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Comment by m-ee | Hacker News Reader

Unless this is a regional thing I wonder where the doctor even got that idea, I wasn't even aware people snort meth until now. Meanwhile I walked past two people lighting up after leaving a job interview in soma last week. Any doctor who's worked in the ER or psych ward in SF would be familiar with how its used, meth induced psychosis is very common around here.

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No such thing as meth-induced psychosis. Yes, people might appear psychotic while under the influence, but that is not psychosis in the clinical sense.

The few that do lose their rationality lose it because they don’t sleep for weeks. They likely also live in an unsafe environment which keeps them in a perpetual state of survival stress.

Survival stress + not sleeping + stimulants —> psychosis. Very rarely any of these alone, unless the individual is predisposed.

I’m not going to say you been in SF but you clearly haven’t walked through the tenderloin and probably not spent a lot of time around people that partake in harder drugs on regular basis. Yes it doesn’t match the clinical description, but that’s because the clinical description wasn’t written by someone who works in the heavily drug ridden areas. More likely by someone who probably only dealt with hard drug users once or twice on their ED rotation during residency

Would you consider the people living in those areas to be living under constant survival stress?

Asking because THAT fucks up people and makes them use drugs to escape their situation.

Possibly, but I've also seen white color workers with steady jobs and nice houses have a psychotic breaks because of heavy meth use. So perhaps it not all survival stress and the drugs have some affect as well.

It is meth induced because the meth keeps the person awake. You sound like someone who has not experienced it first hand.

Could just call it "meth induced paranoia hangover". How often is it persistent to be considered psychosis though?

Because it seems to cause cortical thinning https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135731/ which is correlated with psychosis https://www.medscape.com/viewarticle/952628 and so has been associated as partly causal?

These studies are meaningless, as they cannot distinguish between the effects of the drug and the effects of the illegality of the drug: constant survival stress, negative outlook on self imposed by others, social exclusion, paranoia.

Survival stress, as in PTSD, causes cortical thinning, and explains everything in the scenario without the need to arbitrarily assign blame to methamphetamine.

Survival stress also impacts liver function leading to poor lipid metabolism which in turn can impact cholesterol absorption and lead to cortical thinning. Which is also an effect that we see from methamphetamine use in various animal models, which by it's nature of being controlled trail seems to exclude the stress factor. https://pubmed.ncbi.nlm.nih.gov/28689763/

I would agree with you in general, but there are situations where prescribed methamphetamines also lead to cortical thinning when not used as recreationally. This seems to suggest that stress may not be the entire player here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870784/

It was likely decided because of the dose of meth found in the persons systems that correlates with various findings on dose-dependence https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

If you would like to read more about PTSD findings as it relates to stress and liver function, I would be happy to expound upon the way that corticosteroids impact gut bacteria that directly affect FXR metabolism and bile acids and further lead to cortical thinning. https://academic.oup.com/cercor/article/30/2/575/5521088

Its really fascinating how a drug like methamphetamine impact neuroactive steroids that impact the same pathways tha stress does. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862925/ We've been able to reverse it in rats https://www.sciencedaily.com/releases/2013/10/131007093739.h...

I'm not a medical professional, maybe my terms are off but that's what I've seen it called in the media. In any case people are admitted with what appears to be schizophrenia only to end up perfectly lucid a bit later once the drugs have worn off.

The clinical diagnosis of psychosis can only be established if the symptoms REMAIN after the drugs have worn off.

I don’t know exactly how to respond to this. You’ve clearly got some strong opinions on this and maybe for good reasons.

I suppose I agree that environmental stress, survival stress, and PTSD are all common in the addict community. That’s true.

In my experience though, meth-induced psychosis is a thing. For example, if you understand the following sentence you either have seen or done it!

I once snapped/ghosted 3 points in one draw in order to scare off some gangsters, then the shadow people came.

After that I thought I could talk to programming libraries out loud. Not in a fun way. Meth induced psychosis is absolutely a thing.

We have differing definitions of ”meth-induced psychosis”. The clinical definition of psychosis excludes psychiatric symptoms of intoxication, so your experiences are simply psychiatric effects of meth overdose, not psychosis in the clinical sense.

Now, if those symptoms persist after you (would) pass a piss test, then we are talking about meth-induced psychosis.

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