Summary:
1. Cross-sectional studies (p.1)
2. Controlled experimental studies (p.18) 3. References (p.21)
1. Cross-sectional studies
(Araos et al. , 2015)- Plasma profile of pro-inflammatory cytokines and chemokines in cocaine users under outpatient treatment: influence of cocaine symptom severity and psychiatric co-morbidity
Methods Type of study: Case-control study Design: Cross-sectional
Setting: Outpatients Country: Spain
Participants Population: General population (no specific exclusion)
Status: abstinent of cocaine, consideration of abuse and dependent criteria. Urine analysis performed.
‘cocaine use’: Exclusively intranasal
Report of psychosis/psychotic history: interview with a psychiatrist, with the use of the using the Psychiatric Research Interview for Substance and Mental Diseases (PRISM).
Diagnosis: All cocaine subjects were evaluated according to DSM-IV-TR criteria N = 82 (82 patients and 65 matched-controls)
Age: 18 - 65 years.
Sex of the cocaine group: 67M, 15 F.
Inclusion criteria:
Cocaine users were required to have been diagnosed with a lifetime ‘pathological use’ of cocaine (chronic intoxication and/or binge), and also to be abstinent from the drug for at least 2 weeks before testing.
Exclusion criteria:
(1) personal history of chronic diseases (e.g. cardiovascular, respiratory, renal, hepatic, neurological or endocrinological diseases);
(2) personal history of cancer;
(3) infectious diseases;
(4) incapacitating cognitive alterations and/or severe schizophrenia;
(5) pregnancy for women;
Report -Lifetime cocaine use disorders -Lifetime substance use disorders -Lifetime common psychiatric disorders
Interventions Study of the Plasma profile of pro-inflammatory cytokines Results/Finding
s Cocaine exposure modifies the circulating levels of pro-inflammatory mediators.
These cytokines allowed the categorization of the outpatients into subgroups according to severity, identifying a subgroup of severe cocaine users (9–11 criteria) with increased prevalence of co-morbid psychiatric disorders [mood (54%), anxiety (32%), psychotic (30%) and personality (60%) disorders.
Notes -Although in this study primary psychotic disorders were included, only 2 subjects (<4%) presented such diagnosis.
-Patients were seeking treatment.
1/23
(Brady et al. , 1991)- Cocaine-Induced psychosis Methods Type of study: Cross-sectional study
Design: Cross-sectional, inclusions of patients being consecutively admitted Setting: inpatients
Country: United States of America
Participants Population: General population admitted to an inpatient facility for treatment of cocaine dependence (no specific exclusion)
Status: current users of cocaine, consideration of dependence criteria.
‘cocaine use’: intravenous, inhalation and intranasal.
Report of psychosis/psychotic history: interview with a psychiatrist, with the use of the specific questions regarding cocaine-induced psychotic symptoms. Interviews occurred at least 5 days after the last drug use.
Diagnosis: All cocaine subjects were evaluated according to DSM-III-R criteria for cocaine dependence
N = 55
Age: 18 - 65 years.
Sex of the cocaine group: 37M, 17F.
Inclusion criteria:
Patients dependent to cocaine, consecutively admitted to an inpatient facility for the treatment of cocaine dependence.
Exclusion criteria:
Subjects who fulfilled DSM-III-R criteria for current dependence on another substance and those with a history of or current psychotic disorder unrelated to cocaine use were excluded.
Report -Route of administration
-Amount of cocaine use in grams
-Prevalence of the prevalence of the lifetime cocaine use -Clinical features of CIP
Interventions - Results/Finding
s Fifthy-three percent of individuals interviewed reported experiencing transient cocaine- induced psychosis. There was no significant difference of cocaine use in the month before admission between those who experienced psychosis and those who did not. The psychosis positive group used significantly more cocaine in the year prior to admission (p<0.02) and had a longer duration of use (p<0.05). Males were significantly more likely than female to develop psychosis (p<0.05).
Notes -Patients were seeking treatment.
2/23
(Cubells et al. , 2005)- Rating the severity and character of transient cocaine-induced delusions and hallucinations with a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP)
Methods Type of study: Prospective study Design: Prospective study Setting: outpatients
Country: United States of America
Participants Population: General population with exclusion of primary psychosis
Status: lifetime use of cocaine; lifetime years of regular use, defined as ≥3 times/week for ≥6 months; consideration of lifetime abuse and dependent criteria.
‘cocaine use’: current use – dependence criteria
Report of psychosis/psychotic history: semi-structured interview with the use of the Cocaine Experience Questionnaire (CEQ). The SAPS-CIQ was also used.
Diagnosis/Prevalence: Diagnoses were made with the use of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).
