Psychosis occurs when a person’s thinking becomes dysregulated, and they experience a reality that differs from other people’s. Psychosis can include auditory and visual hallucinations, delusions, or dissociation from the present experience.
Psychotic episodes can be a one-off occurrence or a succession of regular events. If the episodes are frequent and persistent, they may be diagnosed as a psychotic illness such as delusional disorder, schizophrenia, or bipolar disorder.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines drug-induced psychotic disorder as, “the presence of delusions and/or hallucinations, with symptoms occurring soon after the intoxication or withdrawal of a substance or soon after exposure to a medication. The substance must have the potential to produce delusions or hallucinations that result in clinically significant impairment.”[1]
Drug-induced psychosis, also referred to as “stimulant psychosis,” occurs as a direct result of substance use and can trigger or exacerbate these mental illnesses and disrupt people’s everyday lives, including relationships and employment.
Psychosis is prevalent today with as many as 3% of people experiencing symptoms during their lives.[2] Studies surveying patients admitted to clinical settings with psychosis demonstrated that 74% of them had previously been diagnosed with a substance use disorder.[3]
If sufferers pursue professional treatment, drug-induced psychosis is fully treatable. This article seeks to explore the causes, symptoms, and importance for prompt treatment for sufferers of this condition.
Signs of Psychosis
Psychosis is a mental health disorder that temporarily, or persistently, causes the individual to interpret the world in a way that is far-removed from reality.[4]
Some of the most common symptoms of psychosis are:[5]
- Hallucinations – These aresensory perceptions of unreal phenomena, such as hearing, seeing, or tasting things that are not there or that do not exist outside of their minds.
- Delusions – Delusions are irrational, unshakeable beliefs that are not true. The person will hold on to these beliefs even when presented with evidence to the contrary.
- Confused/disturbed thoughts – This includes losing one’s train of thought, changing topics haphazardly, and exhibiting rapid speech. This includes losing one’s train of thought, changing topics haphazardly, and exhibiting rapid speech.
“Delusions are distinguished from mistaken beliefs in that delusional beliefs remain unchanged in the face of clear, reasonable evidence to the contrary” ~ Dr. Carol Tamminga, M.D., Stanton Sharp Distinguished Chair in Psychiatry
Causes of Psychosis
The causes of the majority of psychotic disorders, although widely studied, remain largely unknown. However, various genetic, biological, environmental, and psychological factors play a part in their onset:
- Genetic – Schizophrenia and delusional disorder are more common in those where these psychotic disorders are already apparent within the familial line.
- Biological – Research has demonstrated that an imbalance in the brain’s neurotransmitters, which affect the transmission of messages, can manifest as psychotic symptoms.
- Age – Age is a key factor; adolescents are more at risk of developing psychosis than adults.[6]
- Environmental/Psychological. Psychotic episodes can be triggered by stress and through substance use.[7]
Drug Induced Psychosis Explained
Drug-induced psychosis is complex and affects each individual differently. The primary causes include:
- Taking too much of a certain substance
- Mixing different substances
- Substance withdrawal
Use of substances at any level can cause the onset of psychotic symptoms. However, it is most common to see a gradual onset of drug-induced psychosis as the individual establishes dependency and increases toxicity due to an increase of dosage and frequency.
If the individual has an underlying mental health condition, the use of psychoactive drugs, prescription or illegal, will likely worsen symptoms. This can result in paranoia and/or a severe psychotic episode and can cause the onset or relapse of psychotic disorders such as delusional disorder, schizophrenia, or bipolar disorder.[8]
Some of the symptoms of drug induced psychosis include:[9]
- Paranoia
- Delusions
- Auditory and visual hallucinations
- Anti-social behavior
- Panic attacks
- Confusion
The symptoms and severity of psychotic episodes vary significantly depending on which substances have been taken along with the amount consumed. However, heavy and excessive use of substances can result in prolonged symptoms. Two of the most commonly used substances which can cause psychosis are psychostimulants and marijuana.
Psychostimulants
The most reported cause of stimulant-induced psychosis is from amphetamine and methamphetamine.[10] These psychostimulants impede dopamine re-uptake by binding neurons to dopamine transporters (DAT), which results in an increased concentration of dopamine chemicals. This results in an increased heart rate, hyper-alertness, and a surge in energy.
Common stimulants include cocaine, methamphetamine, amphetamine, caffeine, and nicotine. These substances share similar side effects which include: elevated blood pressure, insomnia, appetite suppression, agitation, and psychosis.
