A case of drug-induced psychosis related to crystalline methamphetamine is described, highlighting the phenomenology and relevant treatment.
A 44-year-old woman with borderline personality traits and severe drug dependence developed a protracted drug-induced psychosis related to chronic high-dose crystalline methamphetamine use. Complete resolution of symptoms occurred with antipsychotic medication and abstinence from methamphetamine. Rapid recurrence of symptoms occurred at a time of high stress associated with minimal methamphetamine use and cessation of low-dose quetiapine. Symptoms rapidly resolved with abstinence, quetiapine and reduction of stressors.
A drug-induced psychosis resembling paranoid schizophrenia can occur with repeated or high-dose use of methamphetamine. While this generally resolves rapidly with cessation of stimulant use, some cases of protracted drug-induced psychosis in vulnerable individuals have been documented. Behavioural sensitization can also occur, and neuroleptics may prevent the recurrence of further psychosis triggered by ongoing low-dose methamphetamine use.
"Methamphetamine abuse is a significant public health concern not only in Korea, but also in other parts of the world.5,8) In humans, abuse of methamphetamine leads to serious psychiatric conditions,9,10,11,12,13) including a variety of psychotic disorders. "
[Show abstract][Hide abstract] ABSTRACT: Objective
It was previously suggested that the malic enzyme 2 (ME2) as the candidate gene for psychosis in fine mapping of chromosome 18q21. Chromosome 18q21 is also one of the possible regions that can contribute to addiction.
We performed a pilot study for discovering candidate gene of chromosome 18q21 in the methamphetamine abusers for elucidating the candidate gene for methamphetamine addiction leading to psychosis. We have selected 30 unrelated controls (16 males, 14 females; age=59.8±10.4) and 37 male methamphetamine abusers (age=43.3±7.8). We analyzed 20 single nucleotide polymorphisms (SNPs) of 7 neuronal genes in chromosome 18q21 for DNA samples that was checked for the data quality and genotype error. The association between the case-control status and each individual SNP was measured using multiple logistic regression models (adjusting for age and sex as covariates). And we controlled false discovery rate (FDR) to deal with multiple testing problem.
We found 3 significant SNPs of 2 genes in chromosome 18q21 (p-value<0.05; adjusting for age as covariate) in methamphetamine abusers compared to controls. We also found 2 significant SNPs of 1 gene (p-value<0.05; adjusting for age and sex as covariates) (rs3794899, rs3794901:MAPK4). Two SNPs in MAPK4 gene were significant in both statistical groups.
MAPK4, the gene for mitogen-activated protein kinase 4, is one of the final 6 candidate genes including ME2 in 18q12-21 in our previous finemapping for psychosis. Our results suggest that MAPK4 can be a candidate gene that contribute to the methamphetamine addiction leading to psychosis.
Clinical Psychopharmacology and Neuroscience 04/2014; 12(1):54-64. DOI:10.9758/cpn.2014.12.1.54
"La pharmacopsychose méthamphétaminique est un tableau délirant aigu polymorphe dont les principaux diagnostics différentiels sont la bouffée délirante aigue ou une décompensation délirante aigue d'une schizophrénie paranoïde . Un usage régulier de méthamphétamine est à l'origine de symptômes psychotiques chroniques . Les signes cliniques les plus fréquemment trouvés sont les hallucinations auditives (dans 85 % des cas), visuelles (46 % des cas) et tactiles (21 % des cas), la persécution (71 % des cas), les thèmes de référence (63 %), le sentiment de devinement de la pensée (40 %), les illusions, un discours bizarre . "
[Show abstract][Hide abstract] ABSTRACT: Methamphetamine is the second illicit drug used after cannabis in North America, Asia, Oceania. It also becomes a prominent part of the European drug scene, especially in East European countries such as Czech Republic and Slovakia. Methamphetamine addiction is a serious worldwide public health problem with many consequences and complications. Significant morbidity, including cardiovascular, infectious, pulmonary, dental diseases and other systems complications are associated with methamphetamine acute or chronic use. Cognitive disorders, psychotic and mood disorders have been reported. There is also substantial evidence that methamphetamine has an adverse impact on social relationships. Treatment of methamphetamine complications is primarily supportive and need a multidisciplinary approach. It can serve as a target to initiate a treatment for the addiction problem. The use of behavioral therapies and pharmacological agents are the best therapeutic approach.
La Presse Médicale 10/2010; 39(12):1246-53. DOI:10.1016/j.lpm.2010.09.003 · 1.08 Impact Factor
"METH can be abused via multiple routes which include oral, intravenous and smoking administration. In addition to its euphorigenic effects, METH can also cause anxiety, increased agitation, delirium, psychotic states, cognitive and psychomotor impairments , seizures, and death (Wilson et al., 1996; Lan et al., 1998; Buffenstein et al., 1999; Yui et al., 1999; Simon et al., 2000; Volkow et al., 2001a; London et al., 2004; Dore and Sweeting, 2006). Cerebral vasculitis, cerebrovascular accidents due to hemorrhage or vasospasm, and cerebral edema have also been reported in METH abusers (Chynn, 1968; Salanova and Taubner, 1984). "
[Show abstract][Hide abstract] ABSTRACT: The amphetamines, including amphetamine (AMPH), methamphetamine (METH) and 3,4-methylenedioxymethamphetamine (MDMA), are among abused drugs in the US and throughout the world. Their abuse is associated with severe neurologic and psychiatric adverse events including the development of psychotic states. These neuropsychiatric complications might, in part, be related to drug-induced neurotoxic effects, which include damage to dopaminergic and serotonergic terminals, neuronal apoptosis, as well as activated astroglial and microglial cells in the brain. The purpose of the present review is to summarize the toxic effects of AMPH, METH and MDMA. The paper also presents some of the factors that are thought to underlie this toxicity. These include oxidative stress, hyperthermia, excitotoxicity and various apoptotic pathways. Better understanding of the cellular and molecular mechanisms involved in their toxicity should help to generate modern therapeutic approaches to prevent or attenuate the long-term consequences of amphetamine use disorders in humans.
Neurotoxicity Research 05/2007; 11(3-4):183-202. DOI:10.1007/BF03033567 · 3.54 Impact Factor
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