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A comparison of psychotic symptoms in subjects with methamphetamine versus cocaine dependence

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Abstract

Rationale

The psychostimulant drugs cocaine and methamphetamine are potent indirect dopamine receptor agonists which act through similar but not identical mechanisms. Studies in humans have observed that a large proportion of those who chronically use these drugs experience psychotic symptoms. However, direct comparisons of psychotic symptom severity between cocaine and methamphetamine users are lacking.

Objectives

The goal of the present study was to directly compare severity of psychotic symptoms between cocaine- and methamphetamine-dependent individuals. Additionally, we sought to determine how concurrent cocaine + methamphetamine dependence would influence psychotic symptoms.

Methods

We recruited 153 polysubstance-using subjects meeting DSM-IV-TR criteria for cocaine dependence, 38 with methamphetamine dependence, and 32 with cocaine + methamphetamine dependence. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) and analyzed using a five-factor model. All participants were also assessed for physical and mental illnesses as well as recent substance use. Most subjects completed a comprehensive neurocognitive battery.

Results

While all three groups exhibited high total PANSS scores, the positive symptom subscale was significantly higher in the methamphetamine-dependent (17.03 ± 6.3) than the cocaine-dependent group (13.51 ± 4.12) and non-significantly higher (p = 0.08) than the cocaine + methamphetamine group (14.44 ± 5.50). Groups also differed on demographic variables, viral infection, and other indices of substance use, which were unlikely to account for the difference in positive symptoms. There were only modest differences between groups in neurocognitive function.

Conclusions

Methamphetamine dependence was associated with more severe positive symptoms of psychosis than cocaine dependence. Concurrent cocaine + methamphetamine dependence did not increase psychosis severity.

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Acknowledgements

The study was funded by the Canadian Institutes for Health Research (CBG-101827, MOP-137103) and the British Columbia Mental Health and Substance Use Services (an Agency of the Provincial Health Services Authority).

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Authors and Affiliations

  1. Department of Pharmacology, 2176 Health Sciences Mall, University of British Columbia, Vancouver, B.C., V6T 1Z3, Canada

    Peter D Alexander, Clara N Kim & Alasdair M Barr

  2. Department of Psychology, Simon Fraser University, Burnaby, B.C., V5A 1S6, Canada

    Kristina M Gicas, Taylor S Willi & Allen E Thornton

  3. Department of Psychiatry, University of British Columbia, Vancouver, B.C., V6T 1Z3, Canada

    Veronika Boyeva, Ric M Procyshyn, Geoff N. Smith, William J Panenka, Andrea A. Jones, Fidel Vila-Rodriguez, G William MacEwan & William G Honer

  4. Department of Radiology, University of British Columbia, Vancouver, B.C., V6T 1Z3, Canada

    Donna J. Lang

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  1. Peter D Alexander
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  2. Kristina M Gicas
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  3. Taylor S Willi
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  15. Alasdair M Barr
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Corresponding author

Correspondence to Alasdair M Barr.

Ethics declarations

In accordance to Tri-Council policy, the study was approved by the University of British Columbia Clinical Research Ethics Board. All participants provided written informed consent and received a modest honorarium for their time.

Conflicts of interest

Drs. Smith, Thornton, Panenka, Vila-Rodriguez, Leonova, Lang and MacEwan report no competing interests. Mr(s). Alexander, Gicas, Willi, Kim, Boyeva, and Jones report no competing interests.

Dr. Honer has received consulting fees or sat on paid advisory boards for: In Silico, Otsuka/Lundbeck, Roche and Eli Lilly; received honoraria from Rush University, University of Ottawa, University of Calgary, University of Hong Kong, British Columbia Health Authorities, the British Association for Psychopharmacology, and the Canadian Psychiatric Association; and received grants from the Canadian Institutes of Health Research (CIHR).

Dr. Procyshyn has received consulting fees from: Janssen, Lundbeck, Otsuka, Pfizer, and Sunovion and is on the speaker’s bureau for AstraZeneca, Janssen, Lundbeck, Otsuka, and Pfizer; and received grants from the Canadian Institutes of Health Research

Dr. Barr has received grant support from BMS Canada.

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Alexander, P.D., Gicas, K.M., Willi, T.S. et al. A comparison of psychotic symptoms in subjects with methamphetamine versus cocaine dependence. Psychopharmacology 234, 1535–1547 (2017). https://doi.org/10.1007/s00213-017-4551-7

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