N = 243 Age: n.a.
Sex of the cocaine group: 143M, 100F.
Inclusion criteria: Unrelated subjects were recruited through clinical referral, advertising, and word-of-mouth in Farmington (University of Connecticut School of Medicine) and New Haven, CT (Yale University School of Medicine).
Exclusion criteria: Subjects meeting DSM-IV criteria for schizophrenia, schizoaffective disorder, bipolar disorder, major depression with psychotic features, or those with a history of a seizure disorder (except cocaine-induced seizures), or a severe medical illness, including a history of AIDS (but not merely of HIV+ status), were excluded.
Report -Lifetime cocaine induced-psychosis, with the use of the CEQ
- Use of the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP)
- Lifetime comorbid substance use
Interventions -Assessment of the Cocaine Experience Questionnaire (CEQ) and the SAPS-CIP Results/Finding
s Authors observed significant positive correlations, respectively, between severity of HAL and DEL, and lifetime number of episodes of cocaine use, and negative correlations with age at onset of cocaine use.
Notes -All subject had dependence criteria to cocaine (current users).
-Patients were seeking treatment.
3/23
(Elangovan et al. , 1993)- Substance abuse among patients presenting at an inner-city psychiatric emergency room Methods Type of study: Prospective study
Design: Prospective study, consecutive admission from January to February 1993 Setting: outpatients
Country: United States of America Participants Population: General population
Status: current users of cocaine
‘cocaine use’: current use – dependence criteria based on the DSM III-R. Urine and blood test performed.
Report of psychosis/psychotic history: Self-report, urine analysis and the resident physician administered a structured clinical interview adapted from the Structured Clinical Interview for DSM III- R (SCID) to identify specific substance use disorders.
Diagnosis: based on the use of the DSM III- R (SCID).
N = 88
Age: 7 to 82-year-old
Sex of the cocaine group: 143M, 100F.
Inclusion criteria: Cocaine users consecutively referred during the study period to the emergency unit
Exclusion criteria: loss of blood samples or urine analysis Report -Current cocaine induced-psychosis
- Lifetime comorbid substance use Interventions - Not relevant
Results/Finding
s The SCID failed to identify 55 percent (36 of 65) of the cocaine-abusing patients identified by the toxicological screen.
Notes -Authors strongly recommend routine toxicological screening in addition to systematic questioning about past drug use.
-No indication concerning the dependence status.
4/23
(Floyd et al. , 2006)- Risk factors for experiencing psychosis during cocaine use: A preliminary report Methods Type of study: Prospective study
Design: Prospective study, consecutive admission from January to February 1993 Setting: inpatients and outpatients
Country: United States of America
Participants Population: Cocaine dependent patients, exclusion of individuals affected by primary psychosis
Status: currently abstinent of cocaine
‘Cocaine use’: Individuals were all dependent to cocaine. A urine test was performed.
Report of psychosis/psychotic history: Based on an interview with the use of the 58-item Cocaine Experience Questionnaire (CEQ).
Diagnosis: based on the use of the CEQ and the DSM-IV N = 51
Age: 19 to 49-year-old
Sex of the cocaine group: 30M, 21F.
Inclusion criteria: Cocaine inpatients (detoxification) or abstinent outpatients. Subjects had been abstinent for at least three weeks prior to the study. All subjects were free of any history of non-cocaine induced psychotic symptoms and of neurological disease.
Exclusion criteria: loss of blood samples or urine analysis Report - Lifetime cocaine induced-psychosis
- Lifetime comorbid substance use Interventions -Not relevant
Results/Finding
s The SCID failed to identify 55 percent (36 of 65) of the cocaine-abusing patients identified by the toxicological screen.
Notes - The population of this study is quite specific, as it is constituted of patients who are willing to be followed or undergo a detoxification.
5/23
(Gonzalez-Saiz et al. , 2014)- Impact of Psychiatric Comorbidity on the In- Treatment Outcomes of Cocaine- Dependent Patients in Therapeutic Communities
Methods Type of study: Prospective study Design: Prospective longitudinal study
Setting: outpatients receiving treatment in therapeutic communities in the region of Andalusia (Spain)
Country: Spain
Participants Population: Cocaine dependent patients.
Status: seeking treatment patients. Interviews occurred 15 to 20 days after the onset of TC treatment;
‘Cocaine use’: Individuals were all dependent to cocaine.
Report of psychosis/psychotic history: Based on an interview with the use of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM).
Diagnosis: based on the use of the CEQ and the DSM-IV-TR.
N = 218
Age: 20 to 55-year-old
Sex of the cocaine group: 199M, 19F.
