A Narrative Review of the Pathophysiology and Treatment of Methamphetamine-Associated Psychosis

Abstract

The evaluation and management of methamphetamine-associated psychosis (MAP) is an area of study with a paucity of large-scale, longitudinal data. Methamphetamine use has soared in popularity worldwide in the past decade, leading to a surge in individuals experiencing its neurotoxic effects. Current evidence suggests that methamphetamine causes neurodegeneration and psychosis through VMAT2 inhibition which raises dopamine and GABA levels in the brain’s dopaminergic pathways, leading to oxidative stress and inflammation. Differentiating MAP from primary psychotic disorders is challenging; high rates of persistent psychosis leading to a diagnosis of primary psychotic disorder and an absence of an etiologic differentiation amongst the DSM-5 diagnostic criteria further complicate the diagnostic process. Once a diagnosis of methamphetamine-associated psychosis is made, benzodiazepines have been shown to provide temporary relief; in addition, depending on the severity and impact of psychotic symptoms, antipsychotics may be indicated both short and long terms for ongoing symptom management. Robust data for these treatments is limited and primarily draws on animal studies or case reports. Further research is needed to codify MAP treatment standards of care.