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• Challenges in reviewing methamphetamine-associated psychosis
  Shalini Arunogiri, Dan I. Lubman
  Published on: 17 September 2017

• Published on: 17 September 2017

  Challenges in reviewing methamphetamine-associated psychosis

  • Shalini Arunogiri, Psychiatrist Monash University; Turning Point, Eastern Health
  • Other Contributors:
    • Dan I. Lubman, Professor of Addiction Studies

  Stuart and colleagues protocol for a systematic review of psychological treatment for methamphetamine use [1] is a timely and relevant response to a significant gap in guidance for treatment of psychological sequelae arising from psychostimulant use. Given that levels of psychological distress and clinical mental health symptoms are very common in people who use methamphetamine, there is an urgent need for psychological treatment guidelines for this population.

  While many psychological interventions to date have also targeted comorbid anxiety and depressive symptoms, psychotic symptoms are also highly prevalent, clinically challenging and often poorly addressed. Methamphetamine-associated psychosis has been associated with significant morbidity, including increased agitation and violence, presentation to acute health services, and considerable health service burden [2]. A subset of individuals may also be at risk of developing more persistent psychotic symptoms, later transitioning to a diagnosis of chronic psychotic disorder.

  To date, the presence of psychotic symptoms has either been excluded, or not routinely screened for, in the majority of studies of psychological treatment for methamphetamine use. For instance, some studies have excluded participants with recent antipsychotic medication use[3], while measurement of psychotic symptoms or clinical assessments of psychotic disorder are typically absent [4-7]. On the other hand, many pharmacological inte...

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  Stuart and colleagues protocol for a systematic review of psychological treatment for methamphetamine use [1] is a timely and relevant response to a significant gap in guidance for treatment of psychological sequelae arising from psychostimulant use. Given that levels of psychological distress and clinical mental health symptoms are very common in people who use methamphetamine, there is an urgent need for psychological treatment guidelines for this population.

  While many psychological interventions to date have also targeted comorbid anxiety and depressive symptoms, psychotic symptoms are also highly prevalent, clinically challenging and often poorly addressed. Methamphetamine-associated psychosis has been associated with significant morbidity, including increased agitation and violence, presentation to acute health services, and considerable health service burden [2]. A subset of individuals may also be at risk of developing more persistent psychotic symptoms, later transitioning to a diagnosis of chronic psychotic disorder.

  To date, the presence of psychotic symptoms has either been excluded, or not routinely screened for, in the majority of studies of psychological treatment for methamphetamine use. For instance, some studies have excluded participants with recent antipsychotic medication use[3], while measurement of psychotic symptoms or clinical assessments of psychotic disorder are typically absent [4-7]. On the other hand, many pharmacological interventions targeting methamphetamine-associated psychosis do not detail the psychological components of treatment. This therefore poses a challenge for reviewers seeking to evaluate psychosis as an outcome measure.

  Clinicians working with this population struggle with the management of this syndrome, and need guidance in evidence-based approaches. The findings of this review will be important in shaping best practice for co-morbidity in this population, so we encourage the authors to consider how to include guidance on psychological interventions for methamphetamine-associated psychosis within the scope of their protocol.

  1. Stuart A, Baker AL, Bowman J, McCarter K, Denham AMJ, Lee N, Colyvas K, Dunlop A, Protocol for a systematic review of psychological treatment for methamphetamine use: an analysis of methamphetamine use and mental health symptom outcomes. BMJ Open 2017; 7.
  2. McKetin R, Degenhardt L, Shanahan M, Baker AL, Lee NK, Lubman DI, Health service utilisation attributable to methamphetamine use in Australia: Patterns, predictors and national impact. Drug and Alcohol Review 2017.
  3. Shoptaw S, Reback CJ, Peck JA, Yang X, Rotheram-Fuller E, Larkins S, Veniegas RC, Freese TE, Hucks-Ortiz C, Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and alcohol dependence 2005; 78:125-134.
  4. Roll JM, Petry NM, Stitzer ML, Brecht ML, Peirce JM, McCann MJ, Blaine J, MacDonald M, DiMaria J, Lucero L, Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry 2006; 163:1993-1999.
  5. Smout MF, Longo M, Harrison S, Minniti R, Wickes W, White JM, Psychosocial treatment for methamphetamine use disorders: a preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance abuse 2010; 31:98-107.
  6. Rawson RA, McCann MJ, Flammino F, Shoptaw S, Miotto K, Reiber C, Ling W, A comparison of contingency management and cognitive‐behavioral approaches for stimulant‐dependent individuals. Addiction 2006; 101:267-274.
  7. Baker A, Boggs TG, Lewin TJ, Randomized controlled trial of brief cognitive‐behavioural interventions among regular users of amphetamine. Addiction 2001; 96:1279-1287.

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  Conflict of Interest:
  None declared.

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