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What Is Amphetamine Psychosis?

Psychosis is a condition that causes a person to experience a disconnect from reality, losing the ability to differentiate real life from psychological processes. Different things may cause psychosis, but one of the most common causes is related to the use of amphetamine. 

Amphetamine-induced psychosis can be caused by two things: the use of amphetamine (substance-induced psychosis) or as a withdrawal symptom (amphetamine withdrawal psychosis).  It is similar to acute paranoid schizophrenia and can occur even in healthy people, lasting short-term from hours to days. It does not usually subside until the substance has been eliminated. 

Psychotic symptoms will typically present as auditory and visual hallucinations and persecutory delusions (occurs when paranoia is extreme). However, more symptoms do exist. 

Some psychotic symptoms have been reported to be present in 13 to 45% of amphetamine users. 

Not all amphetamine users will experience amphetamine psychosis. It depends on several factors like individual difference, reaction to the drug, presence of other mental health conditions, and many more. But like any other psychotic disorder, amphetamine psychosis may be dangerous to both the person suffering the episode and others nearby.

What are Amphetamines?

Amphetamines are psychostimulant drugs known to stimulate the central nervous system (CNS). They cause excitation and speed up the messages traveling between the body and the brain. Amphetamines can promote wakefulness, focus, energy, euphoria, and anorexia (weight loss).

Doctors prescribe Amphetamines to treat several conditions. These include attention deficit hyperactivity disorder (ADHD), Parkinson's Disease, and narcolepsy (when sleep-wake cycles are dysregulated and cause extreme daytime sleepiness). 

Some common examples of amphetamines include methamphetamine, Adderall, and dextroamphetamine.

However, amphetamine use can cause different health issues, such as:

  • Anxiety
  • Hyperactivity
  • Extreme agitation
  • Hypertension (high blood pressure)
  • Arrhythmia (irregular heart rate)
  • Tachycardia (fast heart rate)
  • Headaches 
  • Paranoia
  • Mydriasis (pupil dilation)

A person attempting to quit amphetamine use is also likely to experience amphetamine withdrawal symptoms.

Amphetamine withdrawal side effects and symptoms can include:

  • Tiredness and an increased need for sleep
  • Increased appetite
  • Involuntary bodily movements and twitches
  • Vivid and/or unpleasant dreams
  • Slowed reaction and movement
  • Aches and pains
  • Irritability and/or agitation
  • Depression

Amphetamines have a high potential for abuse, misuse, and dependence. These psychostimulants release dopamine and norepinephrine, which are euphoria-triggering neurochemicals in the central nervous system (CNS). When left untreated, addiction to amphetamines can increase the risk of acute and chronic amphetamine psychosis. 

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Causes of Amphetamine Psychosis

There may be different reasons for amphetamine-induced psychosis. Mental care professionals within the field of psychiatry have proposed various models as hypotheses to explain the development of the disorder. 

For example, one cause may be drug use alone. Although evidence is lacking, this model implies that everyone who takes amphetamines must be psychotic.  

Another hypothesis is the self-medication theory. This model suggests that people with psychiatric disorders may use drugs to reduce their symptoms or antipsychotic medication side effects. This model is controversial, though. While the prevalence of primary psychotic disorder has remained steady, substance abuse incidence in these patients has risen significantly. At the same time, people frequently began abusing drugs before the development of their disease. 

The third hypothesis model relates to primary addiction, suggesting a shared neural pathway between schizophrenia and addiction. These pathways highlight a dysregulation of an expansive neural network in the brain due to neurochemical and neurophysiological changes. These alterations can then raise the likelihood of psychosis occurring in people using the drug. 

Finally, the stress vulnerability model is the hypothesis used to explain the development of amphetamine-induced psychosis. In simple terms, this model suggests that people have a pre-existing risk of psychosis, and substance use can trigger acute episodes of the disorder.

The negative correlation between the two aspects implies that people with low vulnerability would require high doses of amphetamine to produce psychosis. In contrast, people with high vulnerability would require less or low doses of the drug. 

However, these hypothesis models are not the only possible explanations for psychosis. Other risk factors for the disorder may include having several specific genes. These genes may make a person more susceptible to enter a psychotic state after exposure to multiple environmental stressors like amphetamine abuse.

