PP  Vol.2 No.3 , July 2011
Amphetamine Versus Non Amphetamine-Related First Episode Psychosis in Saudi Arabian Patients
Abstract: Background: Amphetamines are illicit psychostimulant drugs that can induce psychotic symptoms. Very few studies have been conducted in Kingdom of Saudi Arabia (SA) on amphetamine abuse and related psychosis. Recently, the pattern of amphetamine abuse in SA showed a significant trend of increased frequency. Objectives: To investigate the extent of amphetamine abuse in a sample of Saudi patients hospitalized for first episode of acute psychosis. Also, to compare in that sample between amphetamine psychosis and other psychoses regarding demographic data, premorbid personality and symptoms profile. Method: 106 patients with acute psychosis were hospitalized and screening of urine for amphetamine was conducted for all. Patients’ psychiatric evaluation included interviewing, and ICD-10 criteria for personality disorders. 30 healthy subjects were also included for comparison with patients. Results: 34/106 of psychotic patients (32%) were positive for amphetamine in urine (≥ 1000 ng/ml). The frequency of personality disorders was significantly higher (P < 0.01) in the patients (54/106; 51%) compared with healthy subjects (6/30; 20%). Also, the incidence of personality disorders was significantly higher (P < 0.01) in amphetamine positive psychosis (25/34; 73.5%) compared with amphetamine negative psychosis (29/72; 40%). Cluster B personality disorders particularly the antisocial and borderline were significantly higher in amphetamine positive psychosis (13/34; 38%) compared with amphetamine negative psychoses (6/72; 8%). The symptom profile showed significant difference between amphetamine positive and amphetamine negative psychosis as regards ideas of reference (50% vs. 14%), suspiciousness (44% vs. 11%), suicidal ideation (38% vs. 23%), paranoid delusions (29% vs. 17%) and increased pulse or blood pressure (29% vs. 7%) respectively. Conclusion: Screening of amphetamine in urine among patients with first episode of acute psychosis can help and support the clinical distinction of amphetamine psychosis from other types of psychosis. This is therapeutically critical since the line of treatment may be different between the two types of psychoses.
Cite this paper: nullE. Desoky, A. El-Tantawy, Y. Raya and A. Al-Yahya, "Amphetamine Versus Non Amphetamine-Related First Episode Psychosis in Saudi Arabian Patients," Pharmacology & Pharmacy, Vol. 2 No. 3, 2011, pp. 101-108. doi: 10.4236/pp.2011.23013.

[1]   K. L. Barry, M. F. Fleming, J. R. Greenley, S. Kropp, P. Widlak, “Characteristics of persons with severe mental illness and substance abuse in rural areas,” Psychiatric Services, Vol. 47, No. 1, January 1996, pp. 88-90.

[2]   I. L. Fowler, V. J. Carr, N. T. Carter, T. J. HLewin, H“HPatterns of current and lifetime substance use in schizophrenia,”H Schizophrenia Bulletin, Vol. 24, No. 3, 1998, pp. 443-455.

[3]   R. G. McCreadie, Scottish Comorbidity Study Group, “HUse of drugs, alcohol and tobacco by people with schizophrenia: case-control study,”H The British Journal of Psychiatry, Vol. 181, October 2002, pp. 321-325.

[4]   K. T. Mueser, P. Nishith, J. I. Tracy, J. DeGirolamo, M. Molinaro, “Expectations and motives for substance use in schizophrenia,” Schizophrenia Bulletin, Vol. 21, No. 3, 1995, pp. 367-378.

[5]   L. Arseneault, M. Cannon, R. Poulton, R. HMurray, HA. HCaspi,H T.E. HMoffitt, H“Cannabis use in adolescence and risk for adult psychosis: Longitudinal prospective study,” British Medical Journal, Vol. 325, No. 7374, November 2002, pp. 1212-1213.

[6]   C. HCurran,H N. HByrappa, HA. HMcBride, H“Stimulant psychosis: systematic review,” The HBritish Journal of PsychiatryH, Vol. 185, September 2004, pp. 196-204.

[7]   E. HJacobs, HD. HFujii, HJ. HSchiffman, HI. HBello,H “An exploratory analysis of neurocognition in methamphetamine-in- duced psychotic disorder and paranoid schizophrenia,” Cognitive and Behavioral Neurology, Vol. 21, No.2, June 2008, pp. 98-103.

