Risperidone for Methamphetamine Induced Psychotic Disorder

Risperidone for Methamphetamine Induced Psychotic Disorder On the efficacy of risperidone for the treatment of methamphetamine induced psychotic disorder, a dose ranging study Induced psychosis, diagnosis and treatment Worldwide growing methamphetamine abuse is one of the most serious health problems with several different consequences for victims, especially in developing countries. Chronic methamphetamine abuse is associated with several psychiatric problems in all countries which are faced to epidemic methamphetamine abuse. Methamphetamine induced psychosis (MIP) is a major medical challenge for clinical practitioner from both diagnostic and therapeutic viewpoints. Stimulant psychosis commonly occurs in people who abuse stimulants, but it also occurs in some patients taking therapeutic doses of stimulant drugs under medical supervision. The main characteristic of meth psychosis is the presence of prominent hallucinations and delusions. Other drugs, such as cocaine and marijuana, can trigger the onset of psychosis in someone who is already at increased risk because they have vulnerability. The current literature review attends to explain several aspects of MIP, including epidemiologically, clinically and investigators proposed pharmacologically treatment based on recently published data. Introduction Amphetamine and methamphetamine have the most substances for abuse among the synthetic psychostimulant across the world1. The overall the prevalence of methamphetamine users (excluding amphetamine users) ranges from 10.5 to 28.5 million people worldwide (0.2% to 0.6% of adults between 15 to 64 years old)2. Accompanied to amphetamine these synthetic psychostimulants are ranked as the 2nd abuser illicit drugs after cannabis as the 1st and before cocaine and opiates1. Many consequences follow methamphetamine abusers including medical, psychiatric, cognitive, legal and socioeconomic problems. It is unclear why methamphetamine abusers are more involved with legal consequences than all other illicit drug abusers3. It might be due to more psychotic symptoms induced by these psychostimulant drugs, or flaring of symptoms in a subtle or stable schizophrenia which could be exacerbated by methamphetamine4. It has been well known that such drugs are able to produce psychotic symptoms in persons with no history of previous psychiatric disorders.5,6 Epidemiology and clinical manifestations of MIP There are other substances able to produce psychosis including cocaine, cannabis, alcohol, hallucinogens, heroin and sedatives7.There will be a diagnostic challenge to meet a net diagnosis for drug-induced psychosis, if the clinical practitioner cannot establish the presence of psychotic symptoms before initiating drug abuse. In a survey, among 400 cases who admitted in different psychiatric emergency departments for their psychotic symptoms, 44% received a substance-induced psychosis diagnosis and 56% were diagnosed essential psychosis8. According to DSM-IV criteria, diagnosis of primary psychosis is usually after at least 4 weeks with persisting symptoms without heavy substance use. In addition to the previous history of substance abuse, other factors lead to drug-induced psychosis including parental substance abuse, dependency to drug (rather than occasional abuse) and visual hallucination. Lower positive and negative syndrome scale with th positive history of drug abuse put in fa vor of drug-induced psychosis, as well as more consciousness to psychotic symptoms and more tendency to suicidal thoughts are another feature of drug-induced psychosis. Generally, reported psychotic symptoms due to MethAmphetamine(MA) abuse, from USA, Japan, Taiwan, Australia and Iran are the same as each other including (as studied by Fasihpour et al) persecutory delusions (82%), auditory hallucination (70.3%), reference delusion (57.7%), visual hallucination (44.1%), grandiosity delusion (39.6%) and jealousy delusion (26.1%)9. Although certain risk factors could not be extracted among documented literature and many conducted studies by different authors in involved countries have been reported more common factors include: 1. Pyschosis induction is largely dose-dependent than duration-dependent5,10,11 2. Positive family history of psychotic symptoms especially in first degree relatives5. Interestingly protracted and more resistant psychosis was occurred in abuser persons, whose one of their first degree relatives has been involved by schizophrenia12.3. Presence of premorbidity in abuser subjects, such as schizoid/schizotypal personality traits, alcohol dependency, antisocial personality disorders and major depression, all can be psychosis induced by methamphetamine5. 4. History of sexual abuse experience, recent higher occasion of MethAmphetamine(MA) abuse plus another illicit substance13. 5. Childhood Attention Deficit Hyperactive Disorder (ADHD) may be associated frequently with psychosis reports14. 