Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
8.6 Major clinical issues with personality disorders and stimulant (including methamphetamine) use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence- 2. Management of people with comorbidity of mental disorders and substance use
- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
8. Personality disorders and substance use- 8.1 Personality disorders
- 8.2 Comorbidity with personality disorders
- 8.3 Major clinical issues with personality disorders and cannabis/ hallucinogen use
- 8.4 Major clinical issues with personality disorders and alcohol use
- 8.5 Major clinical issues with personality disorders and opioid use
- 8.6 Major clinical issues with personality disorders and stimulant (including methamphetamine) use
- 8.7 Major clinical issues with personality disorders and benzodiazepine use
- 8.8 Major clinical issues with personality disorders and inhalant/ solvent use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- Personality disorders are frequently observed in stimulant users.
- Use of stimulants may exacerbate impulsivity, mood disturbance and anger in people with Cluster B type personality disorders.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMA.
- CBT can be used to address stimulant use and is effective.
- Assistance with coping skills may assist with impulsive use of stimulants.
8.6.1 Effects of stimulants on personality disorder
- Personality disorders are frequently observed in stimulant users, in particular cocaine and ecstasy users(41, 337).
- Use of stimulants may exacerbate impulsivity, mood disturbance and anger in people with Cluster B type personality disorders(338, 339).
8.6.2 Interactions between stimulants and therapeutic agents for personality disorders
- Stimulant drugs are likely to exacerbate the effects of SSRI and SNRI antidepressants (and vice versa) and may result in serotonin syndrome (Appendix 1)x(127, 179, 180). Patients should be warned of signs of serotonin syndrome and be monitored.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMAxxx(181, 182).
- Fluoxetine, paroxetine and norfluoxetine can inhibit the metabolism of MDMA through inhibition of the CYPs involved in its metabolism and may therefore cause toxicityx
8.6.3 Management approaches to comorbid personality disorders and stimulant use
- The adverse behavioural, psychological and physical effects of stimulants should be discussed with the patient.
- CBT is effective at reducing stimulant use***(49, 183). In particular, assistance with coping skills may assist with impulsive use of stimulants.
