Metamfetamin Kullanım Bozukluğu
Özet
Metamfetamin, merkezi sinir sistemi üzerinde güçlü ve uzun süreli uyarıcı etkileri olan, bağımlılık potansiyeli yüksek psikostimulan bir maddedir. Dopamin, norepinefrin ve serotonin gibi nörotransmitterleri artırarak beyindeki ödül mekanizmasını etkiler ve hızlı bilişsel-davranışsal değişikliklere yol açar. Akut kullanımda öfori ve uyanıklık sağlarken, kronik kullanım motor becerilerde bozulma, bilişsel gerileme, anksiyete, depresyon ve yüksek oranda psikotik tablolara (sanrılar ve halüsinasyonlar) neden olmaktadır. Tanılama süreçlerinde DSM-5 ve ICD-11 kriterleri kullanılırken, idrar toksikoloji testlerinde yanlış pozitiflik riski bulunduğundan klinik değerlendirme esastır. Maddenin bırakılması durumunda depresyon, yorgunluk ve yoğun aşerme gibi yoksunluk belirtileri gelişmektedir. Akut intoksikasyon ve ajitasyon yönetiminde ilk seçenek benzodiazepinler iken, metamfetamin kullanım bozukluğunun uzun vadeli tedavisi için henüz resmi olarak onaylanmış bir ilaç bulunmamaktadır. Bu nedenle farmakolojik araştırmaların yanı sıra bilişsel davranışçı terapi, pekiştireç odaklı terapi ve Matrix modeli gibi psikososyal yaklaşımlar tedavinin temelini oluşturmaktadır.
Methamphetamine is a psychostimulant substance with a high addictive potential that exerts potent and long-lasting stimulant effects on the central nervous system. It alters the brain reward mechanism by increasing neurotransmitters such as dopamine, norepinephrine, and serotonin, thereby inducing rapid cognitive and behavioral changes. While acute use produces euphoria and alertness, chronic use leads to impaired motor skills, cognitive decline, anxiety, depression, and a high incidence of psychotic states, including delusions and hallucinations. Diagnosis relies on DSM-5 and ICD-11 criteria, and clinical evaluation is essential due to the risk of false positives in urine toxicology tests. Cessation of the substance triggers withdrawal symptoms such as depression, fatigue, and intense craving. Although benzodiazepines are the first-line choice for managing acute intoxication and agitation, there is currently no formally approved medication for the long-term treatment of methamphetamine use disorder. Consequently, alongside ongoing pharmacological research, psychosocial approaches including cognitive behavioral therapy, contingency management, and the Matrix model form the cornerstone of effective treatment strategies.
Referanslar
de Matos EG, Hannemann T-V, Atzendorf J, Kraus L, Piontek D. The consumption of new psychoactive substances and methamphetamine: analysis of data from 6 German federal states. Deutsches Ärzteblatt International. 2018;115(4):49.
Bozkurt M EA, Evren C, Evren C BM. Update on methamphetamine: an old problem that we have recently encountered. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2018;31(1):1-10. .
Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Disease-a-month. 2012;58(2):38-89.
Drugs EMCf, Addiction D. European drug report 2021: trends and developments: Office for Official Publications of the European Communities; 2021.
Ochalek TA, Cumpston KL, Wills BK, Gal TS, Moeller FG. Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic. Jama. 2020;324(16):1673-4.
Merz F. United Nations Office on Drugs and Crime: World Drug Report 2017. 2017. SIRIUS-Zeitschrift für Strategische Analysen. 2018;2(1):85-6.
Gahlinger P. Illegal drugs: A complete guide to their history, chemistry, use, and abuse: Penguin; 2003.
Marin SJ, Doyle K, Chang A, Concheiro-Guisan M, Huestis MA, Johnson-Davis KL. One hundred false-positive amphetamine specimens characterized by liquid chromatography time-of-flight mass spectrometry. Journal of Analytical Toxicology. 2016;40(1):37-42.
Kraemer T, Maurer HH. Determination of amphetamine, methamphetamine and amphetamine-derived designer drugs or medicaments in blood and urine. Journal of Chromatography B: Biomedical Sciences and Applications. 1998;713(1):163-87.
Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009;104(7):1085-99.
Barr AM, Panenka WJ, MacEwan GW, Thornton AE, Lang DJ, Honer WG, et al. The need for speed: an update on methamphetamine addiction. Journal of Psychiatry and Neuroscience. 2006;31(5):301-13.
