Amphetamine Psychosis

Review of Amphetamine Psychosis. By P. H. Connell, M.D., D.P.M. (Pp. 133; illustrated. 21s.) London: Published for the Institute of Psychiatry by Chapman and Hall, Ltd. 1958.

British Medical Journal, 21 Febraury 1959, p. 488

This is the fifth of the Maudsley Monographs. It constitutes an important addition to the literature on the subject of amphetamine addiction. The author begins by reviewing the literature and providing a short review of most of the cases of mental symptoms accompanying overdosage of amphetamine which have been reported in the English and French languages. He then describes 42 patients who had come under his own observation, and comes to general conclusions. In the second part of the book the biochemical tests available for testing the presence of amphetamine, dexamphetamine, and methylamphetamine in body products are discussed; and the author presents as practical and reliable his own modification of the methyl-orange test of Brodie and Udenfriend.

   Dr. Connell believes that psychoses associated with amphetamine usage are much commoner than is usually supposed. The acute psychotic state which results from overdosage closely resembles a paranoid schizophrenia, and is commonly so diagnosed; but it usually clears up within a week. If the illness persists, and biochemical tests show that amphetamine has been eliminated, then another cause must be looked for (for example, a genuine schizophrenia). Amphetamine must be regarded as a true hallucinogen, since a single large dose will cause a psychotic state with hallucinations. The medical profession is given a number of well-meant warnings about how the drug should be used.

   The psychotic state produced by amphetamine is of much clinical interest. There are no physical signs of any diagnostic significance. Yet an experienced clinician would probably suspect a toxic psychosis if he bore the possibility in mind. Features in which it tends to differ from a schizophrenic state are the past history of psychopathic traits, the rapidity of onset, the dream-like quality of the experiences, the tendency towards visual hallucination, and the brisk emotional reaction usually in the direction of anxiety. Only the most hyperacute of paranoid schizophrenic states will mimic this syndrome in all its peculiarities.  

   Dr. Connell does not make use of the word " confusion," but says that in only three cases was there disorientation. It seems probable that, with adequate attention to specific tests, a much larger number of the patients would have shown evidence of some degree of clouding of consciousness. We are not told how many of the patients had a clear and detailed, or a muddled and incomplete, idea of what they had gone through, after the first few days of acute disturbance had passed. It is a matter of much theoretical interest how closely a pseudo-schizophrenic symptomatic psychosis may resemble the true endogenous schizophrenia. It is a pity that the author did not go into this in more detail, merely confining himself to saying that the mental picture may be indistinguishable from acute or chronic paranoid schizophrenia. Nevertheless, he is to be congratulated on a substantial and valuable piece of work.