Methamphetamine psychosis

บทคัดย่อ

Objective To review the currently available knowledge on methamphetamine psychosis from national and international databases. This review addresses methamphetamine psychosis diagnosis, risk factors, clinical manifestation, clinical course, psychosis relapse and chronicity, outcomes, and management.

Materials and methods The English literatures were searched in the database of PubMed, NIDA and Cochran Library and the Thai literatures were searched in Thai library database,  retrieved the articles 20 years back (since 1989) and found 73 related articles.

Results  Methamphetamine could produce a brief psychotic reaction with more vulnerable in high risk group such as psychotic genetic predisposition, pre-morbid brain dysfunction, chronic and heavy methamphetamine use, young onset of methamphetamine use, or problematic personality trait to develop severe or chronic psychosis. The clinical symptoms showed prominent positive psychotic symptoms such as persecutory delusion and hallucination, but negative symptoms such as poverty of speech, psychomotor retardation, and flattened affects were also documented. In acute psychosis, the stepped care approach should be provided based upon the patient’s condition. Benzodiazepines should be the first line treatment, if ineffective, the antipsychotics should be stepped with oral medications, intramuscular and/or intravascular medication, respectively. Both conventional and novel antipsychotics were effective in acute psychosis. More than half of patients experienced relapse psychosis, frequently trigger by methamphetamine reuse. The prolonged psychosis which persisted more than one month should be considered as schizophrenia. Premature death was reported as long-term outcomes of methamphetamine psychosis caused by suicide, accidents and AIDS. Other serious psychiatric symptoms were commonly included drinking problems and depression. These patients also had poor functional outcomes including medical, legal and employment areas.

Conclusion Methamphetamine psychosis presented both positive and negative syndrome of psychosis and responded well to antipsychotics treatment. Methamphetamine reuse was a significant risk of psychosis relapse. The high risk groups were vulnerability to chonicity. The long term outcomes showed mental health, physical health, and social problems.