Rating the severity and character of transient cocaine-induced delusions and hallucinations with a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP)

Boston University, Boston, Massachusetts, United States
Drug and Alcohol Dependence (Impact Factor: 3.42). 11/2005; 80(1):23-33. DOI: 10.1016/j.drugalcdep.2005.03.019
Source: PubMed


Cocaine can induce transient psychotic symptoms. We examined the phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the Scale for Assessment of Positive Symptoms (SAPS), a well-validated instrument for the assessment of schizophrenic psychosis.
We developed a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP), based on the well-validated SAPS. We interviewed 243 unrelated cocaine-dependent adults using both the SAPS-CIP and an instrument for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ).
One hundred and eighty-one (75%) of the subjects endorsed CIP using the CEQ. With the SAPS-CIP, hallucination (HAL) and delusion (DEL) scores correlated strongly, and the DEL domain showed excellent concurrent validity with the CEQ. We observed significant positive correlations, respectively, between severity of HAL and DEL, and lifetime number of episodes of cocaine use, and negative correlations with age at onset of cocaine use.
The results suggest that CIP consists of transient delusional and hallucinatory symptoms, which tend to occur together and co-vary in severity. It appears that rating cocaine-induced paranoia alone (e.g., with the CEQ) can identify most subjects experiencing CIP. However, the SAPS-CIP is useful for quantifying the severity of CIP according to operational criteria. Our data provide additional evidence that CIP is a sensitizing response.