Inclusion criteria: (1) meeting DSM-IV-TR criteria for cocaine dependence, (2) being at least 18 years old, (3) knowing how to read and write, and (4) signing the informed
consent form.
Exclusion criteria: (1) organic cognitive impairment that impeded psychopathological exploration and (2) a criminal case pending trial in the upcoming 3 months that would impede the participant’s continuation of treatment at the center.
Report - Lifetime cocaine induced-psychosis - Lifetime comorbid substance use Interventions -Not relevant
Results/Finding
s The number of psychopathological comorbidities present in the last year among the patients was high (57.8%) and was associated with a worse response to treatment (P = .004). The patients with co-occurring psychiatric disorders had a decreased probability of remaining in the TCs compared with patients who only presented with substance use disorders (hazards ratio = 1.61). Psychiatric comorbidity predicts cocaine-dependent individuals’
likelihood of remaining in residential treatment.
Notes - A clear distinction of patients suffering from prior primary psychosis was reported in the article.
6/23
(Kalayasiri et al. , 2006a)- Risk factors for cocaine-induced paranoia in cocaine-dependent sibling pairs Methods Type of study: Prospective study
Design: Prospective study Setting: inpatients and outpatients Country: United States of America
Participants Population: Cocaine dependent patients. Individuals with a primary psychotic disorder (e.g., schizophrenia) and bipolar disorder were excluded.
Status: currently users and dependent to cocaine
‘cocaine use’: DSM-IV dependence criteria were applied. CIP was operationally defined as positive responses to both of the following questions: “Have you ever had a paranoid experience?” and “Have you ever had a paranoid experience when you were using cocaine?”; these questions are derived from the Cocaine Experience Questionnaire.
Report of psychosis/psychotic history: All subjects were administered the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) by a trained interviewer.
Diagnosis: based on the use of the DSM-IV criteria.
N = 420 (273 CIP) Age: 19 to 49-year-old
Sex of the cocaine group: 201M, 219F.
Inclusion criteria: sibling pairs that met DSM-IV criteria for cocaine dependence Exclusion criteria: loss of blood samples or urine analysis
Report - Lifetime cocaine induced-psychosis - Lifetime comorbid substance use - Average of grams per day consumption Interventions -Not relevant
Results/Finding
s Of 420 probands, 273 (65%) experienced CIP. Probands with CIP were more severely dependent upon cocaine, had an earlier age of onset, were more likely to smoke cocaine, and used cocaine less frequently during the preceding year. Independent analyses of siblings replicated two of the former (i.e., dependence severity and age of onset).
Severity of cocaine dependence, as measured by DSM-IV symptom count, was a strong predictor of the risk for CIP
Notes - Patients were seeking treatment.
7/23
(Miguel et al. , 2018)- Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil
Methods Type of study: Prospective longitudinal study Design: Prospective
Setting: outpatients Country: Brazil
Participants Population: crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil
Status: currently abstinent or users of cocaine
‘cocaine use’: dependence criteria to crack.
Report of psychosis/psychotic history: based on self-report and interview. Substance use diagnoses were made and psychotic symptoms were identified through the use of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) (First et al. 1997).
Diagnosis: based on the use of the DSM-IV N = 65
Age: 18 to 65-year-old
Sex of the cocaine group: 56M, 9F.
Inclusion criteria: outpatients seeking treatment of crack-dependence
Exclusion criteria: participants were excluded from the study for the following reasons:
being abstinent from crack for more than 4 weeks (5); for not having crack as the first drug of choice (6); for being diagnosed with schizophrenia (3) (confirmed using SCID-I); and for not being able to attend treatment at least 3 times per week (7).
Report - Lifetime cocaine induced-psychosis (at least one psychotic symptom) - Lifetime comorbid substance use
Interventions Results/Finding
s Participants presented significant psychiatric symptomatology and impulsivity with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic and comorbid features of this disorder.
Notes - The lifetime cocaine-induced psychotic disorder was based on at least one psychotic symptom.
-Patients were seeking treatment.
8/23
(Roncero et al. , 2017)- Higher severity of cocaine addiction is associated with tactile and somatic hallucinations Methods Type of study: Prospective study
Design: This is a cross-sectional study, conducted with cocaine-dependent patients that began treatment between January 2006 and May 2016.
Setting: inpatients and outpatients Country: Spain
Participants Population: Patients attending an outpatient addictions department: cocaine-dependent patients treated in a Substance Use Disorders Unit, who began treatment between January 2006 and December 2008. Primary psychiatric disorders were excluded.
Status: currently users of cocaine/crack
‘cocaine use’: cocaine-dependent patients
Report of psychosis/psychotic history: Interview with the SCID I, and with the use of several specific questions related to CIP.
