Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2014 Aug 4.
Published in final edited form as: Am J Addict. 2008 Mar-Apr;17(2):83–98. doi: 10.1080/10550490701861201

Presence and Persistence of Psychotic Symptoms in Cocaine- versus Methamphetamine-Dependent Participants

James J Mahoney III 1, Ari D Kalechstein 1, Richard De La Garza II 1, Thomas F Newton 1
PMCID: PMC4119877  NIHMSID: NIHMS372990  PMID: 18393050

Abstract

The primary objective of this study was to compare and contrast psychotic symptoms reported by cocaine and methamphetamine-dependent individuals. Participants included 27 cocaine-dependent and 25 methamphetamine-dependent males, as well as 15 cocaine-dependent and 18 methamphetamine-dependent females. After screening, participants were excluded if they met criteria for any Axis I diagnosis other than nicotine dependence, or methamphetamine or cocaine dependence (ie, participants had to use either methamphetamine or cocaine but were excluded if they met dependence criteria for both). The participants were administered the newly developed Psychotic Symptom Assessment Scale (PSAS), which assesses psychotic symptoms. A high proportion of both cocaine- and methamphetamine-dependent men and women reported delusions of paranoia and auditory hallucinations. However, during the abstinent and intoxicated conditions, methamphetamine-dependent men and women were more likely than cocaine-dependent men and women to report psychotic symptoms. Future studies will compare psychotic symptoms reported by non-dependent recreational stimulant users to stimulant-dependent individuals.

INTRODUCTION

Drug-induced psychosis has been described as indistinguishable from schizophrenia.1 The prevalence of psychosis following the use of stimulants, such as cocaine and methamphetamine, is substantial. For example, Satel and colleagues reported that 68% of study participants experienced highly distressing, albeit transient, paranoia following cocaine use.2 Moreover, recent reports claim that the prevalence of psychotic symptoms among methamphetamine users was 11 times higher than the general population.3 Similar findings have been reported in other studies of cocaine-4 and methamphetamine-dependent individuals.5

While cocaine and methamphetamine use are both risk factors for psychosis, to our knowledge, there have been no investigations comparing the degree of similarity between the psychotic syndromes associated with the use of these drugs. Because both drugs are stimulants, it is reasonable to speculate that the psychotic symptoms induced by cocaine and methamphetamine may be similar. However, given that the drugs have different half–lives (90 min for cocaine vs. 11 hours for methamphetamine), mechanisms of action (monoamine transport inhibition versus release), and long-term effects on brain dopamine systems (with methamphetamine abuse more often associated with neurotoxicity), it may be that the drugs produce differential profiles of psychotic symptoms.6–8

In order to investigate this possibility, we examined the prevalence of psychotic symptoms in cocaine- and methamphetamine-dependent individuals. In addition, we investigated factors that potentially moderate the onset of these symptoms, including route of administration and drug use history. We also compared psychotic symptoms occurring during abstinence to those occurring during stimulant intoxication.

METHODS

Participants

Participants included 42 non-treatment-seeking, cocaine-dependent individuals (27 males, 15 females) and 43 non-treatment-seeking, methamphetamine-dependent individuals (25 males, 18 females). Subjects were recruited from the community via radio and newspaper advertisements. All participants met DSM-IV criteria for cocaine- or methamphetamine-dependence, though no participant met criteria for both current methamphetamine and cocaine abuse or dependence. In addition, all subjects reported either methamphetamine or cocaine as their primary drug of use. The Institutional Review Board of the University of California Los Angeles approved the study and informed consent document. After the risks of the study had been fully explained, all subjects provided informed consent, and were then paid $25 for participation upon completion of the study.

Procedure and Measures

Participants completed an initial battery of questionnaires, including demographic, locator, and recruitment surveys. At the time of assessment, a comprehensive toxicology screen was performed to assess recent substance use. Subjects were administered a variety of assessments, including the SCID (Structured Clinical Interview for DSM-IV-TR diagnoses)9 or MINI (condensed version of the SCID),10 Addiction Severity Index-Lite,11 Beck Depression Inventory II,12 Substance Use Inventory, and Timeline Follow-back. The main instrument used was the Psychotic Symptom Assessment Scale (PSAS; see Appendix), which was developed at UCLA by Drs. Newton and Kalechstein and consists of 32 questions yielding a detailed assessment of psychotic symptoms based on the DSM-IV criteria for psychosis. The PSAS addresses psychotic symptoms such as delusions, hallucinations, and disorganized thoughts (such as ideas of reference, thought broadcasting, and thought insertion), as well as secondary symptoms such as agitation and attention. These secondary symptoms do not necessarily indicate psychotic behavior, but would contribute to psychiatric morbidity produced by psychotic symptoms. The PSAS also assesses the degree to which study participants attributed psychotic symptoms to drug use at the time the symptom occurred as well as whether they attributed the symptoms to drug use in retrospect (at the time of assessment).

