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Stimulant psychosis: systematic review

Pendine Community Mental Health Trust, Cardiff

Neetha Byrappa, MRCPsych

Caswell Clinic, Glanrhyd Hospital

Andrew Mcbride, FRCPsych

Specialist Community Addiction Service, Rectory Centre, Oxford, UK

Correspondence: Dr Catherine Curran, Pendine Community Mental Health Trust, 124-126 Cowbridge Road West, Ely, Cardiff CF5 5BT, UK. E-mail: Cath.Curran{at}CardiffandVale.wales.nhs.uk

Declaration of interest None.

Background Psychosis associated with stimulant use is an increasing problem, but there is little research evidence about the nature of the problem and its management.

Aims To critically review the literature on stimulant psychosis and sensitisation.

Method Systematic review of studies that have investigated stimulant use and psychosis in humans. The main outcome measures were increases in psychosis with stimulant use, and differences between stimulant users and non-users.

Results Fifty-four studies met the inclusion criteria. Experimental studies show that a single dose of a stimulant drug can produce a brief increase in psychosis ratings (a‘response’) in 50-70% of participants with schizophrenia and pre-existing acute psychotic symptoms, unaffected by the presence of antipsychotic medication. Those with schizophrenia who do not have acute psychotic symptoms respond, but less frequently (30%). There has been little research into the longer-term effects of use.

Conclusions Compliance with antipsychotic medication by someone with schizophrenia will not prevent a relapse or worsening of psychotic symptoms if stimulants are used. Low-dose antipsychotic treatment may be beneficial in stimulant users, to prevent sensitisation.

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