Factors Associated with Psychotic and Depressive Symptoms in Methamphetamine Users
Abstract
Methamphetamine use has been recognized as a prominent public health issue, which is associated with psychotic and depressive symptoms. This study aimed to assess factors that show a significant relation with psychotic and depressive symptoms in adults who use methamphetamine.
Methods: We assessed 95 patients who had used methamphetamine within the last month and were admitted to the outpatient treatment clinic. Evaluation of all patients was carried out through face-to-face interviews, and their symptoms were evaluated using different scales. The Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms were employed to assess positive and negative symptoms of psychosis, respectively. Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale, while illness severity was evaluated using the Clinical Global Impression- Severity Scale. Additionally, functioning status was assessed using the Functioning Assessment Short Test, and withdrawal severity was measured by employing the Amphetamine Cessation Symptom Assessment Scale. Craving severity was evaluated using the Stimulant Craving Questionnaire, anxiety severity using the Hamilton Anxiety Rating Scale, and insight status using the Schedule for Assessment of Insight Expanded.
Results: Among the demographic variables, working with family was associated with lower positive symptoms scores (OR = 6.31, P < 0.05). Parole/probation related admissions were associated with lower positive and depressive symptoms scores (OR = 15.06, P = 0.03; OR = 9.87, P = 0.02). Having suicide attempts, number of suicide attempts, and amount of methamphetamine used were found to show association with higher positive (OR = 13.59, P < 0.01; OR = 2.52, P < 0.05; OR = 3.48, P < 0.05, respectively) and depressive symptoms scores (OR = 10.35, P < 0.001; OR = 2.23, P < 0.01; OR = 2.3, P < 0.05). After adjusting for all variables, clinical impression and insight scores remained significantly associated with positive symptoms scores (AOR = 6.74, P < 0.05; AOR = 2.63, P < 0.001, respectively), while anxiety, amphetamine cessation, and positive symptoms scores remained associated with depressive symptoms scores (AOR = 0.48, P < 0.001; AOR = 0.11, P = 0.003; AOR = 0.36, P = 0.02, respectively).
Conclusion: This study appears to be the first to examine the associations between clinical variables and both positive symptoms and depressive symptoms in methamphetamine users. Increased attention should be paid to suicide history, anxiety level, amount of methamphetamine use and loss of insight to provide effective treatment in patients with methamphetamine use.
Ujike H, Sato M. Clinical features of sensitization to methamphetamine observed in patients with methamphetamine dependence and psychosis. Ann N Y Acad Sci. 2004;1025:279-87.
Report WD. United Nations publication, Sales No. E. 21. XI. 8. 2021.
Breen MS, Uhlmann A, Ozcan S, Chan M, Pinto D, Bahn S, et al. Parallel changes in serum proteins and diffusion tensor imaging in methamphetamine-associated psychosis. Sci Rep. 2017;7:43777.
Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253-62.
Hides L, Chan G, Dawe S, McKetin R, Kavanagh DJ, Young RM, et al. Direction of the relationship between methamphetamine use and positive psychotic symptoms in regular methamphetamine users: evidence from a prospective cohort study. Br J Psychiatry. 2021;219(1):361-7.
McKetin R, Kelly E, McLaren J. The relationship between crystalline methamphetamine use and methamphetamine dependence. Drug Alcohol Depend. 2006;85(3):198-204.
Chiang M, Lombardi D, Du J, Makrum U, Sitthichai R, Harrington A, et al. Methamphetamine-associated psychosis: Clinical presentation, biological basis, and treatment options. Hum Psychopharmacol. 2019;34(5):e2710.
Grant KM, LeVan TD, Wells SM, Li M, Stoltenberg SF, Gendelman HE, et al. Methamphetamine-associated psychosis. J Neuroimmune Pharmacol. 2012;7(1):113-39.
Wang G, Zhang Y, Zhang S, Chen H, Xu Z, Schottenfeld RS, et al. Aripiprazole and Risperidone for Treatment of Methamphetamine-Associated Psychosis in Chinese Patients. J Subst Abuse Treat. 2016;62:84-8.
Chen CK, Lin SK, Sham PC, Ball D, Loh EW, Hsiao CC, et al. Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis. Psychol Med. 2003;33(8):1407-14.
