Cortical Morphological Changes in Methamphetamine-Induced Psychosis

Overview

This study investigated cortical structural abnormalities in methamphetamine users with and without psychosis, revealing distinct patterns of cortical thinning associated with psychosis. The findings highlight specific brain regions linked to psychotic symptoms and craving intensity in methamphetamine use disorder.

Background

Methamphetamine (METH) use is a major global health concern, with high prevalence and severe psychiatric consequences including methamphetamine-induced psychosis (MAP). MAP affects nearly half of individuals with METH use disorder (MUD) and is characterized by transient psychotic symptoms. Neuroimaging studies have shown structural and functional brain abnormalities in METH users, particularly in frontal and limbic regions, but detailed cortical patterns related to psychosis and craving remain unclear. Understanding these neurobiological substrates is critical for improving addiction treatment strategies.

Data Highlights

The study enrolled male Han Chinese participants aged 18-55, divided into three groups: MAP (METH use disorder with psychosis), MA (METH use disorder without psychosis), and healthy controls (HCs). Clinical assessments included SCID-5 diagnosis, nicotine dependence (FTND), and craving intensity (VAS). MRI scans were performed to analyze cortical morphology using surface-based morphometry. Psychosis diagnosis required hallucinations/delusions temporally linked to METH use. Exclusion criteria ensured no confounding psychiatric or medical conditions.

Key Findings

• Individuals with MAP exhibited significant cortical thinning in the right lateral orbitofrontal cortex compared to both MA and HC groups.
• MAP patients showed decreased volume in the left pars triangularis gyrus and increased volumes in subcortical limbic regions such as the pallidum, hippocampus, and amygdala.
• Distinct cortical patterns differentiated MAP from MA, suggesting specific neuroanatomical substrates underlying psychosis in METH users.
• Craving intensity correlated with alterations in cortical thickness and connectivity, particularly involving the salience and default mode networks.
• Findings support the involvement of frontal and limbic brain regions in the pathophysiology of MAP and its clinical manifestations.

Clinical Implications

Recognition of specific cortical and subcortical alterations in MAP can aid in early identification and targeted interventions for individuals at risk of psychosis during METH use. Assessment of craving and its neural correlates may inform personalized treatment approaches to reduce relapse. These neuroimaging biomarkers could potentially guide the development of novel therapeutic strategies addressing both psychotic symptoms and addiction severity.

Conclusion

The study delineates distinct cortical morphological changes associated with methamphetamine-induced psychosis, emphasizing the role of frontal and limbic brain regions. These insights enhance understanding of MAP neurobiology and may facilitate improved clinical management of METH use disorder.

References

1. UN Office on Drugs and Crime 2018 -- World Drug Report
2. Wang et al. -- Cortical Thickness and Subcortical Volume Changes in METH Users
3. Luo et al. -- Functional Connectivity Alterations in METH Use Disorder
4. ENIGMA Addiction Working Group -- Subregional Volumetric Alterations in Substance Use Disorders
5. DSM-5 -- Diagnostic Criteria for Substance/Medication-Induced Psychotic Disorder