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Author Topic: Antipsychotics for Amphetamine Psychosis. A Systematic Review  (Read 2818 times)

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source: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00740/full

note: excerpts only. take the source link for the full article

Antipsychotics for Amphetamine Psychosis. A Systematic Review

15 October 2019

ABSTRACT

Background: Among individuals experiencing amphetamine psychosis, it may be difficult to rule out schizophrenia. The use of antipsychotics for the treatment of amphetamine psychosis is sparse due to possible side effects. Some arguments disfavor their use, stating that the psychotic episode is self-limited. Without treatment, some individuals may not fully recover from the psychosis and may develop full-blown psychosis, emotional, and cognitive disturbance. This review aims to investigate the clinical benefits and risks of antipsychotics for the treatment of amphetamine psychosis.

Methods: Electronic search on trials on antipsychotic drugs for amphetamine psychosis from their inception to November 2018 was conducted in PubMed, Scopus, Google Scholar, EBSCOhost, ProQuest, Cochrane Review Database, Medline Ovid, and EMBASE following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Cochrane risk-of-bias tool assessed the risk of bias, the methodological quality of individual trials was assessed by the Oxford Quality Scoring System, and the quality of evidence for recommendations was judged by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The results were synthesized qualitatively and quantitatively.

Results: The investigation of six randomized controlled trials of 314 participants showed that aripiprazole, haloperidol, quetiapine, olanzapine, and risperidone were able to reduce or control the psychotic episode (positive and negative symptoms) induced by amphetamine use with no adverse event. Although the side-effect profile of these agents varied, no drug was clinically superior to others.

Conclusions: This review suggests that antipsychotics seem to be efficacious for amphetamine psychosis on both positive and negative symptoms. Practitioners need to tailor their use based on risks for side effects individually.



Introduction

Rationale: The use of amphetamine encompasses several street drugs that fall under the umbrella of crystal meth, crank, speed, tweek, glass, and so forth, and those with a substituted-phenylethylamine structure, such as amphetamine, dextroamphetamine, and methamphetamine. It also involves the use of other different structures like methylphenidate for the treatment of attention deficit hyperactivity disorder and narcolepsy and designer drugs with amphetamine-type compounds like bath salts, molly, and flakka. Amphetamine use also implicates several plant-derived stimulants with amphetamine’s chemical structure found in khât and kratom. Fenethylline, ephedrine, pseudoephedrine, and 3,4-methylenedioxymethamphetamine or ecstasy are also in the amphetamine category.

A letter to the editor published in 1957 drew attention to the widespread abuse of amphetamine in Great Britain and cases of amphetamine intoxication that could induce paranoia indistinguishable from the symptom of paranoia in schizophrenia. According to the United Nations Office on Drugs and Crime , East and South-East Asia and North America are the central subregions for methamphetamine trafficking worldwide. In 2016, methamphetamine was second after heroin as a drug threat in the United States of America. Worldwide, amphetamine and prescription stimulants reached 34 million among past-year users in 2016, and around 4 out of 10 methamphetamine users experienced psychosis. Among the group of users experiencing amphetamine-induced psychotic disorder (amphetamine psychosis), it may be difficult to rule out schizophrenia. The resolution of the psychotic episode may be incomplete without treatment. The risk of relapse is elevated. There are reports that methamphetamine users are more susceptible to exhibiting psychotic symptoms than the general population, and the psychosis may persist up to 6 months even after abstinence. It is not sure whether amphetamine psychosis is categorically different from other primary psychoses like schizophrenia, though it seems there is a similarity between the two conditions .

Evidence that stimulants may produce long-term psychosis was better supported in animals than in humans. Arunogiri et al. reported that there is moderate evidence that the frequency of use of methamphetamine and the severity of dependence to the drug can increase the chance of developing amphetamine psychosis. The use of amphetamine itself may increase the risk of death due to intoxications, accidents, suicide and homicide, and cardiovascular events such as prolonged QTc interval. Amphetamine psychosis is prevalent among individuals who use the drug. A meta-analysis estimated that 36.5% of methamphetamine users have a history of amphetamine psychosis or substance-induced psychotic disorders.

