Psychosis associated with acute recreational drug toxicity: a European case series.

Euro-Den Research Group ,Odd Martin Vallersnes,Knut Erik Hovda,David M Wood,Alison M Dines,Isabelle Giraudon,Fridtjof Heyerdahl,Paul I Dargan,Christopher Yates

doi:10.1186/s12888-016-1002-7

Euro-Den Research Group , Odd Martin Vallersnes + Show 7 more

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https://doi.org/10.1186/s12888-016-1002-7

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Abstract

BackgroundPsychosis can be associated with acute recreational drug and novel psychoactive substance (NPS) toxicity. However, there is limited data available on how common this is and which drugs are most frequently implicated. We describe a European case series of psychosis associated with acute recreational drug toxicity, and estimate the frequency of psychosis for different recreational drugs.MethodsThe European Drug Emergencies Network (Euro-DEN) collects data on presentations to Emergency Departments (EDs) with acute recreational drug and NPS toxicity at 16 centres in ten countries. Euro-DEN data from October 2013 through September 2014 was retrospectively searched, and cases with psychosis were included. The proportion of cases with psychosis per drug was calculated in the searched Euro-DEN dataset.ResultsPsychosis was present in 348 (6.3 %) of 5529 cases. The median (interquartile range) age was 29 (24-38) years, 276 (79.3 %) were male and 114 (32.8 %) were admitted to psychiatric ward. The drugs most commonly reported were cannabis in 90 (25.9 %) cases, amphetamine in 87 (25.0 %) and cocaine in 56 (16.1 %). More than one drug was taken in 189 (54.3 %) cases. Psychosis was frequent in those ED presentations involving tryptamines (4/7; 57.1 %), methylenedioxypyrovalerone (MDPV) (6/22; 27.3 %), methylphenidate (6/26; 23.1 %), lysergic acid diethylamide (LSD) (18/86; 20.9 %), psilocybe mushrooms (3/16; 18.8 %), synthetic cannabinoid receptor agonists (4/26; 15.4 %) and amphetamine (87/593; 14.7 %), but less common in those involving mephedrone (14/245; 5.7 %), methylenedioxymethamphetamine (MDMA) (20/461; 4.3 %) and methedrone (3/92; 3.3 %). Amphetamine was the most frequent drug associated with psychosis when only one agent was reported, with psychosis occurring in 32.4 % of these presentations.ConclusionThe frequency of psychosis in acute recreational drug toxicity varies considerably between drugs, but is a major problem in amphetamine poisoning. In rapidly changing drug markets and patterns of use, the Euro-DEN sentinel network contributes to measuring the scale of drug-related harms in Europe beyond other more established indicators.

Highlights

Psychosis can be associated with acute recreational drug and novel psychoactive substance (NPS) toxicity
Over the 12 month period there were 5529 cases with acute recreational drug toxicity reported to the European Drug Emergencies Network (EuroDEN) project from the participating centres, and psychosis was recorded as a clinical feature in 348 (6.3%)
We found amphetamine more frequently associated with psychosis than cannabis and cocaine, both as a single agent and in the logistic regression analysis, confirming that psychosis is a major feature of acute amphetamine toxicity

Summary

Introduction

Psychosis can be associated with acute recreational drug and novel psychoactive substance (NPS) toxicity. We describe a European case series of psychosis associated with acute recreational drug toxicity, and estimate the frequency of psychosis for different recreational drugs. Use of classic sympathomimetic drugs like amphetamine, methamphetamine and cocaine can induce acute psychosis [2,3,4]. Whilst the prevalence of psychosis in the community has been estimated at about 0.5% [5, 6], the prevalence of drug induced psychosis among regular drug users has been reported to be in the range of 8-46% for amphetamine [2] and 7-86% for cocaine [3]. Though most drug induced psychoses resolve within a few days, as many as 8-27% have been reported to persist for more than one month [11,12,13]

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