Psychosis in acute methamphetamine intoxication is usually self‐limiting and can be managed in the emergency department: A retrospective series

Abstract

AbstractObjectivesThere is little recent published data characterising acute psychosis associated with methamphetamine intoxication. We aim to describe the clinical features of psychosis, management of acute behavioural disturbance and disposition of patients with psychosis associated with acute methamphetamine intoxication.MethodsThis is a retrospective review of patients presenting with acute (use within 24 h) methamphetamine intoxication, with features of psychosis (presence of delusions, hallucinations or formal thought disorder), to an ED over 4 months in 2020. All presentations were extracted from a toxicology unit database and each medical record reviewed. Demographics, past mental health diagnoses, clinical features and disposition were extracted.ResultsThere were 287 presentations of methamphetamine intoxication over the period. Of these 287 presentations, 205 (71%) had features of acute psychosis, occurring in 171 patients (111 males [65%], median age 36, range 16–57 years). Paranoid delusion occurred in 134 of 205 (65%) presentations and was the most common feature of psychosis. Chemical sedation was given to 194 (95%), with 143 (70%) receiving parenteral sedation to manage acute behavioural disturbance. Complete resolution of psychotic symptoms occurred in 170 of 205 (83%) of exposures. There were 9 of 205 (4%) presentations that resulted in a mental health admission. Most presentations – 200 of 205 (98%) – were managed within the ED, primarily the short‐stay unit. The median length of stay was 15 h (interquartile range 11–20 h).ConclusionsIn this series of patients presenting to ED with acute methamphetamine intoxication, psychosis appeared to occur commonly and was mostly short‐lived, resolving within 24 h in the majority of patients.