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Treatment for amphetamine psychosis

Shoptaw SJ, Kao U, Ling W
Published Online: 
21 January 2009

A minority of individuals who use amphetamines develop full-blown psychosis requiring care at emergency departments or psychiatric hospitals. In such cases, symptoms of amphetamine psychosis commonly include paranoid and persecutory delusions as well as auditory and visual hallucinations in the presence of extreme agitation. More common (about 18%) is for frequent amphetamine users to report psychotic symptoms that are sub-clinical and that do not require high-intensity intervention. Clinical reports suggest the development of amphetamine psychosis and of sub-clinical psychosis symptoms is related to the individual's lifetime history of amphetamine use, i.e., cumulative quantity and frequency of exposure to amphetamines. In one of the only randomised trials of antipsychotic medications for treating amphetamine psychosis, Leelahanaj (2005) reported that olanzapine and haloperidol delivered at clinically relevant doses both showed similar efficacy in resolving psychotic symptoms (93% and 79%, respectively), with olanzapine showing significantly greater safety and tolerability than haloperidol as measured by frequency and severity of extrapyramidal symptoms. These outcomes are consistent with treatments for schizophrenia indicating equivalent efficacy between atypical anti-psychotics and conventional anti-psychotics, mostly haloperidol with older drugs causing more severe side effects (Leucht 1999).While anti-psychotic medications demonstrate efficacy in providing short-term relief when a heavy user of amphetamines experiences psychosis, there is no evidence to guide decisions regarding long-term clinical care using these medications for preventing relapse to psychosis.

This record should be cited as: 
Shoptaw SJ, Kao U, Ling W. Treatment for amphetamine psychosis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003026. DOI: 10.1002/14651858.CD003026.pub3
Assessed as up to date: 
14 March 2008