Can Prescription Amphetamines Cause Psychosis?

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The following is a transcription from the above video on Can Prescription Amphetamines Cause Psychosis?

Hey, everybody, welcome back. The question that is posed today, is formulated as can prescription stimulants or amphetamines for treatment of disorders like ADHD cause psychosis, and the same way that methamphetamines do that is how the question is presented to me. And I will reformulate it to answer as much of your questions as I possibly can. For those of you that are new to the channel. My name is Dr. B with Dr. B addiction recovery on this channel. We do all things related to substance abuse, hopefully for your edification.

Can prescription amphetamines cause psychosis the same way that methamphetamines do?

Can Prescription Amphetamines Cause Psychosis

The question is posed as really a can medication for ADHD type of issues caused psychosis in the same way that methamphetamines do. We are the middle of our stimulant series. And I’m a little bit off track here because it will be leading up to this question as I’m doing a historical approach. But I think so many people are asking and I’m so slow to get these done. I want to dive right into this. As I explained the issue, you will also understand why I am so hesitant to answer this question in general, uh, in the scientific literature, the question of does ADHD, medication costs, psychosis, and the same way methamphetamines do when you look at the scientific clinical literature, uh, there’s really a posity of good information to answer this question, and there can be multiple reasons for this.

And one of them is that you have to sort of tease out so many different factors to be able to get a robust answer. It is difficult to, uh, again, there’s no conspiracy theory, uh, sort of attached to this, but you know, there’s a lot of money behind this issue and it might be avoided for multiple reasons. I don’t know. Nevertheless, it’s an important question and what I can say right off the bat, let me start off with some, uh, what we call anecdotal evidence my many years in, uh, as a professor of emergency medicine, working in a really busy, uh, department, uh, we also ran a psychiatric ER in a county facility in that capacity and scope. I probably saw over 40,000 patients in my time there. And a subset of those patients were pretty severe psychiatric presentations. And after seeing so many of them and dealing with a lot of 51 fifties, uh, schizophrenia, bipolar, all kinds of stuff, uh, there was one thing that started to, uh, pop up on my radar a few times.

And it was interesting as you behave, as you start to see patterns, one of the things I started to notice, uh, is, which was interesting, cause you see patterns is, um, oftentimes people would present in a psychotic state, okay. Psychosis, okay. Which is sort of the hallmark of schizophrenia and some of the amphetamine presentations. And we had a room and uh, uh, this is some years back. So we had a room and they would be put in there and it was sort of one of those padded rooms with a window where the clinician could look in and so could the security that was keeping an eye on them. And, uh, didn’t really have, uh, the straight jacket, but we would take all their clothes and uh, wrap them up in a blanket and put them in there and make sure they got food and so forth. 

I was always inclined to, uh, peek into the window and I would walk right in to the room and sit with them and it would always make, uh, the security quite nervous, but I thought it was important for building rapport with anyone in there in any state of mind that they were in. Oftentimes the typical patient, you could tell if it was psychosis from untreated or poorly treated or out of control, primary psychotic disorders in another video, I’ve explained this, that would be schizophrenia. Okay. And, uh, you know, they’re often homeless, they’re often, uh, quite disheveled. Um, they just look a little bit different every once in a while. And these patients would often be sitting there, urinating all over the place. Sometimes you’d walk in and they’re eating their feces. Sometimes they would take their feces and you’re trying to talk to them to go window and they’d be rubbing it on the window. 

And, uh, those cases, you want to be a little cautious walking in, but every once in a while, I’d see, uh, somebody between the age of 25 and 45, oftentimes, uh, relatively to what I would see on a daily basis, meticulously dressed. Okay. And you would see in the hallway, uh, and again, this was a pretty, uh, hardcore grimy facility. You know, uh, you could often smell urine. You could often smell all kinds of stuff in the hallway and see all kinds of people. Oftentimes in the hallway, I would see very well-dressed, well-mannered what seemed like family sitting there before I even would walk in, as I kept walking back and forth from this room, I already knew what the diagnosis was and what had happened. You had, uh, I recall one in particular, one of the last ones I saw you had a basically normal high functioning individual.

Uh, this particular guy was in his early thirties and the family was successful business. People in town had a, uh, I don’t recall what kind of business it was. And he was a part of that business. But over the last few weeks, he started to behave strangely. And over the last week he had gone into what you can call florid psychosis. Okay. He was hearing voices, he had paranoid, uh, beliefs and they usual thing. And so on it’s in other videos. And what would cause this, uh, you could say, well, you know, before that he had stable set of primary psychotic disorder schizophrenia, no, every time, uh, it was long-term use of prescribed stimulant medication for ADHD. Oftentimes at high doses, I ran into this. It was not common, but you can’t say it was super uncommon. I probably saw four or five of these cases, uh, during my career.
So right then and there we can in the most general way, say that for the most part prescribed stimulant medications can and have the potential to cause psychosis in the same way that elicit methamphetamines. Okay. That we can say in some ways. And I, in a very, very, uh, non-scientific way, uh, why is this difficult and why one, why there’s one half to be cautious in saying that number one, as I said, the literature scan, uh, if you were going to really answer this question, you have to do a few things. Number one, making that statement for someone who has narcolepsy and stim on stimulant medication versus someone who has, uh, an adult versus a child. That’s the other thing let’s talk about it. So if you’re talking about an adult with narcolepsy on stimulant medication, or if you’re talking about an adult on stimulant medication for ADHD, it’s a whole different ballgame because narcolepsy itself, if you look into the details of the presentation and the disease, some of it is highly associated with psychotic disorders and presentations and, and so forth.

