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1.
Pharmacol Res Perspect ; 12(4): e1217, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38923845

RESUMO

It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.


Assuntos
Alucinógenos , Humanos , Alucinógenos/farmacologia , Animais , Estresse Psicológico/psicologia , Psicoses Induzidas por Substâncias/etiologia , Neurotransmissores/metabolismo
5.
Psychopathology ; 57(3): 248-258, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38631303

RESUMO

BACKGROUND: The state of twilight consciousness is marked by a focused narrowing of awareness, maintaining vigilance and attention while simultaneously experiencing perceptual shifts in the surrounding environment. It is crucial to recognize that this twilight state represents not just a contraction but also an expansion of conscious experience. SUMMARY: Substances of abuse, particularly new psychoactive substances, play a significant role in inducing this twilight state. They achieve this by deconstructing essential components of consciousness, such as the perception of time and space. KEY MESSAGE: This paper aimed to explore the phenomenon of the twilight state of consciousness and shed light on how new psychoactive substances can alter the perception of time and space during this twilight phase, potentially triggering exogenous psychosis. This comprehensive inquiry employs a phenomenological approach to the study of consciousness, recognizing it as the primary tool for ascribing significance to this intricate yet often overlooked aspect of psychopathology.


Assuntos
Estado de Consciência , Psicoses Induzidas por Substâncias , Psicotrópicos , Humanos , Estado de Consciência/efeitos dos fármacos , Psicoses Induzidas por Substâncias/etiologia , Psicotrópicos/efeitos adversos , Percepção Espacial , Percepção do Tempo , Conscientização/fisiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
6.
Psychopharmacol Bull ; 54(1): 33-39, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38449474

RESUMO

Synthetic cannabinoids (SCs), a class of new psychoactive substances (NPS) commonly known as "spice," has rapidly gained popularity and become the most ubiquitous NPS on the illegitimate drug market. SCs, unlike natural cannabis (NC), are not controlled by international drug conventions, posing a significant risk to public health. These substances are easily accessible, relatively inexpensive, and challenging to detect in routine drug screenings. The existing literature provides strong evidence of an association between NC use and psychosis, but there is significantly less data on SC psychosis. We present a clinical case report of a 51-year-old African American female with no known psychiatric history who was admitted to the inpatient psychiatric unit after reported paranoia and altered mental status for the preceding six days. During hospitalization, she exhibited disorganization, persecutory delusions, extreme agitation, and bizarre behaviors that included the concealment of a set of stolen keys in her vagina, necessitating an ethics consult. After consideration of differentials, the patient was diagnosed with substance-induced psychotic disorder secondary to SC. The patient was stabilized on 3 mg Risperidone at bedtime. After 16-day hospitalization, she reached her baseline and later revealed that she had recently smoked SC for the first time. The primary goal of this case is to highlight the sequelae of SC-associated psychosis. A SC-associated psychosis could drastically vary from NC and is often undetectable on a typical UDS, which may result in a lifelong primary psychotic disorder misdiagnosis.


Assuntos
Canabinoides , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Delusões , Psicoses Induzidas por Substâncias/etiologia , Hospitalização , Canabinoides/efeitos adversos
7.
Psychopharmacology (Berl) ; 241(7): 1463-1476, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38512593

RESUMO

RATIONALE: Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite. OBJECTIVE: In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms. METHODS: 60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI). RESULTS: Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups. CONCLUSIONS: The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Anorexia , Ansiedade , Metanfetamina , Probióticos , Distúrbios do Início e da Manutenção do Sono , Humanos , Masculino , Adulto , Feminino , Probióticos/administração & dosagem , Ansiedade/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Metanfetamina/efeitos adversos , Anorexia/psicologia , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Risperidona/uso terapêutico , Risperidona/administração & dosagem , Pessoa de Meia-Idade , Método Duplo-Cego , Resultado do Tratamento , Psicoses Induzidas por Substâncias , Adulto Jovem , Antipsicóticos/uso terapêutico , Antipsicóticos/administração & dosagem , Anfetamina , Transtornos Psicóticos/tratamento farmacológico
8.
Schizophr Res ; 267: 182-190, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38554698

