Talk:Stimulant psychosis

Dispute text
Having been diagnosed and hospitalized 3 times with Amphetamine induced psychosis, long term abuser and ex-addict of amphetamines. I totally refute the accuracy of the first line and much of the wording of the last "major update". This is where the text book theory was found$$76.105.62.118 (talk) 04:11, 16 May 2008 (UTC)Danielle Small Text Johnson]]$$... and real medicine cross the line. The previous entry was most accurate in describing the symptoms and causes of amphetamine psychosis. Furthermore cocaine is not a similar or like compound of amphetamines (you cannot derive one from the other) and in know way can a comparison of symptoms and effects be made. Since I'm sick and tired of lame WP edit wars I won't change the the current text, but only to let people know that there is a more accurate description in the page history.

Amphetamine psychosis is a form of psychosis which results from large or chronic doses of amphetamine, methamphetamine or similar compounds (such as cocaine).

Don't be fooled. 67.3.217.215 21:32, 4 Jul 2004 (UTC)


 * Hi there,
 * I've taken the definition from the medical literature so should be accurate. However, your point about cocaine is a good one, and that part of the definition is badly explained, so have re-worded to make the comparison between it and amphetamine clearer (they have similar pharmacological effects although being quite different molecules). - Vaughan 21:53, 4 Jul 2004 (UTC)


 * The medical literature is not always accurate in this regard. As the anon posted, book theory, clinical practice and "street" (not necessarily in the sense of the illicit drug culture) experiences are three different things. Some people can get amphetamine psychosis from a single 5mg tablet, others can take 500mg without a problem; some can get it the first time they try, others use it for the rest of their lives with no problems. And it's not limited to amphetamine; you can get various similar experiences from many different kinds of drugs. In the experience of most legal and illegal users I know of, it is related to a synergy with long-term sleep deprivation (often caused by the drug itself, which is why it is more common with amphetamines, I'd wager). Zuiram 06:36, 7 February 2007 (UTC)
 * What do you consider long term sleep deprivation? Booke988 (talk) 01:07, 15 June 2010 (UTC)

Booke988 (talk) 01:07, 15 June 2010 (UTC)
 * Agreed. It's not the particular drug that's important - it's the effect that matters. Both cocaine and amphetamine are dopamine agonists (and norepinephrine/serotonin to lesser degrees), and as such, both drugs can cause "amphetamine psychosis" (which, as the article explains, is better termed "stimulant psychosis"). The statement that "cocaine is not a similar or like compound of amphetamines" is utterly false for the above reason. Structurally the two drugs are different, and yes, "you cannot derive one from the other", but nonetheless they both have the ultimate effect of increasing synaptic levels of dopamine (and norepinephrine/serotonin).Fuzzform (talk) 05:37, 20 December 2008 (UTC)

Reprising User Zuiram's, et al., remarks ultra and keeping in mind that some people suffer psychotic breaks without having taken any drugs at all; I suggest (or concur) that stimulant psychosis is better understood as sleep deprivation induced psychosis. Of course, it is the stimulant abuse that has induced the sleep deprivation in the ordinary case. But this as mechanism explains why cocaine would be typified as similar to amphetamine and, additionally, lends a general clarification. Although I do not have proper citations at hand I recall from my research that usually such induced psychosis resolves after the sleep depriving agent (being abused in an escalating dosage "binge" pattern) is withdrawn (with the exception of that poor lady in "Requiem for a Dream") and further (this is even more needful of a citation - I originally found it in a psychiatric research journal by Google-ing "amphetamine + tardive stereotypy") that stimulant induced tardive sterotypies (mindlessly repetitive gestures or activities & mentioned immediately infra) may be resolved by administering additional stimulants - jumping the groove, as it were. My understanding is that single low dosage induction of a stimulant psychosis (sic) is exceedingly rare. Key in this whole issue is the phrase "used as directed". Acute or critical long term sleep deprivation might be 72 hours, or less, and at which point you're also courting immune system failure but with more effort it can also be accomplished with extended chronic sleep deprivation. As there has been some mention of symptoms; I wonder if sitting in semi-darkness filing your fingernails for a very long time and not noticing they had some time ago begun bleeding is a psychotic break, a tardive stereotypy from hell, or both. That's about the worst I've seen happen to anyone who thought to have a staying awake contest with Gilgamesh. 216.249.80.160 (talk) 06:41, 21 March 2012 (UTC)

Motor sterotypies
The phrase 'motor stereotypies' is correct. See literature on PubMed. Please do not change it to 'motor stereotypes'.