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    • "Thus, a score of zero ( " none " ) was assigned when the individual was certain that the evaluated symptom did not occur during CI; a value of one ( " doubtful " ) was assigned when the patient admits that the symptom may have been present during cocaine intoxication but they are uncertain; an answer is classified as two ( " mild " ) when the patient admits that the symptom was clearly present at some point during cocaine intoxication; a score of three ( " moderate " ) was assigned when the symptom was clearly present during cocaine intoxication and generated a coherent behavioural response; a value of four ( " marked " ) is indicated when the symptom is clearly present during cocaine intoxication, generating a coherent behavioural response with a high degree of extension/invasion; lastly, a score of five ( " serious " ) occurs when the criteria for four are met and the patient displays verified behavioural response that is clearly dangerous to themselves and others. Cubells et al. (2005) apply a concurrent validity analysis using the HAL and DEL sections of the SAPS-CIP with respect to the Cocaine Experience Questionnaire (CEQ) (Satel et al., 1991) that measures " cocaine-induced paranoia " . This analysis found that " persecution " delusions best explain the item measured by this questionnaire. "
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    ABSTRACT: Cocaine use is significantly associated with psychiatric co-morbidities of which psychotic symptoms are the most typical. The primary goal of this study is to estimate the life-time prevalence of cocaine-induced psychotic symptoms (CIPS) in a sample of patients without a history of primary psychosis, who attended specific out-patient drug-dependence treatment centres (ODDTCs). This is an observational, cross-sectional design and a consecutive sampling technique. The Scale for Assessment of Positive Symptoms-Cocaine Induced Psychosis (SAPS-CIP) was used to interview 114 patients who request treatment at specific ODDTCs for problems related to cocaine use. Most patients, 89.5% (95% CIs: 83.8%-95.2%) had dependence of cocaine and 84.2% (95% CIs: 77.5%-90.9%) showed at least one CIPS. Patients with CIPS had used cocaine more times throughout their and had a more frequency of use during the period of higher abuse severity in the last year, had higher severity of dependence score and had fewer abstinence periods greater than 30 days compared with those without CIPS. Cocaine dependency severity scale scores were significantly greater in patients with CIP compared with those without CIP.
    Psychiatry Research 06/2014; DOI:10.1016/j.psychres.2014.02.024 · 2.47 Impact Factor
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    • "Some risk factors are associated with transient psychosis related to cocaine use: amount of cocaine consumed (Floyd et al., 2006; Kalayasiri et al., 2006a; Mahoney et al., 2008; Vorspan et al., 2012; Roncero et al., 2013a), age of onset of use (Cubells et al., 2005; Kalayasiri et al., 2006a, 2010; Floyd et al., 2006; Vorspan et al., 2012) and co-morbidity with attention deficit hyperactivity disorder (ADHD) (Tang et al., 2007; Roncero et al., 2013b). With respect to borderline personality disorder (BPD), antisocial personality disorder (APD) (Kranzler et al., 1994; Roncero et al., 2013a) and drug use (smoked or intravenous) (Mooney et al., 2006, Kalayasiri et al., 2006b; Vorspan et al., 2012; Roncero et al., 2013c), the association remains unclear. "
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    ABSTRACT: The aim of this study is to compare the clinical characteristics of three groups of patients in treatment for cocaine dependence: patients without any psychotic symptoms (NS), patients with transient psychotic symptoms (PS) and patients with cocaine-induced psychotic disorder (CIPD). An observational and retrospective study of 150 cocaine-dependent patients undergoing treatment in the Drug Unit of the Psychiatry Department of University Hospital Vall d'Hebron in Barcelona (Spain) using these three groups, NS, PS and CIPD, was performed. All patients were evaluated with the PRISM interview. ANOVA, Chi-square tests and multivariate multinomial regression analysis were used to perform statistical analyses. Seven patients with a primary psychotic disorder were discharged. Forty-six patients (32.1%) did not report any psychotic symptoms. Ninety-seven patients (67.9%) presented with a history of any cocaine-induced psychotic symptom and were considered as the cocaine-induced psychotic (CIP) group. Among them, 39 (27.3%) were included in the PS group, and 58 (40.6%) were included in the CIPD group. A history of imprisonment was found significantly more frequently in the PS than the NS group. The distribution of age at onset of dependence, lifetime cannabis abuse or dependence and imprisonment were significantly different between the NS and CIPD groups. We conclude that in cocaine-dependent patients, clinicians should be advised about the risk of development of psychotic symptoms. The presence of some psychotic symptoms could increase the potential risks of disturbing behaviours.
    05/2014; 216(3). DOI:10.1016/j.psychres.2014.01.026
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    • "Five patients with CIP(−) reported delusions, but none scored greater than 1 = " questionable " (as defined in the SAPS-CIP, " The subject reports paranoid, fearful, or unusual thoughts but cannot state with certainty that cocaine use is actually causing them. It may also be unclear whether the experiences represent reasonable responses to the actual danger of the situation " ) on persecutory and somatic delusions scores, in accordance with the analysis by Cubells et al. (2005), who consider that only subjects scoring 1 for both persecutory and somatic delusions or those scoring 2 for either anchor score alone would satisfy criteria for CIP. "
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    ABSTRACT: Cocaine intoxication can induce transient psychotic symptoms. The principal aim of this study was to determine sociodemographic and clinical characteristics associated with cocaine-induced psychosis (CIP) and to identify clinical factors predicting CIP in crack cocaine smokers in Martinique. The second aim was to identify clinical factors associated with severity of CIP, assessed with the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP). Fifty-three cocaine-dependent smokers (45 men and 8 women) seeking treatment for cocaine dependence were included. Patients were assessed using the Cocaine Experience Questionnaire (CEQ), an instrument for the identification of cocaine-induced paranoia, and a French version of the SAPS-CIP, for the severity of CIP. Thirty-five (66%) patients reported cocaine-induced paranoia on the CEQ (CIP(+) patients). The mean SAPS-CIP total score was 6.1 ± 3.7, with a significant difference between CIP(+) and CIP(-) patients (P < 0.0001). Age at first cannabis use was associated with occurrence of CIP on the CEQ, and adolescent-onset cannabis use was associated with severity of hallucinations score on the SAPS-CIP. Cocaine-induced psychosis is frequent in crack cocaine smokers in Martinique, and early cannabis use is associated with the occurrence and the severity of psychotic symptoms during cocaine intoxication in this population. Patients developing psychotic symptoms during cocaine use began smoking cannabis earlier during adolescence than patients without CIP. These results confirm those of previous studies, highlighting the need to better assess early cannabis use in cocaine users, because early cannabis use is associated with severity of CIP.
    Journal of Addiction Medicine 02/2014; 8(1):33-39. DOI:10.1097/ADM.0000000000000003 · 1.76 Impact Factor
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