Amphetamine-Related Psychiatric Disorders Follow-up

  • Author: Michael F Larson, DO; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Oct 27, 2011
 

Further Inpatient Care

  • Admit the patient for observation in the event of mania, severe depression, psychosis, delirium, or if he or she is suicidal or homicidal.
  • A patient who is in a state of delirium should be placed in a quiet, cool (not cold), dimly lit (not dark) room and, if uncontrollable, placed in restraints.
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Further Outpatient Care

  • The patient should be monitored closely for recurring psychosis, depression, mania, anxiety, sleep disturbances, and relapse of amphetamine abuse.
  • Psychiatric follow-up care should occur within, at most, 2 weeks of the initial evaluation to ensure compliance.
  • Depending on the complications of amphetamine abuse in the specific patient, consider a follow-up examination with a neurologist and an internal medicine specialist.
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Inpatient & Outpatient Medications

  • If psychosis persists after the offending substance is eliminated, use of an atypical antipsychotic (risperidone, quetiapine, olanzapine, aripiprazole, ziprasidone) may be considered. No single atypical antipsychotic has been proven to be more beneficial than the others in managing prolonged amphetamine-induced psychosis.
  • Antimanic agents may be continued if mania persists longer than 2 weeks.
  • Antidepressants can be useful if depression persists for 2 weeks after withdrawal. Antidepressants alone may not be as effective as other options in amphetamine-induced depression due to neuronal damage. Medication regimens for treatment-resistant organic mood disorders are the applicable approach.
  • If anxiety persists longer than 2 weeks, consider the use of nonbenzodiazepine drugs. Medications such as beta-blockers, valproic acid, carbamazepine, or gabapentin have shown promise in patients with substance abuse who also have anxiety.
  • Sleep medication may help patients adjust their circadian rhythm and can be used for approximately 1-2 weeks. If sleep medication is required for long periods, a referral to a sleep clinic is recommended.
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Transfer

  • If psychiatric conditions persist, causing social and occupational impairment, inpatient treatment may be required.
  • Medical or neurologic complications require treatment in an inpatient medical or neurologic unit.
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Deterrence/Prevention

  • Abstinence prevents disorders and is the primary treatment.
  • Relapse prevention occurs though patient education, individual psychotherapy, appropriate medical treatment of continuing psychiatric illness (eg, major depression, panic disorder), and attendance at substance abuse meetings.
  • Mandatory weekly urine drug screens help prevent relapse or expose relapse early so that aggressive treatment intervention can be pursued.
  • If psychiatric conditions arise during prescription amphetamine use for ADHD, lower doses may be tried and/or nonamphetamine treatments can be pursued, such as bupropion (Wellbutrin), desipramine, venlafaxine (Effexor), or clonidine. Please refer to the Attention Deficit Hyperactivity Disorder article for a full discussion of treatment options.
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Complications

  • Complications include an increased risk of the following:
    • Psychosis
    • Depression
    • Anxiety disorder
    • Sleep disturbance
    • Memory impairment
    • Medical complications
    • Neurologic complications
    • Abuse of another or several substances
    • Psychosocial impairment
    • Affect dysregulation and aggression[8]
  • If amphetamine abuse and amphetamine-related psychiatric disorders occur in the context of 1 or more personality disorders, the amphetamine-related disorder is more difficult to successfully treat than it is in other contexts.
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Prognosis

  • The patient's prognosis depends on the severity of psychiatric impairment and on the medical complications.
  • Overall, the prognosis is good if the patient abstains from drug use after the initial psychiatric impairment occurs.
  • The prognosis worsens if personality disorders are present.
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Patient Education

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Contributor Information and Disclosures
Author

Michael F Larson, DO  Clinical Instructor, Department of Child and Adolescent Psychiatry, Harvard Medical School; Psychiatrist, Harvard Vanguard Medical Associates and Private Practice

Michael F Larson, DO is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, and American Society of Addiction Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Denis F Darko, MD  Executive Director, Clinical Research and Development, Global Neuroscience, AstraZeneca

Denis F Darko, MD is a member of the following medical societies: American College of Physicians and American Psychiatric Association

Disclosure: AstraZeneca Salary Management position

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief 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.

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