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Another Mass Shooting, Another Psychiatric Drug? Federal Investigation Long Overdue | CCHR International

Despite 27 international drug regulatory warnings on psychiatric drugs citing effects of mania, hostility, violence and even homicidal ideation, and dozens of high profile shootings/killings tied to psychiatric drug use, there has yet to be a federal investigation on the link between psychiatric drugs and acts of senseless violence.

Chapter 5—Medical Aspects of Stimulant Use Disorders - Treatment for Stimulant Use Disorders - NCBI Bookshelf

Some researchers and clinicians describe the development of stimulant-induced psychosis as an evolving process. Panel members depicted MA users as having brief and transient psychotic episodes before a full-blown psychosis emerges after more extensive chronic use. MA users often recognize these early psychotic effects and try to stave them off by self-medicating with alcohol or decreasing drug use. In several articles, Ellinwood and colleagues describe the evolution of MA-induced psychosis as progressively abnormal behaviors--beginning at moderately high doses--with intense feelings of curiosity about the environment and patterns of exploration that result, for example, in examining the punctuation periods in a magazine text for evidence of a secret code (Ellinwood et al., 1973).

Department of Health | The amphetamine withdrawal syndrome

Animal and human studies have confirmed that the methamphetamine withdrawal syndrome may be protracted (the mood disturbance may last up to a year in some cases) and tends to be more severe than cocaine withdrawal (see Cho & Melega, 2002 for a thorough review; Davidson et al., 2001; Volkow, Chang, Wang, Fowler, Franceschi et al., 2001). Similarly, there is some evidence to suggest that individuals who have experienced a methamphetamine-related psychosis are at risk of further psychotic episodes, even in the absence of further psychostimulant use (Yui, Ikemoto, Ishiguro & Goto, 2000).

Engineering euphoria

Isomers of the same molecule, although very similar, often have different effects. For instance, the right-handed isomer of methamphetamine, dextromethamphetamine, is the most potent human stimulant known: This is the “meth” that tweakers crave. But the left-handed isomer of methamphetamine, levomethamphetamine, is a vasoconstrictor with little to no psychoactive effect and is used in nasal decongestants and inhalers. In contrast, both isomers of amphetamine are psychostimulants, so Shire combines both the l- and d- isomers in Adderall, each packaged in two different types of salt carriers. By creating a custom racemic mix of l- and d- isomers, and by using a custom blend of salt carriers for each molecule, Adderall meets the definition of an amphetamine formulation that can be patented for prescription use. In a word: genius. Formulating the perfect blend of speed for children sounds like a task more suited to a crime syndicate than a pharmaceutical company, but Shire put some serious thought into packaging amphetamine into pills for kids with short attention spans. The l- isomer of amphetamine, levoamphetamine, packs a euphoric rush of norepinephrine for a quick and speedy high, with a small release of dopamine for a short period of increased alertness and focus. Levoamphetamine (a.k.a. benzedrine) is a favorite of tweakers who want the most bang for their buck. The d- isomer of amphetamine, dextroamphetamine, produces less of an initial rush but increases the supply of dopamine and norepinephrine in the brain’s synaptic clefts for many hours. Dextroamphetamine (a.k.a. dexedrine) is considered by many to be the first “smart drug,” used experimentally to increase focus, memory, and intelligence.

Drug-Induced Psychosis: How to Avoid Star Gazing in Schizophrenia Research by Looking at More Obvious Sources of Light

They administered dextroamphetamine by mouth on days 1, 3, and 5 to 10 healthy volunteers, and measured the effect on striatal dopamine release before exposure, then the day of first exposure, then 2 weeks later after the third dose, using the PET/[11C] raclopride technique. Each dose of amphetamine caused greater dopamine release in the ventral striatum together with greater behavioral responses. Indeed, 1 year later there was a greater psychomotor response and greater increase dopamine release compared to the initial dose, in the ventral striatum, progressively extending to the dorsal caudate and putamen (Boileau et al., 2006). Such findings have led to the “dopamine sensitization” hypothesis of schizophrenia which postulates that a sensitized dopamine system is responsible for the genesis of psychotic symptoms (Peleg-Raibstein et al., 2009).

