1. health and fitness
2. disorders

IJBPAS, April, 2015, 4(4): 1837-1849
ISSN: 2277–4998
METHAMPHETAMIN INDUCED PSYCHOTIC DISORDERS IN THE PSYCHOTIC
EMERGENCY DEPARTMENT
SEYED MOHAMMAD RASOUL KHALKHALI1, ZEINAB KHOSHNAMA2,
MARYAM ZAVAR MOUSAVI3, REZA AHMADI4, AMIR POURRAJABI5
1: Department Of Psychiatry, shafa hospital, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran
2: Department Of Psychiatry, School of Medicine, Guilan University of Medical Sciences,
Rasht, Iran
3: Department Of Psychiatry, School of Medicine, Guilan University of Medical Sciences,
Rasht, Iran
4: Department Of Psychiatry, School of Medicine, Guilan University of Medical Sciences,
Rasht, Iran
5: Department Of Psychiatry, School of Medicine, Guilan University of Medical Sciences,
Rasht, Iran
ABSTRACT
Methamphetamine induced Psychiatric disorders in the psychiatric emergency department.
The aim of this one-year study was to determine the prevalence and some clinical and sociodemographic disorders caused by methamphetamine abuse found in emergency department
(ED)-admitted patients at the psychiatric emergency department at Shafa Hospital, Rasht,
Iran. All ED-admitted patients at the psychiatric at Shafa Hospital were examined by rapid
and confirmatory methamphetamine-abuse tests following the report they made about the
kind of drug they used, their history of psychiatric disorders reported by the patients
themselves or their family, the patients past and recent drug abuse and the present psychiatric
symptoms. The final diagnosis was obtained according to clinical indicators of DSM-IV-TR
for psychiatric disorders induced by methamphetamine abuse. Out of the 2602 participants in
the study, 1173 people (45%) had been using methamphetamine in the past one year. 179
persons (6.9%) were diagnosed with psychiatric disorders induced by methamphetamine
abuse. In 42 percent of the cases, there were signs of methamphetamine abuse in the past one
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year. The mean age of the male patients was 34 +/- 7.5, 91.6 percent of the patients were
male, 57.5 percent of the patients were single, 66.5 percent did not have a university degree,
81.6 percent were unemployed and 18.4 percent had a prison record. In 89.4 percent had
positive urine test, there was a 96.6 percent of the family’s report of drug abuse, and in 65.9
percent there was a denial of drug abuse. The most frequent disorders induced by
methamphetamine abuse included psychotic disorders (91.6%), intoxication (5%), and mood
disorders (3.4%). A significant association was discovered between a diagnosis with
disorders induced by methamphetamine abuse, and prison record, (P=0.0001). The findings
of this study showed that methamphetamines, a factor inducing psychiatric disorders, also
comorbid with other psychiatric disorders and disorders related to the substance in the
emergency departments. In addition to the importance of this drug as an inductor for
psychiatric disorders in the Iranian society, its undesirable effects in worsening the rates and
the precautions account for other comorbid psychiatric disorders. With the psychiatric
symptoms that are not differentiable from other psychiatric disorders producing stable
psychiatric disorder, there is a possibility that, with the present diagnostic criteria, the actual
effects of this drug in inducing psychiatric disorders may be underestimated.
Keywords: Psychiatric disorders, methamphetamine, and psychiatric emergency
department
INTRODUCTION
Abuse of illicit drugs and dependency on
even more problems [4]. According to
them is a major problem in all societies
experts,
which entails various social, psychiatric and
widespread use of illicit drugs in our
personality problems [1, 2]. Along with
country will be the young population, the
social health, psychiatric, familial, and
spread of satellite towns and the easy access
economic
will
to synthetic drugs in our country [5].
severely affect the addicted person with a
Methamphetamines are among the most
serious decline in his/her individual and
common
social reactions [3]. Although traditional
consumption of methamphetamines had a
narcotics and synthetic illicit drugs threaten
70 percent increase between 1999 and 2000,
all countries, our country, regarding its
and now is used more than heroin and
specific
and
cocaine [6]. Crystalized methamphetamine,
bordering the biggest narcotic-producing
called “shisheh” in Iran, is one of the most
country in the world, Afghanistan, will face
famous inductors which has become most
problems,
geographical
drug
abuse
conditions
the
main
synthetic
reasons
drugs
for
used.