Diagnosis: based on the use of the DSM-IV N = 422
Age: >18
Sex of the cocaine group: 349M, 73F.
Inclusion criteria: Be aged over 18, cocaine dependence according to DSM-IV-TR criteria, and signing the informed consent prior to participation.
Exclusion criteria: Exclusion criteria were to have primary psychotic disorder, severe somatic disease at baseline examination and low language proficiency.
Report - Lifetime cocaine induced-psychosis - Comorbid substance use
Interventions -Not relevant Results/Finding
s Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom.
According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine.
Notes -Patients were seeking treatment.
-Several articles were found for the same first author (Roncero C.), we decided to retain this study, as it is the one which include the largest population.
-Of important, even if these authors have not used a specific scale regarding CIP, several questions were asked in order to identify if patients were affected by CIP symptoms.
9/23
(Satel et al. , 1991)- Clinical Features of Cocaine-Induced Paranoia Methods Type of study: Prospective study
Design: 50 cocaine-dependent men consecutively admitted to a 28-day rehabilitation program.
Setting: inpatients
Country: United States of America
Participants Population: All patients were patients voluntarily entering an inpatient substance abuse rehabilitation program at a Veterans Administration hospital.
Status: currently users of cocaine/crack
‘cocaine use’: current users, admitted to a rehabilitation program
Report of psychosis/psychotic history: Interview with the SCID I and the cocaine experience questionnaire (CEQ).
Diagnosis: based on the use of the DSM-III-R.
N = 50 Age: n.a.
Sex of the cocaine group: 50M, 0F.
Inclusion criteria: Patients affected by primary cocaine dependence.
Subjects who used another substance were included if their cocaine use was primary (i.e., the other substance or substances were used to modify the acute effect of cocaine and there was no abuse of the substance or substances in the absence of cocaine intoxication.
Exclusion criteria: Individuals who also met DSM-III-R criteria for current dependence on any other substance were excluded. Patients with DSM-III-R axis I psychotic disorders and bipolar illness as well as those with axis II schizoid and schizotypal personalities were excluded.
Report - Lifetime cocaine induced-psychosis
- Comorbid substance use, without dependence criteria Interventions -Not relevant
Results/Finding s
Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom.
According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine
Notes - Individuals who also met DSM-III-R criteria for current dependence on any other substance were excluded.
-Patients were seeking treatment.
10/23
(Smith et al. , 2009)- Prevalence of Psychotic Symptoms in Substance Users: A Comparison across Substances Methods Type of study: Prospective study
Design: Longitudinal study targeting intravenous drug users, crack-cocaine users and heroin snorters. This study aimed to reduce the spread of HIV among St. Louis’ most vulnerable drug-using population while improving drug abuse treatment
Setting: outpatients
Country: United States of America
Participants Population: patients were recruited from areas which were known by the St. Louis City Police and Health Departments to be areas with high rates of prostitution, drug use and HIV.
Status: currently users or abstinent of cocaine/crack
‘cocaine use’: current users or abstinent, crack or cocaine, abuse or dependence
Report of psychosis/psychotic history: Respondents were interviewed with the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). The CIDI-SAM is a structured interview module focused on DSM-III-R substance use disorders that expands on the WHO Composite International Diagnostic Interview (CIDI).
Diagnosis: based on the use of the DSM-III-R.
N = 476
Age: 18 to 57-year-old
Sex of the cocaine group: 342M, 134F.
Inclusion criteria: All respondents who acknowledged using a substance more than five times in their lifetime were asked about the use of cannabis, amphetamines, sedatives, club drugs, cocaine, heroin and other opiates, PCP, hallucinogens, and inhalants.
Exclusion criteria: Exclusion of primary disorders Report - Lifetime cocaine induced-psychosis
- Comorbid substance use Interventions -Not relevant
Results/Finding
s Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom.
According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine
Notes - Individuals who also met DSM-III-R criteria for current dependence on any other substance were excluded.
-Patients were seeking treatment.
11/23
(Tang et al. , 2007)- Comorbid Psychiatric Diagnoses and Their Association with Cocaine-Induced Psychosis in Cocaine-Dependent Subjects
Methods Type of study: Prospective study
Design: Cohort of patients. Unrelated subjects were recruited through clinical referral, advertising, and word-of-mouth in Farmington, Connecticut and New Haven.
Setting: outpatients
Country: United States of America
Participants Population: Adult crack smokers primarily seeking treatment for cocaine use disorder
‘cocaine use’: current users of crack, abuse or dependence
Report of psychosis/psychotic history: Self-report for current and previous drugs. the Cocaine Experience Questionnaire (CEQ) 20. Additionnaly, the authors used the Scale for Assessment of Positive Symptoms of Cocaine-Induced Psychosis (SAPS-CIP).