Reliability analyses were conducted to evaluate the internal consistency of each of the subscales. Adequate internal consistency was demonstrated for the subscale querying whether subjects had ever experienced particular psychotic symptoms (alpha = .87), the subscale assessing psychotic symptoms while not intoxicated (alpha =.83), and the subscale assessing while intoxicated (alpha = .86).

The quantity of cocaine or methamphetamine used was assessed by presenting the participants with test tubes containing various amounts of white powder or crystalline substances (0.1–2.0 g), from which they selected an option that best approximated their daily use amount. The subject’s demographics for each group are detailed in Table 1.

TABLE 1.

Demographics

All values represent
percentage or Mean ± SD		 Males Females
Coc (n = 27) MA (n = 25) F(1,50) p Coc (n = 15) MA (n = 18) F(1,31) p
Age (years) 41.9 ± 6.7 38.6 ± 9.0 2.36 .131 36.3 ± 9.2 37.9 ± 8.9 .27 .610
Ethnicity (%) 1.96 .168 .72 .403
   White 11.1 52 20.0 55.6
   African American 63 24 53.3 11.1
   Hispanic 22.2 12 13.3 22.2
   Other 3.7 12 13.3 11.2
Years of use 14.5 ± 8.7 8.1 ± 7.1 8.35 .006* 15.9 ± 10.0 12.3 ± 10.0 1.04 .315
Route of administration (%) 2.42 .126 1.40 .246
   Nasal 29.6 8 20.0 22.2
   Smoking 66.7 52 80.00 66.7
   IV 0 28 0 0
   Other 3.7 12 0 11.1
Education (years) 13.4 ± 2.4 14.2 ± 2.4 1.36 .249 11.9 ± 2.4 13.2 ± 2.2 2.74 .108
Average amount used per day (g) 0.7 ± 0.5 0.4 ± 0.4 6.40 .015* 1.1 ± 1.0 0.9 ± 1.2 .37 .547
Average amount spent per day ($) 48.9 ± 79.8 21.0 ± 17.7 2.81 .100 55.5 ± 76.8 28.6 ± 22.7 1.80 .190
Open in a new tab

Data Analysis

Student t-tests were used to identify group differences across demographic and drug use profile. One-way analyses of variance (ANOVAs) were used to determine if there were any differences with regard to demographic data. Chi-square analyses were used to determine whether cocaine- and methamphetamine-dependent participants differed with respect to the likelihood that they would experience a particular symptom during different mental states (intoxicated versus sober). Chi-square analyses also were used to determine whether the prevalence of psychotic symptoms differed across ethnic groups or route of administration. Correlations were used to determine the level of association between drug use profile and cumulative onset of psychotic symptoms.

RESULTS

Table 1 provides demographic and drug use information for all participants. Cocaine- and methamphetamine-dependent males were similar with regard to age, ethnicity, route of administration, education, and the amount of money spent each week on the primary drug of abuse. Among males, the groups differed with respect to years of use (p = 0.006, cocaine users had been using for significantly longer) and average amount of stimulant used per week (p = 0.015, cocaine users reported using significantly more grams per week). There were no demographic or pattern of use differences among female cocaine and methamphetamine users.

In general, the frequency of psychotic symptoms reported by cocaine and methamphetamine male users was high (see Table 2). For example, a substantial percentage of both male cocaine and male methamphetamine users reported ever experiencing paranoid delusions, including “people are talking about you” (59% vs. 64%, respectively) and “people are watching you" (48% vs. 44%). Furthermore, a notable number of cocaine and methamphetamine male users experienced perceptual disturbances, such as “imagining someone calling your name" (48% vs. 40%). In addition, stimulant users were prone to “lose their train of thought easily" (44% vs. 48%) and “have difficulty completing tasks” (41% vs. 60%). Nonetheless, differences between cocaine- and methamphetamine-dependent males were observed. While sober, in the non-drug using (abstinent) state, methamphetamine-dependent men were more likely than cocaine-dependent men to report “seen or felt things that others could not" (32% vs. 4%, p < 0.01). In addition, methamphetamine-dependent men were more likely than cocaine-dependent men to report, “someone or something has external control over their actions" (16% vs. 0%, p < 0.05). Group differences were not observed for any other psychotic symptoms while sober.

TABLE 2.