These forms of stimulants are found in both illegal substances and in prescription medications. They can be beneficial in treating medical conditions such as attention-deficit/hyperactivity disorder (ADHD), narcolepsy, obesity, and depression.[11] Psychosis due to prescription medication typically only occurs if too much of the substance is taken, if it is abused, or if mixed with other substances.
Cannabis
After alcohol, Marijuana is the most used psychotropic substance in the United States. More than 11.8 million people in 2018 reported marijuana use in the past year.[12] So far, 15 U.S. states and Washington D.C have legalized marijuana for adult recreational use, and 36 states permit medical use of the drug.[13]
The legalization of this drug and its propensity for medical use have caused confusion over its perceived safety. However, extensive research evidences a link between cannabis use and its resulting increasing levels of THC with the onset of schizophrenia.
“Psychosis is associated with more frequent and longer use of cannabis.”
– Di Forti et al
Conclusion
The first step in treating drug-induced psychosis is the complete abstention from the substance that triggered it. If there is a dependence, individuals may need to enter an inpatient, medically-assisted detoxification program. However, if it was a one-off occurrence, then an outpatient rehabilitation plan may suffice.
Treatments will vary depending on the individual’s unique needs. However, a combination of therapeutic modalities to holistically treat the issue will be developed. This will likely include cognitive behavioral therapy (CBT), family therapy, group therapy, and sober peer activities.
It is essential to ensure that symptoms are managed, triggers are uncovered and addressed, and an extensive support network is established to prevent relapse.
If you or anyone you know is struggling, please do not suffer alone. Please contact Heather R. Hayes & Associates. Call 800-335-0316 or email info@heatherhayes.com today.
Sources:
[1] American Psychiatric Association. Arlington, VA: American Psychiatric Association; 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
[2] Early psychosis and psychosis. [Feb;2019 ];https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Psychosis
[3] The impact of substance use disorder on clinical outcome in 643 patients with first-episode psychosis. Lambert M, Conus P, Lubman DI, et al. Acta Psychiatr Scand. 2005;112:141–148.
[4] Kuepper, R. et al. “Continued Cannabis Use and Risk of Incidence and Persistence of Psychotic Symptoms: 10 Year Follow-Up Cohort Study”. BMJ, vol 342, no. mar01 1, 2011, pp. d738-d738. BMJ, doi:10.1136/bmj.d738. Accessed 17 Mar 2021.
[5] “Psychosis | Nightingale Hospital London”. Nightingalehospital.Co.Uk, 2022, https://www.nightingalehospital.co.uk/psychosis/.
[6] Caspi, Avshalom et al. “Moderation of the Effect of Adolescent-Onset Cannabis Use on Adult Psychosis by a Functional Polymorphism in the Catechol-O-Methyltransferase Gene: Longitudinal Evidence of a Gene X Environment Interaction”. Biological Psychiatry, vol 57, no. 10, 2005, pp. 1117-1127. Elsevier BV, doi:10.1016/j.biopsych.2005.01.026. Accessed 17 Mar 2021.
[7] Munro, Alistair. Delusional Disorder. Cambridge University Press, 1999.
[8] Schoeler, Tabea et al. “Association Between Continued Cannabis Use and Risk of Relapse in First-Episode Psychosis”. JAMA Psychiatry, vol 73, no. 11, 2016, p. 1173. American Medical Association (AMA), doi:10.1001/jamapsychiatry.2016.2427. Accessed 17 Mar 2021.
[9] Ham, Suji et al. “Drug Abuse And Psychosis: New Insights Into Drug-Induced Psychosis”. Experimental Neurobiology, vol 26, no. 1, 2017, pp. 11-24. The Korean Society For Brain And Neural Science, https://doi.org/10.5607/en.2017.26.1.11. Accessed 25 Jan 2022.
[10] Henning, Ashley et al. “A Case Study of Acute Stimulant-Induced Psychosis”. Cureus, 2019. Cureus, Inc., https://doi.org/10.7759/cureus.4126. Accessed 25 Jan 2022.
[11] Amphetamine-induced psychosis – a separate diagnostic entity or primary psychosis triggered in the vulnerable? Bramness JG, Gundersen OH, Gusterstam J, et al. BMC Psychiatry. 2012;12:221.
[12] “2018 NSDUH Detailed Tables | CBHSQ Data”. Samhsa.Gov, 2018, https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables.
[13] CNBC, 2021, https://www.cnbc.com/2021/01/06/marijuana-united-states-law.html. Accessed 17 Mar 2021.
