Predictors of Persistent Psychotic Symptoms in Persons With Methamphetamine Abuse Receiving Psychiatric Treatment

Abstract

The objective of this study was to identify predictors of sustained psychotic symptoms after methamphetamine (MA) abuse during the course of 6 months from patterns of MA and other substance use, depressive symptoms, family history of psychosis, antisocial personality disorder, and trauma history. A total of 295 individuals with MA abuse and psychotic symptoms seeking psychiatric services were assessed at baseline and then monthly on symptoms and substance use for 6 months. Trajectory analyses revealed two trajectories of the individuals with positive symptoms, with one group presenting with persistent psychotic symptoms (30% of the sample). Those with persistent psychosis were significantly older, had more severe psychotic symptoms, misused MA for more years, had more antisocial personality traits, and had more sustained depressive symptoms. The strongest predictors of belonging to the persistent psychosis group, via logistic regressions, were more severe psychotic symptoms, longer use of MA, and sustained depressive symptoms. Our results highlight the important comorbidities, especially regarding depressive symptoms and persistent psychosis, in individuals seeking psychiatric help after MA abuse. This study also highlights the importance of identifying people with persistent psychosis within MA users to facilitate rapid and effective treatment of co-occurring psychotic disorder.

The profile of psychiatric symptoms exacerbated by methamphetamine use

“…The affective accompaniment to this psychosis (dominated by depression, suicidality, hostility and self-neglect) is not recognized in the diagnostic criteria for substance-induced psychosis (American Psychiatric Association, 2013) but our results are consistent with Srisurapanont et al (2011), who also found an affective symptom dimension, and other research showing elevated levels of depression among people diagnosed with methamphetamine psychosis relative to other users of the drug (Chen et al, 2003;Lecomte et al, 2013). These collective findings suggest that affective symptoms may be a core feature of the methamphetamine psychosis, perhaps similar to depression with psychotic features or schizoaffective disorder (Tsuang et al, 1982).…”

Understanding the Relationship Between Amphetamines and Psychosis

“…The proportion of Bpersistent type^methamphetamine psychosis in the first, second, and third epidemics of methamphetamine use in Japan were respectively 24, 18, and 41 % [33]. Also outside Japan, the long-lasting symptoms have been observed; one third had psychotic symptoms in a 6-month follow-up in a Canadian study [22], and 9 % had symptoms for more than 1 month in an Iranian study [17]. Even if we cannot be totally sure we are talking about the same thing, the Bpersistent^or Bchronic^psy-chosis after the intake of amphetamines would probably be viewed, in a western perspective, as primary psychosis precipitated by the use of amphetamines.…”

“…Several studies have found a dose-response relationship between precipitation of psychotic symptoms and the amount of amphetamines administered in laboratory investigations [9,11], the amount used during the previous month [14•], age of onset [18][19][20], years of use [21,22], and severity of the SUD [23]. Both the probability of experiencing psychotic symptoms and the severity and duration of the psychosis are affected by these exposures.…”

“…Psychiatric familial morbidity increases the probability and duration of amphetamine-induced psychosis [52,53]. Major depressive disorder occurs more often among users of amphetamines with psychosis compared to those without psychosis [18,54] and more often among users with persistent psychotic symptoms versus those with brief symptoms [22]. Antisocial personality disorder is more prevalent among users of amphetamines with psychosis than among those without [18,54].…”

“…Even if we cannot be totally sure we are talking about the same thing, the Bpersistent^or Bchronic^psy-chosis after the intake of amphetamines would probably be viewed, in a western perspective, as primary psychosis precipitated by the use of amphetamines. Also, the limit of 1 month as differentiating between psychoses from amphetamines and primary psychosis may seem arbitrary [17,22,33].…”