6. Hi gher serum level of methamphetamine and amphetamine are associated with more profound psychotic symptoms4. The route of consumption (oral, smoking, injection) was not a significant factor in Mc Keit et al study6. But according to Matsumoto et al. smoker abuser show more quickly acute psychotic symptoms than who use the injection, because smokers have poor control on MA consumption. In addition psychotic syndromes in injection abusers require more medical care to respond to treatment15. Other personal characteristics such as age at which abuse is started, education, IQ, and duration of methamphetamine use were not associated significantly with risk of psychosis developing among abusers8. Female preponderance for undergoing psychotic symptoms was established among participant persons in the study of Mahoney and his coleagues16. It is noticeable to mention that the results of studies on MIP characteristics are somewhat inconsistent because of different cultural population, different accuracy in methods of studies and so on. But they provide a general opinion for further investigations and more accurate and localized studies. Sign and symptoms of MIP Reported psychotic symptoms among several different studies performed in Japan17, Taiwan5, Australia6, Tailand18 and Iran9 all are unanimous in obtained results. The most common features include persecutory delusion and auditory hallucination followed by delusion of reference, visual hallucination and thought broadcasting. MIP is initiated with excitation and increased focusing or concentration states, following by prepsychotic states and delusions which may subsequently progress to overt psychosis with positive symptoms10. The onset of first psychotic episode from the first occasion of methamphetamine consumption ranges from 1.7 years in smoker abusers to 4.4 years in injectioners19 and or 5.2 years without considering route of abuse10. Individuals with intense eagerness20, injection of methamphetamine and methamphetamine abusers are at higher risk for experiencing more severe psychosis21. Although MIP usually have short courses duration but longer and persistent episodes of psychos is have been reported even after discontinuation of drug abuse and in abstinence period17. As protracted MIP frequently occurred in many studies, it remains unclear whether methamphetamine can produce a chronic psychotic disorder or methamphetamine has uncovered a psychotic disorder in a patient with psychotic background5. The risk factors for developing long lasting MIP include positive family history of first degree relative involved to schizophrenia, premorbidity with a personality disorder specially schizoid/schizotypal form, a former neurological disorder like ADHD, head injury and learning disability2. During the abstinent period, MIP relapse might occur in a previously undergone short MIP, as well as any stressor like insomnia and severe alcohol intake.10,23,24 Methamphetamine and not stress induced MIP relapse occur with a likelihood of 60% to 80% in less than 1week to 1 month respectively, after re-exposure to MA8. A history of more than 2 years MA abuse makes the person susceptible for spontaneous relapse of psychosis without any methamphetamine reabusing for years.10 MIP Treatment pharmacological approaches Although no medical agent(s) are approved as therapeutic drug for MIP yet, due to a few numbers of pharmacological evaluations which have been proformed for finding a suitable choice in recent years. According to bio-molecular neurotransmitters influenced by MA, several pharmacologic agents are proposed for treating MA with clinical implications such as dependency and MIP. In this review a brief will run to introduce involved pharmacological groups separately. Dopaminergic agents Modafinil is a dopaminergic agonist approved essentially for sleep disorders such as narcolepsy, obstructive sleep apnoea/hypopnoea and idiopathic hypersomnia. Modafinil may increase efficacy of cognitive behavioral treatments and decrease craving in methamphetamine dependency25. It may have beneficial effect in schizophrenia and thereby in MIP.26,27 Bupropion, a re-uptake inhibitor of dopamine has demonstrated its effect as decreasing methamphetamine use specially in low to moderated dependency.28,29,30 Methylphenidate (Ritaline) and Dextroamphethamine (d-amphethamine) both increase releasing of dopamine in synaptic cleft and have high capacity to be abused. They show strong efficacy in studies to stop or reduce MA abuse in even deep dependency.31-34 Although the above quoted drugs have not revealed any direct effect for MIP, but it seems that appetite decreasing for MA use occur by these drugs, which can be indirectly effective for managing MIP as well. Aripiperazole, a dopamine D2-receptore partial agonist and a second generation antidepressant is proposed for MethAmphetamine(MA) dependency and MIP. In a study driven by Sulaiman et al. Aripiperazole was effective for diminishing the severity of psychosis resulted from methamphetamine, but it was failed to increase abstinence duration.35 In another study, Farnia et al. compared the efficacy of aripiperazole versus risperidone in MIP cases, in a double blind randomised control trial. After six weeks trial with aripiperazole 15mg/day or risperidone 4mg/day, they concluded that both drugs are able to significantly decrease the MIP severity, however rispridone causes