MAP causing distress and functional disturbance needs to be addressed by medical services to minimise harm to the person experiencing MAP and others. Someone experiencing MAP may feel very unsafe and believe that they are in danger.

As such, it is important to keep calm and avoid intimidating confrontation. Persons with methamphetamine are in a highly aroused state. When coupled with they can feel easily threatened. This can be associated with an increased risk of aggressive behaviour. Depending on the level of psychosis someone is experiencing, they may or may not know that they need help. Seeking clinical support (e.g. mental health crisis team) can help manage the situation. In the meantime, maintaining good body language and communication are important (see Language).

MAP symptoms are often mild and transient, and not every symptom will always be present or observable. If an individual is experiencing distress, opening the discussion around what they are going through can be useful for both the individual and the health worker. Ask the individual if they are comfortable talking about or explaining what they are feeling.

When communicating with someone experiencing MAP, consider:

• That they may not be aware of what is happening to them
• Start with finding common ground – build up to more specific questions
• Let them guide the pace and style of interaction (when reasonable)
• Avoid the term ‘psychosis’ and instead ask about changes in their thoughts, feelings or behaviour. How long have these changes been present? Are they finding them distressing?
• Acknowledge that this experience would be stressful, and that seeking help takes a lot of courage

^{*Adapted from Mental Health First Aid, 2022}

If an individual is experiencing active psychosis, symptoms such as disorganised thought or speech patterns may mean that observation is more helpful in identifying symptoms. For example:

• Are they having conversations with someone who isn’t in the room?
• Are they responding abnormally to things in the environment?

As it can be difficult to formally identify MAP, and to differentiate between MAP and other psychotic symptoms, it might be helpful to use a psychosis screening tool. The National Drug and Alcohol Research Centre (NDARC) have developed a Psychosis Screener which may be useful for health workers in confirming symptoms of psychosis in an individual. Information about interpreting the test is available on the NDARC website. Turning Point have also developed a detailed Methamphetamine Treatment Guideline to assist health professionals in managing methamphetamine use disorder and associated clinical presentations (such as methamphetamine-associated psychosis).

Guidelines for managing acute episodes of psychotic symptoms typically include the use of sedatives or antipsychotic medications. These have been shown to help minimise acute symptoms of psychosis, while still allowing for monitoring and further assessment. Turning Point have also developed a detailed Methamphetamine Treatment Guideline (2018) to assist health professionals in managing methamphetamine use disorder and associated clinical presentations (such as methamphetamine-associated psychosis). The guideline also provides comprehensive information on the pharmacological and behavioural management of acute psychosis.

Treatment should involve a focus on managing the underlying methamphetamine use. Any reduction in methamphetamine use will be a reduction in risk for experiencing further psychotic episodes. Behavioural treatment for methamphetamine dependence is arguably the most optimal approach for reducing psychosis in persons who use methamphetamine.

Other considerations should be around language and environment:

Language

The words and tone you use are important in managing an episode of methamphetamine-induced psychosis. Remember that this event is likely frightening for the person experiencing it, so being direct but reassuring can alleviate the stress of the situation.

• Use clear, non-judgemental, and supportive language
• Avoid overly clinical terminology, and offer explanations on what is happening
• A confident and calm tone can ensure that they feel more secure and at ease
• Listen attentively and engage with the individual, treating them with kindness and respect
• Neutral body language such as keeping your hands visible, and arms by your sides can also signal that you are not a threat
• Avoid arguing or agreeing with any unusual beliefs - stay neutral and offer assistance

Environment

Adapting the setting in which you provide treatment can minimise any risks of escalation and allow the best-possible outcomes for someone experiencing MAP and others. Considerations include:

• A space that is private, quiet, safe, and free from distractions
• Staying in well-lit areas, as this may help reduce visual disturbances
• Provide the individual with as much personal space as possible
• Avoid sudden movements
• Consider the available exits and access to support in the space. If there is only one exit, position yourself closest to it
• Have an exit plan in mind in case the situation escalates and you need to leave for safety reasons
• Remove any items that could be a danger to the individual or others

As MAP is highly related to current and ongoing methamphetamine usage, assisting in the reduction or cessation of methamphetamine use is key to reducing chances of For most people, once they stop using methamphetamine, any psychosis related symptoms stop. However, for a small number of people psychotic symptoms will continue and some will go on to develop a disorder.  There are several reasons why some people may develop psychotic disorders including those previously admitted to hospital for substance-induced psychotic disorder. This research suggests follow-up periods of 2 years to monitor any changes or recurrence in psychotic symptoms. For individuals who have a familial risk for psychosis, there is an increased risk of progression to schizophrenia following an episode of substance-induced psychosis. Health workers can also provide early intervention for individuals whose psychotic symptoms persist even in periods of abstinence, especially if a family history for schizophrenia or other primary psychotic disorder is present. 

Regardless of risk level, addressing the underlying methamphetamine use (i.e. through referrals to treatment or harm reduction programs) will be the most important component for health workers to address. Any reduction in methamphetamine use will reduce further risk of psychotic episodes.

Health workers can use this opportunity to inform the patient of ongoing risks and support them in biopsychosocial treatment for methamphetamine use and dependence.  

