An International Perspective and Review of Cocaine-Induced Psychosis: A Call to Action.

Substance Abuse (Impact Factor: 1.62). 06/2014; DOI: 10.1080/08897077.2014.933726
Source: PubMed

ABSTRACT ABSTRACT Cocaine use can induce transient psychotic symptoms that include suspiciousness, paranoia, hallucinations, and other cocaine-related behaviors. In this commentary, we provide an international perspective while reviewing the recent advances in epidemiology, clinical features, and risk factors related to cocaine-induced psychosis exhibited patients with cocaine use disorders. In some settings, the occurrence of cocaine-induced psychosis has been shown to be as high as 86.5%. Many risk factors have been linked with cocaine-induced psychosis, including: the quantity of cocaine consumed, lifetime amount of cocaine use, onset of cocaine dependence, years of use, routes of administration, other substance use disorder comorbidity, weight, gender, comorbidity with other medical and mental health disorders, genetics, and pharmacological interactions. Research has shown that the evaluation of cocaine-induced psychosis in patients with cocaine use is clinically relevant, especially in those patients who consume high amounts of cocaine, have a cannabis dependence history, have antisocial personality disorder, use administration routes other than intranasal, or exhibit ADHD comorbidity. Currently, the literature lacks information regarding the evolution of cocaine dependence or cocaine-dependent patients' risk for developing schizophrenia or other psychotic disorders. Furthermore, clinicians still do not have an evidence-based pharmacological approach to management of cocaine dependence available to them. Additional research is also needed regarding risk factors such as neurobiological markers and personality traits. Finally, we recommend the development of an integrative model including all of the risk factors and protective factors for cocaine-induced psychosis.

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    ABSTRACT: BackgroundCocaine consumption can induce transient psychotic symptoms, which has been correlated with more severe addiction and aggressive behavior. However, little is known about the nature of the relationship between personality traits and psychotic symptoms in cocaine-dependent patients. This study examined the relationship between neuroticism and cocaine-induced psychosis.MethodsA total of 231 cocaine-dependent patients seeking treatment were recruited to the study. Personality was evaluated by the Zuckerman-Kuhlman Personality Questionnaire. Cocaine-induced psychosis questionnaire, SCID-I, and SCID-II were used to evaluate comorbidity and clinical characteristics. Data analysis was performed in three steps: descriptive, bivariate, and multivariate analyses.ResultsCocaine-induced psychosis was reported in 65.4% of the patients and some personality disorder in 46.8%. Two personality dimensions (Neuroticism-Anxiety and Aggression-Hostility) presented a significant effect on the risk of experiencing psychotic symptoms (t(229) = 2.69, p = 0.008; t(229) = 2.06, p = 0.004), and patients with psychotic symptoms showed higher scores in both variables. On the multivariate analysis, only Neuroticism remained as a significant personality factor independently associated with psychotic symptoms (Wald = 7.44, p<0.05, OR = 1.08, CI 95% 1.02–1.16) after controlling for age, gender and number of consumption substances.ConclusionsAn association between high neuroticism scores and presence of psychotic symptoms induced by cocaine has been found, independently of other consumption variables. Personality dimensions should be evaluated in cocaine-dependent patients in order to detect high scores of neuroticism and warn patients about the risk of developing cocaine-induced psychotic symptoms.
    PLoS ONE 09/2014; 9(9):e106111. DOI:10.1371/journal.pone.0106111 · 3.53 Impact Factor
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    ABSTRACT: Schizophrenia is a complex psychiatric disorder with a characteristic disease course and heterogeneous etiology. While substance use disorders and a family history of psychosis have individually been identified as risk factors for schizophrenia, it is less well understood if and how these factors are related. To address this deficiency, we examined the relationship between substance use disorders and family history of psychosis in a sample of 1219 unrelated patients with schizophrenia. The lifetime rate of substance use disorders in this sample was 50%, and 30% had a family history of psychosis. Latent class mixture modeling identified three distinct patient subgroups: (1) individuals with low probability of substance use disorders; (2) patients with drug and alcohol abuse, but no symptoms of dependence; and (3) patients with substance dependence. Substance use was related to being male, to a more severe disease course, and more acute symptoms at assessment, but not to an earlier age of onset of schizophrenia or a specific pattern of positive and negative symptoms. Furthermore, substance use in schizophrenia was not related to a family history of psychosis. The results suggest that substance use in schizophrenia is an independent risk factor for disease severity and onset. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Psychiatry Research 12/2014; 225(3). DOI:10.1016/j.psychres.2014.12.006 · 2.68 Impact Factor
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    ABSTRACT: Background: Cocaine dependence is a prevalent mental disorder, with unfortunately no specific treatment at the moment. Ibogaine is an extract from an African root, with several evidence pointing to its success in treat-ing several addictive disorders. There are very few human studies evaluating its efficacy in cocaine dependence.