550. Phenotypic assessment of cocaine-induced paranoia and psychotic symptoms (CIPPS)

Abstract

CIPPS occurs in >60% of habitual cocaine users, and is associated with substantial excess morbidity. It rarely occurs on first use of cocaine, but once established, occurs with progressively lower doses. CIPPS also recurs immediately upon relapse from abstinence. Thus, CIPPS is an important clinical problem, and an excellent human model of drug-induced sensitization (DIS). DIS is thought to underlie important aspects of drug addiction, and possibly, of idiopathic psychotic illness. Genetic mechanisms may influence vulnerability to CIPPS. To improve phenotypic assessment for genetic studies, we are characterizing CIPPS using methods validated for schizophrenia. Twenty two subjects meeting DSM-IV criteria for cocaine dependence, but not for psychotic disorders, were interviewed about cocaine-induced experiences, using the Cocaine Experience Questionnaire (CEQ; Satel et al., 1991, Am. J. Psychiat. 148:495), the Scale for Assessment of Positive Symptoms (SAPS; Andreason, 1984, Univ. of Iowa), and the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995, Western Psychol. Svcs). Twenty subjects endorsed cocaine-induced paranoia on the CEQ (91%). In contrast only 23% received elevated baseline scores of Reality Distortion on the BORRTI, suggesting that CIPPS is episode-specific. Nine (41%) received SAPS ratings of at least mild delusions, and 100% of these responses were paranoid in nature (i.e., persecutory, mind-reading, or referential). Thirteen subjects (59%) reported hallucinations, which occurred in visual, auditory, or somatosensory modalities with approximately equal frequencies. CIPPS specifically reflects cocaine intoxication. CIPPS delusions are exclusively paranoid, but hallucinations are variable, and therefore probably represent a less specific disturbance of brain function than delusions.