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1/2. The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence.

    patients with a severe mental illness such as schizophrenia have significant rates of concurrent amphetamine use. Such dual diagnosis patients have been shown to have poorer treatment outcomes. Often, they do not comply with treatment plans and have frequent episodes of hospitalization. There is growing evidence for the role of prescribed dexamphetamine in the treatment of amphetamine dependence. The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence has not been previously reported. Eight schizophrenic patients are described to whom dexamphetamine has been prescribed, with information being extracted retrospectively from case notes. In four out of eight cases, the prescription of dexamphetamine led to apparently good progress both in terms of substance misuse and psychiatric health. In two cases, progress was more equivocal, but appeared to produce some benefit. Two cases could be judged as treatment failures, but the condition and situation of the patients were not worse at the end of treatment than at the beginning. compliance with neuroleptics increased in most cases. No patients exhibited exacerbation of psychosis as a result of treatment. The rate of outcome success is satisfactory when consideration is given to the difficult nature of this patient group, and their previous failure to respond to intensive treatment. It is argued that benefits may be gained from increased compliance with psychiatric treatment in patients prescribed amphetamine, and that this may outweigh possible risks. However, any conclusions are tentative in view of the nature of this study. A small open-label prospective study is recommended.
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ranking = 1
keywords = psychosis
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2/2. Neuropsychiatric consequences (atypical psychosis and complex-partial seizures) of ecstasy use: possible evidence for toxicity-vulnerability predictors and implications for preventative and clinical care.

    Two case reports of ecstasy abuse and its serious neuropsychiatric complications are presented. The first patient developed a florid paranoid psychosis resembling schizophrenia after repeated long-term recreational ecstasy abuse, and significant alterations with intermittent paroxysmal discharges were found in his electroencephalogram. The second patient showed an atypical paranoid psychosis with Fregoli syndrome and a series of complex-partial epileptic seizures with secondary generalization after a first single ecstasy dose. Both subjects presented considerable vulnerability; the first a minimal brain dysfunction after perinatal asphyxia and a persisting attention deficit/hyperactivity disorder, the second a long-lasting opioid addiction. In vulnerable individuals, dose-independent ecstasy abuse can lead to unpredictable and potentially dangerous neuropsychiatric sequelae which require proper initial assessment and adequate treatment.
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ranking = 6
keywords = psychosis
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