Stimulant psychosis

stimulant psychosis Tutorial,D'block Kidderminster hospital,29-10-2004

sensitisation chronic persistent psychosis

Stimulant psychosis:systematic review: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sensitisation: When & Who?.. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Aim and hypothesis ,[object Object],[object Object],Toxic type response Chronic persisting type response

Method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Types of studies ,[object Object],[object Object],[object Object],[object Object]

Inclusion criteria – Experimental ,[object Object],[object Object],[object Object],[object Object]

Inclusion criteria - Longitudinal ,[object Object],[object Object]

Inclusion criteria - Case Control ,[object Object],[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Experimental studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Single dose experimental ,[object Object],[object Object],[object Object]

Two or more doses – experimental ,[object Object],[object Object],[object Object],[object Object],[object Object]

Results of experimental studies.. ,[object Object],[object Object]

Results of experimental studies.. ? controls 10.2% Schizophrenia in remission 28.3% Positive or negativeP<0.0001 Rx or NoRx P= 0.80 Schizophrenia with positive symptoms 51.4%

The Longitudinal studies ,[object Object],[object Object]

The Longitudinal studies ,[object Object],[object Object],[object Object],[object Object],[object Object]

Results of longitudinal studies 9/192-mood incongruent psychosis 11/192- mood congruent psychosis 3 cluster of symptoms identified 5 years Cherland & Fitzpatrick 1999 2/11 Premorbid difficulties +family history 5years Pawluck 1995

Results of longitudinal studies 8000 screened 193 psychosis prone Cocaine users-12 Amphs – 11 Power SMALL Substance use not predictive of psychosis 10 years Kwapil 1996 No evidence 1 year Carroll et al 1993

Case control studies: Stimulant users with & without psychosis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case control studies : psychosis with and without stimulant abuse ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case control studies: stimulant users Vs other drugs ,[object Object],[object Object],[object Object]

Change in psychotic ratings Less dosing with IV

Overall change in psychotic ratings

SENSITISATION ? ,[object Object],[object Object],[object Object]

The effect of stimulants ,[object Object],[object Object],[object Object]

Stimulants,Cannabis > opiates ? ,[object Object],[object Object],[object Object],[object Object]

Difficulties in follow up studies…. ,[object Object],[object Object]

Antipsychotics use? ,[object Object],[object Object],[object Object]

Animal studies ,[object Object],[object Object],[object Object],[object Object],[object Object]

Summary of evidence for sensitisation ,[object Object],[object Object]

Evidences against sensitisation ,[object Object]

Conclusions: ,[object Object],[object Object],[object Object],[object Object]

Hypothesis ? ,[object Object],[object Object]

Even though Poor quality evidence exists for sensitisation occurring in humans, it is Important that people using stimulants should be assertively managed

Stimulant psychosis

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Stimulant psychosis