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 psychedelic drug use. We studied predictors of flashbacks in 36 subjects with flashbacks, along with 80 subjects with a history of MAP psychosis who did not experience flashbacks. Plasma monoamine metabolite levels were assayed in 26 of the 36 subjects with flashbacks, 16 of the 80 subjects without flashbacks, nine subjects with persistent MAP psychosis, and 28 normal controls. None of the 28 controls became psychotic. A square root transformation was applied to all monoaminergic values, resulting in data nearly normally distributed. The subjects with flashbacks had been exposed to stressful events or threatening paranoid-hallucinatory states or both during previous MAP use. Most flashbacks occurred under conditions that provoked a mild fear of other people. Plasma norepinephrine levels were markedly increased during flashbacks. Thus, stressful experiences together with MAP use may have induced noradrenergic hyperreactivity to a mild stress, which in turn may elicit memories of 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 noradrenergic hyperreactivity to a mild stress is a precipitating factor in spontaneous recurrences of MAP psychosis.