Amphetamine Psychosis

It's been a while since I posted something on a clinical topic. Most of my clinical "sharing" has been through the Physician's First Watch project – which continues to go very well.

Today's Docnotes topic: Amphetamine Psychosis. Not much research on this. I was in the unfortunate position of missing the diagnosis about two weeks ago .. and then recognizing it about 1 week ago. Here's a short review of the events .. so perhaps it doesn't happen to you. I'm now be more careful to screen for it in adults who are being treated with stimulants for ADD.

Not much out there, as I mentioned .. but here's a link to the cochrane review: Treatment for amphetamine psychosis .. and here's a link to a case report in pediatrics.

OK .. here goes.

~30 YO WF with a long hx of under-achievement and disorganization – in life and cognition. I had suspected that ADD was a component of her difficulties, and had known her for years. I loaned her a copy (the last one – as we rarely get them back!) of Ned Holowell's wonderful Delivered From Distraction and she took it home to read.   About a month later, she returned and wanted to discuss treatment options. We chose a short-acting stimulant – at a low dose – to see how things went. I often do this – and scheduled a follow-up for two weeks. 

No-show for the two-week visit, but I was informed by a family member that things were going very well.  Taxes paid for the first time in years, work and life in better order than ever.

At about 1 month – we saw each other in the office and she confirmed that things were going great.  So great, in fact, that she had developed a bit of a "sixth sense" about things.  Family life was great, work was great, and her "sixth sense" had enabled her to be able to help others with their problems too.

I wondered a bit about the "sixth sense" but it seemed that things were going so well, we would continue with the treatment and see how things went.  Scheduled a follow-up for another month.

Two weeks later, she called.  In a 90 minute phone conversation (with apologies to my wife for my late arrival home again), it became clear to me that things were not right.  The "sixth sense" had developed into true clairvoyance.  She was stopping people in the street and "connecting" with them – telling them the truth about themselves, connecting with long lost relatives.

What was impressive about her psychosis is that she felt that it was the first time that she was allowing herself to be herself – without censorship of the thoughts or ideas she has always been thinking .. but never felt comfortable expressing. 

The story ends well.  With the help of her (worried) husband – we had a visit in the office.  Turns out that she had been taking the medication in much greater doses than prescribed for the previous 15 days (some is good – more is better?  Nope).  We stopped the medication, and monitored her closely.  She's now back to "normal" and we'll work on other methods of treating the ADD very soon.