Most frequent symptoms of male and female cocaine and methamphetamine users (in either the abstinent or intoxicated states)

Coc (%) MA (%)
Male (n = 27) n = 25)
     Has it ever seemed like people were talking about you or paying extra attention to you? 59 64
     Have you ever felt like people are watching you, spying on you, or checking up on you? 48 44
     Have you ever felt like someone was calling your name, but no one was really calling you? 48 40
     Have you ever felt like you lose your train of thought easily, will go off onto different tangents while speaking, or that people don’t understand you? 44 48
     Do you ever feel like you have a difficult time completing tasks or activities? 41 60
Female (n = 15) (n = 18)
     Has it ever seemed like people were talking about you or paying extra attention to you? 67 67
     Have you ever felt like people are watching you, spying on you, or checking up on you? 47 56
     Have you ever felt like people go out of their way to give you a hard time, are out to get you, or want to hurt you? 47 50
     Have you ever felt like something was wrong with the way a part of your body looked? 40 72
     Have you ever felt like your significant other was having an affair when it was not true? 40 50
     Have you ever felt like someone was calling your name, but no one was really calling you? 60 47
     Have you ever had a difficult time moving your body? 47 47
     Have you ever felt like you get easily agitated or annoyed and cannot control yourself? 47 61
     Have you ever felt like you lose your train of thought easily, will go off onto different tangents while speaking, or that people don’t understand you? 60 67
     Do you ever feel like you have a difficult time completing tasks or activities? 60 67
Open in a new tab

While “high," in the drug using state, methamphetamine-dependent men were more likely than cocaine-dependent men to report, “feeling as if an organization is conspiring against you" (16% vs. 0%, p < 0.05), “you have a special role in society" (24% vs. 4%, p < 0.05), “seen or felt things that others could not" (52% vs. 11%, p < 0.001), and “smelled things others could not” (20% vs. 0%, p < 0.02), and approached significance when asked to report “felt someone was touching you" (14% vs. 0%, p = 0.064; see Table 3). Group differences were not observed for any other psychotic symptoms while high.

TABLE 3.

Onset of selected psychotic symptoms while abstinent from or high on stimulants

Coc (%) MA (%) x2 p
Onset of selected psychotic symptoms while abstinent from stimulants (n = 27) (n = 25)
Males
    Have you ever felt like someone or something outside of yourself was controlling your thoughts or actions? 0 16 4.7 .031
    Have you ever seen or felt things that others could not? 4 32 7.3 .007
Females (n = 15) (n = 18)
    Have you ever felt like you have special powers? 0 28 4.9 .027
    Have you ever felt like something was wrong with the way a part of your body looked? 33 72 5.0 .025
    Have you ever felt like someone is touching you but no one was there? 20 0 4.0 .047
    Have you ever been aware of dressing inappropriately or unusually? Here, inappropriate or unusual means dressing as you would not usually. 0 22 3.8 .051
Onset of selected psychotic symptoms while high on stimulants (n = 27) (n = 25)
Males
    Have you ever felt like an organization has gone out of their way to give you a hard time, are out to get you, or want to hurt you? 0 16 4.7 .031
    Have you ever felt like you hold a powerful role in society or that you should hold a powerful role in society? 4 24 4.6 .032
    Have you ever seen or felt things that others could not? 11 52 10.2 .001
    Have you ever smelled things that others could not? 0 20 6.0 .015
    Have you ever felt like someone is touching you but no one was there? 0 14 3.4 .064
Females (n = 15) (n = 18)
    Have you ever felt strange sensations, such as insects crawling on your body or skin? 27 61 3.9 .048
Open in a new tab

Because there were significant differences in stimulant use detected between the cocaine and methamphetamine groups (ie, years of use and average amount used per week in grams), stimulant use history and the total number of psychotic symptoms (maximum of 32) reported by methamphetamine and cocaine dependent participants were correlated (see Table 4). There were no significant correlations found between any of the groups. Cocaine-dependent males and females averaged 7.6 ± 5.0 and 9.1 ± 5.5 total psychotic symptoms, respectively, and methamphetamine-dependent males and females average 9.7 ± 7.2 and 12.5 ± 5.6 total psychotic symptoms, respectively. In addition, there were no significant differences between total symptoms reported by methamphetamine- and cocaine-dependent males, or between total symptoms reported by methamphetamine- and cocaine-dependent females.

TABLE 4.

