Psychosis cocaine-induced

Wetli, C.V. and Fishbain, D.A. Cocaine-induced psychosis and sudden death in recreational cocaine users. J. Forensic. Sci. 30 873, 1985. 

Chronic cocaine use can cause a syndrome of insomnia, hallucinations, delusions, and apathy. This syndrome develops around the time when the euphoria turns to a paranoid psychosis, which resembles paranoid schizophrenia. Further, after cessation of cocaine use, the hallucinations may stop, but the delusions can persist. Still, the incidence of a persistent cocaine-induced psychosis appears to be rare. One study found only 4 out of 298 chronic cocaine users receiving a diagnosis of psychotic disorder (Rounsaville et al. 1991). This incidence is approximately the... 

After Freud s prescriptions had hooked his famous colleague and patient Fleishel, the cocaine-induced highs crashed into more and more severe depressions, until Fleishel broke into frank psychosis. 

Brady KT, Lydiard RB, Malcolm R, Ballenger JC. Cocaine-induced psychosis. J Clin Psychiatry 1991 52(12) 509-12. 

Ciraulo DA, Rotrosen J, Leiderman D, et al Nefazodone induced alterations of cocaine craving and use in dysphoric cocaine users. Drug Alcohol Depend 60 S38, 2000 Connell PH Amphetamine Psychosis (Maudsley Monographs No 5). London, Oxford University Press, 1938... 

Toxic psychosis Several monoamine stimulants including cocaine are known to produce a temporary or even a lasting psychotic state after heavy use. Reviews of numerous clinical case reports have shown amphetamine to produce a chronic psychotic state, sometimes persisting for months after cessation. There appears to be a sensitization effect in this regard, because after recovery, psychotic states may recur with minimal use of amphetamine or alcohol. When compared to schizophrenic patients, people with amphetamine-induced psychosis demonstrate fewer negative symptoms (Boutros and Bowers 1996). 

The hypothetical link between dopamine and schizophrenia was forged by two reciprocally related findings. The first was that potent dopamine agonist stimulants like d-amphetamine and cocaine could cause a psychosis that was schizophrenia-like, in that it had auditory hallucinations and paranoia. The second was that the neuroleptic drugs that were effective in reversing both schizophrenia and stimulant-induced psychosis were dopamine blockers. Moreover, the antipsychotic potency of the neuroleptics was proportional to their binding affinity to the D2 receptor. 

FIGURE 13—5. Production of reverse tolerance in a cocaine abuser. Repeated intoxication with cocaine may produce complex adaptations of the dopamine neuronal system, such as sensitization or reverse tolerance. Thus, in repeat users, cocaine releases more and more dopamine. In such cases doses of cocaine that previously only induced euphoria can create an acute paranoid psychosis virtually indistinguishable from paranoid schizophrenia. 

Adverse effects of catecholaminergic stimulants, such as amfetamine and cocaine, fall into several categories, based on dose, time after dose, chronicity of use, and pattern of use/abuse (for example 4-5 day bingeing episodes). Adverse effects include not only responses during the period of use but also intermediate and longterm residual effects after withdrawal. For example, in some abusers once an amfetamine psychosis has developed with chronic abuse, only one or two moderate doses are required to induce the full-blown psychosis in its original form, even long after withdrawal (1). This is also evidenced by the precipitous slide to severe re-addic-tion in former abusers who are re-introduced to stimulants. 

Acutely, cocaine can cause anxiety or panic reactions. Used chronically., cocaine can in duce a psychosis that closely resembles that produced by amphetamine. It is generally considered that amphetamine psychosis predominantly mimics the positive symptoms of schizophrenia, but in fact stimulant-induced psychosis can mimic a broad range of symptoms, including negative and bizarre symptoms (44). Paranoid behavior has been produced in experienced cocaine users by continuous (4h) cocaine infusion (45). 

According to Carpenter, Conley, and Buchanan (1998), stimulants such as cocaine and amphetamines activate the dopaminergic system in the brain, which explains why the abuse of stimulants can induce a paranoid psychosis that mimics the positive symptoms representative of schizophrenia. In turn, if a person who is diagnosed with schizophrenia is given stimulants of this type, the psychosis may be exacerbated. It follows, therefore, that the typical antipsychotic medications act by blocking the dopamine receptors. 

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