RESUMO

BACKGROUND: The clinical profiles of methamphetamine-induced psychosis (MIP) and schizophrenia are largely overlapping making differentiation challenging. In this systematic review and meta-analysis, we aim to compare the positive and negative symptoms of MIP and schizophrenia to better understand the differences between them. STUDY DESIGN: In accordance with our pre-registered protocol (CRD42021286619), we conducted a search of English-language studies up to December 16th, 2022, in PubMed, EMBASE, and PsycINFO, including stable outpatients with MIP and schizophrenia. We used the Newcastle-Ottawa Scale to measure the quality of cross-sectional, case-control, and cohort studies. STUDY RESULTS: Of the 2052 articles retrieved, we included 12 studies (6 cross-sectional, 3 case-control, and 2 cohort studies) in our meta-analysis, involving 624 individuals with MIP and 524 individuals with schizophrenia. Our analysis found no significant difference in positive symptoms between the two groups (SMD, -0.01; 95%CI, -0.13 to +0.11; p = 1). However, individuals with MIP showed significantly less negative symptoms compared to those with schizophrenia (SMD, -0.35; 95CI%, -0.54 to -0.16; p = 0.01; I2 = 54 %). Our sensitivity analysis, which included only studies with a low risk of bias, did not change the results. However, our meta-analysis is limited by its cross-sectional approach, which limits the interpretation of causal associations. Furthermore, differences in population, inclusion criteria, methodology, and drug exposure impact our findings. CONCLUSIONS: Negative symptoms are less prominent in individuals with MIP. While both groups do not differ regarding positive symptoms, raises the possibility of shared and partly different underlying neurobiological mechanisms related to MIP and schizophrenia.


Assuntos
Metanfetamina , Psicoses Induzidas por Substâncias , Esquizofrenia , Humanos , Metanfetamina/efeitos adversos , Esquizofrenia/fisiopatologia , Psicoses Induzidas por Substâncias/etiologia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Transtornos Relacionados ao Uso de Anfetaminas/complicações
9.
J Psychopharmacol ; 38(4): 382-394, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38494658

RESUMO

BACKGROUND: Prescribing drugs for psychosis (antipsychotics) is challenging due to high rates of poor treatment outcomes, which are in part explained by an individual's genetics. Pharmacogenomic (PGx) testing can help clinicians tailor the choice or dose of psychosis drugs to an individual's genetics, particularly psychosis drugs with known variable response due to CYP2D6 gene variants ('CYP2D6-PGx antipsychotics'). AIMS: This study aims to investigate differences between demographic groups prescribed 'CYP2D6-PGx antipsychotics' and estimate the proportion of patients eligible for PGx testing based on current pharmacogenomics guidance. METHODS: A cross-sectional study took place extracting data from 243 patients' medical records to explore psychosis drug prescribing, including drug transitions. Demographic data such as age, sex, ethnicity, and clinical sub-team were collected and summarised. Descriptive statistics explored the proportion of 'CYP2D6-PGx antipsychotic' prescribing and the nature of transitions. We used logistic regression analysis to investigate associations between demographic variables and prescription of 'CYP2D6-PGx antipsychotic' versus 'non-CYP2D6-PGx antipsychotic'. RESULTS: Two-thirds (164) of patients had been prescribed a 'CYP2D6-PGx antipsychotic' (aripiprazole, risperidone, haloperidol or zuclopenthixol). Over a fifth (23%) of patients would have met the suggested criteria for PGx testing, following two psychosis drug trials. There were no statistically significant differences between age, sex, or ethnicity in the likelihood of being prescribed a 'CYP2D6-PGx antipsychotic'. CONCLUSIONS: This study demonstrated high rates of prescribing 'CYP2D6-PGx-antipsychotics' in an EIP cohort, providing a rationale for further exploration of how PGx testing can be implemented in EIP services to personalise the prescribing of drugs for psychosis.


Assuntos
Antipsicóticos , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Humanos , Antipsicóticos/uso terapêutico , Farmacogenética , Citocromo P-450 CYP2D6/genética , Estudos Transversais , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/genética , Psicoses Induzidas por Substâncias/tratamento farmacológico
13.
J Pharmacol Exp Ther ; 390(1): 14-28, 2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38272671