[8]   J. Addington, D. Addington, “Patterns, predictors and impact of substance use in early psychosis: A longitudinal study,” Acta Psychiatrica Scandinavica, Vol. 115, No. 4, April 2007, pp. 304-309.

[9]   J. H. HBarnett, HU. HWerners, HS. M. HSecher, HK. E. HHill, HR. HBrazil, HK. HMasson, HD. E. HPernetH, J. B. HKirkbride,H G. K. HMurrayH, E. T. HBullmore,H P. B. HJones, H“Substance use in a population-based clinic sample of people with first-epi- sode psychosis,” The HBritish Journal of PsychiatryH, Vol. 190, June 2007, pp. 515-520.

[10]   R. HCantwell, HJ. HBrewin, HC. HGlazebrook, HT. HDalkin, HR. HFox, HI. HMedley, HG. Harrison, “Prevalence of substance misuse in first-episode psychosis,” The HBritish Journal of PsychiatryH, Vol. 174, February 1999, pp. 150-153.

[11]   S. I. A. Rahim, M. S. Abumadini, M. S. Khalil, T. Musa, “Long-term outcome of treated addiction in Saudi Arabia: predictors of relapse in 10 year follow-up,” The Arab Journal of Psychiatry, Vol.16, No. 2, November 2005, pp. 86-97.

[12]   M. S. AbuMadini, S. I. A. Rahim, M. A. Al-Zahrani, A. O. AL-Johi, (2008). “Two decades of treatment seeking for substance use disorders in Saudi Arabia: trends and patterns in a rehabilitation facility in Dammam,” Drug and Alcohol Dependence, Vol. 97, No. 3, October 2008, pp. 231-236.

[13]   Department of Health and Human Services, “Mandatory Guidelines for Federal Workplace Drug Testing Programs: Final guidelines notice,” Federal Register, Vol. 53, 1989, pp.11969-11989.

[14]   A. HJablensky, HJ. HMcGrath, HH. HHerrman, HD. HCastle, HO. HGureje, HM. HEvans, H“Psychotic disorders in urban areas: an overview of the study on low prevalence disorders,” The Australian and New Zealand of Psychiatry, Vol. 34, No. 2, April 2000, pp. 221-236.

[15]   S. R. Kay, L. A. Opler, J. P. Lindenmayer, “Reliability and validity of the positive and negative syndrome scale for schizophrenics,” Psychiatry Research, Vol. 23, No. 1, January 1988, pp. 99-110.

[16]   S. R. Kay, L. A. Opler, J. P. Lindenmayer, “The positive and negative syndrome scale (PANSS): rationale and standardization,” The British Journal of Psychiatry (Sup- pl), Vol. 7, November 1989, pp. 59-67.

[17]   A. W. Loranger, N. Sartorius, A. Andreoli, P. Berger, P. Buchheim, S. M. Channabasavanna, B. Coid, A. Dahl, R. F. Diekstra, B. Ferguson, et al, “The personality disorder examination: a preliminary report,” Archives of General Psychiatry, Vol. 51, No. 3, March 1994, pp. 215-224. A. W. HLoranger, HM. F.

[18]   HLenzenweger, HA. F. HGartner, HV. L. HSusman, HJ. HHerzig, HG. K. HZammit, J. D. Gartner , R. C. Abrams, R. C. Young,H “Trait-state artifacts and the diagnosis of personality disorders,” Archives of General Psychiatry, Vol. 48, No.8, August 1991, pp. 720-728.

[19]   S. Van Mastrigt, J. Addington, D. Addington, D. “Substance misuse at presentation to an early psychosis program,” Social Psychiatry and Psychiatry Epidemiology, Vol. 39, No. 1, January 2004, pp. 69-72.

[20]   D. Wade, S. Harrigan, J. Edwards, P. M. Burgess, G. Whelan, P. D. McGorry, “Course of substance misuse and daily tobacco use in first episode psychosis,” Schizo- phrenia Research, Vol. 81, No. 2-3, January 2006, pp. 145-150.

[21]   V. M. HGonzalez, HC. M. HBradizza, HP. C. HVincent, HP. R. HStasiewicz, HN. D. HPaas, H“Do individuals with a severe mental illness experience alcohol and drug-related problems? A test of the supersensitivity hypothesis,” Addictive Behaviors, Vol. 32, No. 3, March 2007, pp. 477-490.

