STIMULANT INDUCED PSYCHOSIS

STIMULANT DRUGS
Stimulant drugs are a family of substances which produce physiological states of
increased arousal and subjective states of increased mood, energy and attention.
They include amphetamine, methamphetamine, methylene-dioxy-methamphetamine
(MDMA or “ecstasy”) and cocaine. All act on dopamine pathways, and shared
mechanisms are likely to underlie some of their shared effects. However, there are
also important differences between these substances which may be relevant to
understanding any associations with or impacts on psychosis.
AMPHETAMINE
Amphetamine and methamphetamine are synthetic compounds produced in various
forms including a powdered or tablet form (often known as “speed”), concentrated
paste or liquid form (“base”) and a higher purity, crystalline form (“ice”) (Degenhardt
et al., 2008c). Amphetamines are small molecules with a close structural affinity to
brain amines and in particular to dopamine. They increase the availability and
activity of dopamine and other neurotransmitters through several mechanisms,
including: increased release from synaptic vesicles; blockage of membrane re-
uptake; reduced membrane dopamine transport; inhibited activity of metabolizing
enzymes such as monoamine oxidase, and; increased dopamine synthesis (Barr et al.,
2006). As well as acute chemical effects, there is evidence that repeated
amphetamine exposure may produce ongoing chemical and structural changes
(neurotoxicity) lasting for months or longer (Barr et al., 2006; Hanson et al., 2004).
METHYLENE-DIOXY-METHAMPHETAMINE (MDMA)
Methylene-dioxy-methamphetamine (MDMA) or “ecstasy” shares many of the
properties of methamphetamine, and is often grouped with amphetamine and
methamphetamines in a broader category of “Amphetamine-type stimulants” (United
Nations Office on Drugs and Crime, 2011a). In addition to stimulant effects, ecstasy
may also produce hallucinogenic actions (Barr et al., 2006; National Drug Research
Institute, 2007), which may be related to actions in serotonin pathways (Schenk,
2011; Seger, 2010). Ecstasy has often been associated with patterns of less frequent
use (Agar and Reisinger, 2004), and there is debate as to whether it produces a true
dependence syndrome (Degenhardt et al., 2010a).
COCAINE
Cocaine is a plant-derived compound. It is a larger and more structurally complex
molecule than amphetamine-type stimulant drugs, and has a shorter half-life: 1-3
hours compared with 8-13 hours for methamphetamine (Barr et al., 2006). It acts to
increase the levels of dopamine within the synapses by blocking mono-amine
reuptake, but has less effect on intracellular dopamine levels than amphetamine-type
stimulants, which may indicate a lower potential to cause neurotoxic effects (Seger,
2010). Cocaine’s powerful subjective effects and short half-life may contribute to
psychological dependence, and it may be associated with a higher risk of
dependence when compared to amphetamine-type stimulants (Degenhardt and Hall,
2012a; Agar and Reisinger, 2004).