Amphetamines can promote wakefulness, focus, energy, euphoria, and anorexia (weight loss). These psychostimulants are available for drug treatment in mental health disorders such as attention deficit hyperactivity disorder (ADHD) or 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:
An individual attempting to quit amphetamine use is also likely to experience amphetamine withdrawal symptoms.
Amphetamine withdrawal side effects and symptoms can include:
More importantly, amphetamine use can also lead to psychosis similar to acute paranoid schizophrenia. Amphetamine psychosis occurs even in healthy individuals, lasting short-term from hours to days. It does not usually reside until the substance has been eliminated.
Psychotic symptoms will typically present as hallucinations (primarily auditory and/or visual) 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.
Like any other psychotic disorder, amphetamine psychosis may be dangerous to both the individual suffering the episode and others nearby.
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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 individuals 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, individuals 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 individuals 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 individuals have a preexisting risk of psychosis, and substance use can trigger acute episodes of the disorder. The negative correlation between the two aspects implies that individuals with low vulnerability would require high doses of amphetamine to produce psychosis. In contrast, individuals 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 an individual more susceptible to enter a psychotic state after exposure to multiple environmental stressors like amphetamine abuse.
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.
Individuals who experience stimulant psychosis like that caused by amphetamine will have symptoms similar to primary psychotic disorders. The following list details some of the main symptoms of amphetamine psychosis:
Additionally, methamphetamine abusers with psychosis reported experiencing the delusion of parasitosis or formication. Individuals 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.
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 of whether to consider amphetamine-induced psychosis as a separate diagnostic entity.
Some studies have implied that individuals with amphetamine-induced psychosis will report more pronounced grandiosity and visual hallucinations. However, these acute symptoms do not make diagnosis easier.
Disorganization of thoughts and loosening of associations are not common in amphetamine psychosis, although cases have been reported. These symptoms occur more often in individuals with schizophrenia.
Additionally, recovery from amphetamine-induced psychosis is much faster, although incomplete, when individuals abstain 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 individuals who have abused higher doses of amphetamine and for longer periods.
The neuropathology of amphetamine psychosis and schizophrenia is similar. This means that management and care will not differ very much. Health care professionals may use neuroleptics and antipsychotics, and/or benzodiazepines to address psychosis symptoms and behavioral agitation.
Some antipsychotic medications that have demonstrated some efficacy in treatment include haloperidol and olanzapine. There are, however, no standard guidelines.
As mentioned before, recovery from amphetamine psychosis was faster when individuals 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 individuals are believed to have an addiction to amphetamines, health care professionals may recommend inpatient care and other therapeutic approaches like cognitive-behavioral therapy. Combining treatment of amphetamine use will help individuals taper substance use and address causes that may have given rise to addiction.
When individuals 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.
Because symptoms can include persecutory delusions, 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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Farnia, V., & Golshani, S. (2016, April 01). Amphetamine-Induced Psychosis. Retrieved November 17, 2020, from https://www.sciencedirect.com/science/article/pii/B9780128002124000261
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COVID-19 Questions and Answers: For People Who Use Drugs or Have Substance Use Disorder, Centers for Disease Control and Prevention (CDC), February 2021, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/people-who-use-drugs/QA.html
Amphetamines, United States Drug Enforcement Administration, https://www.dea.gov/factsheets/amphetamines
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