From the Guidelines
Methamphetamine-induced psychosis, including hallucinations of bugs crawling on or under the skin, is a serious condition requiring immediate medical attention, and treatment typically involves stopping methamphetamine use and may include antipsychotic medications like risperidone or olanzapine to manage psychotic symptoms 1. Methamphetamine alters brain chemistry, particularly affecting dopamine levels, which can lead to paranoia and sensory distortions. If experiencing these symptoms, it is crucial to seek immediate medical help as this condition can lead to severe psychological and physical consequences. Some key points to consider in managing methamphetamine-induced psychosis include:
- Stopping methamphetamine use is the first step in treatment
- Antipsychotic medications like risperidone (1-6 mg daily) or olanzapine (5-20 mg daily) may be used to manage psychotic symptoms
- Benzodiazepines such as lorazepam (1-2 mg as needed) might be used short-term for agitation
- Recovery time varies from days to weeks after stopping methamphetamine, though some individuals may develop persistent psychotic symptoms requiring longer treatment
- Staying hydrated, maintaining a calm environment, and avoiding caffeine and other stimulants can help reduce symptom intensity
- Scratching perceived bugs can lead to skin damage and infection, so medical attention is crucial for both the psychological and physical aspects of this condition 1. It is essential to prioritize treatment based on the underlying cause of the psychosis, whether it be primary or secondary, and to consider the potential for co-occurring medical conditions that may be contributing to the psychotic symptoms 1.
From the Research
Methamphetamine Induced Psychosis
- Methamphetamine-induced psychosis (MAP) is a mental disorder induced by chronic methamphetamine use in a subset of users 2.
- The prevalence of MAP has increased in several countries in Europe and Asia where methamphetamine use has increased 2.
- MAP remains difficult to distinguish from primary psychiatric disorders, especially schizophrenia, creating complications in prescribing treatment plans to patients 2.
Treatment Options
- Antipsychotic medications have been shown to alleviate the psychotic symptoms of MAP, but produce debilitating adverse effects and fail to adequately address methamphetamine use in patients 2.
- Quetiapine may be used as an antipsychotic treatment for MAP with comparable therapeutic effects and adverse events to treatment with classical antipsychotic drugs 3.
- Haloperidol and Risperidone are two effective antipsychotic medications for the treatment of positive symptoms of MAP, but other aspects of these two neuroleptic medications such as the long-term treatment effects should be studied 4.
- Olanzapine or quetiapine may be a preferred antipsychotic for MAP, although the evidence for this was rated low-quality due to the high risk of bias or indirectness/intransitivity 5.
Management and Prevention
- Psychosocial treatment for methamphetamine dependence has a strong evidence base and is the optimal first-line treatment approach to reducing rates of psychosis among individuals who use methamphetamines 6.
- Prevention of methamphetamine relapse is the most direct means of preventing recurrence of psychotic symptoms and syndromes 6.
- Long-term management of individuals presenting with recurrent and persistent psychosis, even in the absence of methamphetamine use, may include both behavioral treatment to prevent resumption of methamphetamine use and pharmacological treatment targeting psychotic symptoms 6.