Symptoms of Amphetamine Psychosis

People who experience stimulant psychosis like that caused by amphetamine will have symptoms similar to primary mental disorders such as schizophrenia. Similarly, a person experiencing amphetamine withdrawal psychosis will experience the same symptoms as a person with psychosis due to amphetamine use.

The following list details some of the main symptoms of amphetamine psychosis:

  • Paranoid delusions
  • Auditory hallucinations 
  • Visual hallucinations
  • Disorganization of thoughts
  • Lack of concentration
  • Agitation
  • Grandiosity delusions
  • Jealousy delusion
  • Persecutory delusion
  • Lack of insight

Additionally, people with methamphetamine-induced psychosis reported experiencing the delusion of parasitosis or formication. People with this type of delusion believe that bugs have infested them and/or are biting them. Another term used to describe this symptom is METH mites

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How is Amphetamine-Induced Psychosis Diagnosed?

Amphetamine-induced psychosis can be difficult to diagnose because of its similarities to primary psychosis caused by schizophrenia. It is still a question of debate whether to consider amphetamine-induced psychosis as a separate diagnostic entity. 

Some studies have implied that people with amphetamine-induced psychosis will report more pronounced grandiosity and visual hallucinations. However, these acute symptoms do not make diagnosis easier. 

Although cases have been reported, disorganization of thoughts and loosening of associations are not common in amphetamine psychosis. These symptoms occur more often in people with schizophrenia. 

Additionally, recovery from amphetamine-induced psychosis is much faster, although incomplete, when a user abstains from amphetamine use. 

Further difficulties that arise in diagnosis are masking of psychotic symptoms due to other antipsychotic medication. It may be challenging to tell if abstinence from amphetamine is the main contributor to improvements in mental health. 

Extended psychosis tends to occur in people who have abused higher doses of amphetamine and for longer periods.

Treatment for Amphetamine Psychosis 

The neuropathology of amphetamine psychosis and schizophrenia is similar. This means that management and care will not differ very much. When treating amphetamine psychosis, health care professionals may use neuroleptics and antipsychotic medications and/or benzodiazepines to address psychosis symptoms and behavioral agitation. 

Some antipsychotic drugs that have demonstrated some efficacy in treating substance-induced psychotic disorders include haloperidol and olanzapine. There are, however, no standard guidelines.

As mentioned before, recovery from amphetamine psychosis was faster when a user discontinued taking amphetamine. In fact, in the majority of cases, no pharmacotherapy was necessary to resolve an acute psychosis state when amphetamine use was discontinued. 

If someone is believed to have an addiction to amphetamines, health care professionals may recommend other addiction treatment options such as inpatient care and cognitive-behavioral therapy.  Combining treatment of amphetamine use will help a user taper substance use and address causes that may have given rise to addiction.

What Can Happen If Drug-Induced Psychosis Is Left Untreated?

When a user do not seek treatment for drug-induced psychosis, there is the risk of recurrence and/or worsening symptoms. Acute drug-induced psychosis can become chronic. 

A substance-induced psychotic disorder can cause symptoms such as persecutory delusions. If left untreated, there is the additional risk of danger to oneself or others.

Finally, drug-induced psychosis may be indicative of underlying substance addiction. Many drugs, such as amphetamine, present a risk of severe health conditions like overdose and death.

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Resources

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Bramness, J., Gundersen et al. "Amphetamine-induced psychosis--a separate diagnostic entity or primary psychosis triggered in the vulnerable?." BMC Psychiatry.

Farnia, V., & Golshani, S. (2016, April 01). "Amphetamine-Induced Psychosis." Neuropathology of Drug Addiction and Substance Misuse, Science Direct.

NIDA. "Part 1: The Connection Between Substance Use Disorders and Mental Illness." National Institute on Drug Abuse, 28 May. 2020.

"COVID-19 Questions and Answers: For People Who Use Drugs or Have Substance Use Disorder." Centers for Disease Control and Prevention (CDC), February 2021,

"Amphetamines." United States Drug Enforcement Administration.

Moran, Lauren V et al. “Psychosis with Methylphenidate or Amphetamine in Patients with ADHD.” The New England journal of medicine vol. 380,12 (2019): 1128-1138. doi:10.1056/NEJMoa1813751,

Related Pages

Amphetamines Uses, Effects, and Addiction

Amphetamine Overdose

Illegal Drugs

Meth Psychosis

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