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Published Online: 1 January 2010

Remission of Persistent Methamphetamine-Induced Psychosis After Electroconvulsive Therapy: Presentation of a Case and Review of the Literature

Abstract

Abstract

Illicit methamphetamine abuse represents a major problem in many countries worldwide, including the United States. Prolonged regular smoking or injection of methamphetamine can cause a psychosis, typically characterized by paranoid delusions and auditory hallucinations and often associated with disturbances in mood. These symptoms may persist long after methamphetamine is discontinued and may prove refractory to antipsychotic medications. The authors describe a patient who developed a typical methamphetamine psychosis that persisted despite months of abstinence from methamphetamine and weeks of treatment with antipsychotic medication but that responded promptly to electroconvulsive therapy (ECT) on two separate occasions: on initial presentation and again a year later when the patient relapsed into methamphetamine abuse and developed psychosis again. The authors review the large international literature on methamphetamine psychosis, much of which is from Japan and has not previously been summarized in English. Persistent methamphetamine psychosis has been widely reported in Japan for more than 50 years but is rarely discussed in the American literature, possibly because some such cases are misdiagnosed in the United States as primary psychotic disorders. Given the growing public health problem of methamphetamine abuse in the United States, the distinction between persistent methamphetamine psychosis and a primary psychotic disorder has grown increasingly important. Thus, American clinicians should be alert to the possibility of methamphetamine psychosis and may wish to consider ECT in refractory cases.

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Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 17 - 23
PubMed: 20068123

History

Received: 17 November 2008
Accepted: 13 April 2009
Published online: 1 January 2010
Published in print: January 2010

Authors

Details

David J. Grelotti, M.D.
Gen Kanayama, M.D., Ph.D.
Harrison G. Pope, Jr., M.D., M.P.H.

Notes

Received Nov. 17, 2008; revision received March 20, 2009; accepted April 13, 2009. From the Department of Psychiatry, Massachusetts General Hospital, Boston; the Department of Psychiatry, Harvard Medical School, Boston; McLean Hospital, Belmont, Mass.; and the Biological Psychiatry Laboratory, McLean Hospital. Address correspondence and reprint requests to Dr. Pope at McLean Hospital, Belmont, MA 02178; [email protected] (e-mail).

Competing Interests

All authors report no financial relationships with commercial interests.

Funding Information

Supported in part by an American Psychiatric Institute for Research and Education/Janssen Resident Psychiatric Research Scholarship to Dr. Grelotti.

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