As reported by the National Institute on Drug Abuse (NIDA; 2013) methamphetamine use continues to be a significant problem, with over 12 million people or 4.7 percent of the population having tried methamphetamine at least one time. According to NIDA (2013), methamphetamine use can cause memory loss, aggression, psychotic behavior, damage to one’s cardiovascular system, malnutrition, and dental problems.
Chronic use may cause an individual to have difficulty feeling pleasure outside of use, as well as anxiety, confusion, insomnia, mood disturbance, and violent behavior. Psychotic features experienced include paranoia, delusions, and visual, auditory, and tactile hallucinations. Stress has also been related to spontaneous methamphetamine psychosis in individuals who have abused methamphetamine in the past (NIDA, 2013). With acute methamphetamine intoxication individuals may experience hallucinations (auditory, visual, tactile), persecutory, influence, and control delusions, as well as are prone to violence (Zarrabi, Khalkhali, Hamidi, Ahmadi, & Zavarmousavi, 2016).
Even after intoxication passes, psychosis may occur over a prolonged period of time (Zarrabi et al., 2016). Acute psychosis usually has a maximum period of four to five days (Zarrabi et al., 2016); yet, a differing course of psychosis has been documented in the literature. For instance, three clinical groups for stimulant-induced psychosis have been identified: the first group is characterized by transient psychosis, where the duration of symptoms is limited to four or five days and may be associated with withdrawal; with the second group, psychosis is typically resolved in less than one month; and in the third group, psychosis may last several months or years (Zarrabi et al., 2016). It has been estimated that between 5-10% of individuals with methamphetamine-induce psychosis may not fully recover (as cited in Zarrabi et al., 2016).
Risk factors for methamphetamine-induced psychosis are duration, frequency, and amount of use, history of sexual abuse, family history, other substance use, and co-occurring personality and mood disorders (Grant et al., 2012). Of note, substance intoxication is differentiated from a substance/medication-induced psychotic disorder if reality testing for altered perceptions remains intact (American Psychiatric Association, 2013).
Zarrabi, Khalkhali, Hamidi, Ahmadi, and Zavarmousavi (2016) indicate there are no structured treatment guidelines for methamphetamine-induced psychosis. In their study, risperidone and olazapine were most frequently used, as well as benzodiazepines to reduce restlessness. Antipsychotics were reportedly preferred due to better control of violent behaviors. Another study indicated that quetiapine could also be used as an antipsychotic treatment with comparable effects to haloperidol (Verachai et al., 2014). Electroconvulsive therapy (ECT) has been used to control severe aggression and violent behaviors, as well as thoughts of suicide and homicide in methamphetamine-induced psychosis (Zarrabi et al., 2016). Results indicated that after six to nine sessions of ECT, symptoms began to disappear. Though limited by constraints of a case study, Grelotti, Kanayama, and Harrison (2010) again demonstrated the positive effects of ECT on methamphetamine-induced psychosis.
Overall, the most common symptoms with methamphetamine-induced psychosis are paranoid delusions and auditory hallucinations, and such symptoms may prove resistant or refractory to antipsychotic medications (Grelotti, Kanayama, & Pope, 2010). As indicated in the literature, clinicians faced with refractory cases of methamphetamine-induced psychosis may consider ECT as a treatment option.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Gerlotti, D., Kanayama, G., & Pope, H. G. (2010). Remission of persistent methamphetamine-induced psyhcosis after electroconvulsive therapy: Presentation of a case and review of literature. The American Journal of Psychiatry, 167(1), 17-23.
Grant, K. M., LeVan, T. D., Wells, S. M., Li, M., Stoltenberg, S. F., Gendelman, H. E.,…BEvins, R. A. (2012). Methamphetamine-associated psychosis. Journal of Neuroimmune Pharmacology, 7(1), 113-139.
National Institute on Drug Abuse (NIDA). (2013). Methamphetamine. Retrieved from https://www.drugabuse.gov/publications/research-reports/methamphetamine
Verachai, V., Rukngan, W., Chaswanakrasaesin, K., Nilaban, S., Suwanmajo, S., Thanateerabunjong, R.,…Kalayasiri, R. (2014). Treatment of methamphetamine-induced psychosis: a double-blind randomized controlled trial comparing haloperidol and quetiapine. Psychopharmacology, 231(16), 3099-3108.
Zarrabi, H., Khalkhali, M., Hamidi, A., Ahmadi, R., & Zavarmousavi, M. (2016). Clinical features, course and treatment of methpahetamine-induce psychosis in psychiatric inpatients. BMC Psychiatry, 16, 1-8.
Dannie S. Harris, MA
WKPIC Doctoral Intern