- Vaughan 08:31, 10 Oct 2004 (UTC)

--- This article does not say whether or not amphetamine psychosis can be permanent. I've googled around and found that some people claim that it can cause permanent psychosis :http://www.ravesafe.org/otherinfo/psychosis.htm is one example. Also I've had a personal experience where someone I knew used methamphetamine heavily for a relatively short period of time (about 2 months) and has ever since heard voices and had extremely paranoid thought patterns.


 * If this is at all possible, I'd look for predisposing factors (e.g. genetics), dosage, purity of the drug in question, and so forth. It usually takes a lot to cause a permanent effect, biologically speaking. However, it is possible that a person with the "right" personality traits might later internalize the experience in some way, and change due to that. You sure this acquaintance isn't still using, or having sleep deprivation issues? Zuiram 06:36, 7 February 2007 (UTC)


 * I specifically came onto this page to comment that this article does not mention the permanency/duration of this syndrome; despite this already being noted, I'll leave this comment in the hope that it helps encourage a capable person to find more on this. 82.29.115.246 (talk) 05:10, 3 April 2009 (UTC)

- Fine!! —Preceding unsigned comment added by 58.69.4.211 (talk) 16:33, 24 July 2008 (UTC)


 * Another possibility is that excessive methamphetamine use lead to the development of latent Schizophrenia or Schizoaffective disorder. This is particularly true as regards the use of any synthetic street drugs, which often contain neurotoxic residues from the various chemicals used by untrained individuals in the clandestine synthesis process, as well as other unknown adulterants added by unscrupulous individuals. Or, as was suggested above, it may be due to continued use or sleep deprivation.Fuzzform (talk) 05:37, 20 December 2008 (UTC)

Treatment?
A few words on treatment would be nice. The hospital scenes from Requiem of a Dream were very disturbing.


 * Riding it out, without taking any more of the drug, works for the light cases. Major tranquilizers work for the heavy cases. Benzos may let an otherwise stable person cope with an intermediate case. If the scenes were disturbing (I haven't seen the movie), then good on them, it can be a very disturbing and scary thing to experience. Zuiram 06:36, 7 February 2007 (UTC)


 * Uhh... that movie was quite far removed from reality. I wouldn't take it as being representative of actual real-life drug treatment procedures, or even as a factual representation of drug use in general. It's riddled with factual errors and dramatic exaggerations. But in any case, what Zuiram suggests is more or less the standard set of treatments. Though, I might add that benzodiazepines probably wouldn't be given to someone with a history of drug abuse. Neuroleptics (such as haldol, risperidone, quetiapine, etc.) would be used first; particularly quetiapine, since it's regularly used off-label as a sedative-hypnotic, and is a dopamine antagonist.Fuzzform (talk) 05:37, 20 December 2008 (UTC)

stimulant toxicosis
Suddenly the paragraph on methamphetamine starts discussing stimulant toxicosis. Do they mean psychosis? —Preceding unsigned comment added by 150.203.110.137 (talk) 19:01, 15 August 2009 (UTC)

Caffine
I removed the entire first sentence of this section. It lists the reasons that caffine's potential to cause stimulant psychosis has been overlooked. First, it is original research. Secondly, it goes on to explain how it can happen, whilst citing quotes from doctors. That seems to mean that it, has not, in fact, been overlooked.Mk5384 (talk) 14:21, 19 May 2010 (UTC)

Emergency Treatment section
"This section needs attention from an expert on the subject. See the talk page for details. WikiProject Medicine or the Medicine Portal may be able to help recruit an expert. (November 2009)"

OK, I don't have a lot of time--and mind you, I'm not sure exactly what the particular problem at hand is since I don't edit Wikipedia much--but I'm just gonna breeze through this and give a really quick opinion.

