eMedicine Specialties > Psychiatry > Addiction

Amphetamine-Related Psychiatric Disorders: Differential Diagnoses & Workup

Author: Michael Larson, DO, Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard University
Contributor Information and Disclosures

Updated: Jan 29, 2008

Differential Diagnoses

Cannabis Compound Abuse
Opioid Abuse
Cocaine-Related Psychiatric Disorders
Phencyclidine (PCP)-Related Psychiatric Disorders
Delirium
Schizophrenia
Depression
Toxicity, Heroin
Hallucinogens
Toxicity, Mushroom
Hyperthyroidism
Wernicke-Korsakoff Syndrome
Hypothyroidism
Inhalant-Related Psychiatric Disorders
Insomnia

Other Problems to Be Considered

AIDS-related complex
Thyrotoxicosis
Syphilis

Workup

Laboratory Studies

  • The purpose of the workup is to exclude complications of amphetamine abuse and other causes of psychosis and altered mental status.
  • Laboratory evaluation should include the following tests:
    • Finger-stick blood glucose test
    • CBC determination
    • Determination of electrolyte levels, including magnesium, amylase, albumin, total protein, uric acid, BUN, alkaline phosphatase, and bilirubin levels
    • Urinalysis
    • Stat urine or serum toxicology screening to exclude acetaminophen, tricyclic antidepressants, aspirin, and other potential toxins: Individuals who abuse drugs may ingest a substance called Urine Luck, or pyridinium chlorochromate (PCC), to produce invalid results on urine drug screens. PCC alters the results for cannabis and opiates but elevates levels of amphetamines.
    • Blood test for an alcohol level if the patient appears intoxicated
    • HIV and rapid plasma reagin (RPR) tests

Imaging Studies

  • In the presence of neurologic impairments, CT or MRI helps in evaluating for subarachnoid and intracranial hemorrhage.

Other Tests

  • Perform ECG to evaluate for cardiac involvement.
  • Perform EEG if a seizure disorder is considered possible.
  • Use of the brief psychotic rating scale (BPRS), Beck Depression Scale, violence and suicide assessment, and other measures may be helpful.
  • If persistent psychiatric conditions are noted, neuropsychological testing can be beneficial to assess levels of psychosocial and neurologic function to guide treatment and to assess the need for placement.
  • Results of projective testing, such as the Rorschach test and the Thematic Apperception Test, can help in clarifying thought disorders.
  • During amphetamine intoxication, the Mini-Mental State Examination (MMSE) can be helpful in measuring cognitive change.

Histologic Findings

Repeated exposure to amphetamines is theorized to alter the morphology of dendrites in the prefrontal cortex and in the nucleus accumbens. Amphetamines may increase the length of dendrites for longer than 1 month. These alterations may help explain the behavioral cravings and psychosis that long-term abuse of amphetamines produces.

More on Amphetamine-Related Psychiatric Disorders

Overview: Amphetamine-Related Psychiatric Disorders
Differential Diagnoses & Workup: Amphetamine-Related Psychiatric Disorders
Treatment & Medication: Amphetamine-Related Psychiatric Disorders
Follow-up: Amphetamine-Related Psychiatric Disorders
References
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References

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  2. Substance Abuse and Mental Health Services Administration. (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies; September 2006. [Full Text].

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  8. Farber NB, Hanslick J, Kirby C, et al. Serotonergic agents that activate 5HT2A receptors prevent NMDA antagonist neurotoxicity. Neuropsychopharmacology. Jan 1998;18(1):57-62. [Medline].

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  16. Sills TL, Greenshaw AJ, Baker GB, Fletcher PJ. Acute fluoxetine treatment potentiates amphetamine hyperactivity and amphetamine-induced nucleus accumbens dopamine release: possible pharmacokinetic interaction. Psychopharmacology (Berl). Feb 1999;141(4):421-7. [Medline].

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Further Reading

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Keywords

amphetamine-induced psychotic disorders, amphetamine-induced psychosis, amphetamine, amphetamine derivatives, methamphetamine, dextroamphetamine, 3, 4-methylenedioxymethamphetamine, MDMA, cathinone, methcathinone, ecstasy, XTC, methamphetamine, crystal meth, crystal methamphetamine, ice, khat, Catha edulis Forsk, Qat tree, psychosis, delusions, hallucinations, depression, bipolar affective disorder, schizophrenia, sleep disorders, delirium, para -methoxyamphetamine, PMA, 2, 5-dimethoxy-4-bromo-amphetamine, DOB, 3, 4-methylenedioxyamphetamine, MDA

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Contributor Information and Disclosures

Author

Michael Larson, DO, Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard University
Michael Larson, DO is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Denis F Darko, MD, Director, Central Nervous System Clinical Research, Clinical Science, Green Hospital
Denis F Darko, MD is a member of the following medical societies: American Academy of Sleep Medicine, American College of Physicians, American Medical Association, American Psychiatric Association, American Psychosomatic Society, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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