Stimulant psychosis Classification and external resources ICD-10 F15.5 ICD-9 292.1
Stimulant psychosis is a psychotic disorder that appears in some people who use stimulant drugs. Most commonly, stimulant psychosis occurs in drug abusers who take large stimulant doses but, in rare cases, it can also appear in patients taking therapeutic doses under medical supervision. The most common stimulants involved are amphetamines and cocaine, though others have also been reported.
A 2007 article examined the limited amount of documentation and research currently available on methamphetamine-induced psychotic syndromes. In nearly every case, the symptoms of methamphetamine-induced psychosis (as well as stimulant psychosis in general) will stop within 7–10 days of discontinuing the drug, however, in some cases discontinuation symptoms have been reported to last for months.
Furthermore, a small percentage of long-term or "heavy" users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence.
Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term methamphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.
Spontaneous and long-term recurrences (akin to "flashbacks") are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.
The key distinction between this condition and e.g. a psychotic disorder or schizophrenia, is that the symptoms of a methamphetamine-induced psychotic disorder are not considered to be permanent and will eventually subside with abstinence and proper treatment.
Cocaine is known to induce psychosis as well, and more than half of cocaine abusers report having experienced at least some psychotic symptoms at some point.} Typical symptoms of sufferers include paranoid delusions that they are being followed, and that their drug use is being watched, often with hallucinations to match. Delusional parasitosis with formication ("cocaine bugs") is also fairly common. Cocaine-induced psychosis shows sensitization in that psychosis tends to become more severe and occur more rapidly with repeated use of the drug.
Methylphenidate, a central nervous system stimulant with the same mechanism of action as cocaine, can also lead to a psychosis from chronic use. Although the safety profile of short-term methylphenidate therapy in clinical trials has been well established, repeated use of psychostimulants such as methylphenidate is less clear. The long term effects of methylphenidate such as drug addiction, withdrawal reactions and psychosis has received very little research and thus the long term effects of using stimulants for ADHD are largely unknown. Short term clinical trials show a very low incidence of methylphenidate induced psychosis of 0.01%. A study published in 1999 showed that 6 of 98 children prescribed methylphenidate in an outpatient clinic developed psychosis, but the study was naturalistic, and the lack of a control makes it impossible to determine if this was an effect of the medication. The long term effects on mental health disorders in later life of chronic use of methylphenidate is unknown. Concerns have been raised that long-term therapy might cause drug dependence, paranoia, schizophrenia and behavioral sensitisation, similar to other stimulants. Psychotic symptoms from methylphenidate can include, hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, mania, grandiosity, paranoid delusions, confusion, increased aggression and irritability. Methylphenidate psychosis is unpredictable in whom it will occur. Family history of mental illness does not predict the incidence of stimulant toxicosis in ADHD children.
The withdrawal or rebound symptoms of methylphenidate can include psychosis and depression. Stimulant withdrawal or rebound reactions can occur and should be minimized in intensity, i.e. via a gradual tapering off of medication. A very small study of abrupt withdrawal of stimulants suggests that withdrawal reactions are not typical. Nonetheless withdrawal reactions may still occur in susceptible individuals.
There is evidence that caffeine, in extreme acute doses or when severely abused for long periods of time, may induce psychosis in some individuals. This infrequently reported and somewhat controversial effect has not been very well studied, however, and it is not clear whether it proceeds by a similar mechanism as other stimulant psychoses or whether it is an entirely different phenomenon. However, like other stimulants, caffeine is now known to increase dopamine levels as one of its effects, albeit indirectly.
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Psychoactive substance-related disorder (F10–F19, 291–292; 303–305) General Alcohol Opioids CannabisSID (Short-term effects of cannabis, Cannabis withdrawal) · SUD (Cannabis dependence) Sedative/hypnotic Cocaine StimulantsSID (Stimulant psychosis) · SUD (Amphetamine dependence) · Health effects of caffeine (Caffeine-induced sleep disorder) Hallucinogen Tobacco Volatile solventsInhalant abuse: Toluene toxicity Multiple
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