showed more reduction on positive symptoms while aripiperazole was more effective on negative symptoms.36 The ability of antipsychotics like aripiperazole and haloperidol in suppressing the dopamine releasing in amygdala of animal experiments which caused marked reduction in behavioral sensitivity following MA exposure, may explain its benefits on MIP.37 In another animal model study, it was shown by Futamara et al. that aripiperazole can diminish behavioral sensitization through acting on 5-HT1A receptor.38 Risperidone is evaluated solely for its ability to prolong abstinent period in 4 weeks administration of 3.6mg/day in an open-label trying. Results demonstrate a decrease in meth consumption in abusers.39 Two separate case reports have considered the dramatic response of MIP to risperidone therapy.40,41 Despite safety applications of classic antipsychotics Hatzipetros et al. warned about an unknown toxic effect of conventional antipsychotics like administrating the haloperidol to GABAergic cells in subchronic treatment of MIP might lead to hyperkinetic movement disorder and convulsion42. Other antipsychotics like quetiapine and olanzepine were applied successfully for drug– induced psychosis.43,44 GABAergic agents Several different GABA agents like baclofen45,gabapantine45,46, vigabatrine47,48, topiramate49 and benzodiazepines were proposed for treatment of MA dependency and associated psychosis based on their effects on decreasing the dopamine transmission in mesolymbic system by which reinforcing effects of MA is reduced.50,51 But ,actually conducted trial studies are somewhat inconsistent to suggest a precise recommendation.49,52 Nevertheless Ito K et al. showed that clonazepam in animal model experiments did not obtain explicating of behavioral sensitization in rats which were under treatment with MA.53 Serotonergic agents No pharmacological trial studies lead to any clinical recommendation of serotonergic agents for MIP found in web published searching except for two animal experiments in which the role of serotonergic receptors are evaluated in locomotor activating and developing behavioral sensitization. Kaneko et al. studied the inhibitory effect of fluoxetine and paroxetin, 2 clinically available SSRI agents, on establishing and expression of MA induced behavioral sensitization and suggested a prophylactic role of SSRIs for preventing of psychotic states like hallucination and paranoid symptoms due to methamphetamine abuse.54 Ago et al. demonstrated the critical role of serotonine system in behavioral sensitization formation in mice by osemozotan a 5-HT1A-receptor agonist and ritanserin a 5-HT2-receptore antagonist and again suggested a capacity of serotonergic agents for treating methamphetamine psychosis.55 Opioid antagonist Naltrexone, a pure antagonist of morphine have showed successful outcomes in MA dependency management by decreasing craving, probably because of endogenous opioid system modulating role in reducing of reinforcing effects of metamphetamine.56-61 Behavioral sensitization produced by frequently exposure to methamphetamine is prevented by induction and expression of naltrexone in mice.62 But naltrexone plus N-acetylsysteine, an antioxidant, fail to demonstrate priority to placebo group for MA dependency treatment.63 Although no particular study with emphasis on the effects of naltrexone on MA-induced psychosis was found, it may be associated with precise changes in severity and prevalence of MIP because of its strong effects on abolishing dependency. Other unclassified treatment Minocycline, a second generation antibiotic was proposed for MIP treatment. In two separate case reports minocycline administration were associated with significant results in curing the psychotic symptoms of methamphetamine abuse probably due to its anti-inflammatory effects on micoglia.64,65 Electroconvulsive therapy (ECT) is mentioned for its high capacity to create a dramatic response in a MIP cases whose psychotic symptoms were resistant to conventional pharmacological antipsychotic therapy.66 Discussion Methamphetamine abuse is now going to become an epidemic problem in many countries. Chronic MA abuser underwent many medical psychiatric cognitive and legal consequences. One of the most important complications is the psychosis. Many studies were performed and a plenty of pharmacological drugs were proposed for managing of MA dependency, although none of them were approved yet, but only a few investigations tried to find drugs targeted on psychosis due to MA. These drugs as reviewed in this articles belongs to different biochemical neurotransmitters like dopaminergic antipsychotics, serotonergic agents and GABAergic drugs. All the studied drugs failed to obtain approval validity, although according to the results of conducted studies merely all of these agents could subside the MA associated psychosis. Recognizing neurotransmitter/receptor systems involved and influenced by MA in animal models and human experiments that can elevate knowledge about developing MA-induced psychiatric sy ndromes, especially psychosis, is the best way to overcome MIP pharmacologically and is recommended strongly for future studies.