Diagnosis: DSM-IV diagnoses were established using the Semi-Structured Assessment for Drug Dependence and Alcoholism
N = 243
Age: 18 to 57-year-old
Sex of the cocaine group: 45M, 8F.
Inclusion criteria: outpatients
Exclusion criteria: Subjects with pre-existing psychotic disorders, or those with
a history of a seizure disorder (except cocaine-induced seizures), or a severe medical illness, including a history of AIDS (but not merely of HIVþ status), were excluded.
Report - Lifetime cocaine induced-psychosis - Comorbid substance use
Interventions -Not relevant Results/Finding
s Comorbid substance use and psychiatric disorders were common in this cocaine-dependent sample. Ninety percent of subjects met criteria for substance use disorders other than cocaine dependence; common non-substance-use disorders included antisocial personality disorder (ASPD), adult ASPD, major depression, and attention deficit-hyperactivity disorder (ADHD)
Notes -Patients were seeking treatment.
12/23
(Trape et al. , 2014)- Early Cannabis Use Is Associated With Severity of Cocaine-Induced Psychosis Among Cocaine Smokers in Martinique, French West Indies
Methods Type of study: Prospective study
Design: Study performed over a 1-year period, starting in January 2009 and ending in December 2009
Setting: outpatients
Country: France (Martinique)
Participants Population: Adult crack smokers primarily seeking treatment for cocaine use disorder
‘cocaine use’: current users of crack, abuse or dependence
Report of psychosis/psychotic history: Self-report for current and previous drugs. Patients were assessed using the Cocaine Experience Questionnaire (CEQ), an instrument for the identification of cocaine-induced paranoia, and a French version of the SAPS-CIP, for the severity of CIP.
Diagnosis: based on the use of the DSM-IV N = 53
Age: 18 to 57-year-old
Sex of the cocaine group: 45M, 8F.
Inclusion criteria: Patients dependent to cocaine and seeking treatment. Patients older than 18 years, cocaine dependence according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria (American Psychiatric Association, 2000), and smoking cocaine as the main actual pattern of cocaine use
Exclusion criteria: acute or chronic primary psychotic disorder, mood disorder with psychotic features, chronic antipsychotic medication, severe somatic disease and severe cognitive disorders, and acute cocaine or alcohol intoxication at baseline examination.
Report - Lifetime cocaine induced-psychosis - Comorbid substance use
Interventions -Not relevant Results/Finding
s
Thirty-five (66%) patients reported cocaine-induced paranoia on the CEQ (CIP(+) patients).
The mean SAPS-CIP total score was 6.1 ± 3.7, with a significant difference between CIP(+) and CIP(−) patients (P < 0.0001). Age at first cannabis use was associated with occurrence of CIP on the CEQ, and adolescent-onset cannabis use was associated with severity of hallucinations score on the SAPS-CIP.
Notes -Patients were seeking treatment.
13/23
(Vergara-Moragues et al. , 2012)- Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders
Methods Type of study: Prospective study
Design: Observational, cross-sectional design Setting: inpatients
Country: Spain
Participants Population: Cross-sectional observational design in which we assessed 227 cocaine- dependent patients from six public TCs of the Andalusian Drug and Addiction Plan. The targeted population consisted of individuals with a diagnosis of cocaine dependence that initiated and finished treatment in TCs between May 2008 and September 2010.
‘cocaine use’: current users of cocaine who sought treatment. ((a) current (during the last years) and (b) lifetime diagnosis (before12months)). Use of the Psychiatric Research Interview for Substance and Mental Disorders.
Report of psychosis/psychotic history: Self-report, and assessment with the use of the interview for Substance and Mental Disorders (PRISM). Assessment after at least 15 days of treatment.
Diagnosis: based on the use of the DSM-IV-TR N = 227
Age: >18
Sex of the cocaine group: 207M, 20F.
Inclusion criteria: (1) DSM-IV-TR diagnosis of cocaine dependence for the last 12 months;
(2) being at least 18 years old; (3) knowing how to read and write; (4) signing the informed consent form.
Exclusion criteria: (1) organic cognitive impairment impeding psycho pathological exploration; (2) pending legal issues that would impede continuation of treatment at the center.
Report - Lifetime cocaine induced-psychosis - Current cocaine induced-psychosis - Lifetime schizophrenia diagnosis - Comorbid substance use
Interventions -Not relevant Results/Finding
s The data indicate that more than 65% of the sample experienced a lifetime co-occurring psychiatric comorbidity. Substance-induced mood (21.6%) and psychotic (11.5%) disorders were more prevalent in this population than independent mood (12.3%) and psychotic (7.5%) disorders.
