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Psychiatric Co-morbidity in Ketamine and Methamphetamine Dependence: a Retrospective Chart Review

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Abstract

Both ketamine and methamphetamine (MA) have become very popular and have been abused worldwide over the past two decades. However, the relationship between dependence on ketamine or MA and psychiatric comorbidities is still unclear. This study aimed to examine the frequency of co-morbid psychiatric disorders in patients dependent on ketamine or methamphetamine who were receiving treatment at three substance abuse treatment clinics (SACs) in Hong Kong. This was a retrospective chart review. The medical records of 183 patients (103 with ketamine and 80 with MA dependence) treated between January 2008 and August 2012 were retrieved. Patients’ demographic data, patterns of substance abuse and comorbid psychiatric diagnoses were recorded. The mean age of onset and duration of substance abuse were 18.1 ± 4.7 and 9.2 ± 6.2 years for ketamine and 19.9 ± 8.8 and 10.5 ± 9.8 years for MA users, respectively. Psychotic disorders were more common in MA dependent users (76.2 % vs. 28.2 %, p < 0.001), whereas mood disorders were more common in ketamine dependent users (27.2 % vs. 11.2 %, p = 0.008). Ketamine and MA dependence have a notably different profile of psychiatric co-morbidity. Compared with MA dependence, ketamine dependence is more likely to be associated with mood disorders and less likely with psychotic disorders.

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References

  • Adell, A., Jimenez-Sanchez, L., Lopez-Gil, X., & Romon, T. (2012). Is the acute NMDA receptor hypofunction a valid model of schizophrenia? Schizophrenia Bulletin, 38(1), 9–14.

    Article  PubMed  Google Scholar 

  • Akindipe, T., Wilson, D., & Stein, D. J. (2014). Psychiatric disorders in individuals with methamphetamine dependence: prevalence and risk factors. Metabolic Brain Disease, 29(2), 351–357.

    Article  CAS  PubMed  Google Scholar 

  • Ali, B., Seitz-Brown, C. J., & Daughters, S. B. (2015). The interacting effect of depressive symptoms, gender, and distress tolerance on substance use problems among residential treatment-seeking substance users. Drug and Alcohol Dependence, 148, 21–26.

    Article  PubMed  PubMed Central  Google Scholar 

  • Angrist, B. M., & Gershon, S. (1970). The phenomenology of experimentally induced amphetamine psychosis--preliminary observations. Biological Psychiatry, 2(2), 95–107.

    CAS  PubMed  Google Scholar 

  • Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., et al. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351–354.

    Article  CAS  PubMed  Google Scholar 

  • Bramness, J. G., Gundersen, Ø. H., Guterstam, J., Rognli, E. B., Konstenius, M., Løberg, E. M., et al. (2012). Amphetamine-induced psychosis a separate diagnostic entity or primary psychosis triggered in thevulnerable? BioMed Central Psychiatry, 12, 221.

    Article  PubMed  PubMed Central  Google Scholar 

  • Browne, C. A., & Lucki, I. (2013). Antidepressant effects of ketamine: mechanisms underlying fast-acting novel antidepressants. Frontiers in Pharmacology, 4, 161.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chambers, R. A., Krystal, J. H., & Self, D. W. (2001). A neurobiological basis for substance abuse comorbidity in schizophrenia. Biological Psychiatry, 50(2), 71–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cheung, Y., & Cheung, N. (2010). Drug policy in Hong Kong: changes and challenges. Paper presented at the Anti-Drug International Conference, Taipei, Taiwan.

  • Curran, H. V., & Morgan, C. (2000). Cognitive, dissociative and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later. Addiction, 95(4), 575–590.

    Article  CAS  PubMed  Google Scholar 

  • Darke, S., Kaye, S., McKetin, R., & Duflou, J. (2008). Major physical and psychological harms of methamphetamine use. Drug and Alcohol Review, 27(3), 253–262.

