Prior psychiatric studies have found that GABAergic cortical dysfunction seems to relate to schizophrenia.Īmphetamine-related psychiatric disorders can occur with acute or chronic use. This damage leads to dysregulation of glutamate in the cerebral cortex, a precursor to psychosis. Studies also suggest increased dopaminergic pathways lead to glutamate excesses in the cerebral cortex, altering the function of cortical GABAergic neurons. This leads to a change in cognitive-behavioral function, which is thought to be a precursor to primary psychosis. In vivo studies found changes in the prefrontal cortex of rats exposed to repeated amphetamine use. Dopamine and norepinephrine release in the nucleus accumbens results in a feeling of euphoria and a reward feedback loop, which may result in addiction. Amphetamines can also lead to increased monoamines in the cytosol by interactions with vesicular monoamine transporter 2. Some studies have suggested about 30% of patients with amphetamine-induced psychosis end up with a primary psychosis over time.Īmphetamines inhibit monoamine (dopamine, norepinephrine, epinephrine, serotonin) reuptake, leading to increased monoamine concentrations in the neuronal synapse. Users of amphetamines are also twice as likely to need long-term treatment than users of other drugs (17% versus 8%). In addition to this, patients who have an amphetamine use disorder and are entering substance abuse treatment centers have a higher likelihood of being referred by the criminal justice system than patients with all other substance use disorders combined (59% versus 38%). Demographic characteristics associated with increased risk of amphetamine use disorder include living in rural areas, Caucasian, Hispanic and Asian ethnicities, lower socioeconomic status, male gender, preexisting mood disorder, adverse childhood events, and prior substance use disorders. Overdose deaths attributed to amphetamines increased by 33% from 2015 to 2016, with 10,333 overdose deaths in 2017. Based on the most recent 2018 United States National Survey on Drug Use and Health, approximately 1.9 million people aged 12 or older used amphetamines in the past year, with overall use remaining steady since 2015. Of these, an estimated 17 million people are dependent on amphetamines. According to the 2019 United Nations World Drug Report, it is estimated that in 2017, roughly 0.6 percent of the global population aged 15–64, or 29 million people, had used amphetamines in the past year. Amphetamines impair the cognitive thought process and subsequently precede acute psychosis. This suggests that continued impairment due to amphetamine use is a precursor to psychosis.Īfter cannabis, amphetamines are the most widely abused illicit drug worldwide. There is also a clear pattern of high dosage and daily usage correlating with higher risks of substance-induced psychosis. Most agree that psychosis following amphetamine use is characterized by persecutory delusions, visual hallucinations, and symptoms resembling acute psychosis most commonly observed in schizophrenia. Given the acute symptoms associated with amphetamine intoxication, it is difficult for the clinician to distinguish amphetamine-associated psychosis from the acute psychosis of a primary mental disorder. Symptoms typically last hours to days, based on dosage and strength, and dissipate once the drug is eliminated from the body. Peak plasma levels can range from 5 to 10 minutes via intravenous administration and up to 2 to 3 hours if taken transmucosal. The routes of amphetamine administration may be inhalation, intravenous, intramuscular, or transmucosal (oral/nasal). Amphetamines can be easily manufactured using common household materials, including acetone, red phosphorus, sodium hydroxide, sulfuric acid, ammonia, toluene, along with over-the-counter medicines, ephedrine, and pseudoephedrine. The majority of illegal amphetamines in North America are produced in rural areas of Mexico and the United States in clandestine labs. Recreational use of amphetamines has reached epidemic proportions in Asia, Australasia, and the United States. Today, amphetamines are clinically used to treat short-term obesity, narcolepsy, and attention deficit disorder with hyperactivity. Amphetamine was first manufactured in 1893 to treat asthma and upper respiratory congestion, but indications and usage in the medical field have increased over the last century. Amphetamines, such as methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA), belong to a class of compounds called phenethylamines which induce catecholaminergic effects in the CNS and peripheral circulation.
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