"Severe paranoia and hallucinations should be treated as a medical emergency, especially for amphetamines or amphetamine-like drugs." I agree. Either that or be taken in off the streets. It would be a medical emergency, obviously, if there is risk of overdose, seizure, stroke/heart attack (high blood-pressure, etc., etc.), but evidently--only perhaps in some River-Phoenix-death scenario--most of the time one cannot predict whether or not a person is 60 seconds away from collapsing onto the pavement due to some sudden cardiac arrest.

"A user who is tweaking, has been awake for a long time, and/or believes they are in immediate danger may put themselves (or others) at a grave risk for harm while trying to elude or respond defensively to a delusion or a hallucination (see Fight-or-flight response)." This is true albeit maybe not written in the best way. Of course in general it's not healthy to achieve this state--and again, no one can predict when (or whether or not) any medical emergencies would occur just based on someone's behavior and the fact that they've been up for five days--so it definitely would not a bad idea to have such a person checked out. Oh and perhaps it's better said--or specified rather, in case there's any confusion--that hallucinations alone are not what I'd typically consider to be a "medical" emergency. Whether or not it should be treated like one given that the person has ingested drugs is a different story, but this section does confuse itself quite a bit.

"Some facilities may have sufficient funding, programs, and resources to address both mental health and substance abuse issues. This may be the most appropriate clinical setting for an amphetamine user who has presented with psychotic symptoms." I do not like the latter sentence because it implies that someone has used the substance illegally (as opposed to it being prescribed), but that is just how I personally think. It may be the most appropriate clinical setting if the person has both mental health and substance abuse problems, but what if you're just a kid who's fed a too-high dosage of Adderal each morning with Cheerios and a glass of OJ?

"In other situations, facilities only address one or the other. In Chicago, for example, publicly funded substance abuse treatment providers commonly refuse to admit an amphetamine user before any psychiatric emergency (i.e. amphetamine-induced psychosis) is treated by a psychiatric provider." I have no idea about the Chicago thing. And I feel like this is getting a bit off-topic--or what's the word I'm looking for? Weird? Specific? Not specific enough? I don't know, and maybe it's just me anyway.

"Additionally, providers may fail to recognize the difference between amphetamine-induced psychosis and another mental illness." That's true, although again poorly-expressed. The reason I say that is because first we're talking about how the facilities help, then it trails off into shortcomings of facilities. But, eh.

"Either situation typically results in a psychiatric commitment (which entails the administration of sedatives and observation over a period of several days) and discharge with little-to-no additional follow-up treatment for substance addiction (when applicable)." I kind-of disagree. If I present at some random ER with psychotic symptoms and no insurance, they will release me after they give me a few benzos (or whatever) and the symptoms calm down. I know of many patients that have come into an ER (after dialing 9-1-1 amidst an amphetamine-induced episode) and to my knowledge, this is typically what happens there--i.e., they treat you and let you go. If you are acting 'crazy' and walking on the street and decide to wander into some non-profit clinic that does treat these 'emergencies' and you are actually in the right mind to ask for help--or if someone manages to drag you in (good luck)--then... Well, I suppose there must be clinics like that. I am not familiar with that, but just that it is not always, or even 'typically', 'several days'. It just depends on the place. And again, in having just written that last sentence, I feel like this is kind of OT or perhaps, rather, just too particular to a certain type of 'treatment facility' with which the author was familiar.

And, yes, this section does also need citations. 97.120.165.85 (talk) 10:24, 26 October 2010 (UTC)

cocaine
"Cocaine is known to induce psychosis as well, and more than half of cocaine abusers report having experienced at least some psychotic symptoms at some point. "

WHere is the source for this? I know many people who use cocaine occasionally and have never heard of anyone who experienced pyschotic symptons. I'm sure heavy users are different but most users only use recreationally as a party drug. —Preceding unsigned comment added by 72.66.81.97 (talk) 01:34, 1 April 2011 (UTC)


 * Psychotic symptoms aren't just when you run off naked into the night, screaming about nazi aliens out to get you. You needn't act on jerkiness, overdriven fight-or-flight response, or start talking to walls. The typical stuff like "whoa... coulda sworn I saw someone over there out of the corner of my eye, must be a trick of the light" thoughts, light anxiety in the proximity of assertive strangers, or just nervous attentiveness to loud sounds or bright lights - all of that is mild stimulant psychosis already. Pretty much everybody gets that and the mild forms are typically considered "side effects". It's generally only the medium to severe symptoms like unprovoked aggression or panic attacks that people perceive as this, but in actuality, pretty much everything starting from "caffeine jitters" and up is already stimulant psychosis. — Preceding unsigned comment added by 208.127.80.59 (talk) 17:25, 10 September 2011 (UTC)