Meaning Of a Family Essay

Everyone has their own meaning of a family. However, all families share some common characteristics that are outlined in a family definition essay. As per the dictionary definition of a family, all its members live in a common house and are linked together with each other economically. All family members are also emotionally linked and have a strong bond. A family consists of adults of both the sexes who are married to each other and have children. A family definition essay must highlight these aspects in an interesting manner and describe each element or constituent of a family. On Getting Family Essay Ideas There are several aspects to a family, such as the intricacies of relations, values, and the love and affection amongst its members. Hence, family essay ideas are also numerous; choices include education, jobs, house work, and the responsibilities and duties of each member. So, to get more interesting family essay ideas and top-quality content for the same, you can seek the expert help of professional writers and writing companies. Custom writing agencies have subject experts who offer guidance in choosing and writing effective essays for all your requirements. Choosing Family Essay Topics Several types of families exist in our society. So, there is ample choice when it comes to writing essays on issues associated with each type of family structure. Family essay topics can cover the family structure, organization, responsibilities and the bond shared among family members. Writing about the family can be an intricate task, which calls for the need of expert help. Professional writers with expertise in different essay writing styles, formats and subjects can help simplify the task of selecting family essay topics and make them more relevant. Writing Essay about Family Writing an essay about family can be a touching experience; albeit a daunting one, as the writer has to effectively express his/her feelings for the family members. The essay about family can focus on instances that depict the family’s togetherness and the bond between its members. One can also write about the family’s contribution during difficult times. For expert help on essay writing in varied subjects, help is right at hand with professional writing services. Companies like BookwormLab.com have a team of specialists to write on a variety of subjects in the most authoritative manner. And you shouldn’t break their heart. From one hand it’s great to be the only child in a family but in some cases it’s not. On the plus side parents always ready to help you but on the contrary when there is too much care it seems not to be good, because you cannot show your independence, do something yourself. Also you can feel lonely and bored. But your parents often do whatever their child want and if it’s necessary they help you and warn. They always spend their time doing something together with child to make him happy or teach something. And you have to appreciate their care and love. Because nobody except them love you so much and know a lot about you. As for me, I am the only child in family. And sometimes I think about how will I live if I have a sister or brother. Sometimes it is so boring to be at home along. I think about my parents, that all my childhood they helped me and did everything for me. But it doesn’t mean that I’m the main person in my family. Family it’s also our grandmothers, grandfathers, aunts, uncles. And the family tree has a long history of generations that sometimes are so ancient that we cannot remember the member of it, the name and occupation. And of coarse we know about our forefathers from our grandparents. As for me it’s really interesting to know who lived before me. And when I begin to ask my parents about forefathers I find for myself a lot of interesting things. For example some features of character which I have or part of appearance. But it’s a pity that I know not a lot of people in my family branch.

