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Open Access Highly Accessed Debate

Amphetamine-induced psychosis - a separate diagnostic entity or primary psychosis triggered in the vulnerable?

Jørgen G Bramness1*, Øystein Hoel Gundersen1, Joar Guterstam2, Eline Borger Rognli1, Maija Konstenius2, Else-Marie Løberg3, Sigrid Medhus1, Lars Tanum1 and Johan Franck2

Author Affiliations

1 Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway

2 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

3 Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway

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BMC Psychiatry 2012, 12:221  doi:10.1186/1471-244X-12-221

Published: 5 December 2012

Abstract

Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. Schizophrenia spectrum disorder and amphetamine-induced psychosis are further linked together by the finding of several susceptibility genes common to both conditions. These genes probably lower the threshold for becoming psychotic and increase the risk for a poorer clinical course of the disease.

The complex relationship between amphetamine use and psychosis has received much attention but is still not adequately explored. Our paper reviews the literature in this field and proposes a stress-vulnerability model for understanding the relationship between amphetamine use and psychosis.

Keywords:
Drug induced psychosis; Amphetamine; Methamphetamine; Primary psychotic disorder; Schizophrenia