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126

Section 3

Organic syndromes of schizophrenia:

9 Stimulantsandpsychosis

Nash N. Boutros, Matt P. Galloway, and Eric M. Pihlgren
Facts box

bias toward the atypical antipsychotics as
r
Acute intoxication with psychostimulants
first-line treatment.

r

commonly leads to the acute emergence of
Early treatment and retention of stimulant
psychotic symptoms.

users in mental health care services is

r
Careful history taking and urine and blood
recommended to prevent the development of
tests are usually sufficient to alert the
a chronic psychotic condition.

clinician to the possibility of a drug-related
problem.

r
Depending solely on the clinical presentation
Whether or not psychostimulant use can cause a
is not advisable given the current state of
chronic psychotic disorder in humans that is clinically
knowledge.

similar to schizophrenia remains an open and impor-r
A period of followup in the absence of
tant question with diagnostic, therapeutic, and prognos-continued drug use is usually helpful to
tic implications. In this chapter, we examine the exist-confirm a diagnosis.

ing literature to determine if there is enough evidence
r
First use of amphetamines or cocaine before
to support the notion that abuse of psychostimulants
the age of 16 years and severe cannabis or
can cause chronic psychotic disorders. We also inves-cocaine dependence may be related to an
tigate whether drug-induced psychotic states can be
increased risk of psychosis.

self-sustaining (i.e. autonomous) or require continued
r
Stimulant-induced psychoses are very likely
drug use. If continued drug use is necessary, what level
to clear within several days to about 1 month
of use is needed in order to sustain the syndrome?

of abstinence. Only 1%–15% of patients with
Psychostimulant models of psychosis are impor-stimulant-induced psychoses maintain some
tant animal models for human schizophrenia
[1, 2, 3,

psychotic symptoms after a month.

4].
Angrist and Gershon
[5]
observed that the symp-r

tomatology of experimentally induced amphetamine
Research from Japan showed that family

psychosis closely resembles endogenous schizophre-members of patients with methamphetamine
nia. Similarly, Snyder
[6]
considered amphetamine
psychosis had a five times greater morbid
psychosis to be a “model” schizophrenia due to the
risk for schizophrenia than users without
strong similarity of its clinical features to paranoid
psychosis.

r

schizophrenia.

The pattern of stimulant abuse most

Acute intoxication with psychostimulants (i.e.,

commonly associated with the induction of

methamphetamine (MA), amphetamine, or cocaine)
psychosis is the initial use of lower doses,
commonly leads to the acute emergence of psychotic
typically administered in an escalating

symptoms
[7]
. Although this can contribute to diag-manner and ultimately leading to multiple
nostic confusion in the emergency room, careful his-binges or runs.

r

tory taking and urine-and-blood tests are usually suf-The current trend for psychostimulant-

ficient to alert the clinician to the possibility of a
induced psychosis is for initial treatment

drug-related problem
[8]
. Although these authors pre-with antipsychotics, with a
sented evidence that some clinical differences can
127