What Pit Bulls Can Teach Us About Profiling - 1386 Words

For most of my awkward teenage years my classmates were afraid to tell me dumb blonde jokes. When I asked why they were unwilling to share their joke, their eyes would go straight to my hair, implying that I was the dumb blonde. This was the first time I had to question one of the most trivial jokes as if it was a reflection of myself and my mind. It was as if my peers believed my hair color measured the amount of intelligence I possessed. To generalize is â€Å"to make something more widespread or common† (Dictionary). Society had made a generalization about my hair color and now I was experiencing the consequences. Malcolm Gladwell, a writer for The New Yorker wrote the essay â€Å"Troublemaker; What Pit Bulls can teach us about profiling†. He comments on society’s habit to veer into the territory of generalizations and stereotypes. Utilizing examples such as pit bulls, Muslims as terrorists, and the New York Police Department, to convey his point. He first str uctures his essay by agreeing with the judgment of banning pit bulls. Unexpectedly, he takes a turn and declares that it is not the pit bulls that are the problem, but societies assumptions about the breed. His central thesis revolves around the consequences of over- generalization in a society. He embodies this point with the quote, â€Å"It doesn’t work to generalize about a relationship between a category and a trait when that relationship isn’t stable† (Gladwell 4). This claim is backed up through the use of statistics andShow MoreRelatedRevision Memo On The Classroom1711 Words   |  7 Pagesbefore revision, This was implicit from the instructor, I do not think this is effectively important unless there is a small time schedule. One aspect of my essay I struggle to revise is passive voice and sentences beginners. I am so peeved right now about how I could not get better phrases to start off some sentences, and the fact that I was not get this essay on tim e. An aspect of my revision that I am proud of is the little usage of passive voice, weak phrases and the increase amount of transitional

Thomas Hardy Poems - 16083 Words

HAP IF but some vengeful god would call to me From up the sky, and laugh: Thou suffering thing, Know that thy sorrow is my ecstasy, That thy love s loss is my hate s profiting! Then would I bear, and clench myself, and die, Steeled by the sense of ire unmerited; Half-eased, too, that a Powerfuller than I Had willed and meted me the tears I shed. But not so. How arrives it joy lies slain, And why unblooms the best hope ever sown? --Crass Casualty obstructs the sun and rain, And dicing Time for gladness casts a moan.... These purblind Doomsters had as readily strown Blisses about my pilgrimage as pain. HAP ANALYSIS Firstly the word hap means that which happens by chance. The poem is a sonnet, although it†¦show more content†¦Line 11, there is an alliteration of  ´C ´, â€Å"crass casualty† that creates a sharp angry yet satisfying tone. Personification is the device seen in this sonnet as it is seen at line 9,†joy lies slain† where joy is seen as a person being killed by an assassin, hence being slain. Line 12, time is personified as a gambler who throws a â€Å"moan† as he is throwing the dice in an attempt for it to land on happiness. The persona challenges god fiercely in an outraged tone, a sad tone is being detected in hardy’s witting because god is such a powerful being that rains down misfortunes on humans, so he targets his anger towards the deity. He is frustrated in the last stanza thus resulting in him regarding the occurrences in nature as merely chance. The audience feels his intensity and thus the mood of the poem is sad. Symbols in the poem are the sky which represents heaven high up above that holds a more powerful being than mankind. Tears represent the persona’s hurt that he is being the victim of a vengeful god. Sun and rain represent every occurrence in nature that is then deemed to be ruled by chance and not a supreme being, and the pilgrimage represents the journey of life. NEUTRAL TONES WE stood by a pond that winter day, And the sun was white, as though chidden of God, And a few leaves lay on the starving sod, --They had fallen fromShow MoreRelatedThomas Hardy Poems2405 Words   |  10 Pages| HAP (1865) | |    If but some vengeful god would call to me From up the sky, and laugh: Thou suffering thing, Know that thy sorrow is my ecstasy, That thy loves loss is my hates profiting! Then would I bear, and clench myself, and die, Steeled by the sense of ire unmerited; Half-eased, in, that a Powerfuller than I Had willed and meted me the tears I shed. But not so. How arrives it joy lies slain, And why unblooms the best hope ever sown? --Crass Casualty obstructs the sun and rain, AndRead MoreThomas Hardy s The Darkling Thrush And The Lost Baby Poem1586 Words   |  7 Pagesof a life or the end of a century, both Lucille Clifton and Thomas Hardy