[22]   D. HHarris, HS. L. HBatki, H“Stimulant psychosis: symptom profile and acute clinical course,” HThe American Journal on Addiction, Vol.9, No.3, Winter 2000, pp.H 28-37.

[23]   N. Chivite-Matthews, A. Richardson, J. O’Shea, J. Bec- ker, N. Owen, S. Roe, et al, “Drug misuse declared: Findings from 2003/2004 British crime survey,” Home office statistical survey, 2005.

[24]   C. L. HCaton, HR. E. HDrake, HD. S. HHasin, HB. HDominguez, HP. E. HShrout, HS. HSamet, HB. Schanzer, “Differences between early phase primary psychotic disorders with concurrent substance use and substance-induced psychoses,” Archives of General Psychiatry, Vol. 62, No. 2, February 2005, pp. 137-145.

[25]   M. J. HSchiller, HM. HShumway, HS. L. HBatki, H“Patterns of substance use among patients in an urban psychiatric emergency service,” HPsychiatric Services, Vol. 51, No.1, January 2000, pp. 113-115.

[26]   M. HLambert,H P. HConus, HD. I. HLubman, HD. HWade, HH. HYuen, HS. HMoritz, D. Naber, B. G. Schimmelmann, H“The impact of substance use disorders on clinical outcome in 643 patients with first episode psychosis,” Acta Psychiatrica Scandinavics, Vol. 112, No.2, August 2005, pp. 141-148.

[27]   L. HHides, HS. M. HCotton, HG. HBerger, HJ. HGleeson, HC. HO’Donnell, HT. HProffitt, HP. D. McGorry, D. I. Lubman, “The reliability and validity of the alcohol, smoking and substance involvement screening test (ASSIST) in first episode psychosis,” Addictive Behaviors, Vol. 34, No. 10, October 2009, pp. 821-25.

[28]   C. L. HCaton, HR. E. HDrake, HD. S. HHasin, HB. HDominguez, HP. E. HShrout, HS. HSamet, HB. Schanzer, “Differences between early phase primary psychotic disorders with concurrent substance use and substance-induced psychoses,” Archives of General Psychiatry, Vol. 62, No. 2, February 2005, pp. 137-145.

[29]   J. M. Brown, G. R. Hanson, A. E. Fleckenstein, “Regulation of the vesicular monoamine transporter-2: a novel mechanism for cocaine and other psychostimulants,” J Pharmacol Exp Ther, Vol 286, No. 3, March 2001, pp. 762-767.

[30]   A. M. HBarr,H W. J. HPanenka, HG. W. HMacEwan, HA. E. HThornton, HD. J. HLang, HW. G. HHoner, W. GH., T. Lecomte, “The need for speed: an update on methamphetamine addiction,” J Psychiatry Neurosci, Vol. 31, No.5, September 2006, pp. 301-313.

[31]   C. K. HChen, HS. K. HLin, HP. C. HSham, HD. HBall, HE. W. HLoh, HC. C. HHsiao, HY. L. HChiangH, S. C. HReeH, C. H. HLeeH, R. M. HMurray,H “Premorbid characteristics and co-morbidity of methamphetamine users with and without psychosis,” Psychological Medicine, Vol. 33, No. 8, November 2003, pp. 1407-1414.

[32]   C. C. Cruickshank, K. R. Dyer, (2009). “A review of the clinical pharmacology of methamphetamine,” Addiction, Vol. 104, No. 7, July 2009, pp. 1085-1099.

[33]   M. J. Schiller, M. Shumway, S. L. Batki, “Utility of Routine Drug Screening in a Psychiatric Emergency Setting,” Psychiatric Servoces, Vol. 51, No. 4, April 2000, pp. 474- 478.

[34]   R. McKetin, J. McLaren, D. Lubman, L. Hides, “The prevalence of psychotic symptoms among methamphetamine users,” Addiction, Vol. 101, No. 4, April 2000, pp. 1473-1478.

[35]   A. HBaker, HS. HBucci, HT. J. HLewin, HR. HRichmond, HV. J. HCarr, H“Comparisons between psychosis samples with different patterns of substance use recruited for clinical and epidemiological studies,” Psychiatry Research, Vol.134, No. 3, April 2005, pp. 241-250.

