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Am J Psychiatry 1991; 148:495-498
Copyright © 1991 by American Psychiatric Association
Clinical features of cocaine-induced paranoia
SL Satel, SM Southwick and FH Gawin
Yale University School of Medicine, New Haven, Conn. 06516.
OBJECTIVE: The authors' objective was to assess the frequency and nature of
cocaine-induced paranoia. METHOD: They interviewed 50 cocaine- dependent
men consecutively admitted to a 28-day rehabilitation program. RESULTS:
Thirty-four (68%) of the 50 men reported highly distressing transient
paranoid states in the context of cocaine use. The men who experienced
paranoia did not differ from those who did not in age, race, or measures of
cocaine use. The mean duration and amount of cocaine use before development
of paranoia of the men who reported paranoia were not significantly
different from the mean lifetime duration and amount of cocaine used by the
men who did not report paranoia. Paranoia became more severe and developed
more rapidly with continued cocaine use. CONCLUSIONS: The transient
paranoid state appears to be a common feature of cocaine dependence and
does not seem to be simply a result of exceeding a threshold of use.
Rather, affected individuals might possess a predisposition to this
drug-induced state. The fact that paranoia became more severe and developed
more rapidly with continued drug use is consistent with a sensitization
model of cocaine-induced paranoia. In vulnerable individuals, limbic
sensitization may underlie its expression, but localization to a specific
brain region is speculative. Quantity of use and route of administration do
not appear directly to predispose to this phenomenon. Future investigations
must be aimed at uncovering the markers and meaning of vulnerability to
transient paranoia in heavy cocaine users.
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