Drug & Alcohol Services South Australia WHO Multi-Site Project on Methamphetamine-induced Psychosis: A descriptive report of findings from participating countries. Robert Ali1,2, Michael Baigent1, John Marsden3, Maristela Montiero4, Manit Srisurapanont5, Agueda Sunga6, Robyn Vial1, Kiyoshi Wada7 DASSA Research Monograph No. 20 Research Series 1 Drug and Alcohol Services South Australia, Adelaide, South Australia 2 Department of Clinical and Experimental Pharmacology, University of Adelaide, Adelaide South Australia 3 National Addiction Centre, Institute of Psychiatry, University of London, London, UK 4 Department of Mental Health, Substance Abuse and Rehabilitation, Pan American Health Organization, Washington DC, USA 5 Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 6 Bureau of International Health Cooperation, Department of Health, Manila, Philippines 7 Department of Drug Dependence Research, National Institute of Mental Health, NCNP, Chiba, Japan ISBN 0-9803130-0-7 © Drug & Alcohol Services South Australia 2006 This work is copyright. 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CONTENTS CONTENTS ................................................................................................................................................... i LIST OF TABLES........................................................................................................................................ iv LIST OF FIGURES ...................................................................................................................................... vi ABBREVIATIONS ...................................................................................................................................... vii ACKNOWLEDGMENTS............................................................................................................................ viii EXECUTIVE SUMMARY ............................................................................................................................. ix SECTION 1: INTRODUCTION.................................................................................................................... 1 1.1 Background.................................................................................................................1 1.2 Study aims .................................................................................................................. 1 1.3 Structure of the report ................................................................................................. 2 SECTION 2: OVERVIEW OF LITERATURE .............................................................................................. 3 2.1 Pharmacology and use of methamphetamine............................................................. 3 2.1.1 Pharmacology and neurobiological actions of methamphetamine ................ 3 2.1.2 Routes of methamphetamine administration................................................. 4 2.1.3 Effects of methamphetamine ........................................................................ 4 2.1.4 Methamphetamine abuse and dependence.................................................. 5 2.2 Methamphetamine psychosis...................................................................................... 5 2.2.1 Past research into amphetamine-induced psychosis .................................... 5 2.2.2. Symptoms of methamphetamine psychosis.................................................. 5 2.2.3 Duration of methamphetamine psychosis ..................................................... 6 2.2.4 Recurrence of methamphetamine psychosis ................................................ 7 2.2.5 Treatment for methamphetamine psychosis ................................................. 8 2.3 Methamphetamine use in the four sites ...................................................................... 8 2.3.1 Methamphetamine use in Australia............................................................... 8 2.3.2 Methamphetamine use in Thailand ............................................................... 8 2.3.3 Methamphetamine use in the Philippines...................................................... 9 2.3.4 Methamphetamine use in Japan ................................................................... 9 2.4 Summary..................................................................................................................... 9 SECTION 3: METHODOLOGY................................................................................................................. 10 3.1 Method ...................................................................................................................... 10 3.1.1 Study questionnaire .................................................................................... 10 3.1.2 Interviewers................................................................................................. 11 3.1.3 Subject recruitment ..................................................................................... 11 3.1.4 Procedure ................................................................................................... 12 3.1.5 Ethics Approval ........................................................................................... 12 i SECTION 4: RESULTS.............................................................................................................................13 4.1 Demographic characteristics of the sample...............................................................13 4.1.1 Age and gender distribution ........................................................................13 4.1.2 Educational profile.......................................................................................13 4.1.3 Employment profile......................................................................................14 4.1.4 Marital status and living arrangements........................................................15 4.1.5 Participant profiles.......................................................................................17 4.1.6 Summary.....................................................................................................17 4.2 Source of referral and past diagnoses.......................................................................17 4.2.1 Sources of referral for hospital admission .................................................177 4.2.2 Past psychiatric history................................................................................18 4.2.3 Medications prior to admission....................................................................19 4.2.4 Participant profiles.......................................................................................19 4.2.5 Summary.....................................................................................................20 4.3 Extent, patterns and routes of methamphetamine administration..............................21 4.3.1 Lifetime amphetamine type substance use .................................................21 4.3.2 Frequency of methamphetamine use in last 12 months..............................22 4.3.3 Route of methamphetamine administration.................................................23 4.3.4 Availability and substitution .........................................................................25 4.3.5 Other drug use ............................................................................................26 4.3.6 Participant profiles.......................................................................................28 4.3.7 Summary.....................................................................................................29 4.4 Consequences of methamphetamine use .................................................................30 4.4.1 Methamphetamine abuse and dependence ................................................30 4.4.2 Problems and experiences related to methamphetamine use.....................34 4.4.3 Legal issues ................................................................................................36 4.4.4 Social Context of use. .................................................................................37 4.4.5 Participant profiles.......................................................................................38 4.4.6 Summary.....................................................................................................39 4.5 Physiological and psychological symptomatology.....................................................40 4.5.1 SF-12 Physical and mental health status summaries..................................40 4.5.2 Methamphetamine-induced psychosis ........................................................41 4.5.3 Symptoms of methamphetamine psychosis - Manchester Scale ................49 4.5.4 Negative symptoms of methamphetamine psychosis - Manchester Scale..51 4.5.5 Summary of methamphetamine-induced psychosis symptoms...................52 4.5.6 Other psychiatric morbidity..........................................................................53 4.5.7 Participant profiles.......................................................................................54