Content suggestion - Seperate symptoms section
I recommend giving "symptoms of stimulant psychosis" its own section since the symptoms are essentially identical for all the substituted amphetamines (a little less so for caffeine). I think this would be more useful and easy to read than the piecemeal discussion of symptoms spread over the amphetamine, cocaine, and caffeine sections. --Manicjedi (talk) 19:36, 9 November 2011 (UTC)

Merger Proposal
I think Amphetamine Withdrawal Psychosis (AWP) should be merged into Stimulant psychosis. AWP is more or less a subtype of (amphetamine induced) stimulant psychosis, and information on amphetamine psychosis is already contained in this page. Consequently, I don't see any reason for a distinct wikipedia article on a subtype of amphetamine induced psychosis to exist. Seppi333 (talk) 18:16, 23 August 2013 (UTC)
 * Against, I think Amphetamine Withdrawal Psychosis should just be deleted, it's just not recognized. The current section of this article concerning amphetamines is already complicated enough (communicating the relationship between amphetamine psychosis and vulnerability to schizophrenia) and discussion of this will just complicate things further. I note that the Cochrane review of treatment for amphetamine withdrawal ( http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003021.pub2/pdf ) makes no mention of amphetamine withdrawal psychosis or of psychotic symptoms emerging on withdrawal. Further the article for amphetamine withdrawal psychosis is actually longer than the section for the recognized amphetamine psychosis within this article. Also the main amphetamine articles don't appear to have any mention of psychosis appearing on withdrawal. I think if it should be included anywhere it should be under the withdrawal sections of those articles, not here, and one line if that. Woodywoodpeckerthe3rd (talk) 21:46, 23 August 2013 (UTC)
 * Agree most of it needs deleting. It is controversial at best and at most deserves one line. Thus an easy merge with a redirect left here. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 22:07, 23 August 2013 (UTC)
 * Stimulant withdrawal psychosis does occur. It is uncommon or rare but psychosis and psychotic depression can occur as a withdrawal reaction. For what it is worth I have personally experienced it from amphetamines and it lasted for 3 days and had no psychosis while on amphetamine only when stopping. I agree that it is not notable enough to have it's own article and the article should probably be redirected or deleted and any useful content merged to here. It may be worth a brief 1 or 2 sentence mention per WP:DUEWEIGHT on the relevant dopaminergic stimulant articles of this uncommon or rare but important withdrawal reaction.-- MrADHD  |  T@1k?  23:27, 23 August 2013 (UTC)
 * Woodywoodpecker, the Cochrane Review mentions 'paranoia' on the 2nd page as a withdrawal symptom from amphetamines and paranoia is a core symptom of psychosis so I am not sure the Cochrane Review is a good source for you to use to argue amphetamine withdrawal is devoid of psychosis.-- MrADHD  |  T@1k?  23:50, 23 August 2013 (UTC)
 * Paranoia is not exclusively a symptom of psychosis, it's present in many other disorders. So the presence of paranoia as a withdrawal symptom in the Cochrane review does not imply that they consider psychosis to be a symptom of withdrawal. I'm not arguing psychosis doesn't occur on occasion, it's just not recognized generally in the literature as reflected in the Cochrane review, and so it doesn't merit a stand alone article of such depth. Woodywoodpeckerthe3rd (talk) 01:08, 24 August 2013 (UTC)
 * Yes, paranoia can occur in different disorders and to differing levels of severity and have different causes and contexts but it still is a core symptom of psychosis and significant or severe paranoia would usually be classed as psychosis but the Cochrane Review does not elaborate. I agree that stimulant withdrawal psychosis is not notable enough to have a stand alone article. A brief mention on relevant pages of these occasional but severe withdrawal symptoms is all that is warranted.-- MrADHD  |  T@1k?  12:34, 27 August 2013 (UTC)
 * I disagree on paranoia, it is not a core symptom of psychosis because you can be floridly psychotic and not have any paranoia whatsoever, that this is the case is also reflected in dsm-iv-tr, but yes agree that paranoia to the point of delusion is a psychotic symptom. Agree with the brief mention in the withdrawal sections. Woodywoodpeckerthe3rd (talk) 20:09, 27 August 2013 (UTC)

