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How do you formulate and diagnose patients with chronic psychosis that developed after methamphetamine use but persists after cessation of use?
In some patients, psychotic symptoms persist long after methamphetamine cessation and lack the classic course or negative symptoms of schizophrenia. Diagnostically, how do you conceptualize and document these cases? Do you use a schizophrenia spectrum diagnosis, stimulant-induced psychotic disorder, or unspecified psychotic disorder?
Answer from: at Community Practice
This is a conundrum for me in an urban outpatient private practice. I have a number of patients (mostly men in their 30s, 40s, and 50s) who became paranoid after crystal meth use. Those symptoms are quite resistant to neuroleptic medications, even at high doses, even when the CM use has stopped. I h...
Answer from: at Community Practice
I have found older antipsychotics (Haldol, trifluoperazine) to be more effective for these patients than the newer agents.
Answer from: at Community Practice
I saw this several times in the Psych Emergency, where a lot of the patients would be psychotic on meth, but sometimes they would end up in jail for many months, and were then sent back to the hospital upon release from jail with a negative drug test, but still psychotic, so then they were treated a...
Answer from: at Community Practice
Article on this: Glasner-Edwards et al., PMID 25373627.It's a sad situation. Meth has been flooding our country, and some patients, due to this, develop persistent symptoms. The meth our patients are taking is a cooked-up drug cartel neurotoxic substance. Scary. Good article on it in the Atlant...
Answer from: at Community Practice
I have seen this in the Iowa prison system, where I worked for 15 years. As you can imagine, it is a mixed bag of results over time. If symptoms do resolve or decrease significantly, it takes much more time than expected, over a year. If they have been IV meth for years, it is a different story&mdas...
It's seen with all recreational drugs, that’...
Well stated, Dr. @Thapar. You don't know how much ...
Thanks, Dr. @Kohanski.