Amphetamine psychosis
Encyclopedia
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 very large doses but, in rare cases, it can also present in patients taking therapeutic doses under medical supervision. The most common stimulants involved are amphetamines and cocaine
, though others have also been reported.
, and in extreme cases, catatonia
.
Physical symptoms of prolonged stimulant abuse or acute overdose tend to accompany these psychotic symptoms in cases of stimulant psychosis (but not organic psychosis). These additional symptoms may include aggression
, arrhythmia, dilated pupils, diarrhea
, hypertension
, hyperthermia
, nausea
, rapid breathing, restlessness, seizures, sleep deprivation
, tremor
, and vomiting
.
proper, as well as the substituted amphetamines. The amphetamine molecule consists of a phenethylamine
core with a methyl group
attached to the alpha carbon
. The substituted amphetamines consist of the same structure with one or more substitutions
; prevalent examples include cathinone
, cocaine
, DOM
, ephedrine
, MDMA, methamphetamine
, methcathinone
, and methylphenidate
, though a large number of such compounds have been synthesized.
A 2007 article 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) ceased within 7-10 days after discontinuation of the drug. However, in some cases discontinuation symptoms were reported to last for months.
A small percentage of long term or high dose users may continue to experience intermittent psychotic episodes on an ongoing basis within the first year of abstinence. Though uncommon, these experiences offer some anecdotal evidence regarding the neurotoxic effects of long term amphetamine use, and the improvements that users tend to experience when these neurotoxic conditions are partially or fully reversed.
Spontaneous and long term recurrences (similar to "flashbacks"
) are hypothesized to be triggered or exacerbated by high stress and sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.
A key distinction between persistent stimulant psychosis and organic psychotic disorders like schizophrenia is that the symptoms of a amphetamine-induced psychotic disorder are not considered to be permanent and will eventually subside with a sufficient duration of abstinence.
has a similar potential to induce temporary psychosis, with more than half of cocaine abusers reporting at some psychotic symptoms at some point. Typical symptoms of sufferers include paranoid delusions that they are being followed and that their drug use is being watched, often with accompanying hallucinations which support the delusional beliefs. Delusional parasitosis with formication
("cocaine bugs") is also a fairly common reaction. Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug, meaning psychosis tends to become more severe with repeated, intermittent use.
is a central nervous system stimulant with a similar mechanism of action as cocaine, and can also lead to psychosis from chronic abuse. Although the safety profile of short term methylphenidate therapy has been well established in clinical trials, the specific effects of long term use of nearly all psychostimulants, including methylphenidate, is less clear; the long term effects of using stimulants, even at therapeutic doses, are largely unknown. Short term clinical trials show a very low incidence (0.01%) of methylphenidate induced psychosis at therapeutic dose levels. A naturalistic
study published in 1999 showed that 6 of 98 children prescribed methylphenidate in an outpatient clinic developed psychotic symptoms; however, the lack of a control group makes it impossible to attribute these effects to the medication. The long term effects on mental health disorders in later life of chronic use of methylphenidate is unknown. Concerns have been raised that long term therapy might cause drug dependence, paranoia
, schizophrenia
, and behavioral sensitization in a similar manner as other stimulant drugs. 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 as family history of mental illness does not predict the incidence of stimulant toxicosis in children with ADHD.
Withdrawal symptoms of methylphenidate can include psychosis
and depression
. Stimulant withdrawal
or rebound reactions can occur and should be minimized in intensity, i.e. via a gradual tapering off of medication. A very small study of abrupt withdrawal from stimulants suggests that withdrawal reactions are not typical. Nonetheless, withdrawal reactions may still occur in susceptible individuals.
Caffeine induced psychosis is infrequently reported in the medical literature and remains controversial due to the lack of supporting information. It is not clear whether it proceeds by a similar mechanism as other stimulant psychoses or whether it is an entirely different process. Like other stimulants, caffeine increases dopamine
levels, though only indirectly.
and atypical antipsychotics have been shown to be helpful in the early stages of treatment. This is followed by abstinence from psychostimulants, supported with counseling or medication designed to assist the individual preventing a relapse and the resumption of a psychotic state.