(outdent) Psychosis due to withdrawal from cocaine is mentioned in this review, and this review describes psychosis due to methamphetamine withdrawal,  and here is discussion of an amphetamine withdrawal psychosis,, I am sure that more references can be found via google books or elsewhere for this unusual but severe withdrawal effect.-- MrADHD | T@1k?  23:27, 23 August 2013 (UTC)


 * I'd need to double-check, but I think all the non-stub ADHD psychostimulant stimulant articles (ex. amphetamine, dextroamphetamine, lisdexamfetamine (that page needs to be renamed to lisdexamphetamine for consistency, but that's another issue), methamphetamine, methylphenidate, etc) link to this page in the place of a psychosis section. If it's not already there when I get a chance to look, I'll add that section with a wikilink to this page.Seppi333 (talk) 00:16, 24 August 2013 (UTC)
 * The point I was differentiating was that stimulant (amphetamine) psychosis is a psychosis that occurs while using the drug at high/abuse levels chronically, and the psychosis may persist once the drug has been withdrawn. Amphetamine withdrawal psychosis in contrast is a psychosis that appears on drug withdrawal and disappears on drug reinstatement like the other withdrawal symptoms, which is why I argued it should be in the withdrawal section of those articles and not here. Woodywoodpeckerthe3rd (talk) 00:58, 24 August 2013 (UTC)
 * That's a fair point. Although, I was actually responding to MrADHD's statement about putting a clause about AWP in all associated articles - it would be a simpler approach to write about it on this page and just link here from the associated section(s) of other articles.  I prefer less redundancy whenever possible.  Seppi333 (talk) 04:30, 24 August 2013 (UTC)
 * Amphetamine withdrawal psychosis is not recognized as a subtype of amphetamine psychosis, so I don't think it should be here. Rather than see it as some kind of specific syndrome for which there is little recognition it should be considered that symptoms of psychosis such as paranoid delusions, disordered thinking, somatic/auditory hallucinations,mania and psychotic depression may occur during withdrawal. There is case study evidence this occurs, that evidence can be referenced in the amphetamine articles. I understand the point about redundancy however there are huge overlaps between the amphetamine articles already and this is relatively minor.    Woodywoodpeckerthe3rd (talk) 22:41, 26 August 2013 (UTC)
 * Personally, I agree with you Woody - I think the material should be deleted since I've never heard of such a disorder, but I'm deferring to Doc James' medical expertise as opposed to my own opinion on this one (my discussion with him on User_talk:Jmh649 led to this merger proposal).Seppi333 (talk) 23:04, 26 August 2013 (UTC)

I've added main article links to this page on dextroamphetamine, lisdexamfetamine, methamphetamine, adderall and methylphenidate. Amphetamine was the only page that already had a link. I more or less just pasted the material from the amphetamine psychosis section to each of those pages. I'd appreciate it if someone took the time to quickly check over these edits to make sure I didn't do something careless/stupid. Thanks! :) Seppi333 (talk) 01:54, 27 August 2013 (UTC)
 * Looks good to me Woodywoodpeckerthe3rd (talk) 20:11, 27 August 2013 (UTC)

Due to the lack of medrs-quality sources on amphetamine withdrawal psychosis, I'm going to make this merge within the next 24 hours and include 1 or 2 lines on that topic as suggested by  Doc James. I'd appreciate it if someone could check on this article around this time tomorrow to ensure I haven't missed anything relevant to the merge. Regards, Seppi333 (talk) 22:44, 21 September 2013 (UTC)

"psychoses"?
In the following section and paragraph:

"Transition to schizophrenia

A 2019 systematic review and meta-analysis by Murrie et al. found that the pooled proportion of transition from amphetamine-induced psychosis to schizophrenia was 22% (5 studies, CI 14%–34%). This was lower than cannabis (34%) and hallucinogens (26%), but higher than opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.[35]"

Is it a typo? psychosis is the correct spelling? 149.109.58.32 (talk) 01:55, 31 January 2024 (UTC)