[36]   H. C. HMargolese, HL. HMalchy, HJ. C. HNegrete, HR. HTempier, HK. H. HGill, H“Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences,” Schizophrenia Research, Vol. 67, No. (2-3), April 2004, pp. 157-66.

[37]   A. HDavies, HM. A. HAdena, HN. A. HKeks, HS. V. HCatts, HT. HLambert, HI. HSchweitzer, H “Risperidone versus haloperidol: Meta-analysis of efficacy and safety,” HClinical The- rapeutics, HVol.20, No.1, January-February 1998, pp. 58- 71.

[38]   HCarlson, C. DH., HCavazzoni, P. AH., HBerg, P. HH., HWei, HH., HBeasley, C. MH., HKane, J. MH. (2003). An integrated analysis of acute treatment-emergent extrapyramidal syndrome in patients with schizophrenia during olanzapine clinical trials: comparisons with placebo, haloperidol, risperidone, or clozapine. HJ Clin PsychiatryH, 64, 898-906.

[39]   B. M. HSchanzer, HM. B. HFirst, HB. HDominguez, HD. S. HHasin, HC. L. HCaton, H“Diagnosing psychotic disorders in the emergency department in the context of substance use,” HPsychiatric ServHices, Vol. 57, No. 10, October 2006, pp. 1468-1473.

[40]   D. S. Bell, “The experimental reproduction of amphetamine psychosis,” Archives of General Psychiatry, Vol. 29, No.1, July 1973, pp. 35-40.

[41]   H. Ujiki, M. Sato, “Clinical features of sensitization to methamphetamine observed in patients with methamphetamine dependence and psychosis,” Annals of the New York Academy of Sciences, Vol. 1025, October 2004, pp. 279-87.

[42]   M. A, HTest,H L. S. HWallisch, HD. J. HAllnessH, K. HRipp, H“Substance use in young adults with schizophrenic disorders,” HSchizophrenia BullHetin Vol.15, No.3, 1989, pp. 465-4765.

[43]   C. J. Van Dongen, Smoking and persistent mental illness: an exploratory study,” Journal of Psychosocial. Nursing and Mental Health Services, Vol. 37, No. 11, November 1999, pp. 26-34.

[44]   M. HSrisurapanont, HR. HAli, HJ. HMarsden, HA. HSunga, HK. HWada, HM. HMonteiro, H“Psychotic symptoms in methamphetamine psychotic in-patients,” The International Journal of Neuropsychopharmacology, Vol. 6, No. 4, December 2003, pp. 347-352.

[45]   D. HHarris, HS.L. HBatki, H“Stimulant psychosis: symptom profile and acute clinical course,” The American Journal on Addiction, Vol. 9, No. 1, Winter 2000, pp. 28-37.

[46]   I. I. Solano, M. G. DeChavez, “Premorbid personality disorders in schizophrenia,” Schizophrenia Research, Vol. 44, No. 2, August 2000, pp.137-144.

[47]   D. Lichtermann, E. Karbe, W. Maier, “The genetic epidemiology of schizophrenia and of schizophrenia spectrum disorders,” European Archives of Psychiatry and Neuroscience, Vol. 250, No.6, 2000, pp. 304-310.

[48]   M. S. HKeshavan, HH. S. HDuggal, HG. HVeeragandham, HN. M. HMcLaughlin, HD. M. HMontrose, HG. L. HHaas, HN. R. Schooler, “Personality dimensions in first-episode psychoses,” The American Journal of Psychiatry, Vol. 162, No. 1, January 2005, pp. 102-109.

[49]   J. C. Maxwell, “Emerging research on methamphetamine,” Current Opinion in Psychiatry, Vol. 18, No. 3, May 2005, pp. 235-242.

[50]   S. D. Gray, Fatovich, D. M. McCoubrie, D. L., Daly, F. F. “Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation,” The Medical Journal of Australia, Vol. 186, No. 7, April 2007, pp. 336-339.

[51]   L. HHidesH, S. M. HCotton,H G. HBergerH, J. HGleesonH, C. HO’DonnellH, T. HProffittH, P. D. HMcGorryH, D. I. HLubmanH, “The reliability and validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis,” HAddictive Behaviors, Vol. 34, No. 10, October 2009, pp. 821-25.