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...
drugs. Most commonly, stimulant psychosis occurs in drug abusers
Drug abuse
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...
who take very large doses but, in rare cases, it can also present in patients taking therapeutic doses under medical supervision. The most common stimulants involved are amphetamines and cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, though others have also been reported.
Signs and Symptoms
The symptoms of stimulant psychosis vary slightly between different stimulant drugs, but are largely shared with the symptoms of organic psychosis, including hallucinations, delusions, thought disorderThought disorder
In psychiatry, thought disorder or formal thought disorder is a term used to describe incomprehensible language, either speech or writing, that is presumed to reflect thinking. There are different types...
, and in extreme cases, catatonia
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
.
Physical symptoms of prolonged stimulant abuse or acute overdose tend to accompany these psychotic symptoms in cases of stimulant psychosis (but not organic psychosis). These additional symptoms may include aggression
Aggression
In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...
, arrhythmia, dilated pupils, diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, hyperthermia
Hyperthermia
Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate...
, nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, rapid breathing, restlessness, seizures, sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
, tremor
Tremor
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...
, and vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
.
Amphetamine
Amphetamine and its derivatives are well known to induce psychosis, typically when abused chronically or in high doses. The generic term "Amphetamines" describes both amphetamineAmphetamine
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,...
proper, as well as the substituted amphetamines. The amphetamine molecule consists of a phenethylamine
Phenethylamine
Phenylethylamine or phenethylamine is a natural monoamine alkaloid, trace amine, and also the name of a class of chemicals with many members well known for psychoactive drug and stimulant effects. Studies suggest that phenylethylamine functions as a neuromodulator or neurotransmitter in the...
core with a methyl group
Methyl group
Methyl group is a functional group derived from methane, containing one carbon atom bonded to three hydrogen atoms —CH3. The group is often abbreviated Me. Such hydrocarbon groups occur in many organic compounds. The methyl group can be found in three forms: anion, cation and radical. The anion...
attached to the alpha carbon
Alpha carbon
The alpha carbon in organic chemistry refers to the first carbon that attaches to a functional group . By extension, the second carbon is the beta carbon, and so on....
. The substituted amphetamines consist of the same structure with one or more substitutions
Substitution reaction
In a substitution reaction, a functional group in a particular chemical compound is replaced by another group. In organic chemistry, the electrophilic and nucleophilic substitution reactions are of prime importance...
; prevalent examples include cathinone
Cathinone
Cathinone, or Benzoylethanamine, is a monoamine alkaloid found in the shrub Catha edulis and is chemically similar to ephedrine, cathine and other amphetamines. Cathinone induces the release of dopamine from striatal preparations that are prelabelled either with dopamine or its precursors. It is...
, cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
, DOM
2,5-Dimethoxy-4-methylamphetamine
2,5-Dimethoxy-4-methylamphetamine is a psychedelic and a substituted amphetamine...
, ephedrine
Ephedrine
Ephedrine is a sympathomimetic amine commonly used as a stimulant, appetite suppressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia....
, MDMA, methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
, methcathinone
Methcathinone
Methcathinone , is a psychoactive stimulant, sometimes used as a recreational drug and considered addictive. It is usually snorted, but can be smoked, injected, or taken orally...
, and methylphenidate
Methylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
, though a large number of such compounds have been synthesized.
A 2007 article 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) ceased within 7-10 days after discontinuation of the drug. However, in some cases discontinuation symptoms were reported to last for months.
A small percentage of long term or high dose users may continue to experience intermittent psychotic episodes on an ongoing basis within the first year of abstinence. Though uncommon, these experiences offer some anecdotal evidence regarding the neurotoxic effects of long term amphetamine use, and the improvements that users tend to experience when these neurotoxic conditions are partially or fully reversed.
Spontaneous and long term recurrences (similar to "flashbacks"
Flashback (psychological phenomenon)
A flashback, or involuntary recurrent memory, is a psychological phenomenon in which an individual has a sudden, usually powerful, re-experiencing of a past experience or elements of a past experience. These experiences can be happy, sad, exciting, or any other emotion one can consider...
) are hypothesized to be triggered or exacerbated by high stress and sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.
A key distinction between persistent stimulant psychosis and organic psychotic disorders like schizophrenia is that the symptoms of a amphetamine-induced psychotic disorder are not considered to be permanent and will eventually subside with a sufficient duration of abstinence.