RESUMO

Abuse of novel arylcyclohexylamines (ACX) poses risks for toxicities, including adverse neurocognitive effects. In vivo effects of ring-substituted analogs of phencyclidine (PCP), eticyclidine (PCE), and ketamine are understudied. Adult male National Institutes of Health Swiss mice were used to assess locomotor effects of PCP and its 3-OH, 3-MeO, 3-Cl, and 4-MeO analogs, PCE and its 3-OH and 3-MeO analogs, and ketamine and its deschloro and 2F-deschloro analogs, in comparison with those of methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), and two benzofuran analogs of MDMA. PCP-like interoceptive effects for all of these ACXs were determined using a food-reinforced drug discrimination procedure in adult male Sprague Dawley rats. A novel operant assay of rule-governed behavior incorporating aspects of attentional set-shifting was used to profile psychosis-like neurocognitive effects of PCP and 3-Cl-PCP in rats, in comparison with cocaine and morphine. PCP-like ACXs were more effective locomotor stimulants than the amphetamines, PCE-like ACXs were as effective as the amphetamines, and ketamine-like ACXs were less effective than the amphetamines. Addition of -Cl, -OH, or -OMe at the 3-position on the aromatic ring did not impact locomotor effectiveness, but addition of -OMe at the 4-position reduced locomotor effectiveness. Lethal effects were induced by drugs with -OH at the 3-position or -OMe at the 3- or 4-position. All novel ACXs substituted at least partially for PCP, and PCP and 3-Cl-PCP elicited dose-dependent psychosis-like neurocognitive deficits in the rule-governed behavior task not observed with cocaine or morphine. Novel ACXs exhibit substantial abuse liability and toxicities not necessarily observed with their parent drugs. SIGNIFICANCE STATEMENT: Novel arylcyclohexylamine analogs of PCP, PCE, and ketamine are appearing on the illicit market, and abuse of these drugs poses risks for toxicities, including adverse neurocognitive effects. These studies demonstrate that the novel ACXs exhibit PCP-like abuse liability in the drug discrimination assay, elicit varied locomotor stimulant and lethal effects in mice, and induce psychosis-like neurocognitive effects in rats.


Assuntos
Fenciclidina , Ratos Sprague-Dawley , Animais , Masculino , Camundongos , Fenciclidina/análogos & derivados , Fenciclidina/toxicidade , Ratos , Psicoses Induzidas por Substâncias/etiologia , Cicloexilaminas , Atividade Motora/efeitos dos fármacos , Cognição/efeitos dos fármacos , Condicionamento Operante/efeitos dos fármacos , Locomoção/efeitos dos fármacos , Drogas Ilícitas/efeitos adversos , Drogas Ilícitas/toxicidade , Ketamina/análogos & derivados , Ketamina/toxicidade , Transtornos Relacionados ao Uso de Substâncias/psicologia , Abuso de Fenciclidina
16.
Actas esp. psiquiatr ; 51(4): 188-192, Julio - Agosto 2023.
Artigo em Espanhol | IBECS | ID: ibc-226457

RESUMO

Introducción. Las salas de venopunción supervisadas (MSIR) son centros extremadamente importantes para las personas que usan drogas intravenosas (PWID), ya que las MSIR brindan un lugar sanitariamente seguro para el consumo de sustancias psicoativas ilícitas, teniendo un impacto importante en las tasas de sobredosis y las infecciones virales transmitidas por vía sanguínea. Métodos. Descripción de los síntomas psicóticos inducidos observados en una MSIR y su relación con la sustancia utilizada. El análisis se realizó con datos recopilados entre el 01/01/2009 y el 31/08/2021. Resultados. Se registraron 3731 autoinyecciones (68,7% heroína, 29,1% cocaína, 2,1% speedball y 0,2% otra sustancia) durante el período estudiado. Los síntomas psicóticos solo se observaron en el 7,1% del total de autoinyecciones. Sin embargo, se detectaron grandes diferencias entre las sustancias: el 23,2% de los consumos de cocaína estuvieron relacionados con síntomas psicóticos, el 20,8% de las inyecciones de speedball presentaron síntomas psicóticos y solo el 0,3% de las venopunciones de heroína se relacionaron con síntomas psicóticos (X2 =604.99; p<0.001). Además, algunas variables señalan que los síntomas psicóticos inducidos por sustancias pueden estar asociados con una mayor gravedad clínica. Conclusiones. Los sujetos con consumo de cocaína o speedball que acuden a MSIR pueden presentar síntomas psicóticos inducidos por sustancias, siendo esto un criterio de mayor gravedad clínica. Por lo tanto, los protocolos de las MSIR deben analizarse y adaptarse en función de la sustancia utilizada y la inducción de síntomas psicóticos. Además, se necesita más investigación en esta área. (AU)


