Amphetamine Versus Non Amphetamine-Related First Episode Psychosis in Saudi Arabian Patients

Background: Amphetamines are illicit psychostimulant drugs that can induce psychotic symptoms. Very few studies have been conducted in Kingdom of Saudi Arabia (SA) on amphetamine abuse and related psychosis. Recently, the pattern of amphetamine abuse in SA showed a significant trend of increased frequency. Objectives: To investigate the extent of amphetamine abuse in a sample of Saudi patients hospitalized for first episode of acute psychosis. Also, to compare in that sample between amphetamine psychosis and other psychoses regarding demographic data, premorbid personality and symptoms profile. Method: 106 patients with acute psychosis were hospitalized and screening of urine for amphetamine was conducted for all. Patients’ psychiatric evaluation included interviewing, and ICD-10 criteria for personality disorders. 30 healthy subjects were also included for comparison with patients. Results: 34/106 of psychotic patients (32%) were positive for amphetamine in urine (≥ 1000 ng/ml). The frequency of personality disorders was significantly higher (P < 0.01) in the patients (54/106; 51%) compared with healthy subjects (6/30; 20%). Also, the incidence of personality disorders was significantly higher (P < 0.01) in amphetamine positive psychosis (25/34; 73.5%) compared with amphetamine negative psychosis (29/72; 40%). Cluster B personality disorders particularly the antisocial and borderline were significantly higher in amphetamine positive psychosis (13/34; 38%) compared with amphetamine negative psychoses (6/72; 8%). The symptom profile showed significant difference between amphetamine positive and amphetamine negative psychosis as regards ideas of reference (50% vs. 14%), suspiciousness (44% vs. 11%), suicidal ideation (38% vs. 23%), paranoid delusions (29% vs. 17%) and increased pulse or blood pressure (29% vs. 7%) respectively. Conclusion: Screening of amphetamine in urine among patients with first episode of acute psychosis can help and support the clinical distinction of amphetamine psychosis from other types of psychosis. This is therapeutically critical since the line of treatment may be different between the two types of psychoses.