Notes -Patients suffering from primary psychosis were not excluded; however clear report of the percentage of substance induced psychosis is mentioned. To extract the prevalence, the exclusion of these individuals, as the one presenting mood disorders in needed.
-Patients were seeking treatment.
14/23
(Vergara-Moragues et al. , 2014)- Cocaine-induced psychotic symptoms in clinical setting Methods Type of study: Prospective study
Design: Observational, cross-sectional design Setting: outpatients
Country: Spain
Participants Population: Sample of patients without a history of primary psychosis, who attended specific outpatient drug-dependence treatment centers.
‘cocaine use’: current users of cocaine who sought treatment. The authors used the LSI- Cocaine is a structured clinical interview that provides a profile of CIPS severity, and the SAPS-CIP.
Report of psychosis/psychotic history: Self-report, and assessment with the use of the Scale for the Assessment of Positive Symptoms of Cocaine-Induced Psychosis
Diagnosis: based on the use of the DSM-III-R N = 114
Age: >18
Sex of the cocaine group: 99M, 15F.
Inclusion criteria: (a) cocaine use that was considered problematic by the patient, accompanied by a request for treatment for this addiction (independently of whether other substances were being used); (b)18 years of age or older; and(c) ability and willingness to sign the informed consent form.
Exclusion criteria: (a) a current or lifetime
Diagnosis of primary psychosis (schizophrenia, schizophreniform disorder, schizoaffective disorder, or delusional disorder) evaluated by the psychiatric research interview for Substance and Mental Disorders (PRISM);(b) a manic episode at the time of the interview;
or (c) intoxication or serious organic disease at the time of the interview Report - Lifetime cocaine induced-psychosis
- Comorbid substance use Interventions -Not relevant
Results/Finding
s Most patients, 89.5%(95%CIs:83.8–95.2%) had dependence of cocaine and 84.2%(95%CIs:77.5–90.9%) showed at least one CIPS. Patients with CIPS had used cocaine more times throughout their lives and had a more frequency of use during the period of higher abuse severity in the last year, had higher severity of dependence score and had fewer abstinence periods greater than 30 days compared with those without CIPS.
Notes -Patients were seeking treatment.
15/23
(Willi et al. , 2017)- Characterization of white matter integrity deficits in cocaine-dependent individuals with substance-induced psychosis compared with non-psychotic cocaine users
Methods Type of study: Prospective study
Design: Observational, cross-sectional design recruited between November 13, 2008, and July 31, 2011- this article is based on a previous study (Vila-Rodriguez et al. 2013)
Setting: outpatients Country: Canada
Participants Population: Sample of patients recruited from single-room occupancy hotels located in a low-income neighborhood and managed by a not-for-profit housing agency.
‘cocaine use’: current cocaine use with DSM-IV criteria for cocaine dependence, verified by a positive urine toxicology.
Report of psychosis/psychotic history: Self-report, and assessment with the use of the Mini-International Neuropsychiatric Interview, and it was supplemented by a clinical interview and mental status examination carried out by a psychiatrist.
Diagnosis: Based on the use of the DSM-IV N = 67
Age: 18 to 58-year-old
Sex of the cocaine group: 45M, 22F.
Inclusion criteria: living in one of four single-room occupancy hotels and ability to communicate in English. Inability to provide informed consent was the sole exclusion criterion.
Exclusion criteria: history of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of schizophrenia, schizoaffective disorder, psychosis not otherwise specified or bipolar disorder. Further exclusionary criteria included past moderate or severe traumatic brain injury (loss of consciousness >30 minutes or confusion
>24 hours after injury), stroke, significant MRI artifacts (motion, major distortion) and other gross morphometricbrain abnormalities (i.e. encephalomalacia).
Report - Lifetime cocaine induced-psychosis - Comorbid substance use
Interventions - Results/Finding
s - The CAP group showed significantly lower fractional anisotropy values than the CDN group (p<0.05) in voxels within white matter tracts of fronto-temporal, fronto-thalamic and interhemispheric pathways. The greatest differences in white matter integrity were present in the corpus callosum, corona radiata, bilateral superior longitudinal fasciculi and bilateral inferior longitudinal fasciculi. Additionally, the CAP group had voxels of significantly higher radial diffusivity in a subset of the previously mentioned pathways. These results are the first description of white matter integrity abnormalities in a SIP sample and indicate that differences in these pathways may be a shared factor in the expression of different forms of psychosis.
Notes -Current cocaine users.