prove that endings can be difficult, yet there is some form of hope within each of their poems. Hardy’s â€Å"The Darkling Thrush† and Clifton’s â€Å"The Lost Baby Poem† have different styles due to the poets vastly different backgrounds, yet both poems posses a similar somber tone throughout, with a glimmer of positivity by the end of each. Lucille Clifton and Thomas Hardy have vastly different writing styles, which could be attributedRead More Thomas Hardys Use of Fallen Women in His Writings Essay examples544 Words   |  3 PagesThomas Hardys Use of Fallen Women in His Writings Thomas Hardy sheds new light on the idea of the fallen woman. Throughout several of his works, he portrays the fallen woman through her own eyes, and, in doing so, presents a different perspective. Three of his works which establish this new perspective are the poem, The Ruined Maid, and the novels Far from the Madding Crowd and Tess of the dUrbervilles. In The Ruined Maid, which he wrote in 1866, Hardy focuses on one womans recentRead MoreThe Darkling Thrush by Thomas Hardy Essay1021 Words   |  5 PagesThe Darkling Thrush by Thomas Hardy The poem entitled The Darkling Thrush, written by Thomas Hardy, has a very appealing connotation. The work can be separated into two parts; the dismal part pertaining to the beginning of winter and the second part focusing on one small aspect of good in all of the dismal surrounding it. The general idea of the poem is that the dismal winter is approaching, but there are some incidences of goodness in this depressing time. TheRead MoreThe Life and Work of Thomas Hardy Essay784 Words   |  4 PagesOut of so many authors, writers, and poets, Thomas Hardy was far the most sincere and the most famous writer that made an impact in English literature during the Victorian times. He accomplished many things and wrote a lot of books, poems, and novels. Most of his stories were not really similar to the plot of his life, but his writing career lasted about fifty years long maybe more. At first publishers rejected some of his very first novels and poetry, but even though this occurred he kept doingRead MoreEssay on Thomas Hardy1663 Words   |  7 Pages Thomas Hardy Thomas Hardy, written by Trevor Johnson, is the detailed journey through the life of one of England’s greatest writers. This biography describes some of the major details of his life such as his family, his education, and his major works. amp;#9;Thomas Hardy was born in 1840 at the Village of Upper Bochampton. He was the child of a country stonemason. Hardy was the third Thomas of his family. His mother’s maiden name was Jemima Hand and she and her husband led Hardy to have anRead MorePoem Analysis : Are You Digging On My Grave 719 Words   |  3 Pages Ah, Are You Digging on My Grave, is a poem written by Thomas Hardy. The central theme of this poem is death, which is also seen in several different forms throughout the works of Thomas Hardy. There is a great deal of disappointment expressed in this poem. The Oxford Reader s Companion to Hardy deems it, a satire of circumstance (Page 378). Thus, death and the afterlife are things of tragedy in this particular work. The point that Hardy makes is that no love or hate outlasts death. Read MoreThomas Hardy- Tess of the D’urbervilles (Non-African)1366 Words   |  6 PagesTHEMATIC PRE-OCCUPATION, DICTION, SETTING AND PLOT, ASSESS THOMAS HARDY â€Å"TESS OF THE D’URBERVILLES AND MORAL†. THOMAS HARDY- TESS OF THE D’URBERVILLES (NON-AFRICAN) Pre-Occupation Thomas hardy first in his career became an apprentice to John Hicks. A Dorchester Architect for several years, his practice architecture in Dorchester, he also simultaneously studied Greek and Latin. It was during this period that he began written poetry. In 1862, Hardy moved to London ad worked as a Architect for ArthurRead MoreThomas Hardy s Under The Waterfall1666 Words   |  7 PagesThomas Hardy’s â€Å"Under the Waterfall† is a poem that can be interpreted in many different ways. One cannot deny the power and influence nature has over the two lovers. The reader can understand that a voice is evoked by a memory of having a picnic in August near a waterfall with their romantic partner every time he or she places their hands into a pool of water or basin of water . One says â€Å"he or she† because the poem does not specifically tell the reader if it is the woman or man speaking. HardyRead More Thomas Hardy and His Religious Beliefs Essay examples724 Words   |  3 PagesThomas Hardy and His Religious Beliefs Thomas Hardy was born into a very active Christian family. He was the son of Orthodox Christians who made sure that he regularly attended services. Many of Hardys relatives were involved in the church. Some were members of the clergy and some were musicians at the local church. Hardy, a member of the Stinsford parish, taught a Sunday school class when he was a young man. He even had aspirations of becoming a member of the clergy himself. He became very