Amphetamine-Related Psychiatric Disorders Follow-up

Updated: Sep 12, 2017
  • Author: Amy Barnhorst, MD; Chief Editor: Glen L Xiong, MD  more...
  • Print
Follow-up

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.

Next:

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.

Previous
Next:

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.

Previous
Next:

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.

Previous
Next:

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.

Early medication treatments have been tried with desipramine and lithium [12] ; aripiprazole vs. methylphenidate vs. placebo [13] ; bupropion [14] ; and naltrexone. [15]

The most recent published study at the time of this review assessed the efficacy of extended-release methylphenidate. The intention-to-treat analysis failed to demonstrate statistical difference between extended-release methylphenidate (n=40) compared with placebo (n=39). The authors noted that the study was limited by significantly higher dropout rates in the placebo arm. [16]

Currently, there are no medications that are routinely prescribed as standard-of-care or approved by the FDA for the treatment of amphetamine use disorder.

Previous
Next:

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 [17]

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.

Previous
Next:

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.

Previous
Next:

Patient Education

Instruct the patient to abstain from alcohol and illicit drugs, especially because dual diagnosis is a real issue. The only effective treatment is abstinence.

Patients should be in a support group.

The family must be educated about the patient's addiction and its dangers.

Refer the patient for psychosocial counseling.

Hospitalize the patient if he or she is suicidal or homicidal.

Refer the patient for substance abuse counseling.

Helpful Web sites include the following

For excellent patient and family education resources, see eMedicineHealth's patient education articles Drug Dependence and Abuse and Substance Abuse.

Previous