Symptômes psychotiques et psychostimulants

Abstract

ObjectivesPsychostimulants such as cocaine, amphetamines and their derivatives, methamphetamine or novel synthetic drugs such as cathinones are known to cause psychotic symptoms. The objective of this study is to determine the frequency of psychotic symptoms induced by psychostimulants, including novel psychoactive substances (NPS), their clinical characteristics, their evolution, and their treatments. MethodsA review of selected documents was carried out following the principles of systematic research in Medline from 02/12/2017 to 02/12/2022. We included articles in French or English dealing with psychotic symptoms, episodes and disorders induced by psychostimulants in humans, and excluded articles dealing with animal models, those not distinguishing between substances other than psychostimulants, and NPS and non-NPS psychostimulants, and articles focusing exclusively on individuals with previously diagnosed schizophrenia. The data was input in a table for non-NPS psychostimulants and another table for NPS psychostimulants. ResultsThe search found 41 articles on non-NPS psychostimulants and 9 articles on NPS. Psychotic symptoms induced by psychostimulants, including NPS, are frequent in a population of medicalized consumers: 18 to 80% according to studies. Psychotic symptoms show typical features with prominent positive symptoms, especially persecutory delirium, auditory, visual and tactile hallucinations, less negative, and cognitive symptoms. We noted more agitation, even auto-aggressiveness or hetero-aggressiveness. The clinical presentation is frequently accompanied by signs of toxic impregnation, in particular tachycardia, palpitations, hypertension, sweating or mydriasis. The data suggest a possible evolution in a chronic presentation. Psychostimulant-induced psychotic symptoms appear to be improved by treatments such as benzodiazepines for agitation and antipsychotics. The data was less rich regarding NPS but broadly consistent with the findings presented above. A summary of practical implications is provided. ConclusionThe psychotic symptoms induced by psychostimulants present specific, although not exclusive, characteristics. They should be the subject of particular attention, in especially looking for urinary toxins, although certain substances such as cathinones are not detected by current laboratory practices. They may be subject to a specific treatment depending on their severity and duration. In some cases, they could evolve into a chronic presentation and constitute a separate disorder or a vulnerability that should be the subject of integrated care covering both consumptions and psychiatric symptoms.