Amphetamine-Related Psychiatric Disorders - An Overview.

What Is Amphetamine?

Amphetamine is a drug that acts as a CNS expand stimulant and is used to treat mental disorders like narcolepsy, depression, obesity, and other attention deficit disorders. Amphetamine also has certain non-medicinal uses as it is used for recreational purposes in such cases, it becomes addictive. It is structurally composed of two enantiomers: levoamphetamine and dextroamphetamine.

What Is Amphetamine-Induced Psychosis?

Amphetamine is a drug used to treat various disorders like depression, obesity, narcolepsy, etc. Still, when this drug is used for a prolonged duration or when used for recreational purposes like elevating mood, it is consumed in higher doses. It can cause psychosis which is a state of Amphetamine intoxication and has a similar presentation to mental disorders like schizophrenia. It has been a topic of discussion lately, but the exact relationship between Amphetamine use and psychosis is not completely understood. Amphetamine-related psychosis includes hallucinations and delusion, increased motor activity, disorganization of thoughts, lack of insight, anxiety, suspicion, and auditory hallucinations. Amphetamine-induced psychosis is usually caused after prolonged exposure to high doses of Amphetamine or when used for shorter periods along with substances that can cause drug interactions and reactions.

How Does Amphetamine Cause Psychosis?

Amphetamines are CNS stimulants called phenethylamines. The chemical structure of Amphetamine contains a methyl group to the alpha position on its carbon chain, which results in lipophilicity, increasing its volume of distribution, and CNS stimulation. It is a drug composed of levoamphetamine and dextroamphetamine. The mechanism of action of this drug is to inhibit dopamine and monoamine reuptake by inhibiting its transporters; it increases the amount of dopamine in the synapse and the cytosol as well, which is considered to be the possible cause of neurotoxicity that leads to the psychotic symptoms.

What Are the Symptoms of Psychosis?

As mentioned earlier, Amphetamine-induced psychosis has a similar presentation to schizophrenia.

A person with Amphetamine-induced psychosis has the following symptoms:

• Lack of concentration.

• Delusions of persecution.

• Increased motor activity.

• Disorganization of thoughts.

• Lack of insight.

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• Anxiety.

• Suspicion and auditory hallucinations.

What Is the Difference Between Schizophrenic Psychosis and Acute Psychosis Induced by Amphetamines?

To differentiate between schizophrenic psychosis and acute psychosis induced by Amphetamines is difficult, but studies have shown that both are different entities. The psychosis induced by amphetamine is cured in a week or two after discontinuation of the drug, whereas schizophrenia requires treatment and takes longer to heal. To diagnose, this is used as one of the criteria where a person on Amphetamine is asked to discontinue the medication, and then symptoms are monitored. If the symptoms improve on discontinuation, it is considered acute psychosis induced by Amphetamines. An individual might experience relapse or intermittent attacks, which are commonly accompanied by stress.

Are Amphetamine-Related Psychiatric Disorders Confused With Other Disorders?

Amphetamine-related psychotic disorders have a similar presentation to the following disorders apart from schizophrenia:

• Delirium.

• Depression.

• Opioid abuse.

• Thyrotoxicosis.

• Hypothyroidism.

• Inhalant-related disorders.

• Insomnia.

How Is Amphetamine-Related Psychosis Diagnosed?

It is very difficult to diagnose Amphetamine related psychosis due to agitation or history not mentioned properly. The diagnosis should be considered in any patient with tachycardia, hypertension, and psychosis. A detailed history is a key to diagnosis; attention must be paid to finding the route of drug administration, duration of use, and frequency of administration. The subject must be questioned if any other substance or drugs were ingested along with the Amphetamines as drug interactions or interaction with alcohol can also cause psychosis.

Clinical Examination Findings Would Be as Follows:

• Malnourished.

• Behavior changes.

• Tachycardia.

• Hypertension.

• Hyperthermia.

• The intraoral exam reveals decayed dental enamel and inflamed gingiva.

• Decreased salivation.

Subjects with Amphetamine-related psychosis generally have suicidal thoughts. Therefore, the staff must be alerted when such patients present due to psychosis.

Laboratory Evaluations-

Many patients who use Amphetamine for recreational, mood elevation purposes do not give the proper history or tend to lie, or patients with chronic symptoms who are unable to give history require laboratory examinations to support and confirm the diagnosis.

Following are the lab investigations used to detect Amphetamine use:

• Urine screening.

• Serum toxicology screening.

• Complete electrolyte panel.

• Serum lactate.

• Creatinine.

• Electrocardiogram in patients with tachycardia.

• X-ray imaging to rule out any associated trauma.

How Is Amphetamine-Related Psychosis Treated?

A full-blown Amphetamine-induced psychosis develops in very few individuals and presents as a medical emergency with symptoms like auditory and visual hallucinations and paranoid and persecutory delusions; these patients require emergency medical care to prevent further complications. The most common drugs used to revert Amphetamine psychosis are intravenous benzodiazepines (Lorazepam, Diazepam, or Midazolam) as first-line agents. Other agents used are Risperidone, Haloperidol, Ziprasidone, and Olanzapine. Lipophilic beta-blockers, such as Metoprolol and Labetalol. It is advised that the clinician never delay the treatment of Amphetamine related psychosis while waiting for the laboratory findings, as it is observed that discontinuation of Amphetamine resolves the symptoms in a week.

Conclusion:

Amphetamine-related psychotic disorders develop due to short or prolonged use of Amphetamine. This CNS stimulant acts by inhibiting dopamine and monoamine reuptake, which increases the dopamine in the synapse cytosol leading to neurotoxicity that results in psychosis. Amphetamine is prescribed in patients with depression, anxiety, and obesity to treat the symptoms, but in some cases, individuals use it for recreational purposes as well; the side effects of intoxication depend mainly on the route, frequency, and duration of administration. Amphetamine intoxication can also result from interaction with other drugs or substances like alcohol. The patient presents as malnourished, hallucinated, has tachycardia, and may have suicidal thoughts. Amphetamine-related psychiatric disorders are generally confused with schizophrenia and other substance-induced mental disorders. The condition may sometimes get severe and require emergency medical help; the treatment mainly aims at discontinuation of Amphetamine and monitoring symptoms that are expected to resolve in a week.