this
The
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
popular especially among young people in
be associated with psychiatric disorders
Iran
[7].
such as disorders in thinking, memory
Methamphetamine is an inductor and an
problems, aggressiveness and violence. The
addictive drug which mainly comprises
side-effects of methamphetamine abuse on
amphetamine C9 H13 N. Stimulating the
cognitive abilities are evident and they
dopaminergic system, this substance will
include
cause physiological responses such as an
recalling,
deduction,
increase in hypodermic blood flow, changes
modification,
and
in the rate of heartbeats, blood pressure, and
information. Some of these disorders will
neurobiological responses recorded by brain
persist even for a short time after quitting.
scanning systems such as the FMRI, as well
In addition to physiological side-effects of
as excited behaviors resulting in a state
these drugs, recent studies have focused on
known as rush, or flush [7]. In the latest
a number of mental problems related to
formal statistical figures regarding addiction
methamphetamine. It seems that people
in Iran which was conducted in a rapid,
addicted to this drug suffer more mental and
large-scale evaluation of addiction across
psychiatric disorders compared to those
Iran, addiction to methamphetamine was
addicted to other types of narcotics, and lose
found to be at 5.2 percent of the whole
control more readily [13]. Chronic abuse of
population of addicted people [8]. These
methamphetamine can also result in such
statistics show that the pattern of abuse of
mental behavior as extreme pessimism,
synthetic drugs such as crack, heroin and
confusion, visual and aural illusions, and
Methamphetamine, in Iran in the past years
aggressive behavior. Psychotic symptoms
has undergone significant changes [9].
can persist for even months or years after
Methamphetamines
the use of such drugs [10].
and
other
countries
account
for
adverse
effects
on
learning,
information
ignoring
irrelevant
susceptibility to infection, especially HIV,
Numerous studies have been conducted on
loss of weight, and dental problems,
drug abuse and consequent psychiatric
affecting vital organs such as the heart and
disorders
the brain [10]. Studies have examined the
departments at hospitals all over the world
existence of psychiatric diseases in those
[14]. In the study conducted by Saberi and
addicted
colleagues in 2010,
methamphetamines,
and
have
in
patients
in
emergency
in Tehran, Iran,
reported the existence of mood disorders,
Methamphetamine was determined to be the
psychotic
stress-related
most important cause of delirious jealousy,
disorders [11, 12]. Methamphetamines can
absence of attention to time and place, and
disorders,
and
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
self-injury [10]. In the study by Salo (et al,
hospital were examined for the study. After
2011),
the
the preliminary check-in procedures, the
following disorders: 28.6 percent initial
patients are examined by the department
psychotic
drug
assistants for physical check-up, psychiatric
dependence, 13.2 % delirious disorders
and the routine tests, and detecting drugs.
induced by methamphetamine, 10.6 percent
After the initial examination, instructions
mood
to
will be given to the heads of department.
methamphetamine, and 3.7 percent stress-
And patients who are checked in at the
related
psychiatric department will be referred to
addicted
people
disorders,
disorders
suffered
23.8
%
related
disorders
induced
by
methamphetamine abuse [13].
the respective departments in the hospital.
With regards to the increase in the abuse of
In this way, it will be possible to monitor
synthetic
as
and examine all these inpatients. Assistants
Methamphetamine in our country, and
and the psychologist in charge of this study
reports from psychiatric hospitals regarding
(mentioned in the paper) examined the
an increase in the disorders related to
history of the patients in a period of between
Methamphetamine observed in psychiatric
8 and 24 hours after the check-in time, and
wards, the recent study has aimed to
maintained their examination until the final
examine the prevalence of abuse of this
diagnosis. Study findings were categorized
drug and the clinical specifications, and
in
socio-demographic disorders caused by
information about the patients, and clinical
Methamphetamine
specifications
inductors
such
observed
in
the
two
main
groups:
including the
demographic
psychiatric
psychiatric department at Shafa Hospital in
record of the patients, drug abuse, present
Rasht, Iran, which is the only psychiatric
psychiatric symptoms, and the self-report by
department covering Guilan Province, with
the patients, and the report from the family
a population of 3.5 million, and parts of
of the patients about the drug abuse and
neighboring provinces.