    Article  PubMed  Google Scholar 

  • Durell, T. M., Kroutil, L. A., Crits-Christoph, P., Barchha, N., & Van Brunt, D. L. (2008). Prevalence of nonmedical methamphetamine use in the United States. Substance Abuse Treatment, Prevention, and Policy, 3, 19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freeman, T. P., Morgan, C. J., Pepper, F., Howes, O. D., Stone, J. M., & Curran, H. V. (2013). Associative blocking to reward-predicting cues is attenuated in ketamine users but can be modulated by images associated with drug use. Psychopharmacology, 225(1), 41–50.

    Article  CAS  PubMed  Google Scholar 

  • Gahlinger, P. M. (2004). Club drugs: MDMA, gamma-hydroxybutyrate (GHB), Rohypnol, and ketamine. American Family Physician, 69(11), 2619–2626.

    PubMed  Google Scholar 

  • Glasner-Edwards, S., Marinelli-Casey, P., Hillhouse, M., Ang, A., Mooney, L. J., Rawson, R., et al. (2009). Depression among methamphetamine users: association with outcomes from the methamphetamine treatment project at 3-year follow-up. The Journal of Nervous and Mental Disease, 197(4), 225–231.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grant, K. M., LeVan, T. D., Wells, S. M., Li, M., Stoltenberg, S. F., Gendelman, H. E., et al. (2012). Methamphetamine-associated psychosis. Journal of Neuroimmune Pharmacology, 7(1), 113–139.

    Article  PubMed  Google Scholar 

  • Hasselmann, H. (2014). Ketamine as antidepressant? Current state and future perspectives. Current Neuropharmacology, 12(1), 57–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Javitt, D. C., & Zukin, S. R. (1991). Recent advances in the phencyclidine model of schizophrenia. American Journal of Psychiatry, 148(10), 1301–1308.

    Article  CAS  PubMed  Google Scholar 

  • Javitt, D. C., Zukin, S. R., Heresco-Levy, U., & Umbricht, D. (2012). Has an angel shown the way? Etiological and therapeutic implications of the PCP/NMDA model of schizophrenia. Schizophrenia Bulletin, 38(5), 958–966.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jentsch, J. D., & Roth, R. H. (1999). The neuropsychopharmacology of phencyclidine: from NMDA receptor hypofunction to the dopamine hypothesis of schizophrenia. Neuropsychopharmacology, 20(3), 201–225.

    Article  CAS  PubMed  Google Scholar 

  • Klosterkotter, J., Hellmich, M., Steinmeyer, E. M., & Schultze-Lutter, F. (2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry, 58(2), 158–164.

    Article  CAS  PubMed  Google Scholar 

  • Krystal, J., Perry, E., Gueorguieva, R., Belger, A., Madonich, S., Abi-Dargham, A., et al. (2005). Comparative and interactive human psychopharmacologic effects of ketamine and amphetamine: implications for glutamatergic and dopaminergic model psychoses and cognitive function. Archives of General Psychiatry, 62(9), 985–995.

    Article  CAS  PubMed  Google Scholar 

  • Krystal, J. H., Karper, L. P., Seibyl, J. P., Freeman, G. K., Delaney, R., Bremner, J. D., et al. (1994). Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses. Archives of General Psychiatry, 51(3), 199–214.

    Article  CAS  PubMed  Google Scholar 

  • Lapidus, K. A., Levitch, C. F., Perez, A. M., Brallier, J. W., Parides, M. K., Soleimani, L., et al. (2014). A randomized controlled trial of intranasal ketamine in major depressive disorder. Biological Psychiatry, 76(12), 970–976.

  • Lee, S., Guo, W., Tsang, A., Mak, A., Wu, J., Ng, K., et al. (2010). Evidence for the 2008 economic crisis exacerbating depression in Hong Kong. Journal of Affective Disorders, 126(1–2), 125–133.

    Article  PubMed  Google Scholar 

  • Lin, S. K., Ball, D., Hsiao, C. C., Chiang, Y. L., Ree, S. C., & Chen, C. K. (2004). Psychiatric comorbidity and gender differences of persons incarcerated for methamphetamine abuse in Taiwan. Psychiatry and Clinical Neurosciences, 58(2), 206–212.

