Does Manganese Contribute to Methamphetamine-Induced Psychosis?
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ACUTE CARE PHARMACOLOGY AND TOXICOLOGY (A KING, SECTION EDITOR)
Does Manganese Contribute to Methamphetamine-Induced Psychosis? Irina N. Richards 1 & John R. Richards 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review describes the increasing global problem of methamphetamine (MA) use and development of psychosis, the molecular and structural basis for this form of psychosis, and its treatment. The putative contribution of manganese (Mn), a common element found widely in nature and industry, to the development of MA-induced psychosis is discussed in relation to its shared toxicity with MA. Recent Findings Both MA and Mn cause damage to brain monoaminergic, glutaminergic, and GABAergic systems and to the blood brain barrier, leading to higher exposure to Mn. Iron (Fe) deficiency can also lead to Mn overexposure. Polymorphisms for genes encoding metabolic enzymes and transport proteins increase risk of toxicity and development of psychosis. Impaired hepatic Mn excretion from viral hepatitis also risks Mn toxicity. Summary It is possible that potential synergistic and/or additive effects of Mn in concert with MA may worsen, prolong, or shorten onset of psychosis. Keywords Methamphetamine . Amphetamine . Manganese . Psychosis . Schizophrenia
Introduction Patients who use amphetamine and its derivatives, such as methamphetamine (MA), frequently present to emergency departments, primary care clinics, and mental health treatment centers for acute care of a wide spectrum of medical and psychiatric illnesses and injuries from blunt and penetrating trauma [1]. Based on the 2019 United Nations World Drug Report, 29 million people, or an estimated 0.6% of the global population aged 15–64, had used amphetamines in the past year, with the highest prevalence in North America and Australasia [2]. The most recent 2018 United States National Survey on Drug Use and Health revealed approximately 1.9 This article is part of the Topical collection on Acute Care Pharmacology and Toxicology * John R. Richards [email protected] 1
Department of Hospital Based Medicine, Kaiser Permanente Medical Center, Vacaville, CA, USA
2
Department of Emergency Medicine, University of California Davis Medical Center, PSSB 2100, 4150 V Street, Sacramento, CA 95817, USA
million people age 12 or older used amphetamines in the past year, with overall use remaining steady since 2015 [3]. Overdose deaths attributed to stimulants in general increased by 33% from 2015 to 2016, with 10,333 overdose deaths in 2017 [4]. This increasing trend is also reflected in urine drug screening between 2013 and 2019, in that samples testing positive for MA increased 6-fold from 1.4% in 2013 to 8.4% in 2019 [5]. In addition to neglect of hygiene and nutrition, patients who use MA may exhibit agitation, violence, paranoia, and acute psychosis that is virtually indistinguishable from that caused by schizophrenia [6]. Chronic MA use may lead to a permanent neurological disorder resembling Parkinson’s disease [7
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