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35th AM (2025) - Poster Session
Crystal Clear Guidance on the Recognition and Mana ...
Crystal Clear Guidance on the Recognition and Management of Methamphetamine-Induced Psychosis
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Pdf Summary
Methamphetamine-induced psychosis (MIP) is a significant clinical issue, with methamphetamine (MA) users being up to five times more likely to develop psychosis, and about 40% experiencing psychotic symptoms during their lifetime. MIP symptoms commonly present acutely with persecutory delusions, tactile and auditory hallucinations, often resolving with abstinence. However, 18-25% of users experience persistent MIP that continues beyond intoxication or withdrawal, sometimes indistinguishable from schizophrenia in symptom profile.<br /><br />Diagnosing MIP is challenging due to overlapping symptoms with primary psychotic disorders and common co-occurring substance use. Traditional DSM-5 criteria for substance-induced psychotic disorder can be insufficient because psychosis may persist beyond one month despite abstinence, and urine toxicology cannot exclude primary psychotic illness.<br /><br />Diagnostic criteria for MIP distinguish acute (AMIPD) and persisting forms (PMIPD). AMIPD requires recent MA use and at least one psychotic symptom such as paranoia or hallucinations causing distress or impairment. PMIPD involves ongoing psychotic symptoms beyond intoxication, subdivided into subacute (resolving within one month of abstinence) and chronic (persisting longer).<br /><br />Risk factors influencing MIP development include age, age at MA onset, dose and frequency of use, severity of dependence, route of administration, concurrent substance use, psychiatric comorbidities, family history, trauma exposure, and neurological disorders.<br /><br />Management goals emphasize rapid stabilization, minimizing complications, and supporting abstinence to lower psychosis recurrence. Early recognition with emergency department care—including supportive discharge planning (e.g., BEAT Meth protocol)—and individualized treatment with antipsychotics are key. Most cases are self-limited after MA cessation, warranting as-needed antipsychotics for agitation; persistent MIP may require longer-term therapy.<br /><br />Evidence supports various antipsychotics such as aripiprazole, risperidone, paliperidone, quetiapine, olanzapine, and haloperidol, including long-acting injectable formulations. Psychosocial interventions like contingency management and cognitive behavioral therapy (e.g., Matrix Model) are standard for relapse prevention.<br /><br />No formal guidelines currently exist for acute MIP recognition and management, highlighting a need for expert consensus and dissemination of clinical practice recommendations. This work is supported by the National Institute on Drug Abuse and aims to improve outcomes in this vulnerable population.
Keywords
Methamphetamine-induced psychosis
MIP
Methamphetamine
Psychotic symptoms
Persecutory delusions
Hallucinations
DSM-5 criteria
Substance-induced psychotic disorder
Antipsychotic treatment
Psychosocial interventions
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