  • Malhotra, A. K., Pinals, D. A., Weingartner, H., Sirocco, K., Missar, C. D., Pickar, D., et al. (1996). NMDA receptor function and human cognition: the effects of ketamine in healthy volunteers. Neuropsychopharmacology, 14(5), 301–307.

    Article  CAS  PubMed  Google Scholar 

  • Maxwell, J., & Rutkowski, B. (2008). The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992–2007. Drug and Alcohol Review, 27(3), 229–235.

    Article  PubMed  Google Scholar 

  • McCambridge, J., Winstock, A., Hunt, N., & Mitcheson, L. (2007). 5-Year trends in use of hallucinogens and other adjunct drugs among UK dance drug users. European Addiction Research, 13(1), 57–64.

    Article  PubMed  Google Scholar 

  • McKetin, R., Kozel, N., Douglas, J., Ali, R., Vicknasingam, B., Lund, J., & Li, J. H. (2008). The rise of methamphetamine in Southeast and East Asia. Drug and Alcohol Review, 27(3), 220–228.

    Article  PubMed  Google Scholar 

  • McKetin, R., Lubman, D., Lee, N., Ross, J., & Slade, T. (2011). Major depression among methamphetamine users entering drug treatment programs. The Medical Journal of Australia, 195(3), S51–S55.

    PubMed  Google Scholar 

  • McKetin, R., McLaren, J., Lubman, D. I., & Hides, L. (2006). The prevalence of psychotic symptoms among methamphetamine users. Addiction, 101(10), 1473–1478.

    Article  PubMed  Google Scholar 

  • Misawa, F., Shimizu, K., Fujii, Y., Miyata, R., Koshiishi, F., Kobayashi, M., … Kashima, H. (2011). Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects? A cross-sectional study. BioMed Central Psychiatry, 11, 118.

  • Moghaddam, B., Adams, B., Verma, A., & Daly, D. (1997). Activation of glutamatergic neurotransmission by ketamine: a novel step in the pathway from NMDA receptor blockade to dopaminergic and cognitive disruptions associated with the prefrontal cortex. Journal of Neuroscience, 17(8), 2921–2927.

    CAS  PubMed  Google Scholar 

  • Morgan, C. J., Duffin, S., Hunt, S., Monaghan, L., Mason, O., & Curran, H. V. (2012). Neurocognitive function and schizophrenia-proneness in individuals dependent on ketamine, on high potency cannabis (‘skunk’) or on cocaine. Pharmacopsychiatry, 45(7), 269–274.

    Article  CAS  PubMed  Google Scholar 

  • Morgan, C. J., Muetzelfeldt, L., & Curran, H. V. (2010). Consequences of chronic ketamine self-administration upon neurocognitive function and psychological wellbeing: a 1-year longitudinal study. Addiction, 105(1), 121–133.

    Article  PubMed  Google Scholar 

  • Morgan, C. J. A., Mofeez, A., Brandner, B., Bromley, L., & Curran, H. V. (2004). Acute effects of ketamine on memory systems and psychotic symptoms in healthy volunteers. Neuropsychopharmacology, 29(1), 208–218.

    Article  CAS  PubMed  Google Scholar 

  • Morgan, C. J. A., Muetzelfeldt, L., & Curran, H. V. (2009a). Ketamine use, cognition and psychological wellbeing: a comparison of frequent, infrequent and ex-users with polydrug and non-using controls. Addiction, 104(1), 77–87.

    Article  PubMed  Google Scholar 

  • Morgan, C. J., Huddy, V., Lipton, M., Curran, H. V., & Joyce, E. M. (2009b). Is persistent ketamine use a valid model of the cognitive and oculomotor deficits in schizophrenia? Biological Psychiatry, 65(12), 1099–1102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mouri, A., Noda, Y., Enomoto, T., & Nabeshima, T. (2007). Phencyclidine animal models of schizophrenia: approaches from abnormality of glutamatergic neurotransmission and neurodevelopment. Neurochemistry International, 51(2–4), 173–184.

    Article  CAS  PubMed  Google Scholar 

  • Narcotics Division, Security Bureau. (2013). Central Registry of Drug Abuse, drug abusers for 2002–2011. Hong Kong: the Government of Hong Kong SAR. Retrieved from http://www.nd.gov.hk/en/statistics_list. htm.