Health workers can assist with educating the individual in:

• Recognising the warning signs of symptoms (such as feeling more anxious or paranoid than usual or seeing/hearing strange things).
• Treatment or rehabilitation support – providing advice about structured programs, or cessation advice
• Psychosocial support such as peer support groups or counselling
• Management of co-occurring disorders such as and as these may increase chance of relapse to methamphetamine use
• Monitoring and managing physical health issues related to methamphetamine use
• Minimising social stressors (such as housing, finances, legal problems, or social support) and accessing services that may be able to assist in these areas

The Comorbidity Guidelines has a useful guide for AOD and health workers on coordinating care for individuals

Alderson, H. L., Semple, D. M., Blayney, C., Queirazza, F., Chekuri, V., & Lawrie, S. M. (2017). Risk of transition to schizophrenia following first admission with substance-induced psychotic disorder: a population-based longitudinal cohort study. Psychological Medicine, 47(14), 2548–2555. doi:10.1017/S0033291717001118 

Arunogiri, S., Foulds, J., McKetin, R., & Lubman, D. I. (2018a). A systematic review of risk factors for methamphetamine-associated psychosis. Australian and New Zealand Journal of Psychiatry, 52(6), 514–529. https://doi.org/10.1177/0004867417748750

Arunogiri, S., McKetin, R., Verdejo-Garcia, A., & Lubman, D. I. (2020). The Methamphetamine-Associated Psychosis Spectrum: a Clinically Focused Review. International journal of mental health and addiction, 18(1), 54-65. https://doi.org/10.1007/s11469-018-9934-4

Boden, J. M., Foulds, J. A., Newton-Howes, G., & McKetin, R. (2023). Methamphetamine use and psychotic symptoms: findings from a New Zealand longitudinal birth cohort. Psychological Medicine, 53(3), 987-994. https://doi.org/10.1017/s0033291721002415

Chrzanowska, A., Man, N., Akhurst, J., Sutherland, R., Degenhardt, L., & Peacock. (2022). Trends in drug-related hospitalisations in Australia, 1999-2021. NDARC. https://doi.org/10.26190/wrsv-3b78

Degenhardt, L., Hall, W., Korten, A. and Jablensky, A. (2005) Use of brief screening instrument for psychosis: Results of a ROC analysis, Sydney: National Drug and Alcohol Research Centre.

Glasner-Edwards, S., & Mooney, L. J. (2014). Methamphetamine Psychosis: Epidemiology and Management. CNS Drugs, 28(12), 1115-1126. https://doi.org/10.1007/s40263-014-0209-8

Humphreys, M., Martin, C., Theodoros, T., Andronis, D., & Isoardi, K. (2024). Psychosis in acute methamphetamine intoxication is usually self-limiting and can be managed in the emergency department: A retrospective series. Emergency medicine Australasia, 36(1), 24-30. https://doi.org/10.1111/1742-6723.14287

McKetin, R., Kaye, S. S., Clemens, K. J., & Hermens, D. (2013a). Chapter 70 - Methamphetamine Addiction. In Principles of Addiction (pp. 689–698). Elsevier Inc. https://doi.org/10.1016/B978-0-12-398336-7.00070-X

McKetin, R., Lubman, D. I., Baker, A. L., Dawe, S., & Ali, R. L. (2013b). Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study. JAMA psychiatry, 70(3), 319–324. https://doi.org/10.1001/jamapsychiatry.2013.283

McKetin, R., Lubman, D. I., Najman, J. M., Dawe, S., Butterworth, P., & Baker, A. L. (2014). Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study. Addiction (Abingdon, England), 109(5), 798-806. https://doi.org/10.1111/add.12474

 McKetin, R., Baker, A. L., Dawe, S., Voce, A., & Lubman, D. I. (2017). Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders. Psychiatry Research, 251, 349–354. https://doi.org/10.1016/j.psychres.2017.02.028

McKetin, R., Leung, J., Stockings, E., Huo, Y., Foulds, J., Lappin, J. M., Cumming, C., Arunogiri, S., Young, J. T., Sara, G., Farrell, M., & Degenhardt, L. (2019). Mental health outcomes associated with the use of amphetamines: A systematic review and meta-analysis. EClinicalMedicine, 16, 81-97. https://doi.org/10.1016/j.eclinm.2019.09.014

Medhus, S., Mordal, J., Holm, B., Mørland, J., & Bramness, J. G. (2013). A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards. Psychiatry research, 206(1), 17–21. https://doi.org/10.1016/j.psychres.2012.09.023

Mental Health First Aid. (2022). Psychosis: Mental Health First Aid Guidelines. In Mental Health First Aid International (Ed.), (2.3 ed.).

Rusyniak, D. E. (2011). Neurologic manifestations of chronic methamphetamine abuse. Neurol Clin, 29(3), 641-655. https://doi.org/10.1016/j.ncl.2011.05.004

Voce, A., Calabria, B., Burns, R., Castle, D., & McKetin, R. (2019). A Systematic Review of the Symptom Profile and Course of Methamphetamine-Associated Psychosis. Substance Use & Misuse, 54(4), 549-559. https://doi.org/10.1080/10826084.2018.1521430

Wearne, T. A., & Cornish, J. L. (2018). A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology. Frontiers in Psychiatry, 9.  https://doi.org/10.3389/fpsyt.2018.00491

Quednow, B. B., Geyer, M. A., & Halberstadt, A. L. (2020). Chapter 39 - Serotonin and schizophrenia. In C. P. Müller & K. A. Cunningham (Eds.), Handbook of Behavioral Neuroscience (Vol. 31, pp. 711-743). Elsevier. https://doi.org/https://doi.org/10.1016/B978-0-444-64125-0.00039-6