Total Psychotic Symptoms reported and Variables of Interest (including drug use patterns and BDI scores)

Total psychotic
symptoms
reported versus		 Males Females
Coc (p) MA(p) Coc(p) MA(p)
BDI-II scores .218 .078 .120 .618
Years of stimulant use .325 .764 .904 .309
Days used in last 30 .763 .605 .697 .200
Amount used per week (g) .301 .570 .173 .767
Open in a new tab

In comparison with males, the frequency of psychotic symptoms reported by cocaine and methamphetamine female users was high (see Table 2). For example, a substantial percentage of both cocaine and methamphetamine females reported paranoid delusions during either the high or abstinent conditions, including “people are talking about you" (67% vs. 67%), “people are watching you" (47% vs. 56%, respectively), and “people go out of their way to hurt you" (47% vs. 50%, respectively). Also, both groups endorsed paranoid delusions of “something is wrong with the way your body looks” (40% vs. 72%, respectively) and “feeling as if your significant other was having an affair” (40% vs. 50%, respectively). In addition, both groups experience auditory hallucinations such as “imagine someone calling your name” (60% vs. 47%, respectively). In addition, stimulant users were prone to “feeling easily agitated" (47% vs. 61%, respectively), “have a difficult time moving your body" (47% vs. 47%), “lose train of thought easily" (60% vs. 67%, respectively) and “have difficulty completing tasks” (60% vs. 67%, respectively).

Important differences between cocaine- and methamphetamine-dependent females were observed. While sober, in the non-drug using (abstinent) state, methamphetamine-dependent women were more likely than cocaine-dependent women to report, “having special powers" (28% vs. 0%, respectively, p < 0.05), “something is wrong with the way your body looks” (72% vs. 33%, respectively, p < 0.05), and “dressing inappropriately” (22% vs. 0%, respectively, p = 0.05).Cocaine-dependent women were more likely than methamphetamine-dependent women to report “imagine someone touching you” (20% vs. 0%, respectively, p < 0.05). Group differences were not observed for any other psychotic symptoms while sober. While “high," in the drug-using state, methamphetamine-dependent women were more likely than cocaine-dependent women to report “feeling strange sensations (61% vs. 27%, respectively, p < 0.05).

Several other factors may contribute to the presence or persistence of psychotic symptoms in stimulant users. The data indicate that BDI scores, years of stimulant use, days of stimulant use in the past 30, and amount stimulant used per week (grams) were not correlated with the report of psychotic symptoms in either cocaine- or methamphetamine-dependent males and females (see Table 4).

Given the differences in ethnic distribution between the cocaine and methamphetamine using individuals in the current study, Table 5 details the most prevalent symptoms and the percentage of African-American, Caucasian, Hispanic and other participants that reported those symptoms. African-American, methamphetamine-dependent males and females were more likely to report “people are talking about you” (p < 0.05) as well as “have difficulty completing tasks” (p < 0.05) when compared to Caucasian, Hispanics, and others. However, for the remaining most prevalent symptoms, the analysis indicates that there were no significant differences between the report of psychotic symptoms and the percentage of each ethnic group reporting those symptoms. Because a considerable percentage of participants reported smoking (67% of male and 80% of female cocaine users and 52% of male and 67% of female methamphetamine users) as their primary route of administration, compared to intravenous (0% of male and 0% of female cocaine users and 28% of male and 0% of female methamphetamine users), nasal (30% of male and 20% of female cocaine users and 8% of male and 22% of female methamphetamine users), or other (4% of male and 0% of female cocaine users and 12% of male and 11% of female methamphetamine users), an analysis was conducted to determine whether there were route of administration differences among the affirmative report of psychotic symptoms. There were no differences between route of administration and the report of the most common psychotic symptoms (see Table 5).

TABLE 5.