    Google Scholar 

  • Narcotics Division, Security Bureau. (2011). Central Registry of Drug Abuse Sixty-first Report. Hong Kong: the Government of Hong Kong SAR. Retrieved from http://www.nd.gov.hk/pdf/report/crda_61st/crda_61st_full_report.pdf.

    Google Scholar 

  • Rawson, R., Anglin, M., & Ling, W. (2002). Will the methamphetamine problem go away? Journal of Addictive Diseases, 21(1), 5–19.

    Article  PubMed  Google Scholar 

  • Salo, R., Flower, K., Kielstein, A., Leamon, M. H., Nordahl, T. E., & Galloway, G. P. (2011). Psychiatric co-morbidity in methamphetamine dependence. Psychiatry Research, 186(2–3), 356–361.

    Article  PubMed  Google Scholar 

  • Sato, M. (1992). A lasting vulnerability to psychosis in patients with previous methamphetamine psychosis. Annals of the New York Academy of Sciences, 654, 160–170.

    Article  CAS  PubMed  Google Scholar 

  • Seiden, L. S., Sabol, K. E., & Ricaurte, G. A. (1993). Amphetamine: effects on catecholamine systems and behavior. Annual Review of Pharmacology and Toxicology, 33, 639–677.

    Article  CAS  PubMed  Google Scholar 

  • Shoptaw, S., Peck, J., Reback, C. J., & Rotheram-Fuller, E. (2003). Psychiatric and substance dependence comorbidities, sexually transmitted diseases, and risk behaviors among methamphetaminedependent gay and bisexual men seeking outpatient drug abuse treatment. Journal of Psychoactive Drugs, 35(sup1), 161–168.

  • Stone, J. M., Pepper, F., Fam, J., Furby, H., Hughes, E., Morgan, C., et al. (2014). Glutamate, N-acetyl aspartate and psychotic symptoms in chronic ketamine users. Psychopharmacology, 231(10), 2107–2116.

    Article  CAS  PubMed  Google Scholar 

  • Sulaiman, A. H., Said, M. A., Habil, M. H., Rashid, R., Siddiq, A., Guan, N. C., et al. (2014). The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia. Comprehensive Psychiatry, 55(Suppl 1), S89–S94.

    Article  PubMed  Google Scholar 

  • Szymkowicz, S., Finnegan, N., & Dale, R. (2013). A 12-month naturalistic observation of three patients receiving repeat intravenous ketamine infusions for their treatment-resistant depression. Journal of Affective Disorders, 147(1–3), 416–420.

    Article  CAS  PubMed  Google Scholar 

  • Tamminga, C. A., Lahti, A. C., Medoff, D. R., Gao, X. M., & Holcomb, H. H. (2003). Evaluating glutamatergic transmission in schizophrenia. Annals of the New York Academy of Sciences, 1003, 113–118.

    Article  CAS  PubMed  Google Scholar 

  • Tang, A., Liang, H. J., Ungvari, G. S., & Tang, W. K. (2011a). Referral patterns and clinical characteristics of subjects referred to substance abuse clinic of a regional hospital in Hong Kong. East Asian Archives of Psychiatry, 21(1), 22–27.

    CAS  PubMed  Google Scholar 

  • Tang, A., Cheung, R. Y., Liang, H. J., Ungvari, G. S., & Tang, W. K. (2011b). Psychiatric morbidity at a female residential drug treatment centre in Hong Kong. East Asian Archives of Psychiatry, 21(1), 28–31.

    CAS  PubMed  Google Scholar 

  • Tang, W. K., Liang, H. J., Lau, C. G., Tang, A., & Ungvari, G. S. (2013). Relationship between cognitive impairment and depressive symptoms in current ketamine users. Journal of Studies on Alcohol and Drugs, 74(3), 460–468.

    Article  CAS  PubMed  Google Scholar 

  • Tang, W. K., Morgan, C. J., Lau, G. C., Liang, H. J., Tang, A., & Ungvari, G. S. (2015). Psychiatric morbidity in ketamine users attending counselling and youth outreach services. Substance Abuse, 36(1), 67–74.