results from diagnostic laboratory tests of
METHODOLOGY
drug and methamphetamine, all of which
This study was conducted at the psychiatric
are recorded in the research profile. At the
department at Shafa Hospital in Rasht,
end, those diagnosed with psychiatric
between August 2012 and 2013. as a cross-
disorders related to methamphetamine abuse
sectional study. Sampling was easy and
were examined psychologically too. The
available and all ED-admitted patients at the
final
psychiatric emergency department of the
diagnostic criteria of psychiatric disorders
diagnosis
was
determined
when
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
induced by methamphetamine abuse based
psychiatric disorders were not linked only
on diagnostic factors of DSM-IV-TR were
with methamphetamine abuse, but with
found
abuse of other drugs (Diagram 1). The
to
exist.
Since
the
diagnostic
procedures and examinations are part of
mean
diagnostic and treatment programs, and
psychiatric
professional protection of patients’ private
methamphetamine abuse was 34 ±7.5, out of
information,
whom 91.6% were men, 66.5 % without a
it
is
believed that
such
age
of
those
diagnosed
with
linked
with
disorders
principles have been observed.
high school diploma, 81.6% unemployed,
Collected data were processed by SPSS:
and 18.4% had a prison record. There was a
quantitative data were examined for mean
meaningful association between psychiatric
values
disorders
and
standard
deviation,
and
caused
by
methamphetamine
qualitative data were examined in terms of
abuse and prison record. (P=0.0001) But
prevalence. The chi-squre test was used for
there was not a statistically meaningful
the statistical analysis and values less than
association
0.05 were considered as meaningful.
disorders and age, gender, marital status,
RESULTS
education, and jobs (Table 1).
Out of the 2602 participants in the study,
164 patients (91.6%) were diagnosed with
1173
psychotic
people
(42%)
had
been
using
between
these
disorders,
9
psychiatric
(5%)
with
methamphetamine in the past one year, 179
intoxication, and 6 (3.4%) with mood
(6.9%) of whom were diagnosed with
disorders
psychotic
abuse
disorders
induced
by
caused
(Table
2).
by
methamphetamine
There
was
not
a
methamphetamine abuse based on DSM-IV-
meaningful association between research
TR
(28.5%)
variables and psychiatric disorders induced
people
by methamphetamine abuse. 160 patients
(66.5%) methamphetamine dependence, 9
(89.4%) had positive urine tests, 173
people
of
(96.6%) had positive reports from the
methamphetamine were diagnosed. Out of
family as to methamphetamine abuse, and
the
118 patients (65.9%) denied any drug abuse
criteria.51
people
methamphetamine
(5%)
remaining
Although
abuse,
119
intoxication
994
they
people
had
a
(38.2%).
history
of
Table 3.
methamphetamine abuse, based on the
DISCUSSION AND CONCLUSION
psychiatric
criteria,
initial
This study aimed at analyzing psychiatric
disorders
were
associated
methamphetamine
abuse,
or
psychiatric
with
disorders related to methamphetamine abuse
diagnosed
in patients admitted to the psychiatric
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Seyed Mohammad Rasoul Khalkhali et al
Research Article
department at Shafa Hospital in a one-year
admitted
period. Previous studied had shown that in
methamphetamine–related
endemic regions one to two percent of
disorders (Diagram 1). This means that the
admissions at emergency departments and 8
diagnosed
percent
psychiatric
directly related to methamphetamine abuse
departments relate to methamphetamine
based on DSM-IV-TR diagnostic criteria,
abuse. Methamphetamine abuse has recently
and not related to any other diagnosis
had a rapid growth, turning into a major
pertaining to I or any other drug. Various
challenge
for
studies found no differentiable link between
Unofficial
estimates
of
admissions
health
at
analysis
have
[16].