Route of administration and ethnicity differences for the most common symptoms

Gender Stim     Symptom
Have you ever felt/imagined that: 		Route of administration x2 p
Nasal (%)** Smoking (%) IV (%) Other (%)
Male Coc People are talking about you 25 72 NA 100 3.3 .54
People are watching you 25 56 NA 100 1.6 .22
Someone was calling your name 38 50 NA 100 .69 .51
Lose train of thought easily 38 44 NA 100 .66 .53
Had difficulty completing tasks 38 39 NA 100 .71 .50
Male MA People are talking about you 0 69 86 33 2.4 .10
People are watching you 0 31 71 67 1.9 .17
Someone was calling your name 50 46 43 0 .77 .53
Lose train of thought easily 0 54 71 0 2.4 .10
Had difficulty completing tasks 0 62 71 67 1.1 .36
Female Coc People are talking about you 33 75 NA NA 1.9 .20
People are watching you 33 50 NA NA .24 .64
People go out of their way to hurt you 33 50 NA NA .24 .64
Body dysmorphism 67 33 NA NA 1.0 .33
Significant other was having an affair 0 50 NA NA 2.6 .13
Someone calling your name 67 58 NA NA .06 .81
Difficult time moving your body 33 50 NA NA .24 .64
Easily agitated 67 42 NA NA .54 .47
Lose train of thought easily 100 50 NA NA 2.6 .13
Had difficulty completing tasks 67 58 NA NA .06 .81
Female MA People are talking about you 50 75 NA 50 2.4 .10
People are watching you 75 42 NA 100 1.9 .17
People go out of their way to hurt you 25 58 NA 50 .70 .57
Body dysmorphism 50 83 NA 50 1.7 .21
Significant other was having an affair 25 67 NA 0 .83 .49
Someone calling your name 50 46 NA 50 .77 .53
Difficult time moving your body 25 55 NA 50 2.6 .08
Easily agitated 75 50 NA 100 1.7 .21
Lose train of thought easily 50 75 NA 50 2.4 .10
Had difficulty completing tasks 75 75 NA 0 1.1 .36
Ethnicity
White (%) AA (%) Hispanic (%) Other (%)
Mal Coc People are talking about you 33 65 50 100 .60 .63
People are watching you 33 53 33 100 .62 .61
Someone was calling your name 33 59 33 0 .78 .51
Lose train of thought easily 0 59 33 0 1.7 .19
Had difficulty completing tasks 0 47 33 100 1.3 .30
Male MA People are talking about you 77 83 0 33 3.6 .03*
People are watching you 46 67 33 0 1.2 .32
Someone was calling your name 50 50 0 33 .86 .48
Lose train of thought easily 46 83 33 0 2.2 .11
Had difficulty completing tasks 54 100 67 0 3.8 .03*
Female Coc People are talking about you 33 75 100 50 .92 .47
People are watching you 0 75 0 50 3.2 .07
People go out of their way to hurt you 33 50 50 50 .07 .98
Body dysmorphism 33 25 50 100 1.3 .33
Significant other was having an affair 0 50 50 50 .73 .55
Someone calling your name 67 63 50 50 .06 .98
Difficult time moving your body 33 38 50 100 .83 .50
Ethnicity
Gender Stim Symptom White (%) AA (%) Hispanic (%) Other (%) x2 p
Easily agitated 33 38 100 50 .83 .50
Lose train of thought easily 33 63 50 10 .67 .59
Had difficulty completing tasks 33 63 50 100 .67 .59
Female MA People are talking about you 70 50 75 50 3.6 .03*
People are watching you 50 50 50 100 1.2 .32
People go out of their way to hurt you 50 100 25 50 .73 .55
Body dysmorphism 70 100 75 50 .69 .57
Significant other was having an affair 50 100 25 50 2.1 .13
Someone calling your name 67 50 25 0 .86 .48
Difficult time moving your body 60 0 75 100 .20 .90
Easily agitated 60 50 50 100 1.5 .26
Lose train of thought easily 60 100 75 50 2.3 .11
Had difficulty completing tasks 70 100 50 50 3.8 .03*
Open in a new tab
*

p < 0.05.

**

Percentages reflect individuals within each condition that experienced that particular psychotic symptom.

DISCUSSION

In the current report, we show that the frequency of several psychotic symptoms reported by cocaine and methamphetamine males and females was high. Common psychotic symptoms included paranoid delusions, erotomanic delusions, grandiose delusions, and perceptual disturbances.

Of interest, methamphetamine-dependent males, as compared to cocaine-dependent males, were more likely to exhibit select psychotic symptoms. For example, a higher percentage of methamphetamine users reported visual and tactile hallucinations and felt that someone or something had external control over them during the abstinent state. In addition, a higher percentage of methamphetamine male users reported delusions of paranoia and grandiosity as well as visual, auditory, and olfactory hallucinations while intoxicated. Also, a higher percentage of methamphetamine-dependent females, when compared to cocaine-dependent females, reported feeling strange sensations while intoxicated. The frequency of participants reporting suspiciousness (paranoia) in this study was lower than the report of McKetin and colleagues.3 The lower rate of paranoia among our participants probably was due to the fact that participants with a history of schizophrenia or non-drug induced psychosis were excluded from the current study, while McKetin and colleagues included such participants in their study.

Despite the fact that the cocaine-dependent males reported a longer duration of stimulant use in years, the analyses revealed that cocaine users were less prone to experience selected psychotic symptoms than methamphetamine users. The identification of the neurobiological mechanisms that underlie vulnerability to psychosis is beyond the scope of this study; however, we speculate that these findings may be reflective of the neurotoxic effects produced by methamphetamine, as compared to cocaine. Although cocaine and methamphetamine are similar in that they both bind to presynaptic transporters and inhibit monoamine uptake, the significantly longer half-life of methamphetamine, as compared to cocaine, may also contribute to the greater incidence of psychotic symptoms in methamphetamine users.6

Some studies have found that African-Americans are at greater risk for stimulant-induced psychosis,13,14 while others report opposite trends4,15 or negative associations.2,16 In a previously published meta-analytic report looking at migration and incidence of schizophrenia, it was found that African-Americans were more at risk than Caucasians for experiencing symptoms of psychosis.17 While ethnic differences were noted in the current study between the two sample populations, our analysis indicated that ethnicity did not moderate the prevalence of most psychotic symptoms.