Yamamoto BK, Moszczynska A, Gudelsky GA. Amphetamine toxicities: classical and emerging mechanisms. Annals of the New York Academy of Sciences. 2010;1187(1):101-21.
Courtney KE, Ray LA. Methamphetamine: an update on epidemiology, pharmacology, clinical phenomenology, and treatment literature. Drug and alcohol dependence. 2014;143:11-21.
Edition F. Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc. 2013;21:591-643.
Saunders JB. Substance use and addictive disorders in DSM-5 and ICD 10 and the draft ICD 11. Current opinion in psychiatry. 2017;30(4):227-37.
Wood E, Stoltz Ja, Zhang R, Strathdee SA, Montaner JS, Kerr T. Circumstances of first crystal methamphetamine use and initiation of injection drug use among high‐risk youth. Drug and alcohol review. 2008;27(3):270-6.
Fowler JS, Volkow ND, Logan J, Alexoff D, Telang F, Wang G-J, et al. Fast uptake and long-lasting binding of methamphetamine in the human brain: comparison with cocaine. Neuroimage. 2008;43(4):756-63.
Cho AK, Melega WP. Patterns of methamphetamine abuse and their consequences. Journal of addictive diseases. 2001;21(1):21-34.
Pike E, Stoops WW, Rush CR. Acute buspirone dosing enhances abuse-related subjective effects of oral methamphetamine. Pharmacology Biochemistry and Behavior. 2016;150:87-93.
Moszczynska A, Callan SP. Molecular, behavioral, and physiological consequences of methamphetamine neurotoxicity: implications for treatment. Journal of pharmacology and experimental therapeutics. 2017;362(3):474-88.
Rusyniak DE. Neurologic manifestations of chronic methamphetamine abuse. Neurologic clinics. 2011;29(3):641-55.
Hart CL, Gunderson EW, Perez A, Kirkpatrick MG, Thurmond A, Comer SD, et al. Acute physiological and behavioral effects of intranasal methamphetamine in humans. Neuropsychopharmacology. 2008;33(8):1847-55.
Zweben JE, Cohen JB, Christian D, Galloway GP, Salinardi M, Parent D, et al. Psychiatric symptoms in methamphetamine users. American Journal on Addictions. 2004;13(2):181-90.
Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harvard review of psychiatry. 2005;13(3):141-54.
Mancino MJ, Gentry BW, Feldman Z, Mendelson J, Oliveto A. Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study. The American journal of drug and alcohol abuse. 2011;37(2):131-6.
Lecomte T, Dumais A, Dugre JR, Potvin S. The prevalence of substance-induced psychotic disorder in methamphetamine misusers: a meta-analysis. Psychiatry research. 2018;268:189-92.
Grant KM, LeVan TD, Wells SM, Li M, Stoltenberg SF, Gendelman HE, et al. Methamphetamine-associated psychosis. Journal of Neuroimmune Pharmacology. 2012;7(1):113-39.
Dean AC, Groman SM, Morales AM, London ED. An evaluation of the evidence that methamphetamine abuse causes cognitive decline in humans. Neuropsychopharmacology. 2013;38(2):259-74.
Ujike H, Sato M. Clinical features of sensitization to methamphetamine observed in patients with methamphetamine dependence and psychosis. Annals of the New York Academy of Sciences. 2004;1025(1):279-87.
Scott JC, Woods SP, Matt GE, Meyer RA, Heaton RK, Atkinson JH, et al. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychology review. 2007;17(3):275-97.
Shin E-J, Dang D-K, Tran H-Q, Jeong JH, Nah S-Y, Jang C-G, et al. Current understanding of methamphetamine-associated dopaminergic neurodegeneration and psychotoxic behaviors. Archives of pharmacal research. 2017;40(4):403-28.
Gouzoulis-Mayfrank E, Härtel-Petri R, Hamdorf W, Havemann-Reinecke U, Mühlig S, Wodarz N. Methamphetamine-related disorders. Deutsches Ärzteblatt International. 2017;114(26):455.
Härtel-Petri R, Krampe-Scheidler A, Braunwarth W-D, Havemann-Reinecke U, Jeschke P, Looser W, et al. Evidence-based guidelines for the pharmacologic management of methamphetamine dependence, relapse prevention, chronic methamphetamine-related, and comorbid psychiatric disorders in post-acute settings. Pharmacopsychiatry. 2017;50(03):96-104.
Ballester J, Valentine G, Sofuoglu M. Pharmacological treatments for methamphetamine addiction: current status and future directions. Expert review of clinical pharmacology. 2017;10(3):305-14.
