Abstract
Methamphetamine is a potent psychostimulant that can induce psychosis among recreational and chronic users, with some users developing a persistent psychotic syndrome that shows similarities to schizophrenia. This review provides a comprehensive critique of research that has directly compared schizophrenia with acute and chronic METH psychosis, with particular focus on psychiatric and neurocognitive symptomatology. We conclude that while there is considerable overlap in the behavioral and cognitive symptoms between METH psychosis and schizophrenia, there appears to be some evidence that suggests there are divergent aspects to each condition, particularly with acute METH psychosis. Schizophrenia appears to be associated with pronounced thought disorder, negative symptoms more generally and cognitive deficits mediated by the parietal cortex, such as difficulties with selective visual attention, while visual and tactile hallucinations appear to be more prevalent in acute METH-induced psychosis. As such, acute METH psychosis may represent a distinct psychotic disorder to schizophrenia and could be clinically distinguished from a primary psychotic disorder based on the aforementioned behavioral and cognitive sequelae. Preliminary evidence, on the other hand, suggests that chronic METH psychosis may be clinically similar to that of primary psychotic disorders, particularly with respect to positive and cognitive symptomatology, although negative symptoms appear to be more pronounced in schizophrenia. Limitations of the literature and avenues for future research are also discussed.
Highlights
There appears to be a high degree of concordance in the type, prevalence and severity of positive symptoms between METHinduced psychosis and schizophrenia, confirming that it would be difficult to distinguish between the two conditions in the clinical setting based on the positive symptoms alone
While auditory hallucinations appear to be the most common hallucination reported in METH psychosis and schizophrenia, visual and tactile hallucinations appear to be more prominent in acute/transient
TW conducted the review; TW wrote the initial version of the manuscript with subsequent contribution from JC
Summary
The current review will describe and critique the literature that has compared the clinical profile of schizophrenia with (i) acute METH psychosis and (ii) chronic METH psychosis, with particular focus on positive, negative and cognitive symptoms. Prior to conducting the literature search, inclusion criteria were formulated from the aims, to determine which studies would be suitable but to provide a unique perspective to the review and to minimize the occurrence of methodological flaws These included: [1] studies had to based on people, aged 16 years and older; [2] the current review focused on research relating to methamphetamine (rather than amphetamine or other psychostimulants); [3] studies had examined profiles associated with METH psychosis (i.e., no studies looking at the cognitive effects of METH without psychosis); [3] studies had to have directly compared METH psychosis with schizophrenia or primary psychotic disorder [4] METH usage had to precede the presentation of psychosis in order to focus on METH-induced psychotic syndromes; [5] only original research studies were included (i.e., reviews were omitted); [6] Case studies were omitted [for a review and examination of historical case studies of METH psychosis, please see [59]]. Srisurapanont et al [113] found that while there were no difference in the type and severity of positive symptoms between METH psychosis and schizophrenia, the METH psychosis group tended to have more severe hallucinations and delusions
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