Drug Induced Psychosis
According to the National Alliance on Mental Illness, psychosis refers to an episode in which an individual has a break from reality. This often includes but doesn’t require, delusions, or false beliefs that are firmly held despite clear evidence to the contrary, and hallucinations. About 3 in every 100 people will experience at least one episode of psychosis in their lifetimes.
Drug-induced psychosis, also known as substance-induced psychotic disorder, is simply any psychotic episode that is related to the abuse of an intoxicant. This can be due to any of the following : taking too much of a certain drug, having an adverse reaction after mixing substances, during withdrawal from a drug, or if the individual has underlying mental health issues. Though it’s not actually true that taking a certain kind of drug can suddenly trigger a severe mental illness where none had existed, mental illness is a predictor of substance abuse, and someone prone to psychosis can be triggered by becoming overly intoxicated.
Substance abuse is defined as any use of an illicit intoxicant, any use of a prescription medication outside the direction of a doctor, or excessive use of legal substances such as alcohol. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health, 9.3 percent of individuals in the US, age 12 and older, needed treatment for a drug or alcohol problem in 2009. This does not include people who occasionally abuse drugs but are not considered to have a dependence issue. This amounts to 23.5 million people.
Psychosis Due to Drugs
Many recreational and prescription drugs can induce psychotic symptoms that can mimic serious psychiatric disorders.
Drug-induced psychosis has been associated with suicidal thoughts, dangerous and violent behaviour, hospitalization, and arrests.
Because treatment modalities can vary, it is important to ascertain whether psychotic symptoms are substance-induced or caused by other factors.
Drugs That Can Cause Psychosis
Heavy, long-term use of many substances can result in psychotic symptoms. However, certain drugs are more likely to cause psychotic symptoms than others. These include:
The use of methamphetamine can lead to paranoia, persecution delusions, and auditory and visual hallucinations.
One common hallucination is the feeling of bugs crawling on one’s skin. These symptoms might subside after stopping use, but they can also persist for weeks or longer, and may increase one’s susceptibility for developing future psychosis. Even after long periods of abstinence, psychotic symptoms may return in periods of stress.
Cannabis use has long been associated with psychotic symptoms. The first evidence came from the Swedish Conscripts Study of 45,570 military inductees who were followed-up for 15 years.
The results showed that those who had used cannabis by the age of 17 were 2.4 times more likely to develop schizophrenia than non-users. The risk of schizophrenia rose to 6 times that of non-users for heavy cannabis users (more than 50 times at initial interview).
Up to 50% of cocaine users will show some symptoms of psychosis after use. The risk increases with needle or freebased use.
Persecution delusions and tactile hallucinations are common. Psychotic symptoms can persist days, months, and sometimes years after use has stopped.
Amphetamine (Speed) can cause psychotic symptoms similar to methamphetamine and cocaine after repeated use.
Alcohol can cause delusions, mental confusion, disorganized speech, and disorientation. Typically, these symptoms subside upon sobriety.
Alcohol is one of the most commonly abused substances among individuals with schizophrenia, although diagnosis usually precedes use.
Psychedelic drugs (e.g., LSD, PCP, etc)
These drugs can induce temporary effects that mimic psychosis. However, these symptoms typically cease when the drug wears off.
For most people, psychotic symptoms will not be present after first use. It is only after repeated use that psychotic symptoms become more prevalent and long-lasting.
Club/recreational drugs (e.g., ecstasy)
Ecstasy can cause psychotic symptoms, antisocial behaviour, and panic attacks. Persistent psychosis has been reported after a single use in some people.
Prescription meds (e.g., ketamine)
Ketamine users typically exhibit a variety of symptoms that mimic psychosis including delusions, cognitive impairments, disordered thinking, and incoherent speech.
Treatment and Recovery from substance-induced Psychosis
Drug induced psychosis can be treated, but it may be complicated by the challenge of making a correct diagnosis. In an emergency, regardless of the cause or diagnosis, psychosis can be treated with hospitalization and medications. Hospitalization is important to keep the patient safe until the symptoms are resolved. Medications, including antipsychotics and sedatives, can help resolve symptoms more quickly and can help the patient relax.
Once a patient has detoxed from whatever substance triggered psychotic symptoms, and from any other substance being used, a better diagnosis can be made. It is important to diagnose any mental illnesses as well as substance abuse disorders. For treatment to be effective, all issues have to be identified and addressed.
For most people going through substance-induced psychosis, the psychotic symptoms will not persist. They are usually temporary, and ongoing residential treatment will address any underlying mental illnesses as well as substance abuse disorders through behavioural therapy, medical care, social support, self-care, lifestyle changes, relapse prevention therapy, and other strategies.
In rare cases patients may experience long-term or chronic psychosis from substance use. In these instances, treatment may involve more specific strategies, like those used to treat psychotic disorders such as schizophrenia. Treatment may include a combination of behavioural therapies and antipsychotic medications to control and manage symptoms.
Treatment for any type of psychosis, including cases triggered by substance use, can be complicated, because patients struggle to recognize that their delusions and other experiences are not grounded in reality. The best outcomes result from residential care in which a patient can get intensive care and round-the-clock supervision. Treating underlying substance abuse and mental illness will help most patients recover and be able to manage their lives outside of care.
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