Symptoms of Amphetamine Psychosis

A salient feature of amphetamine psychosis is that the clinical manifestation is apparent during the time an individual is under the influence of the drug, but the clinical manifestation disappears when the drug is no longer in the body. During the syndromal episode, the psychosis is mostly indistinguishable from schizophrenia. Bell reviewed 15 cases of individuals exposed to amphetamine and noted that visual hallucinations were prominent.

There are anecdotal reports of individuals seeing giant snakes that are biting them and demons from hell ripping off their soul over and over. Amphetamine users experience a high frequency of persecutory delusions, delusions of jealousy, delusions of reference, delusions of mind-reading, agitation, visual and auditory hallucinations, thought insertion and thought broadcasting, derealization, and depersonalization. In 152 participants diagnosed with methamphetamine-induced psychosis, delusions of persecution (85.5%), violence (75.6%), intimate partner violence (61.2%), and auditory hallucinations (51.3%) were prominent. Users of amphetamine may be at higher risk for injury during the psychotic episode. During the psychosis, users can also become a safety risk for others.

Clinical Benefits: See the source link

Side Effects and Serious Adverse Events: See the source link

Conclusions

The delineation of neurophysiological mechanisms that underlie different psychotic disorders (schizophrenia, schizoaffective disorder, or substance-induced psychotic disorder) is still ongoing. Besides probing genetics, neurotransmitters, and brain imaging as biomarkers, electroencephalography (EEG) has been proposed as one of the methods to portray a psychotic disorder. Howells et al., in a case-controlled study of participants in outpatients from the Western Cape Province, South Africa, found that delta/alpha frequency activity during resting with eyes closed was lower in the control group compared with participants diagnosed with schizophrenia and methamphetamine-induced psychotic disorder, and lower for bipolar disorder than methamphetamine-induced psychotic disorder.

Similar results were reported during the resting with eyes open and continuous performance task. Sato suggested that a lasting change at the nerve terminal membranes’ transporters in the striatumWiki and nucleus accumbensWiki may provoke the induction and expression of stimulant-induced sensitization, which may engender vulnerability to schizophrenia-like psychotic episodes in methamphetamine-induced psychosis.

Single-photon emission computed tomography showed a reduction in DA transporter density in the nucleus accumbens and caudate/putamen associated with the duration of methamphetamine use. Magnetic resonance spectroscopy showed a reduced ratio of creatine plus phosphocreatine (Cr + PCr)/choline-containing compounds.

These findings support that amphetamine psychosis is a different clinical entity. Pharmacological treatment for amphetamine psychosis may need to be specific to the disease itself.

This review suggests that antipsychotics are efficacious and clinically relevant for the treatment of amphetamine psychosis. However, amphetamine psychosis may respond to any of the arsenal of antipsychotics for the treatment of primary psychotic illnesses (psychosis not induced by a drug), and the psychosis induced by amphetamine may be self-limited. The cause of the disease is amphetamine, but the effect is difficult to delineate. A more targeted treatment will perhaps be found when neurophysiological findings can explain the clinical manifestation of the illness.

Individuals with amphetamine psychosis are both medically and psychiatrically unstable. The possibility exists that the psychosis may become chronic and trigger the development of a full-blown primary psychosis in patients who are genetically predisposed to a primary psychotic illness. Thus, the choice of treating amphetamine psychosis with antipsychotics seems to be clinically and ethically appropriate. Practitioners need to tailor their use based on individuals’ risks for side effects.

The trials investigated lacked placebo-controlled arms. The feasibility of a placebo-controlled trial in mentally unstable patients is challenging for researchers due to ethical and legal problems that may surface. It is not clear, considering these ethical limitations, whether more placebo-controlled trials are needed for the treatment of amphetamine psychosis.
« Last Edit: June 01, 2023, 01:18:48 AM by Chip »
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