16/23
(Zayats et al. , 2013)- A complex interplay between personality domains, marital status and a variant in CHRNA5 on the risks of cocaine, nicotine dependences and cocaine-induced paranoia.
Methods Type of study: Prospective study Design: Prospective study
Setting: outpatients (four different sites of inclusion) Country: United States of America
Participants Population: General population with exclusion of bipolar disorders and schizophrenia Status: lifetime use of cocaine; according to the DSM-IV criteria
‘cocaine use’: lifetime use– dependence criteria
Report of psychosis/psychotic history: semi-structured interview
Diagnosis: All subjects were assessed with the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA), which yields a DSM-IV based lifetime diagnoses for a variety of psychiatric and substance use disorders.
N = 2192 Age: 18-65
Sex of the cocaine group: 1163M, 1029F.
Inclusion criteria: Recruitment was conducted at four sites: the University of Connecticut Health Center (UCONN, Farmington, CT), the Yale University School of Medicine (New Haven, CT), the University of Pennsylvania School of Medicine (UPENN, Philadelphia, PA) and the Medical University of South Carolina (MUSC, Charleston, SC).
Exclusion criteria: Individuals with a primary diagnosis of bipolar affective disorder or schizophrenia were excluded. Cases with nicotine dependence only were excluded from these analyses. Subjects who were widowed at the time of recruitment were excluded (because this would not reasonably be expected to correlate with the subject’s personality).
Report -Lifetime cocaine induced-psychosis, use of the SSADDA -Lifetime comorbid substance use
Interventions -Study of Personality traits were characterized in terms of five factors based on the NEO (the Big Five Model-BFM)
-Genetic variant (variant in CHRNA5) Results/Finding
s For CIP, marriage was observed to moderate its correlation with openness and neuroticism (OR= 1.39, 95% CI= 1.18–1.63, p= 7.64e-04 and OR = 1.26, 95% CI = 1.12–1.42, p= 1.27e- 03 respectively). The correlations moderated by rs16969968 were those of conscientiousness and CD (OR = 1.62, 95%CI: 1.23–2.12, p = 8.94e-04) as well as CIP (OR = 1.21, 95% CI:
1.11–1.32, p = 4.93e-04 when comparing group A versus group C). No significant interactions were observed in African American population. The Bonferroni-corrected significance threshold was set to be 1.67e-03.
Notes -All subject had dependence criteria to cocaine.
-Patients were seeking treatment at least to some extent.
17/23
2. Controlled experimental studies
(Kalayasiri et al. , 2006b)- Self-reported paranoia during laboratory “binge” cocaine self-administration in humans Methods Type of study: Controlled experimental study
Design: experimental study Setting: inpatients
Country: United States of America
Participants Population: Inpatient. Participants were recruited from the Clinical Neuroscience Research Unit (CNRU) and the Yale General Clinical Research Center (GCRC), New Haven, Connecticut
Status: currently users of cocaine
‘cocaine use’: dependence criteria to cocaine. Subjects were dependent on cocaine for at least 2 years, and actively using cocaine by a high potency, rapid onset route (i.e., smoking or intravenous; as confirmed by positive urine toxicology testing). DSM-IV cocaine- dependence criteria.
Report of psychosis/psychotic history: Self-reports of paranoia during the interventions.
Subject reports of cocaine-induced subjective effects, including paranoia (“I feel paranoid”), euphoria (“I feel high”) and craving (“I want cocaine”), were assessed at 5-min intervals by visual analog scale [VAS; 0 (not at all) to 10 (most ever)] using a touch-screen laptop computer. The Cocaine Experience Questionnaire was used (Satel et al. 1991).
In addition, a retrospective assessments of cocaine use history (e.g., age of onset of cocaine use, duration of cocaine use, average money spent for cocaine per day, days per week of cocaine use, and route of administration) were obtained by unstructured interview at the time of screening/enrollment.
Diagnosis: based on the use of the DSM-III-R N = 46
Age: 18 to 45-year-old
Sex of the cocaine group: 19M, 9F.
Inclusion criteria: patient with a history of smoked cocaine use, averaging at least twice a week over the past 6 months; current exposure to at least 1 g cocaine within a 4- to 6-hr period; no current medical problems; and not pregnant or breast feeding, and using acceptable birth control methods.
Exclusion criteria: Individuals with a primary psychotic disorder (e.g., schizophrenia) were excluded, as were individuals dependent upon alcohol, sedative-hypnotics, or opiates.
Individuals were free of clinically significant medical (e.g., cardiac) and neurological (e.g., seizure) illness, as established by medical/psychiatric history and physical, neurological, and laboratory examinations (e.g., EKG, blood, chemistries, hematology, and urinalysis).
