welcome to the cracks in the ice webinar series€¦ · welcome to the cracks in the ice webinar...
TRANSCRIPT
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WELCOME TO THE CRACKS IN THE ICE WEBINAR SERIES
www.cracksintheice.org.au
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www.cracksintheice.org.au
Methamphetamine and mental healthAssociate Professor Rebecca McKetinNational Drug Research InstituteCurtin University
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Why methamphetamine and mental health?
How common are mental health disorders?
Methamphetamine psychosis
Overview
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Acknowledgements
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WHY METH AND MENTAL HEALTH?
• Who is using the drug• Trauma and life experience
• Self-medication • E.g., Depression leads to increased substance use
• Drug use • Dependence leads to worse mental health
• Lifestyle (e.g., financial issues, social isolation)• Pharmacological effects
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What is so special about meth?- Acts on brain circuitry involved in emotional regulation
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What it does in the brain:
• Monoamines: • Dopamine (feel good, confidence, energy,
altertness)• Serotonin (mood regulation, sleep cycles,
appetite)• Noradrenaline (fight or flight response)
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During intoxication
• Monoamines: • Dopamine (feel good, confidence, energy –
alertness)• Serotonin (mood regulation, sleep cycles,
appetite)• Noradrenaline (fight or flight response)
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After a binge “come-down”
• Monoamines: • Dopamine (feel good, confidence, energy –
alertness)• Serotonin (mood regulation, sleep cycles,
appetite)• Noradrenaline (fight or flight response)
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After chronic heavy use
• Monoamines: • Dopamine (feel good, confidence, energy –
alertness)• Serotonin (mood regulation, sleep cycles,
appetite)• Noradrenaline (fight or flight response)
= depressed, anxious, irritable, disturbed sleep
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After chronic heavy use (withdrawal)
• Monoamines: • Dopamine (feel good, confidence, energy –
alertness)• Serotonin (mood regulation, sleep cycles,
appetite)• Noradrenaline (fight or flight response)
= all energy and fight and no zen
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Pre-existing factors –trauma, genetics,
other life situation
Mental Health –depression, anxiety
Substance use disorders – self-
medication, predisposition
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How common are ‘disorders’?
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Depression and anxiety (% past year)
Primary Substance-related EitherMajor depression 44 39 83Social Phobia 24 17 41Panic Disorder 26 10 36Any of the above 57 47 88
DSM-IV diagnosis made using Composite International Diagnostic InterviewMethamphetamine dependent (n = 486), most entering drug treatment
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% with DSM-IV major depression/anxiety in the past year
Major depression or anxiety disorder
57%
Substance-related
depression/anxiety
disorder31%
Neither12%
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One year later (after treatment):
What happens after they stop using / are no longer dependent on meth?
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57% had a comorbid
depression/anxietywhen dependent
Still dependent on meth53%
had depression/anxiety
63% had depression/anxiety
(n = 97)
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at least half needed intervention for
depression and/or anxiety disorders
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Suicidality
• In the year before treatment:• 40% had thought about committing
suicide• 28% had made a plan• 16% had attempted
• Need to identify and manage risk
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“Out of control ... sedated and restrained, a man is taken to an ambulance after a psychotic episode believed to involve methamphetamine use in Darlinghurst” SMH, July 9, 2007
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What is causing these psychotic symptoms?
• Methamphetamine intoxication causes too much dopamine• Too much dopamine can cause psychotic symptoms• Can be experimentally induced• Drugs that block dopamine block meth-induced psychosis• Same drugs that are used to treat schizophrenia
• Picture more complicated in reality:• Chronic use can change the regulation of dopamine and
other systems –lasting vulnerability, which interacts with pre-disposition to psychosis
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How common is psychosis?
0
20
40
60
80
100
General population Methamphetamineusers
Psyc
hosi
s (%
)
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Symptoms of psychosis are more common
0
5
10
15
20
25
30
35
40
45%
Psychotic disorder Symptoms of psychosis
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“Yeah everyone was out to get me… I always
felt I was being followed.
I’d get taxi drivers to drop me off miles
away from where I was going …I was afraid
people were coming to get me.
I swear today there’s something behind it, I
personally think it’s real.”
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“I kept seeing people, and having
conversations with people who weren’t
there…
I sat on the tram tracks having a conversation
with someone one day …A tram was coming
and when (my friends) realised that I wasn’t
going to move away they came and picked
me up off the tracks”
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Psychotic symptoms occur on a continuum of severity:
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%Up to 2 hours 32> 2 to 3 hours 20> 3 to 48 hours 4> 2 days to one week 7> 1 week to one month 10> 1 month 14Ongoing 13
Only 11% went to hospital because of their psychotic symptoms
How long do psychotic symptoms last:
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Dose-related increase in psychotic
symptoms with more frequent
meth use
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Psychosis increases risk of violent behaviour
29McKetin R, Lubman D, Najman J, Dawe S, Butterworth P, Baker A. Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study (Under revision with Addiction)
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How do we differentiate between meth-related symptoms of psychosis and schizophrenia?
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Symptoms broadly similar:
Methamphetamine psychosis Schizophrenia
Delusions Delusions
Hallucinations Hallucinations
Some other symptoms Some other symptoms
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But…Methamphetamine psychosis Schizophrenia
Persecutory delusions Persecutory delusionsNon-persecutory delusions
Auditory hallucinations Auditory hallucinationsComplex auditory hallucinations
Visual hallucinations Visual hallucinationsMore other hallucinations
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Different clinical courseMethamphetamine psychosis Schizophrenia
Persecutory delusions Persecutory delusionsNon-persecutory delusions
Auditory hallucinations Auditory hallucinationsComplex auditory hallucinations
Visual hallucinations Visual hallucinationsMore other hallucinations
Hours to days – stops soon after stopping use
Persists after stopping use
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Different treatmentMethamphetamine psychosis Schizophrenia
Persecutory delusions Persecutory delusionsNon-persecutory delusions
Auditory hallucinations Auditory hallucinationsComplex auditory hallucinations
Visual hallucinations Visual hallucinationsMore other hallucinations
Hours to days – stops soon after stopping use
Persists after stopping use
Treat meth use Treat psychosis AND meth use
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Closing thought
Mental health care should be provided to substance use patients – almost all need it.
Drug treatment should be provided for mental health patients – drug dependence is going to worsen symptoms and outcomes in most cases
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Find out more at:www.comorbidity.edu.auwww.cracksintheice.org.au
Thank [email protected]
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Dealing drugs Property crime Violent crime Psychoticsymptoms
Severely hostilebehaviour
Disability due topoor mental
health
Disability due topoor physical
health
16+ days of meth use in the past month 1 to 15 days of meth use in the past month No meth use