The Link Between Psychotic Disorders and Substance Use | Psychiatric Times

The most robust body of evidence for the relationship between the onset of psychotic disorders and drug use comes from the Swedish conscript studies.12,13 Baseline drug use information was taken at intake to the army for these studies. The authors found that cannabis use, and to a lesser extent amphetamine use, predicted onset of psychotic disorder later in adulthood. The explanatory variable was age at use, with younger age predicting psychotic disorders. This relationship did not exist for other drugs used, such as cocaine. A more recent cohort study in New Zealand confirmed the relationship between cannabis use and the onset of psychotic disorders.14 This study demonstrated that younger age of first cannabis use predicted younger age of psychotic disorder onset in individuals with the Val/Val genotype for COMT on the Val158Met polymorphism (a gene that codes for the activity level of an enzyme involved in the breakdown of dopamine).

Adderall for ADHD / ADD: Uses, Dosages, Side Effects, and Benefits of Treatment

There have been 11 reported cases of psychotic reaction from among 7,000,000 prescriptions for Adderall written since 1996.

Crappy studies

Unfortunately, the extant studies on side effect risk of the stimulants used for ADHD treatment have many limitations. All have been restricted to relatively short durations of exposure; and most are based on an assumption that a dose of methylphenidate is equivalent to half of an equal dose of amphetamine. Therefore, amphetamine is administered at 50% of the methylphenidate dose using fixed-dose designs, rather than titrating to a pre-determined efficacy endpoint before comparing adverse events. Most studies have not incorporated measurement of plasma drug level achieved although few relationships between these common adverse events and plasma levels have been noted 15. Nevertheless, it is potentially important that treatment within approved dose ranges with amphetamines, especially newer extended-release formulations, have produced residual low, but detectable, steady-state blood levels up to 24 h after administration. Thus many individuals experience some degree of continuous drug exposure. Although not tested, this finding suggests that cardiovascular complications, which have been associated with both normal aging and amphetamine abuse in young addicts, may appear earlier in older adults receiving maintenance amphetamine treatment 26. Regarding the detection of risk for uncommon or rare severe psychological or behavioral reactions to stimulants, controlled studies have not been large enough to pinpoint risk factors or determine differential risk by treatment assignment. Finally, a common observation across studies of the pharmacokinetics, pharmacodynamics, and safety profiles of amphetamine is the high degree of interindividual variability across most measures and endpoints. This variability calls for additional caution in application of the increasingly common practice of prescribing stimulants concurrent with use of other psychotropic medications 27, 28.

Understanding the Relationship Between Amphetamines and Psychosis | SpringerLink

Most people with psychosis, who use stimulants, also use cannabis, and cannabis is the most commonly used illicit drug among first-episode schizophrenia cases [40, 44, 45, 46, 48, 49, 50]. A recent review of stimulant-use disorders in people with psychosis found that cannabis use was the variable that most strongly correlated with stimulant use [51•]. Cannabis and methamphetamine have been suggested as the two most important drugs involved in the pathogenesis of psychosis and schizophrenia [34]. As the effect of cannabis, to a certain extent, counters that of amphetamines, users often take it to end amphetamine binges. Studies on psychosis in users of amphetamines seldom report on concurrent cannabis use. Given that cannabis often accompanies the use of amphetamines, it is uncertain to what extent the effect of cannabis might have influenced the evidence on the association between amphetamines and psychosis.

Florida Agency Investigated Nikolas Cruz After Violent Social Media Posts - The New York Times

Agency investigators identified Mr. Cruz, who had turned 18 a few days earlier, as a “vulnerable adult due to mental illness.” In addition to depression, Mr. Cruz had autism and attention-deficit hyperactivity disorder, the report said. He was regularly taking medication for the A.D.H.D. It was unclear whether he was taking anything for the depression, according to the report.

12 of 14

A large dose of intravenous methamphetamine hydrochloride reproduced the amphetamine psychosis in 12 of 14 patients dependent on amphetamine sulfate and failed to produce a psychosis in two patients who were eventually found to have not used amphetamine regularly above the therapeutic dose range. The psychosis was the facsimile of the disorder observed during drug abuse—a schizophrenic-like state of paranoia in a setting of clear consciousness accompanied by auditory or visual hallucinations, or both, but without thought disorder. Since in some cases the onset of the psychosis was sudden and occurred within one hour of commencing the intravenous injection, hypotheses about depletion of catecholamines and long term metabolites may need to be reconsidered.

