Stimulant and methamphetamine use — acute MAP to definitive care (MEQ)

(i) MAP definition and discriminators. Methamphetamine-associated psychosis is a syndrome of delusions and/or hallucinations temporally linked to methamphetamine use, often with clear consciousness. Dose-related association with heavier use periods is established. Primary psychotic disorder is favoured when symptoms persist substantially after verified abstinence, premorbid decline or strong family history emerges, or longitudinal course diverges from use intensity. Day-one labelling of lifelong schizophrenia after a single binge is premature; equally, substance induction does not mean no treatment.^[2]

(ii) Immediate priorities. Medical: observations, ECG already done — continue cardiac and metabolic monitoring; manage hypertension/tachycardia per emergency protocols; trend CK; exclude evolving ACS, hyperthermia, stroke. Behavioural: low-stimulus environment, de-escalation, oral medication first if needed, IM only if required under local rapid-tranquillisation guidance; avoid unnecessary restraint. Dangerous psychosis: time-limited antipsychotic after medical screen; violence/suicide risk documentation; legal status under local statute principles.^[1]

(iii) Withdrawal course and crash risk. After binge cessation: early crash with fatigue/hypersomnia; peak dysphoria, anhedonia, irritability and craving around day 2; improvement over about 1–2 weeks with residual sleep/mood symptoms possible. Not typically seizure-dominant like alcohol, but suicide risk in the crash requires active safety planning.^[3]

(iv) Definitive package. Psychosocial first-line per specialty guidance: contingency management (strongest signal), CBT/CRA, Matrix-style multi-element care, harm reduction, housing, sexual health. No methadone-equivalent licensed standard. Limited pharmacotherapy examples if specialist-context: mirtazapine 30 mg nocte (trial regimens) or naltrexone XR 380 mg IM every 3 weeks + bupropion XL 450 mg daily (ADAPT-2) with exclusions/monitoring — never presented as universal mandatory cure.^[1][4][5]

(v) Dual diagnosis and disposition. Treat psychosis and stimulant use concurrently; do not withhold care for perfect abstinence. Disposition by risk: observation/inpatient if high violence or suicide risk; else shared community mental health + AOD follow-up with early review as crash evolves.^[1]