Methamphetamine-induced psychosis (MIP) usually resolves within days to weeks after stopping drug use. However, some vulnerable individuals may experience prolonged symptoms. We present the case of a woman who developed long-lasting psychotic symptoms following minimal methamphetamine exposure, shedding light on risk factors and the importance of holistic care. 

A 53-year-old woman experienced vivid hallucinations and fixed delusional beliefs after limited methamphetamine use (monthly smoking over eight months, totaling approximately eight exposures). Despite initial denial of drug use, urine immunoassay toxicology confirmed amphetamines during emergency department presentation. Her symptoms persisted for over 18 months despite abstinence confirmed by ten subsequent negative urine drug screens. Antipsychotic treatment with risperidone (later switched to aripiprazole 10 mg daily due to side effects), alongside cognitive behavioral therapy (CBT), gradually led to improvement.

This case challenges assumptions that MIP resolves quickly and only occurs with heavy use. It also highlights how coexisting vulnerabilities, such as attention-deficit/hyperactivity disorder (ADHD) and social isolation, can amplify risk. Early substance screening, empathetic rapport, and flexible treatment were key in helping the patient recover. Even small amounts of methamphetamine can be associated with persistent psychosis. Clinicians should remain vigilant and support recovery with pharmacological and psychological approaches.

Attention deficit hyperactivity disorder (ADHD), CBT for psychosis, Drug-induced psychosis, Methamphetamine induced psychosis, Methamphetamine use, Residual psychosis, Stimulant induced psychosis, Substance induced psychotic disorder, Substance misuse in older adults