Psychosis and methamphetamine (ice)
Some people who have never experienced psychosis will have a psychotic episode triggered by methamphetamine use. Typically, methamphetamine induced psychosis resolves within a few days to a week after the effects of the drug wears off and the person rests and recuperates. A quiet, low stimulus environment is recommended.
However, some people will have psychotic symptoms as a side effect of ice lasting for weeks or months. These people need specialist psychiatric treatment and usually need antipsychotic medication.
Methamphetamine can trigger a first episode of psychosis in a person who was already at risk of developing schizophrenia or a related psychotic illness. In people recovering from a psychotic illness, methamphetamine use can trigger a relapse.
Acute effects of methamphetamine
Some acute effects of ice use or ice withdrawal symptoms can look similar to symptoms of longer term psychosis. Acute side effects of ice can include intense fear, paranoia, and panic states; hallucinations; loss of behavioural control; and aggression. Withdrawal from methamphetamine can also cause irritability and agitation.
People who use methamphetamine present in states that range from having mild, low grade psychotic symptoms to full blown psychosis.
At one end of the spectrum, clients will tell us: “When I’m using I just start seeing these things, things happen and I have some weird experiences.”
But they remain capable of stepping back from these unusual experiences and recognise them for what they are – symptoms of sleeplessness and the effects of methamphetamine.
This situation is very different from the other end of the spectrum; working with a client who is psychotic and unable to discriminate between what is real and what is not.
In the middle of the spectrum, we see many clients with suspiciousness or odd thoughts that do not progress to psychosis. Many people that use methamphetamine tell us that they experience low grade psychotic symptoms like visual illusions, fleeting hallucinations, or odd thoughts that come and go.
Psychosis symptoms
Psychosis symptoms reflect significantly impaired contact with reality. Symptoms include:
- Hallucinations, including auditory, tactile, visual, gustatory (taste), and olfactory (smell) hallucinations
- Delusions, defined as fixed, false beliefs that do not change even when there is evidence that the belief is not logical (not including culturally shared beliefs)
- Paranoia (a form of delusion) which can extend from unwarranted suspiciousness and distrust, to delusions of persecution
- Disordered thought, including confusion, inability to concentrate, sped up or slowed down thinking, and jumping between topics with no apparent connection
- Bizarre behaviour in response to delusions or hallucinations
- Mood swings
Asking about psychosis symptoms
Workers may not routinely attempt to assess whether people who use methamphetamine are experiencing psychotic symptoms as a side effect. However, psychotic symptoms can disrupt our work with clients and make treatment less effective. For example, a client may experience a voice telling them not to listen to their practitioner.
While it may be obvious when a client has hallucinations, we can miss more subtle symptoms of psychosis. We may attribute signs to anxiety or personality unless we monitor and consider carefully and ask about the symptoms directly.
A sensitive way of questioning people may be: “People who use methamphetamine sometimes feel scared or worried from time to time, or may even hear or see things that other people can’t. Has that ever happened to you?”
If a client answers yes, then gentle questioning to gain more detail is warranted: “Can you tell me a little more about that?”
The information gained may trigger the need for a full mental health assessment.
Helping clients to identify what triggers psychotic symptoms and their particular early warning signs should be integral to an ongoing support plan, including a relapse prevention plan.
It’s equally important not to assume that if the person is suspicious or seemingly paranoid that it is psychotic in nature. It may be quite possible that they are in a dangerous situation. Careful questioning is crucial.
Signs of mild (low grade) psychosis as a side effect of ice include:
- Acting in a suspicious, guarded or hypervigilant manner (eg, constantly checking for threats in an exaggerated way)
- Overvaluing ideas (eg, placing special significance on ordinary events)
- Responding to illusions or misinterpreting the environment (eg, mistaking a shadow for a person, or a random sound for a police car siren)
- Behaving erratically (eg, falsely accusing others of doing something wrong, arguing with strangers)
Signs of acute psychosis as a side effect of ice include:
- Responding to delusions (eg, feeling persecuted, believing others are threatening them or spying on them)
- Responding to hallucinations (eg, hearing police cars, feeling bugs crawling under the skin, seeing things that are not there)
- Behaving strangely or uncontrolledly (eg, shouting back at hallucinatory voices, whispering unnecessarily, barricading a room, checking doors and blinds, carrying a weapon)
- Speaking oddly (eg, being illogical, disconnected or incoherent)
- Showing extreme or rapid mood swings.
Looking to improve your skills in responding to methamphetamine? Our half day online workshop Breaking the Ice: Tailoring treatment for people who use methamphetamine is for you.
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