Can Methamphetamine Use Lead to Paranoia and Psychosis? - Psychiatry

Dr. Zheng Jingming reply Psychiatry

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Hello, it is highly likely that your friend has been diagnosed with amphetamine psychosis.
It is recommended to consult a psychiatrist for differential diagnosis, addiction treatment, and therapy.
Below is a brief overview of the relationship between amphetamines and psychosis, as well as concepts related to diagnosis, addiction, and treatment.
Substance abuse has become a widely recognized social issue in recent years and is a significant concern for many clinical practitioners.
Since its synthesis in 1887, there have been over thirty derivatives of amphetamines.
The most commonly abused form in Taiwan is methamphetamine, colloquially known as "ice," "speed," or "crystal." It can be smoked, ingested orally, or injected.
After use, the drug can be detected in urine, but it is typically undetectable after 48-72 hours.
Amphetamines have a potent effect on the brain, which can lead to significant psychological or neurological damage.
The relationship between amphetamine use and the onset of psychosis is complex; it remains unclear whether psychosis is a direct result of amphetamine use or if it triggers underlying psychotic disorders.
Amphetamine psychosis can occur in two scenarios: in acute intoxication or in long-term users.
Acute intoxication occurs with a single, large dose (often seen in inexperienced users or accidental ingestions) and requires emergency medical attention, as it can lead to psychotic symptoms and potentially fatal outcomes due to causes such as cerebral hemorrhage, cerebral edema, heart failure, and hyperthermia.
In long-term users, amphetamine psychosis is more common among those using high doses (greater than 90-100 mg/day, though individual tolerance varies), particularly in intravenous users and those with a history of use spanning 1-3 years or more.
Long-term, high-dose use of amphetamines can lead to drug tolerance, making overdose deaths less common.
A notable phenomenon in amphetamine psychosis is that even after cessation of use, a small amount of amphetamine or significant stress can trigger a recurrence of psychotic symptoms.
Clinical symptoms of amphetamine psychosis resemble those of paranoid schizophrenia, ranging from early signs such as talkativeness, laughter, anxiety, and fear, to more severe symptoms like paranoid delusions, suspicion, illusions, and hallucinations.
Auditory hallucinations are most common, but visual, tactile, or gustatory hallucinations can also occur.
Additionally, compulsive behaviors are frequently observed, and there may be associated suicidal, self-harming, or aggressive behaviors.
Clinically, although patients may have normal memory and orientation, those using high doses or with habitual use often act based on their illusions or hallucinations, leading to accidents.
For instance, some patients may hear non-existent voices urging them to commit suicide, resulting in fatal outcomes.
There have been tragic incidents, such as cases of filicide or arson and self-harm linked to amphetamine psychosis.
Most psychiatric symptoms gradually resolve within a few days after discontinuation of the drug, rarely extending beyond a month.
However, some cases may persist for over six months, and a few can last for more than a year or even several years, necessitating differentiation from schizophrenia.
Some psychiatrists may classify cases lasting over a year directly as schizophrenia.
Distinguishing between symptoms of amphetamine psychosis and paranoid schizophrenia can be challenging; however, amphetamine psychosis typically exhibits less disorganized thinking, inappropriate affect, or bizarre delusions, and does not show the marked personality deterioration seen in schizophrenia.
Additionally, individuals with amphetamine psychosis tend to be younger, often have a history of alcohol or substance abuse, and frequently present with antisocial personality traits, as well as a family history of substance use disorders.
Once addicted to amphetamines, withdrawal symptoms can appear within approximately 24 hours of cessation, including fatigue, depression, anxiety, irritability, and generalized weakness, with severe cases potentially leading to suicidal behavior.
Individuals exhibiting amphetamine psychosis should seek psychiatric or addiction treatment, which may include hospitalization.
Treatment typically involves the use of antipsychotic medications, but fundamentally, it is crucial to address the addiction to amphetamines.
Currently, Taiwan's mental health approach views addiction as a "disease," treating substance abusers as patients.
This disease perspective allows for proactive medical intervention in addiction treatment.
The basis of the disease model is that patients must have the motivation to change their addiction and be willing to actively participate in treatment to address the issues stemming from substance abuse.
Substance use is merely a manifestation or symptom, a means of escape from difficulties and conflicts; the real change must occur within the individual, which requires psychological rehabilitation for addiction.
This reflects the current medical model encompassing biological, psychological, and social treatment approaches.
Family support is also essential, treating them as patients and patiently assisting them in adhering to long-term treatment.
If you have further questions, feel free to email me.
Dr.
Cheng Jingming, Psychiatrist, Qishan Hospital, Department of Health
Email: [email protected]

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Reply Date: 2002/04/07