    Article  CAS  PubMed  Google Scholar 

  • UNODC. (2014). World drug report 2014. Vienna: United Nations.

    Book  Google Scholar 

  • Ujike, H., Katsu, T., Okahisa, Y., Takaki, M., Kodama, M., Inada, T., et al. (2009). Genetic variants of D2 but not D3 or D4 dopamine receptor gene are associated with rapid onset andpoor prognosis of methamphetamine psychosis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 33(4), 625–629.

    Article  CAS  PubMed  Google Scholar 

  • Vearrier, D., Greenberg, M., Miller, S., Okaneku, J., & Haggerty, D. (2012). Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Disease-a- Month, 58(2), 38–39.

    Article  PubMed  Google Scholar 

  • Wong, G. L., Tam, Y. H., Ng, C. F., Chan, A. W., Choi, P. C., Chu, W. C., et al. (2014). Liver injury is common among chronic abusers of ketamine. Clinical Gastroenterology and Hepatology, 12(10), 1759–1762.

    Article  CAS  PubMed  Google Scholar 

  • Yang, C., & Hashimoto, K. (2014). Rapid antidepressant effects and abuse liability of ketamine. Psychopharmacology, 231(9), 2041–2042.

    Article  CAS  PubMed  Google Scholar 

  • Yee, C. H., Lai, P. T., Lee, W. M., Tam, Y. H., & Ng, C. F. (2015). Clinical outcome of a prospective case series of patients with ketamine cystitis Who underwent standardized treatment protocol. Urology, 86(2), 236–243.

    Article  PubMed  Google Scholar 

  • Zarate, C. A., Jr., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R., Luckenbaugh, D. A., et al. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856–864.

    Article  CAS  PubMed  Google Scholar 

  • Zilberman, M. L., Tavares, H., Blume, S. B., & el-Guebaly, N. (2003). Substance use disorders: sex differences and psychiatric comorbidities. Canadian Journal of Psychiatry, 48(1), 5–13.

    Article  PubMed  Google Scholar 

  • Zweben, J. E., Cohen, J. B., Christian, D., Galloway, G. P., Salinardi, M., Parent, D., & Methamphetamine Treatment Project. (2004). Psychiatric symptoms in methamphetamine users. The American Journal on Addictions, 13(2), 181–190.

    Article  PubMed  Google Scholar 

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Contributors

Authors WK Tang and HJ Liang designed the study and wrote the protocol. Authors HJ Liang, Y Lin and CX Zhang managed the literature searches and summaries of previous related work, undertook the statistical analysis and wrote the first draft of the manuscript. Author Alan Tang and Fu Chan helped collect the data and gave valuable suggestion about the protocol and draft. Author GS Ungvari checked the writing of the manuscript and gave critical comments. Tom Freeman gave valuable comments for the first draft and revision version of our manuscript. All authors contributed to and have approved the final manuscript.

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Authors and Affiliations

  1. Department of Psychiatry, 7F, Shatin Hospital, The Chinese University of Hong Kong, 33 A Kung Kok Street, Ma On Shan, New Territories, Hong Kong SAR, China

    Wai Kwong Tang, Huajun Liang, Yong Lin & Chenxi Zhang

  2. Department of Psychiatry, Prince of Wales Hospital, Hong Kong SAR, China

    Alan Tang

  3. Department of Psychiatry, North District Hospital, Hong Kong SAR, China

    Fu Chan

  4. Clinical Psychopharmacology Unit, University College London, London, UK

    Tom P. Freeman

  5. University of Notre Dame/Marian Centre, Perth, Australia

    Gabor S. Ungvari

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  1. Wai Kwong Tang
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  2. Huajun Liang
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  5. Alan Tang
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Correspondence to Wai Kwong Tang.

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Tang, W.K., Liang, H., Lin, Y. et al. Psychiatric Co-morbidity in Ketamine and Methamphetamine Dependence: a Retrospective Chart Review. Int J Ment Health Addiction 15, 956–966 (2017). https://doi.org/10.1007/s11469-016-9681-3

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