Previous studies have shown that some individuals are likely to experience psychotic symptoms after using relatively modest amounts of a stimulant,18 whereas others do not do so until exposure to relatively larger doses of stimulants.19 Our clinical research group has conducted several inpatient laboratory studies in which methamphetamine was administered to methamphetamine-dependent patients and cocaine was administered to cocaine-dependent patients. Over a course of several years and testing of more than 100 patients, we have administered low doses of methamphetamine (≤ 30 mg) and cocaine (≤ 40 mg) approximately 500 times and have not noted drug-induced psychotic symptoms such as paranoia, hallucinations, or delusions. Further research is needed to determine risk factors and protective factors for development of drug-induced psychosis.

Several limitations should be noted. First, although the PSAS items are internally consistent, the validity of the measure has not been determined. Second, the current data reflect retrospective reports of psychotic symptoms by the participant rather than observation of psychotic symptoms by others. Also, when investigating whether ethnic and route of administration differences exist, it must be noted that the samples sizes were relatively small and more data is necessary in order to make a definitive conclusion. Future studies are needed to investigate the development and characteristics of psychotic symptoms following the experimental administration of methamphetamine or cocaine.

APPENDIX

Psychotic Symptom Assessment Scale

Date: _____________
Subject Initials: _________
Subject #: ___________

To be administered by the Research Assistant

Read the following directions prior to beginning: Please answer the following questions by answering with the number that most accurately corresponds to your experience. The scale’s range is from 0–10, with 0 indicating never, 5 indicating often (one-half of the time), and 10 indicating always.

As used here, “while you were high” indicates that you had used cocaine or methamphetamine within the last 24h, and “while sober” indicates that you had not used cocaine or methamphetamine for one week or more. If you use both cocaine and methamphetamine, discuss this with the administrator.

1. Has it ever seemed like people were talking about you or paying extra attention to you?
     1a. Yes/no
     1b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     1c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        1d. Did you feel then that you were experiencing this due to drug use?    Yes     No
        1e. Do you feel now that these experiences were due to drug use?          Yes     No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

2. Have you ever felt like you were receiving special messages from the radio, TV, newspaper, or the way that things were
   arranged around you?
     2a. Yes/no
     2b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     2c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        2d. Did you feel then that you were experiencing this due to drug use? Yes    No
        2e. Do you feel now that these experiences were due to drug use?       Yes    No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

3. Have you ever felt like people are watching you, spying on you, or checking up on you?
     3a. Yes/no
     3b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     3c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        3d. Did you feel then that you were experiencing this due to drug use?  Yes      No
        3e. Do you feel now that these experiences were due to drug use?        Yes      No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

4. Have you ever felt like people go out of their way to give you a hard time, are out to get you, or want to hurt you?
     4a. Yes/no
     4b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     4c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        4d. Did you feel then that you were experiencing this due to drug use?     Yes       No
        4e. Do you feel now that these experiences were due to drug use?           Yes       No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

5. In these situations, do you feel like there is an organization or group behind these actions?
      5a. Yes/no
      5b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      5c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         5d. Did you feel then that you were experiencing this due to drug use?      Yes      No
         5e. Do you feel now that these experiences were due to drug use?            Yes      No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

6. Have you ever felt like you have special powers?
     6a. Yes/no
     6b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     6c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        6d. Did you feel then that you were experiencing this due to drug use?  Yes      No
        6e. Do you feel now that these experiences were due to drug use?        Yes      No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

7. Have you ever felt like there is a specific or special mission to your life?
     7a. Yes/no
     7b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     7c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

8. Have you ever felt like you hold a powerful role in society or that you should hold a powerful role in society?
     8a. Yes/no
     8b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     8c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        8d. Did you feel then that you were experiencing this due to drug use?     Yes      No
        8e. Do you feel now that these experiences were due to drug use?           Yes     No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

9. Have you ever felt like something was wrong with the way a part of your body looked?
     9a. Yes/no
     9b. Did this occur while you were sober (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
     9c. Did this occur while you were high (yes / no)
     If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
        9d. Did you feel then that you were experiencing this due to drug use? Yes     No
        9e. Do you feel now that these experiences were due to drug use?       Yes     No
   *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
   *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

10. Have you ever had any unusual religious experiences, such as communication with God?
      10a. Yes/no
      10b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      10c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         10d. Did you feel then that you were experiencing this due to drug use? Yes    No
         10e. Do you feel now that these experiences were due to drug use?       Yes    No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

11. Have you ever felt like your significant other was having an affair when it was not true?
      11a. Yes/no
      11b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      11c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         11d. Did you feel then that you were experiencing this due to drug use?    Yes     No
         11e. Do you feel now that these experiences were due to drug use?          Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