Yang M, Yang C, Liu T, London ED. Methamphetamine-associated psychosis: links to drug use characteristics and similarity to primary psychosis. Int J Psychiatry Clin Pract. 2020;24(1):31-7.
McKetin R, Dawe S, Burns RA, Hides L, Kavanagh DJ, Teesson M, et al. The profile of psychiatric symptoms exacerbated by methamphetamine use. Drug Alcohol Depend. 2016;161:104-9.
Glasner-Edwards S, Mooney LJ. Methamphetamine psychosis: epidemiology and management. CNS Drugs. 2014;28(12):1115-26.
McKetin R, Baker AL, Dawe S, Voce A, Lubman DI. Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders. Psychiatry Res. 2017;251:349-54.
Chen CK, Lin SK, Sham PC, Ball D, Loh el W, Murray RM. Morbid risk for psychiatric disorder among the relatives of methamphetamine users with and without psychosis. Am J Med Genet B Neuropsychiatr Genet. 2005;136b(1):87-91.
Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006;67(2):247-57.
Zweben JE, Cohen JB, Christian D, Galloway GP, Salinardi M, Parent D, et al. Psychiatric symptoms in methamphetamine users. Am J Addict. 2004;13(2):181-90.
Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, Hillhouse M, Ang A, Rawson R. Clinical course and outcomes of methamphetamine-dependent adults with psychosis. J Subst Abuse Treat. 2008;35(4):445-50.
McKetin R, Lubman DI, Baker AL, Dawe S, Ali RL. Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study. JAMA Psychiatry. 2013;70(3):319-24.
Voce A, Burns R, Castle D, Calabria B, McKetin R. A latent class analysis of psychiatric symptom profiles associated with past-month methamphetamine use. Psychiatry Res. 2021;298:113760.
Voce A, Burns R, Castle D, Calabria B, McKetin R. Is there a discrete negative symptom syndrome in people who use methamphetamine? Compr Psychiatry. 2019;93:27-32.22. First, M.B., Williams, J.B.W., Karg, R.S., Spitzer, R.L. Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA, APA, 2016.
Elbir M, Alp Topbaş Ö, Bayad S, Kocabaş T, Topak OZ, Çetin Ş, et al. [Adaptation and Reliability of the Structured Clinical Interview for DSM-5-Disorders - Clinician Version (SCID-5/CV) to the Turkish Language]. Turk Psikiyatri Derg. 2019;30(1):51-6.
Andreasen NC. Methods for assessing positive and negative symptoms. Mod Probl Pharmacopsychiatry. 1990;24:73-88.
Erkoc S, Arkonaç O, Atakli C, Ozmen E. The reliability and validity of scale for the assesment of the negative symstoms. Dusunen Adam - J. Psychiatry Neurol. Sci. 1991;4:14-5.
Torres IJ, O'Leary DS, Andreasen NC. Symptoms and interference from memory in schizophrenia: evaluation of Frith's model of willed action. Schizophr Res. 2004;69(1):35-43.
Erkoç, Ş., Arkonaç, O., Ataklı, C., Özmen, E. The reliability and validity of scale for the assessment of the negative symptoms. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 1991; 2(4): 14-15.
Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-9.
Suzan O, Aylin U, Senar B, Elif K. Montgomery-Asberg depression rating scale: inter-rater reliability and validity study. Turk Psikiyatri Derg. 2001;12:185-94.
Guy W. Clinical Global Impressions (CGI) scale, modified. task force for the handbook of psychiatric measures. Handbook of Psychiatric Measures (1st edn)(ed Rush JA) APA. 2000.
Rosa AR, Sánchez-Moreno J, Martínez-Aran A, Salamero M, Torrent C, Reinares M, et al. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3:5.
Aydemir O, Uykur B. [Reliability and validity study of the Turkish version of functioning assessment short test in bipolar disorder]. Turk Psikiyatri Derg. 2012;23(3):193-200.
McGregor C, Srisurapanont M, Mitchell A, Longo MC, Cahill S, White JM. Psychometric evaluation of the Amphetamine Cessation Symptom Assessment. J Subst Abuse Treat. 2008;34(4):443-9.
Northrup TF, Green C, Walker R, Greer TL, Trivedi MH. On the invariance of the Stimulant Craving Questionnaire (STCQ) across cocaine and methamphetamine users. Addict Behav. 2015;42:144-7.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5.