Psychosis incidence highly variable internationally -- ScienceDaily

Among the contributing factors under consideration, they found that the strongest area-level predictor of high rates of psychotic disorders was a low rate of owner-occupied housing. The researchers used owner-occupied housing as an indicator of socio-economic affluence and stability. "Areas with higher rates of owner-occupied housing have lower rates of psychosis, which may be linked to social deprivation. People in areas that are socially deprived may have more social stresses, which could predict psychosis incidence, as suggested by other studies. An alternative explanation could be that owner-occupied housing is an indicator of social stability and cohesiveness, relating to stronger support networks," said the study's first author, Hannah Jongsma (University of Cambridge). In line with previous research, higher incidence of psychosis was also associated with younger age (although the authors also identified a secondary peak in middle age among women), males, and ethnic minorities. A related paper investigating psychosis incidence in a rural region of England, also led by Dr Kirkbride and published last week in JAMA Psychiatry, found that while people from ethnic minorities are more likely to experience a psychotic disorder, these rates become lower in areas with a high degree of ethnic diversity -- both for the majority- and minority-ethnic individuals, potentially suggesting that greater social connections between individuals from different backgrounds is protective against some mental health issues.

Cannabis Use and Hypomania in Young People: A Prospective Analysis | Schizophrenia Bulletin | Oxford Academic

Data were available on 3370 participants. Cannabis use at least 2–3 times weekly was associated with later hypomania (OR = 2.21, 95% CI = 1.49–3.28) after adjustment. There was a dose–response relationship (any use vs weekly). Cannabis use mediated the association of both childhood sexual abuse and hypomania, and male gender and hypomania. The cannabis use-hypomania link was not mediated by depression or psychotic symptoms.

Childhood infection and adult schizophrenia: A meta-analysis of population-based studies

Our meta-analysis indicates an association between childhood CNS viral infection and risk of adult non-affective psychosis.

Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia

The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community “moments feed” to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform.

Screening those at risk of psychosis may help prevent violence, reduce stigma: Study shows that violent ideation before first psychotic episode highly correlates with violent acts -- ScienceDaily

The direct question "have you had thoughts of harming anyone else?," elicited zero responses of violent ideation from any of the 200 participants. However, the indirect question "have you felt that you are not in control of your own ideas or thoughts?" elicited reports of violent ideation from 56 individuals.

8% of adolescents show psychotic symptoms? (Pot moves you from 3% to 10% to get 8% global?)

To do their study, the research team first confirmed results from both the United Kingdom and Netherlands showing the presence of a small group of individuals (in Montreal, 8%) among the general population of adolescents who report recurrent psychotic-like experiences. Second, the researchers explored how marijuana use between 13 and 16 years of age increases the likelihood of belonging to the 8%. Finally, they examined whether the relationship between increasing use of marijuana and increasing psychotic-like experiences can be explained by emerging symptoms of anxiety or depression, or by the effects of substance use on developing cognitive abilities.

Long lasting effects of chronic heavy cannabis abuse. - PubMed - NCBI

A total of 33.3% (n = 16) of the total examined cannabis users were currently imprisoned. The years of abuse ranged from 1 to 35 years and the median daily dose was 5.84.4 gr and 4.84.0 gr for prisoners (n = 16) and non prisoners (n = 32), respectively. A total of 39.6% of the users experienced hallucinations (mostly auditory), 54.2% experienced delusions (mostly ideas of reference and persecution), 85.4% had organic brain dysfunction in a test addressing visual-motor functioning and visual perception skills, and all users (100%) were found to have organic brain dysfunction in a test of visual memory immediate recall. The cannabinoid metabolite levels in the hair samples were consistent with the reported history of substance abuse and total grams of consumption for the participants below 35 years old (p < .001). Statistically elevated cannabinoids levels were observed in users with auditory hallucinations compared to users without any hallucinations (p = .019).

Jet lag linked to psychosis | Times Higher Education (THE)

"People who have a previous history of affective or psychiatric states should be cautious about flying without getting some preventive treatment from a consulting psychiatrist," he said. The research, to be published in the journal Comprehensive Psychiatry , involved 81 patients from North and South America, the East Asia and Australia - who had travelled eastwards across at least seven time zones - and 71 from Europe, whose journeys covered at most three time zones. Twenty eight per cent of the first group suffered symptoms of a psychotic episode or affective disorder within seven days of landing having had no previous psychiatric history or having been in full remission for at least a year prior to the flight.