 So that’s gonna really change the disease, state, demographics that you’re evaluating. And if you’re gonna make that statement about it, uh, you can’t make it about the same thing with ADHD. Okay. Number two, which medication you talking about? Okay. Are you talking about Netflix affinity data? I think it’s literally, are you talking about Adderall? Okay. Are you talking about [inaudible]? Okay. That’s another question that you have to consider. Number three, you do have to consider comorbid substance abuse or other psychiatric disorders in the patient before you can pull the plug and say that judgment, right? It can be the case that the patient who is on ADHD medication for adult ADHD is also suffering from psychiatric disorders. Even severe depression can have a psychotic feature. It’s not common, but it’s, it’s there. And you have to evaluate for comorbid substance abuse. Oftentimes nowadays there are so many people that are, uh, whether it’s smoking marijuana, drinking a lot of alcohol, uh, doing all kinds of synthetic stimulants, all of these can contribute to the presentation of psychosis, uh, number four, those things that I do see nowadays that people present with are just off the chart. 

Okay. Way more than the sort of indications or needed amount for the stimulant medications. And let’s just keep it down to Ritalin and Adderall types of medication. Okay. Those things seem to be quite often me, uh, and uh, many times off label and that’s how they are used. So let’s really put that, uh, and, uh, sort of a formal, um, uh, language. Okay. A, a lot of people on this medication, stimulants in particular, methylphenidate is as well. I looked it up in one study and I see a clinically there already abusing other forms of illicit substances and drugs. All of which can contribute to this psychosis too. There’s got to be a dose-related response and effect, which has to be taken into consideration. When you look at these, uh, study, if you’re going to study this three, there may be a lot of comorbid primary psychotic disorders that still even haven’t been undetected, including bipolar disorder, manic episodes, all of which adding a stimulant prescription can cause psychosis. Okay. So there’s a lot of nuances here. I want to add a couple of more things on this issue and other videos we’ll get into much more details about this, uh, as well, one of the dangers of discussing this is, uh, and my, on my Tech-Talk. If someone looks at it closely, my position 

Can come across confusing. And one of the posts that I really make the point that attention deficit, spectrum of disorders are underdiagnosed and over treated, which sounds contradictory. And here’s what I mean. There is so many people out there that can use treatment for this medication as the associated complications and morbidity and quality of life with it are so profound, including legal issues, poor school performance, poor job performance, core, uh, relationship outcomes. Uh, and it’s really an emotionally based disease that it needs to be evaluated and treated. The problem is treatment of this medication or treatment of this disease, especially when you’re dealing with a potent medication that has a lot of side effects. In addition to a high abuse, potential has to be a really closely monitored evaluated, and almost finding the cherry spot of the medication and the dose, since that’s really not done in our system, okay, this itself contributes to wrong dosing for the wrong patient, for the wrong indications. 

And then you see this stuff being as one of the most prescribed medications on the planet. And that itself is a contributing factor to potential psychotic episodes. We’re not even discussing the other issues by prescribing a stimulant, such as this as sympathetic. Sympathomimetics such as this, because this stuff also has profound effects on the cardiovascular system, including hypertension, cardiovascular events that are catastrophically both in the heart and in the brain. Okay. And this stuff long-term can potentially cause neuroplastic changes. So one of the things that we can pick from here that we can say definitively is number one, from what we’ve seen and from the minimal evidence that’s out there. And when I say minimal, there’s a lot of data out there, but large random trials that really tease these things out. Aren’t there, but we can probably safely clinically say that this stuff can induce psychosis under the right circumstances. What should we draw out from that? Uh, and again, I haven’t gone into all of the medications. This is sort of a general overview. What can we draw out from that?

So A lot of people, when they watch a video like this and so forth, we’re like, wow, no way. I’m not putting my kid on this stuff. Or in this case, we’re talking about adults. This is bad stuff. No, that’s not what I’m saying. What I’m saying is every single thing you do to a patient and the patient should be aware of this should be with a very, very, very intimate evaluation of the risk and fit and a constant monitoring of the patient and evaluating their response to the medication and looking for signs of trouble, whether it’s substance abuse or any sort of cardiovascular effects or any kind of psychiatric symptoms. So really, um, I think what we’ve distilled out of this is that this medication as a high abuse potential, uh, prescription stimulant B, uh, it can cause a lot of problems, including psychosis. So be conscientious, thoughtful, discuss it extensively with your clinician before you start this medication and be vigilant of the fact that you can run into problems. I hope that’s helpful. I try to approach it in a really broad way within the stimulant series and then future ones. I can talk about specific ones and start breaking it down to pediatrics, narcolepsy, ADHD. I really want to finish the historical approach to this medication. If you liked this video, please don’t forget like us subscribe ringed up L consider our Patriot, and I will see you guys soon. Peace.

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