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Psychosis induced by amphetamines

Bramness, Jrgen G.; Rognli, Eline B.

Current Opinion in Psychiatry: July 2016 - Volume 29 - Issue 4 - p 236–241
doi: 10.1097/YCO.0000000000000254
ADDICTIVE DISORDERS: Edited by John B. Saunders and Linda B. Cottler
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Purpose of review The study reviews publications on the use of methamphetamine and amphetamine in relation to psychotic symptoms, substance-induced psychosis, and primary psychosis published between July 2014 and December 2015. The databases MEDLINE, Embase, and PsycINFO were searched using the terms ‘amphetamine psychosis’ and ‘methamphetamine psychosis’ for the time period 1 July 2014 to 31 December 2015.

Recent findings There were 37 studies published on the subject during this time period. Risk factors for psychotic symptoms, substance-induced psychosis, and primary psychosis included patterns of drug use, but results also pointed to the importance of nondrug-related vulnerability. Cognitive impairment is associated with both amphetamine use and psychosis, and the impairment among those with amphetamine-induced psychosis resembles that of schizophrenia. At the neuronal level, GABAergic mechanisms may offer some understanding about the association between stimulant use and psychosis. Several different types of antipsychotic medication are effective for treating agitation and psychosis, but drugs with high DRD2 blockade should be used with caution. Some novel treatments are described, but are not sufficiently repeated to be recommended.

Summary During the past 18 months, studies have been published that cover risk factors, neuronal mechanisms, and treatment. These recent results do not differ from previous understandings, but the role of cognition and GABAergic dysfunction should be further investigated, and knowledge about resilience factors is still scarce. Also, a clearer evidence base for medical treatment of psychosis with concurrent amphetamine use is warranted.

Video abstract http://links.lww.com/YCO/A33

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aNorwegian Centre for Addiction Research (SERAF), University of Oslo

bDivision of Mental Health and Addiction, Oslo University Hospital, Oslo

cNorwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway

Correspondence to J⊘rgen G. Bramness, Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Box 1039 Blindern, 0315 Oslo, Norway. Tel: +47 23368977; fax: +47 23368986; e-mail: j.g.bramness@medisin.uio.no

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