Report - Lifetime cocaine induced-psychosis
Interventions - Participants underwent a laboratory session, during which they received a 2-h,
intravenous cocaine self-administration sessions at 8, 16, and 32mg/70kg doses, including 18 in a placebo-controlled design.
Results/Finding
s Self-reports of paranoia showed significant main effects of cocaine dose (p=0.0002) and time (p=0.0003), and were statistically distinguishable from placebo at the two highest doses (16 and 32mg). These effects were accounted for by a subgroup of vulnerable subjects in whom self-reports were consistent across dose and test–retest sessions. Subjects with CIP did not differ from those without CIP with respect to demographic, cocaine use, or cocaine self-administration variables.
Notes - For this study, we have extracted the current cocaine-induced psychosis under controlled experimental conditions, and not the lifetime cocaine induced-psychosis rate.
18/23
(Mooney et al. , 2006)- Preliminary observations of paranoia in a human laboratory study of cocaine Methods Type of study: Controlled experimental study
Design: experimental study Setting: outpatients
Country: United States of America
Participants Population: Outpatient. Participants were recruited from the Minneapolis/St. Paul area by word of mouth, fliers, and newspaper advertisements.
Status: currently users of cocaine/crack
‘cocaine use’: dependence criteria to crack and cocaine. DSM-IV cocaine-dependence criteria.
Report of psychosis/psychotic history: Subjective effects of cocaine were measured 4.5 min before and 2.5, 10 and 15 min after the dose, using the Cocaine Effects Questionnaire.
Diagnosis: DSM-IV N = 44
Age: 20 to 45-year-old
Sex of the cocaine group: 23M, 0F.
Inclusion criteria: patient with a history of smoked cocaine use, averaging at least twice a week over the past 6 months; current exposure to at least 1 g cocaine within a 4- to 6-hr period; no current medical problems; and not pregnant or breast feeding, and using acceptable birth control methods.
Exclusion criteria: (a) had a diagnosis of Axis I disorders from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders(American Psychiatric Association, 1994) other than cocaine and nicotine dependence; (b) currently used alcohol or other drugs on a daily basis; (c) were on parole or probation or had a legal history of violence; (d) had received treatment for chemical dependency within the past 6 months or expressed a desire to seek treatment; (e)were seropositive for HIV; and (f) used any psychotropic medications (i.e., antidepressant, antianxiety, mood stabilizers, etc.) within the past 6 months.
Report - Lifetime cocaine induced-psychosis
Interventions - Participants underwent a laboratory session, during which they received a single dose of smoked cocaine (0.4 mg/kg), using an apparatus
Results/Finding
s Twenty-nine of 44 participants (67%) reported feeling Paranoid/Suspicious in response to cocaine. Those who reported feeling Paranoid/Suspicious were more likely to be older and male.
Notes - For this study, we have extracted the current cocaine-induced psychosis under controlled experimental conditions, and not the lifetime cocaine induced-psychosis rate.
19/23
(Reid et al. , 2004)- Sensitization to the Psychosis-Inducing Effects of Cocaine Compared with Measures of Cocaine Craving and Cue Reactivity
Methods Type of study: Prospective study Design: Prospective
Setting: outpatients
Country: United States of America
Participants Population: outpatient seeking treatment at a substance abuse treatment program Status: currently users of cocaine/crack
‘cocaine use’: dependence criteria to crack and cocaine.
Report of psychosis/psychotic history: cocaine-dependent subjects (based on SCID DSM- IV criteria) were profiled with the Addiction Severity Index (ASI)
Diagnosis: DSM-IV N = 23
Age: n.a.
Sex of the cocaine group: 23M, 0F.
Inclusion criteria: outpatients seeking treatment of crack-dependence
Exclusion criteria: Subjects were excluded if they were diagnosed with a current Axis I psychiatric disorder or ever had an Axis I psychotic disorder, according to the SCID DSM- IV criteria. Enrollment in a methadone maintenance program was also exclusionary.
Report - Lifetime cocaine induced-psychosis (at least one psychotic symptom) - Current cocaine induced-psychotic symptoms (paranoia)
- Last 30 days comorbid substance use Interventions - Craving evaluation
Results/Finding
s Sensitization to cocaine-induced psychosis was negatively correlated with baseline measures of drug dependence severity and indices of cocaine craving over the preceding 24 hours but not with measures of cocaine cue reactivity
Notes - Evidence for a history of cocaine-induced psychosis (paranoia) was reported by 21 of 23 subjects; however, only eight subjects showed evidence for sensitization to this effect.
- Patients were seeking treatment.
20/23
References