MK Y. Hamilton anxiety rating scale: interrater reliabilty and validity study. Turk J Psychiatry. 1998;9:114-7.
Sanz M, Constable G, Lopez-Ibor I, Kemp R, David AS. A comparative study of insight scales and their relationship to psychopathological and clinical variables. Psychol Med. 1998;28(2):437-46.
Arslan S, Gunay Kilic B, Karakilic H, Cosar B, Isikli S, Isik E. Icgorunun uc bilesenini degerlendirme olcegi: guvenilirlik ve gecerlik calismasi. Turkiye'de Psikiyatri. 2001;3:17-24.
Roy A, Karoum F, Pollack S. Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide. Arch Gen Psychiatry. 1992;49(6):447-50.
Volkow ND, Chang L, Wang GJ, Fowler JS, Leonido-Yee M, Franceschi D, et al. Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry. 2001;158(3):377-82.
Kuo CJ, Liao YT, Chen WJ, Tsai SY, Lin SK, Chen CC. Causes of death of patients with methamphetamine dependence: a record-linkage study. Drug Alcohol Rev. 2011;30(6):621-8.
McKetin R, Leung J, Stockings E, Huo Y, Foulds J, Lappin JM, et al. Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis. EClinicalMedicine. 2019;16:81-97.
Hajebi A, Amini H, Kashani L, Sharifi V. Twelve-month course and outcome of methamphetamine-induced psychosis compared with first episode primary psychotic disorders. Early Interv Psychiatry. 2018;12(5):928-34.
Lee WC, Fang SC, Chen YY, Liu HC, Huang MC, McKetin R. Exploring the mediating role of methamphetamine use in the relationship between adverse childhood experiences and attempted suicide. Addict Behav. 2021;123:107060.
Chen CK, Lin SK, Huang MC, Su LW, Hsiao CC, Chiang YL, et al. Analysis of association of clinical correlates and 5-HTTLPR polymorphism with suicidal behavior among Chinese methamphetamine abusers. Psychiatry Clin Neurosci. 2007;61(5):479-86.
Kalayasiri R, Verachai V, Gelernter J, Mutirangura A, Malison RT. Clinical features of methamphetamine-induced paranoia and preliminary genetic association with DBH-1021C→T in a Thai treatment cohort. Addiction. 2014;109(6):965-76.
Salo R, Fassbender C, Iosif AM, Ursu S, Leamon MH, Carter C. Predictors of methamphetamine psychosis: history of ADHD-relevant childhood behaviors and drug exposure. Psychiatry Res. 2013;210(2):529-35.
Sulaiman AH, Said MA, Habil MH, Rashid R, Siddiq A, Guan NC, et al. The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia. Compr Psychiatry. 2014;55 Suppl 1:S89-94.
Arunogiri S, Foulds JA, McKetin R, Lubman DI. A systematic review of risk factors for methamphetamine-associated psychosis. Aust N Z J Psychiatry. 2018;52(6):514-29.
Hides L, Dawe S, McKetin R, Kavanagh DJ, Young RM, Teesson M, et al. Primary and substance-induced psychotic disorders in methamphetamine users. Psychiatry Res. 2015;226(1):91-6.
McKetin R, Hickey K, Devlin K, Lawrence K. The risk of psychotic symptoms associated with recreational methamphetamine use. Drug Alcohol Rev. 2010;29(4):358-63.
APA APA. Diagnostic and statistical manual of mental disorders. APA. 2013.
Rognli EB, Håkansson A, Berge J, Bramness JG. Does the pattern of amphetamine use prior to incarceration predict later psychosis?--a longitudinal study of amphetamine users in the Swedish criminal justice system. Drug Alcohol Depend. 2014;143:219-24.
Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249-65.
Cole MG, Bellavance F, Mansour A. Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis. Am J Psychiatry. 1999;156(8):1182-9.
Kendler KS, Gardner CO, Prescott CA. Toward a comprehensive developmental model for major depression in men. Am J Psychiatry. 2006;163(1):115-24.
Shin J, Cho E. Trajectories of depressive symptoms among community-dwelling Korean older adults: findings from the Korean longitudinal study of aging (2006-2016). BMC Psychiatry. 2022;22(1):246.
| Files | ||
| Issue | Vol 19 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v19i1.14334 | |
| Keywords | ||
| Depression Methamphetamine Psychosis Substance Use | ||
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