Cocaine
CocaineCocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
has a similar potential to induce temporary psychosis, with more than half of cocaine abusers reporting at some psychotic symptoms at some point. Typical symptoms of sufferers include paranoid delusions that they are being followed and that their drug use is being watched, often with accompanying hallucinations which support the delusional beliefs. Delusional parasitosis with formication
Formication
Formication is the medical term for a sensation that resembles that of insects crawling on the skin. It is one specific form of a set of sensations known as paresthesia, which also include the more common prickling, tingling sensation of "pins and needles"...
("cocaine bugs") is also a fairly common reaction. Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug, meaning psychosis tends to become more severe with repeated, intermittent use.
Methylphenidate
MethylphenidateMethylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
is a central nervous system stimulant with a similar mechanism of action as cocaine, and can also lead to psychosis from chronic abuse. Although the safety profile of short term methylphenidate therapy has been well established in clinical trials, the specific effects of long term use of nearly all psychostimulants, including methylphenidate, is less clear; the long term effects of using stimulants, even at therapeutic doses, are largely unknown. Short term clinical trials show a very low incidence (0.01%) of methylphenidate induced psychosis at therapeutic dose levels. A naturalistic
Naturalistic observation
Naturalistic observation is a research tool in which a subject is observed in its natural habitat without any manipulation by the observer. During naturalistic observation researchers take great care to avoid interfering with the behavior they are observing by using unobtrusive methods...
study published in 1999 showed that 6 of 98 children prescribed methylphenidate in an outpatient clinic developed psychotic symptoms; however, the lack of a control group makes it impossible to attribute these effects to the medication. The long term effects on mental health disorders in later life of chronic use of methylphenidate is unknown. Concerns have been raised that long term therapy might cause drug dependence, paranoia
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
, schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, and behavioral sensitization in a similar manner as other stimulant drugs. Psychotic symptoms from methylphenidate can include, hearing voices
Hearing Voices
Hearing Voices or Hearing voices may be:* Auditory hallucination* Hearing Voices , 2001 audio-recording collection by D. Mahler* Hearing Voices Movement, a different way of viewing people who hear voices...
, visual hallucinations, urges to harm oneself, severe anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
, grandiosity
Grandiosity
Grandiosity is chiefly associated with narcissistic personality disorder, but also commonly features in manic or hypomanic episodes of bipolar disorder....
, paranoid delusions, confusion
ConFusion
ConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...
, increased aggression
Aggression
In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...
, and irritability
Irritability
Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....
. Methylphenidate psychosis is unpredictable in whom it will occur as family history of mental illness does not predict the incidence of stimulant toxicosis in children with ADHD.
Withdrawal symptoms of methylphenidate can include 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"...
and depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
. Stimulant withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
or rebound reactions can occur and should be minimized in intensity, i.e. via a gradual tapering off of medication. A very small study of abrupt withdrawal from stimulants suggests that withdrawal reactions are not typical. Nonetheless, withdrawal reactions may still occur in susceptible individuals.
Caffeine
There is limited evidence that caffeine, in high doses or when chronically abused, may induce psychosis in some individuals.Caffeine induced psychosis is infrequently reported in the medical literature and remains controversial due to the lack of supporting information. It is not clear whether it proceeds by a similar mechanism as other stimulant psychoses or whether it is an entirely different process. Like other stimulants, caffeine increases dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
levels, though only indirectly.
Treatment
Treatment consists of palliative care during the acute intoxication phase: maintaining hydration, body temperature, blood pressure and heart rate at acceptable levels until the drug is sufficiently metabolized to allow vital signs to return to baseline. TypicalTypical antipsychotic
Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis...
and atypical antipsychotics have been shown to be helpful in the early stages of treatment. This is followed by abstinence from psychostimulants, supported with counseling or medication designed to assist the individual preventing a relapse and the resumption of a psychotic state.
See also
- AmphetamineAmphetamineAmphetamine 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,...
- Delusional parasitosisDelusional parasitosisDelusional parasitosis is a form of psychosis whose victims acquire a strong delusional belief that they are infested with parasites, whereas in reality no such parasites are present...
- Dopamine hypothesis of psychosis
- PsychosisPsychosisPsychosis 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"...
External links
- Chronic amphetamine use and abuse - Review published in 2000.