Introduction. Medically supervised injecting rooms (MSIRs) are extremely important facilities for people who inject drugs (PWID) as MSIRs provide a safe place for the consumption of street-sourced drugs, impacting overdose rates and viral transmitted infections. Methods. The current paper describes more than 10 years of our MSIR experience regarding psychotic symptoms and their relationship with the substance used. The analysis was performed using data collected between 01/01/2009 and 08/31/2021. Results. 3731 self-injections (68.7% heroin, 29.1% cocaine, 2.1% speedball, and 0.2% other substance) were recorded during the studied period. Psychotic symptoms were only observed in 7.1% of the total self-injections. However, large differences were detected among substances: 23.2% of cocaine consumptions were related to psychotic symptoms, 20.8% of speedball injections presented psychotic symptoms, and only 0.3% of heroin consumptions had psychotic symptoms (X2=604.99; p<0.001). Also, some other variables highlight that psychotic symptoms induced by substances may be associated with higher clinical severity. Conclusions. subjects with cocaine or speedballuse who attend MSIRs may present substance-induced psychotic symptoms, having higher clinical severity. Thus, MSIRs’ protocols should be analyzed and adapted in terms of the substance used and the induction of psychotic symptoms. Moreover, further research is necessary on this critical issue. (AU)


Assuntos
Humanos , Psicoses Induzidas por Substâncias , Flebotomia , Transtornos Psicóticos
19.
Addiction ; 118(10): 1975-1983, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37157055

RESUMO

AIMS: To determine whether the risk of psychotic symptoms during weeks of methamphetamine use was dependent on, increased by, or independent of having a family history of psychosis. DESIGN: Secondary analysis of 13 contiguous 1-week periods of data (1370 weeks). A risk modification framework was used to test each scenario. SETTING: Geelong, Wollongong and Melbourne, Australia. PARTICIPANTS: Participants in a randomized controlled trial of treatment for methamphetamine dependence (n = 148) who did not have a primary psychotic disorder on enrolment. MEASUREMENTS: Psychotic symptoms in the previous week were defined as a score of 3+ on any of the Brief Psychiatric Rating Scale items of hallucinations, unusual thought content or suspiciousness. Any (vs no) methamphetamine use in the previous week was assessed using the Timeline Followback method. Self-reported family history of psychosis was assessed using the Diagnostic Interview for Psychosis. FINDINGS: The risk of psychotic symptoms in the past week was independently associated with methamphetamine use in that week (relative risk [RR] = 2.3, 95% CI = 1.3-4.3) and with having a family history of psychosis (RR = 2.4, 95% CI = 0.9-7.0); the joint risk among participants with a family history of psychosis during weeks when they were using methamphetamine was large (RR = 4.0, 95% CI = 2.0-7.9). There was no significant interaction between a family history of psychosis and methamphetamine use in predicting psychotic symptoms (interaction RR = 0.7 95% CI = 0.3-1.8), but there was a small non-significant excess risk due to the interaction (0.20 95% CI = -1.63 to 2.03). CONCLUSIONS: Among people dependent on methamphetamine, the relative risk of psychotic symptoms during weeks of methamphetamine use does not appear to be dependent on, or increased by, having a family history of psychosis. However, a family history of psychosis does appear to be an independent risk factor that contributes to the absolute risk of psychotic symptoms in this population.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Metanfetamina , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Humanos , Psicoses Induzidas por Substâncias/psicologia , Transtornos Psicóticos/epidemiologia , Alucinações/psicologia , Fatores de Risco , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-37115153

RESUMO

Objective: To analyze the psychopathology and pattern of remission in cannabis-induced psychotic disorder with treatment.Methods: This was a prospective cohort study of a group of patients admitted with new-onset psychosis, cannabis use, and no evidence of other drug abuse from January 1 to June 31, 2019, to the psychiatry inpatient department of a multispecialty tertiary care hospital in Kerala, India. Patients were evaluated at admission and after 1 week in the hospital and 1 month after discharge using the Structured Clinical Interview for the Positive and Negative Syndrome Scale and the Clinical Global Impressions-Severity of illness scale.Results: Fifty-six male subjects were recruited for the study. The mean age of the subjects was 22.2 years, and the majority were active smokers of nicotine and cannabis. Total duration of abuse and family history of substance use in first-degree relatives correlated with severity of psychosis. Hostility, excitement, and grandiosity were the predominant positive symptoms, and these symptoms showed a steady reduction toward the end of the study. The most frequent negative symptoms were emotional withdrawal, passive or apathetic social withdrawal, and difficulty in abstract thinking, and these symptoms also showed significant improvement (P < .001 for all). For symptoms such as somatic concern and guilt feelings, significant treatment response was noted only in the initial week (P < .001).Conclusions: Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis.


Assuntos
Cannabis , Abuso de Maconha , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Humanos , Masculino , Adulto Jovem , Adulto , Estudos Prospectivos , Abuso de Maconha/complicações , Abuso de Maconha/terapia , Transtornos Psicóticos/terapia , Psicoses Induzidas por Substâncias/etiologia , Psicoses Induzidas por Substâncias/terapia
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