determined
to
the
department
psychiatric
psychiatric
disorders
–related
methamphetamine
suffered
were
psychotic
methamphetamine to be the 2nd most
disorders and other psychotic disorders such
widely used illicit synthetic drug in Iran,
as schizophrenia [22]. Therefore, in the
and that psychiatric disorders pertaining to
process of diagnosis, reports from the
the abuse of methamphetamine are on the
family, drug-detection tests, and signs of
rise [17]. The relative mean age of patients
poisoning in the check-in file of the patient,
admitted to the psychiatric department and
with a view to exclude any effect from other
the consequent psychiatric disorders are
drug
similar to previous studies. Most of the
Participants in this study were those without
patients were male, young, single and
any history of psychiatric disorders and
without a high school diploma, which
present symptoms could not be related to
corresponds to previous studies [18-21]. The
any drug or diagnosis. Another considerable
implication
finding from this study is that 38.2 percent
is
that
educational
and
will
be
of
crucial
admitted to
preventive programs must focus more on
of those
such people.
department who were not diagnosed with
Efforts have been made in this study to
psychiatric
perform more accurate diagnostic tests to
methamphetamine abuse had in fact a
determine prevalence of methamphetamine-
history for methamphetamine abuse. This
related psychiatric disorders in patients
can show that regarding the final diagnosis
admitted to psychiatric departments, and to
made about those who were checked in
use a range of laboratory tests, family’s
methamphetamine abuse was determined to
reports, and clinical symptoms to reach a
exist
more accurate estimation. The diagram
psychiatric disorders such as psychotic
shows that 6.9 percent of those who were
disorders,
disorders
with
other
mood
the
importance.
psychiatric
pertaining
patients
disorders,
to
suffering
personality
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
disorders, etc, which can naturally affect the
detection tests only detect a certain density
rate of and precaution for these disorders
of the drug within a limited time of use
and can lead to worse consequences in the
(about
case of any of the disorders coinciding [18].
disorders induced by drug abuse can persist
Among those patients admitted to our
even after quitting the drug and when the
department,
symptoms
disorders
who
caused
suffered
days).
However,
are
psychiatric
gone
[24].
methamphetamine
Methamphetamine-abuse is correlated with
abuse, the patient’s report of his/her drug
anti-social behaviors and criminal acts.
abuse did not correlate much with the final
Many
diagnosis from the report, urine tests, and
methamphetamine end up in prison because
reports from the family. Patients admitted to
of their criminal behaviors [25]. Our study
the department might deny any drug use,
showed
despite the undeniable clinical evidence, the
correlation between prison record and a
patient’s profile and reports from the family
diagnosis
confirming drug abuse. This finding is hard
psychiatric disorders. This means that those
to explain. It is possible that legal concerns
diagnosed with methamphetamine-induced
and worries about assuming responsibility
psychiatric disorders were less likely to
for drug abuse are the cause. But this
have had a prison record. The discrepancy
hypothesis may not be firmly supported
might be explained regarding the fact that
given that a patient suffering psychotic
our group of the 6.9 percent of the
disorders may not feel inhibited to express
participants in question had no history of
concerns or admit to having abused other
multiple-drug addiction, or any previous
drugs. It is also possible that the patient is
record of psychiatric disorders, while the
affected by the illness, and that neurotoxic
case was different for the other group of
drugs can affect those areas vital to
participants who had a previous history of
judgment and cognition [23].
psychiatric disorders as well as a history of
Clinically speaking, it is important to note
other drugs along with methamphetamine,
that the report from the family about the
which might explain the discrepancy in the
behavioral characteristics and evidence
result. Apart from a specific group of
relating to drug abuse and consequent
participants who were chosen for this study,
intoxication
determining
a large number of participants who had been
indicator than the self-report by the patient
hospitalized had a history of multiple-drug
and drug-detection tests. Necessary drug-
addiction,
are
by
psychiatric
3
a
more
of
a
of
those
addicted
statistically
to
meaningful
methamphetamine-induced
including
methamphetamine,
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
cannabis, and alcohol. The most common
Japanese authors diagnose as permanent
pattern of abuse among Iranians is multiple-
psychosis induced by methamphetamine
drug addiction, all of which are able to
abuse is believed, by others, to be a type of
cause psychiatric disorders. In Iran, the
schizophrenia [28]. Symptoms of manic
common pattern of drug abuse is the use of
phase pertaining to bipolar disorder can
methamphetamine
another
easily be mistaken for acute phase of
narcotic in order to induce more pleasure
poisoning pertaining to methamphetamine
and hide such symptoms as insomnia [26].
