Substituted amphetamines Drugs in the
class of amphetamines, or substituted amphetamines, are known to induce "amphetamine psychosis" typically when chronically abused or used in high doses. Commonly abused amphetamines include
methamphetamine,
MDMA, and
4-FA, as well as
substituted cathinones like
α-PVP,
MDPV, and
mephedrone, though a large number of other closely related compounds have been recently synthesized.
Methylphenidate is sometimes incorrectly included in this class, although it is nonetheless still capable of producing stimulant psychosis. The symptoms of amphetamine psychosis include auditory and visual hallucinations, grandiosity,
delusions of persecution, and
delusions of reference concurrent with both clear consciousness and prominent extreme agitation. A Japanese study of recovery from methamphetamine psychosis reported a 64% recovery rate within 10 days rising to an 82% recovery rate at 30 days after methamphetamine cessation. However it has been suggested that around 5–15% of users fail to make a complete recovery in the long term. Furthermore, even at a small dose, the psychosis can be quickly reestablished. The symptoms of acute amphetamine psychosis are very similar to those of the acute phase of
schizophrenia although in amphetamine psychosis visual hallucinations are more common and
thought disorder is rare. Amphetamine psychosis may be purely related to high drug usage, or high drug usage may trigger an underlying vulnerability to schizophrenia. The disorders are often distinguished by a rapid resolution of symptoms in amphetamine psychosis, while schizophrenia is more likely to follow a chronic course. Although rare and not formally recognized, a condition known as Amphetamine Withdrawal Psychosis (AWP) may occur upon cessation of substituted amphetamine use and, as the name implies, involves psychosis that appears on withdrawal from substituted amphetamines. However, unlike similar disorders, in AWP, substituted amphetamines reduce rather than increase symptoms, and the psychosis or mania resolves with resumption of the previous dosing schedule.
Cocaine Cocaine has a similar potential to induce temporary psychosis with more than half of cocaine abusers reporting at least some psychotic symptoms at some point. Typical symptoms include paranoid delusions that they are being followed and that their drug use is being watched, accompanied by hallucinations that support the delusional beliefs. Cocaine-induced psychosis shows sensitization toward the psychotic effects of the drug. This means that psychosis becomes more severe with repeated intermittent use.
Phenidates Methylphenidate and its
analogues (such as
ethylphenidate,
4F-MPH, and
isopropylphenidate) share similar pharmacological profiles as other
norepinephrine-dopamine reuptake inhibitors. Chronic abuse of methylphenidate has the potential to lead to psychosis. Similar psychiatric side effects have been reported in a study of ethylphenidate. No studies regarding psychosis and 4F-MPH or isopropylphenidate have been conducted, but given their high DAT binding and cellular uptake activity, the possibility of stimulant psychosis remains.
Caffeine There is limited evidence that
caffeine, in high doses or when chronically abused, may induce psychosis in normal individuals and worsen pre-existing psychosis in those diagnosed with schizophrenia. ==Differential diagnosis==