Stimulant Psychosis

AMPHETAMINES
Amphetamine psychosis is a toxic reaction closely resembling schizophrenia that may occur after chronic, short-term, or single large-dose amphetamine use. Onset of symptoms with IV usage can occur within 30-75 minutes. With oral ingestion, the syndrome may be seen within hours in apparently sensitized subjects by as little as 55 to 75 mg of dextroamphetamine. Characterized as a paranoid psychosis, the syndrome was first described by Young in 1938, six years after the introduction of amphetamine as a decongestant and narcoleptic (Young and Scoville 1938). Presentation In 1958, Connell (1958) published his classic study of amphetamine psychosis in 42 patients (27 males, 15 females) which represented the first large sample that described this syndrome. He conducted a structured psychiatric and drug history interview of these patients, who had been hospitalized because of violence, suicide attempts, and requests for police protection. Twelve patients reported being chased by a gang; another ten complained of persecution of one kind or another. All patients provided extremely detailed information about their paranoia. Importantly, Connell noted that it was difficult to nearly impossible for an experienced psychiatrist to differentiate between amphetamine psychosis and paranoid schizophrenia. Over a third of the patients on whom drug histories were available received the drug from their physicians for indications that included fatigue, depression, "pep," and obesity. The doses that produced the reactions were coarsely estimated as ranging from 50 to 1687 mg. Among this group, doses of greater than 500 mg/day were common. Although the majority of the patients developed the reactions after prolonged drug use, nine (21%) developed psychotic reactions after a single dose or a large dose divided over a three-day period. The entire series consisted of patients ingesting the drug orally. The most important clinical sign of the toxic psychosis was the lack of disorientation in these individuals and positive schizophrenic-like symptoms. Delusions of persecution, in 34 (81%); hallucinations, in 29 (69%); ideas of reference were present in 26 (60%); auditory visual hallucinations, in 21 (50%); tactile hallucinations, in 5 (12%); and olfactory hallucinations, in 4 (10%). In the 35 patients on whom information was available, 77% recovered in six to seven days. The most obvious symptoms of withdrawal were dysphoria followed by sleepiness. Angrist and Gershon (1969) described 60 amphetamine-related admissions to Bellevue Psychiatric Hospital in New York City. The patients had been using oral or IV amphetamines for a mean of 3.7 years (once to 20 years) at a mean dose of 166 mg/d (20-800 mg/d). Table 1 shows the primary presenting symptomatology in the patients. Table 1. Presenting symptomatology of 60 amphetamine psychosis admissions. Paranoid-hallucinatory psychosis 19 (32%) Paranoid psychosis 13 (22%) Hallucinosis 4 (7%) Suicide attempts or gestures 4 (7%) Bizarre behavior 4 (7%) Exhaustion 3 (5%) Barbiturate overdose 3 (5%) Emotional lability 3 (5%) Destructive outbursts 2 (3%) Assaultiveness 2 (3%) Bell (1973) was able to produce an amphetamine psychosis in 12 of 14 patients dependent on amphetamine within usually 30-75 minutes of the start of an IV infusion. The dosing endpoint was when the blood pressure increased by 50% of its resting level. All except four of the injections were concluded within an hour while the remainder were terminated within 75 minutes. Total doses of 55-640 mg produced paranoid delusions in 12/14 (86%) of the subjects. The paranoia was mild in most subjects. Many tried to conceal the fact that they were experiencing a psychosis. The constant features were paranoia in a setting of clear consciousness, ideas of reference and ideas of influence. The psychosis lasted from 1-2 days in 9 cases and for 6 days in 2 cases and 26 days in a patient who was actually covertly ingesting his own amphetamine "stash" while in the hospital. Auditory hallucinations were reported in eight (57%) while visual hallucinations were reported in five (36%) patients. On recovery all except two of the 12 who had become psychotic described auditory and/or visual hallucinations. Interestingly, all 12 while intoxicated attempted to conceal their psychotic symptoms, even when it was clearly evident from their abnormal behavior and speech that they were psychotic. Importantly, no evidence of delirium was noted in any of these cases. This is of forensic importance in that intoxicated patients may be paranoid and hallucinating but not disoriented, confused or having memory difficulty.

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lorenzo_benzo said:

Furthermore, for me it only takes 2 days (48 hours) on meth, and i start to get paranoid, and get twisted thoughts, hearing/seeing shit that isn't there e.g. police. But driving in this state is kinda scarey, you feel like a F1 driver, and you gotta get away from the other cars not noticing that you drifting around corners and being wreckless.

Best thing for psychosis is sleep, benzos, or anti-psychotics (just in case).

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Samson said:

I think psychosis is caused by an imbalance between adrenaline and dopamine, with the former going disproportionately higher than the latter. This can be fixed by taking tyrosine.

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