abuse. In addition to this examination, a
In an atmosphere where there is a tendency
substance that can cause chronic psychosis
for
is able to enable a schizophrenia-like
multiple-drug
along
with
addiction,
and
the
disturbed life of the patient, which can be
debilitating
worsened if they suffer from psychosis too,
methamphetamine as a trigger point for a
and when data collection can become more
process which is to eventually be diagnosed
difficult, it will not be very accurate to term
as schizophrenia will cause even more
a drug psychosis. There is usually no exactly
doubt, which will make it difficult to make a
known interval between the time of drug
correct diagnosis of schizophrenia.
abuse and when the symptoms begin to
55.4 percent (n=651) of those who had had
appear. There are some who have a history
methamphetamine -abuse in the past year
of methamphetamine abuse and the related
were diagnosed with multiple-drug abuse
psychosis
psychotic
too. 29.2 percent (n=343) were diagnosed
symptoms even when not using the drug
with other psychiatric disorders. Regarding
[27]. The symptoms are not case-specific,
the former group, one cannot find a definite
and both positive and negative symptoms
relationship between psychiatric disorders
can be seen in the case of permanent
and a drug, although one cannot rule out any
damage due to prolonged drug abuse, and
of the drugs’ effects. As for the latter, it is
because of neurotoxic effects on the frontal
possible that those who were diagnosed with
and striatal areas, even if there has not been
methamphetamine -induced schizophrenia
a prolonged use of the drug or over one
actually
month [23]. The authors of DSM are still
caused by a certain methamphetamine dose.
skeptical about the diagnosis for permanent
At a glance, it can be said that although only
psychosis induced by methamphetamine
6.9 percent of those visiting emergency
abuse which is strongly believed by oriental
departments
and
methamphetamine-induced
can
Japanese
demonstrate
researchers,
and
what
process
suffered
were
[29].
permanent
Defining
psychosis
diagnosed
with
psychiatric
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IJBPAS, April, 2015, 4(4)
Seyed Mohammad Rasoul Khalkhali et al
Research Article
disorders, the rate of 45 percent of patients
The scope of our study was limited to the
admitted to the emergency departments
participants
(suffering from either drug abuse in the past
impatiens, and not all in the society. As our
one year, or a known psychiatric disorder,
study
or multiple-drug abuse at the time of check-
patient,some non emergent disorders, like
in) shows the magnitude of this hazard, and
methamphetamine related sleep disorders
its disastrous effect on each and every
and
related problem including initial psychiatric
disorders were not actually diagnosed.
was
from
the
focused
methamphetamine
population
on
of
emergency
related
sexual
disorders or multiple-drug abuse.
Table 1: an analysis of demographic specifications of ED-admitted patients at Shafa Hospital, who were
diagnosed with methamphetamine-induced psychiatric disorders
variable
number
percentage
Less than 30
62
34.6
age
30 to 40
79
44.1
More than 41
38
21.2
female
15
8.4
gender
male
164
91.6
single
103
57.5
Marital status
married
57
31.8
divorced
19
10.6
illiterate
12
6.7
primary
22
12.3
Without a high school diploma
119
66.5
education
High school diploma and
25
14
associate degree
University degree
1
0.6
clerk
5
2.8
jobless
164
81.6
profession
Small business
16
8.9
worker
12
6.7
yes
33
18.4
Prison record before
or at present
no
146
81.6
Table 2: prevalence of all types of methamphetamine-related side-effects in ED-admitted patients at
Shafa Hospital
Side-effects
number
percent
Mood disorders
6
3.4
Psychotic disorders
164
91.6
intoxication
9
5
total
179
100
Table 3: prevalence of methamphetamine-induced psychiatric disorders in ED-admitted patients at Shafa Hospital
Type of verification
Status of verification
number
percentage
Urine test
yes
no
total
Family of patients
yes
no
total
patient
yes
no
total
160
19
179
173
6
179
61
118
179
89.4
10.6
100
96.6
3.4
100
34.1
65.9
100
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Research Article
Diagram 1: frequency distribution of ED-admitted patients at Shafa Hospital between August 2012 and
August 2013
Ayandeh
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