PRECIPITATING FACTORS IN SPONTANEOUS RECURRENCE OF METHAMPHETAMINE PSYCHOSIS

This paper examines noradrenergic hyperactivity in response to stress in the development of spontaneous recurrences of methamphetamine (MAP) psychosis, a phenomenon known as flashbacks, in studies of psychedeli c drug use. We studied predictors of flashbacks in 36 subjects with fl ashbacks, along with 80 subjects with a histroy of MAP psychosis who d id not experience flashbacks. Plasma monoamine metabolite levels were assayed in 26 of the 36 subjects with flashbacks, 16 of the 80 subject s without flashbacks, nine subjects with persistent MAP psychosis, and 28 normal controls. None of the 28 controls became psychotic. A squar e root transformation was applied to all monoaminergic values, resulti ng in data nearly normally distributed. The subjects with flashbacks h ad been exposed to stressful events or threatening paranoid-hallucinat ory states or both during previos MAP use. Most flashbacks occurred un der conditions that provoked a mild fear of other people. Plasma norep inephrine levels were markedly increased during flashbacks. Thus, stre ssful experiences together with MAP use may have induced noradrenergic hyperreactivity to a mild stress, which in turn may elicit memories o f MAP psychosis associated with stressful experiences. A mild fear of other people precipitated the flashbacks, including markedly increased noradrenergic activity. The results of this study suggest that noradr energic hyperreactivity to a mild stress is a precipitating factor in spontaneous recurrences of MAP psychosis.