Illicit
methamphetamine abuse represents a major problem in many countries worldwide, including the United States. Prolonged regular smoking or injection of
methamphetamine can cause a
psychosis, typically characterized by paranoid delusions and
auditory hallucinations and often associated with disturbances in mood. These symptoms may persist long after
methamphetamine is discontinued and may prove refractory to
antipsychotic medications. The authors describe a patient who developed a typical
methamphetamine psychosis that persisted despite months of abstinence from
methamphetamine and weeks of treatment with
antipsychotic medication but that responded promptly to electroconvulsive therapy (ECT) on two separate occasions: on initial presentation and again a year later when the patient relapsed into
methamphetamine abuse and developed
psychosis again. The authors review the large international literature on
methamphetamine psychosis, much of which is from Japan and has not previously been summarized in English. Persistent
methamphetamine psychosis has been widely reported in Japan for more than 50 years but is rarely discussed in the American literature, possibly because some such cases are misdiagnosed in the United States as primary
psychotic disorders. Given the growing public health problem of
methamphetamine abuse in the United States, the distinction between persistent
methamphetamine psychosis and a primary
psychotic disorder has grown increasingly important. Thus, American clinicians should be alert to the possibility of
methamphetamine psychosis and may wish to consider ECT in refractory cases.