12. Have you ever felt that someone loves you from a distance, even though they deny it?
      12a. Yes/no
      12b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      12c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         12d. Did you feel then that you were experiencing this due to drug use?   Yes       No
         12e. Do you feel now that these experiences were due to drug use?         Yes       No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

13. Have you ever felt like someone could read your mind or felt like telepathy, magic, witchcraft, or hypnotism has affected you in some way?
      13a. Yes/no
      13b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      13c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         13d. Did you feel then that you were experiencing this due to drug use?  Yes        No
         13e. Do you feel now that these experiences were due to drug use?        Yes        No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

14. Have you ever felt like electricity, x-rays, or radiowaves are or have affected you?
      14a. Yes/no
      14b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      14c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         14d. Did you feel then that you were experiencing this due to drug use ?      Yes    No
         14e. Do you feel now that these experiences were due to drug use?            Yes    No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

15. Have you ever felt like someone or something outside of yourself was controlling your thoughts or actions?
      15a. Yes/no
      15b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      15c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         15d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         15e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

16. Have you ever felt like someone or something else was putting thoughts into or removing thoughts from your head?
      16a. Yes/no
      16b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      16c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         16d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         16e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

17. Have you ever felt like people could hear your thoughts?
      17a. Yes/no
      17b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      17c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         17d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         17e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

18. Have you ever felt like someone was calling your name, but no one was really calling you?
      18a. Yes/no
      18b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      18c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         18d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         18e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

19. Have you ever heard tapping noises, whispers, or music that others couldn’t hear?
      19a. Yes/no
      19b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      19c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         19d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         19e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

20. Have you ever seen or felt things that others couldn’t?
      20a. Yes/no
      20b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      20c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         20d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         20e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

21. Have you ever felt like someone is touching you but no one was there?
      21a. Yes/no
      21b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      21c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         21d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         21e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

22. Have you ever felt strange sensations, such as insects crawling on your body or skin?
      22a. Yes/no
      22b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      22c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         22d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         22e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

23. Have you ever felt that things taste or smell differently than they should?
      23a. Yes/no
      23b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      23c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         23d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         23e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

24. Have you ever smelled things that others could not?
      24a. Yes/no
      24b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      24c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         24d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         24e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

25. Have you ever had a difficult time moving your body?
      25a. Yes/no
      25b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      25c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         25d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         25e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

26. Have you ever had too much energy and could not control your body?
      26a. Yes/no
      26b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      26c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         26d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         26e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

27. Have you ever felt like you get easily agitated or annoyed and cannot control yourself?
      27a. Yes/no
      27b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      27c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         27d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         27e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

28. Have you ever displayed inappropriate sexual behavior? Here, inappropriate means behavior you would not usually participate in.
      28a. Yes/no
      28b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      28c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         28d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         28e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

29. Have you ever been aware of dressing inappropriately or unusually? Here, inappropriate or unusual means dressing as you would not usually.
      29a. Yes/no
      29b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      29c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         29d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         29e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

30. Have you ever been told or been aware that your facial expressions are unrelated to what you are talking about or feeling (like smiling while talking about something sad)?
      30a. Yes/no
      30b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      30c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         30d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         30e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

31. Have you ever felt like you lose your train of thought easily, will go off onto different tangents while speaking, or that people don’t understand you?
      31a. Yes/no
      31b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      31c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         31d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         31e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

32. Do you ever feel like you have a difficult time completing tasks or activities?
      32a. Yes/no
      32b. Did this occur while you were sober (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
      32c. Did this occur while you were high (yes / no)
      If yes, rate the frequency: 0 1 2 3 4 5 6 7 8 9 10
         32d. Did you feel then that you were experiencing this due to drug use?     Yes     No
         32e. Do you feel now that these experiences were due to drug use?           Yes     No
    *Did this happen after a certain amount of drugs or after a certain number of days? Please explain:
   ______________________________________________________________________________________________________________________
   ______________________________________________________________________________________________________________________
    *If this has occurred while you were using drugs, was it more evident during your high, while you were coming down, or
   was there no clear distinction? Please explain:_______________________________________________________________________
   ______________________________________________________________________________________________________________________

Administrator, Please complete at the end of the interview:
Please comment on the subject’s affect:
Please comment on the subject’s speech:
Please comment on the subject’s appearance:
Please comment on the subject’s body language:
Additional comments:

Footnotes

Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf

This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden.