The narrative drive = human instinct

If a person goes from being a political martyr to a mental patient in just a few days—the sign of a successful hospital stay, by most standards—her life may begin to feel banal and useless. Insight is correlated with fewer hospital readmissions, better performance at work, and more social contacts, but it is also linked with lower self-esteem and depression. People recovering from psychotic episodes rarely receive extensive talk therapy, because insurance companies place strict limits on the number of sessions allowed and because for years psychiatrists have assumed that psychotic patients are unable to reflect meaningfully on their lives. (Eugen Bleuler, the psychiatrist who coined the term “schizophrenia,” said that after years of talking to his patients he found them stranger than the birds in his garden.)

Denying a Diagnosis

Today, insight is assessed every time a patient enters a psychiatric hospital, through the Mental Status Examination, but this form of awareness is still poorly understood. Patients are considered insightful when they can reinterpret unusual occurrences—growing angel’s wings, feeling as if their organs have been removed, decoding political messages in street signs—as psychiatric symptoms. In the absence of any clear neurological marker of psychosis, the field revolves around a paradox: an early sign of sanity is the ability to recognize that you’ve been insane. (A “correct attitude,” for most Western psychiatrists, would exclude interpretations featuring spirits, demons, or karmic disharmony.)

Participants' perceived benefits of family intervention following a first episode of psychosis: a qualitative study - Nilsen - 2014 - Early Intervention in Psychiatry - Wiley Online Library

Patients and family members reported benefits that could be classified in five categories: (i) developing insight and acceptance requires understanding of the fact that the patient has an illness, and recognizing the need for support; (ii) recognizing warning signs requires an understanding of early signs of deterioration in the patient; (iii) improving communication skills is linked to new understanding and better communication both within the family and in groups; (iv) Learning to plan and solve problems requires the ability to solve problems in new ways; (v) becoming more independent requires patients to take responsibility for their own life.

The effects and determinants of exercise participation in first-episode psychosis: a qualitative study | BMC Psychiatry | Full Text

Preliminary research has indicated that increasing physical activity and fitness during the first-episode of psychosis (FEP) can improve physical health and support functional recovery [14, 15, 16]. In a recent feasibility trial (the “iBeep” study) of an exercise intervention delivered through EIP services for patients with FEP, significant improvements were observed in cardio-metabolic health, positive and negative symptoms and cognitive functioning after just 10 weeks [17]. Additionally, adherence and retention rates were substantially higher than in previous exercise trials in schizophrenia [8, 17], perhaps due to the nature of the intervention applied, or certain characteristics of the first-episode sample. We conducted a qualitative study of patients who had participated in the iBeep trial. The aim of this investigation was to explore the perceived benefits of exercise as experienced by people with FEP, and to establish the barriers and facilitating factors for increasing physical activity in this patient group. These findings could inform the development of future studies, and the implementation of exercise interventions within EIP services.

The Human Connectome Project: 180 zones per hemisphere

The researchers report that they’ve found a total of 180 distinct areas per hemisphere, regions which are bounded by sharp changes in cortical architecture, function, connectivity, and/or topography.

Self-reported impact of exercise on psychosis: good quotes

Participants generally felt that exercise was capable of providing acute relief for psychiatric symptoms. These effects varied across participants. Some reported relief from positive symptoms (i.e. auditory hallucinations and paranoia) and others for negative symptoms (amotivation and anhedonia). This seemed to depend on which aspects of psychosis characterised the individual’s current condition.

Towards a study of exercise impact on schizophrenia

We aim to conduct a trial where these methodological considerations are addressed by comparing a 12-week aerobic high-intensity interval training (HIIT) program to skills training of the same duration, with regard to: 1) aspects of cognitive function, especially memory, attention and executive function, and 2) psychiatric symptom load (negative and positive symptoms) and wellbeing. Post-treatment improvement in cognition and psychotic symptoms are anticipated. We hypothesize that the individuals in the Exercise Group (EG) will perform better than individuals in the Computer Skills Group (CSG) on aspects of cognitive function, especially memory, attention and executive function. In addition, we expect ameliorated positive and negative symptoms in the EG.