Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Emerg Med Australas. 2024 Feb;36(1):24-30. doi: 10.1111/1742-6723.14287. Epub 2023 Jul 17.
There 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.
This 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.
There 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).
In 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.
目前鲜有关于甲卡西酮中毒后急性精神病的相关报道。本研究旨在描述与甲卡西酮急性中毒相关的精神病患者的临床特征、急性行为障碍的管理以及患者的处置情况。
这是一项回顾性研究，纳入了 2020 年 4 个月内在急诊科就诊的 287 例甲卡西酮急性中毒（24 小时内使用）并伴有精神病特征（存在妄想、幻觉或思维形式障碍）的患者。所有患者均从毒理学单位数据库中提取，并对每份病历进行了回顾。提取的信息包括人口统计学特征、既往精神健康诊断、临床特征和处置情况。
在此期间，共有 287 例甲卡西酮中毒患者就诊。在这 287 例患者中，205 例（71%）出现急性精神病，发生在 171 例患者中（男性 111 例[65%]，中位年龄 36 岁，范围 16-57 岁）。妄想性妄想在 205 例（65%）的就诊中较为常见，是精神病最常见的特征。194 例（95%）患者接受了化学镇静治疗，143 例（70%）患者接受了静脉镇静治疗以控制急性行为障碍。205 例（83%）暴露者的精神病症状完全缓解。205 例中有 9 例（4%）就诊导致精神科住院治疗。205 例中的大多数（98%）在急诊科内得到了治疗，主要是在短期留观病房。中位住院时间为 15 小时（四分位间距 11-20 小时）。
在本系列急诊科就诊的急性甲卡西酮中毒患者中，精神病似乎很常见，且大多是短暂的，大多数患者在 24 小时内缓解。