Publisher's Disclaimer: The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

REFERENCES

  • 1.Ellinwood EH, Jr, Kilbey MM. Fundamental mechanisms underlying altered behavior following chronic administration of psychomotor stimulants. Biol Psychiatry. 1980;15:749–757. [PubMed] [Google Scholar]
  • 2.Satel SL, Southwick SM, Gawin FH. Clinical features of cocaine-induced paranoia. Am J Psychiatry. 1991;148:495–498. doi: 10.1176/ajp.148.4.495. [DOI] [PubMed] [Google Scholar]
  • 3.McKetin R, McLaren J, Lubman DI, Hides L. The prevalence of psychotic symptoms among methamphetamine users. Addiction. 2006;101:1473–1478. doi: 10.1111/j.1360-0443.2006.01496.x. [DOI] [PubMed] [Google Scholar]
  • 4.Brady KT, Lydiard RB, Malcolm R, Ballenger JC. Cocaine-induced psychosis. J Clin Psychiatry. 1991;52:509–512. [PubMed] [Google Scholar]
  • 5.Iwanami A, Sugiyama A, Kuroki N, et al. Patients with methamphetamine psychosis admitted to a psychiatric hospital in Japan. A preliminary report. Acta Psychiatr Scand. 1994;89:428–432. doi: 10.1111/j.1600-0447.1994.tb01541.x. [DOI] [PubMed] [Google Scholar]
  • 6.Cook CE. Pyrolytic characteristics, pharmacokinetics, and bioavailability of smoked heroin, cocaine, phencyclidine, and methamphetamine. NIDA Res Monogr. 1991;115:6–23. [PubMed] [Google Scholar]
  • 7.Newton TF, Roache JD, De La Garza R, II, et al. Safety of intravenous methamphetamine administration during treatment with bupropion. Psychopharmacology (Berl) 2005;182:426–435. doi: 10.1007/s00213-005-0102-8. [DOI] [PubMed] [Google Scholar]
  • 8.Javaid JI, Musa MN, Fischman M, Schuster CR, Davis JM. Kinetics of cocaine in humans after intravenous and intranasal administration. Biopharm Drug Dispos. 1983;4:9–18. doi: 10.1002/bdd.2510040104. [DOI] [PubMed] [Google Scholar]
  • 9.Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description. Arch Gen Psychiatry. 1992;49:624–629. doi: 10.1001/archpsyc.1992.01820080032005. [DOI] [PubMed] [Google Scholar]
  • 10.Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(SuPeople. 20):22–33. quiz 34–57. [PubMed] [Google Scholar]
  • 11.McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat. 1992;9:199–213. doi: 10.1016/0740-5472(92)90062-s. [DOI] [PubMed] [Google Scholar]
  • 12.Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–597. doi: 10.1207/s15327752jpa6703_13. [DOI] [PubMed] [Google Scholar]
  • 13.Kalayasiri R, Sughondhabirom A, Gueorguieva R, et al. Self-reported paranoia during laboratory “binge" cocaine self-administration in humans. Pharmacol Biochem Behav. 2006;83:249–256. doi: 10.1016/j.pbb.2006.02.005. [DOI] [PubMed] [Google Scholar]
  • 14.Blazer DG, Hays JC, Salive ME. Factors associated with paranoid symptoms in a community sample of older adults. Gerontologist. 1996;36:70–75. doi: 10.1093/geront/36.1.70. [DOI] [PubMed] [Google Scholar]
  • 15.Kalayasiri R, Kranzler HR, Weiss R, et al. Risk factors for cocaine-induced paranoia in cocaine-dependent sibling pairs. Drug Alcohol Depend. 2006;84:77–84. doi: 10.1016/j.drugalcdep.2005.12.002. [DOI] [PubMed] [Google Scholar]
  • 16.Bartlett E, Hallin A, Chapman B, Angrist B. Selective sensitization to the psychosis-inducing effects of cocaine: a possible marker for addiction relapse vulnerability? Neuropsychopharmacology. 1997;16:77–82. doi: 10.1016/S0893-133X(96)00164-9. [DOI] [PubMed] [Google Scholar]
  • 17.Cantor-Graae E, Zolkowska K, McNeil TF. Increased risk of psychotic disorder among immigrants in Malmo: a three-year first-contact study. Psychol Med. 2005;35:1155–1163. doi: 10.1017/s0033291705004721. [DOI] [PubMed] [Google Scholar]
  • 18.Curran C, Byrappa N, McBride A. Stimulant psychosis: systematic review. Br J Psychiatry. 2004;185:196–204. doi: 10.1192/bjp.185.3.196. [DOI] [PubMed] [Google Scholar]
  • 19.Angrist B, Sathananthan G, Wilk S, Gershon S. Amphetamine psychosis: behavioral and biochemical aspects. J Psychiatr Res. 1974;11:13–23. doi: 10.1016/0022-3956(74)90064-8. [DOI] [PubMed] [Google Scholar]

RESOURCES