stressors are also likely to have significance in the onset and prognosis of this disorder.

Perhaps most importantly, "ramifications of a misdiagnosed psychotic illness are potentially long-lasting and harmful to a patient. It is, therefore, crucial that health care providers be aware of the complex relationship between substance abuse, psychotic symptoms, and independent psychotic disorders". This viewpoint coincides with the opinion of medical and mental health professionals who consider timely recognition and appropriate treatment of AWP to be essential to minimising impact on an individual's present and future functioning.