Treatment of Drug-Induced Psychosis

Symptoms of Substance-Induced Psychosis

A person who is struggling with substance-induced psychosis will present various symptoms related to psychosis because of substance use.

Some common substance-induced psychotic disorder symptoms include:

• Irregular thoughts
• Poor psychomotor behavior
• Hallucinations – perceptions of something that is not actually there
• Delusions – false beliefs
• Paranoia
• Dissociation – disconnect from the real world
• Alexithymia – lack of emotions or emotional expression

Substance-induced psychosis treatment should be done immediately because psychotic episodes often require hospitalization to keep the person from harming themselves. A medical professional will also need to determine if the psychotic disorder is related to substance use.

What Drugs Cause Psychosis?

Many substances can cause psychosis, either while the user is high or after prolonged usage. Cocaine and amphetamine stimulants, such as methamphetamine, are widely known for their ability to cause psychotic symptoms. Hallucinations, delusions, paranoia, and disordered thinking are all possible effects of these drugs. Additional common offenders include psychedelic drugs such as LSD and club drugs like ecstasy and MDMA, which are often reported in cases of drug-induced psychosis. These substances are likely to result in psychotic symptoms, particularly when used heavily or excessively, leading to prolonged episodes of psychosis.

LSD, psilocybin mushrooms, and phencyclidine (PCP), among other hallucinogens, can also result in transitory psychotic experiences, which are frequently characterized by severe perceptual distortions and altered states of consciousness. Cannabis use, especially in high doses, can potentially hasten the onset of psychosis. Long-term cannabis usage is associated with a higher risk of acquiring psychotic diseases, including schizophrenia, according to studies. Although the precise mechanism is not entirely known, it is thought that the psychoactive component of cannabis, THC (delta-9-tetrahydrocannabinol), can affect the neurotransmitter systems of the brain and can induce temporary schizophrenia-like psychotic symptoms such as paranoia, delusions, anxiety, and hallucinations.

Additionally, specific dissociative anesthetics like ketamine and synthetic cannabinoids (commonly referred to as "spice" or "K2") can produce psychotic symptoms. Both these substances and some prescription medicines are frequently abused. Drug-induced psychosis relating to prescription medication usually occurs when people aren't taking the drug at the recommended dose or continuing to use the drug beyond the advised period of time. Misuse of these drugs can mimic psychosis in the form of delusions and disordered thinking.

Always keep in mind that basic psychotic disorders like schizophrenia have a complicated etiology combining genetic, environmental, and neurochemical factors. The psychosis brought on by substance abuse differs from these diseases. However, taking some drugs can significantly increase the risk of experiencing either brief or lengthy psychotic episodes. Drugs such as cocaine, cannabis, and hallucinogens can also worsen symptoms of existing mental illnesses, adding another layer of complexity to the management and understanding of these conditions.

How Long Does Substance-Induced Psychosis Last?

Substance-induced psychotic episode length can depend on several factors, including the kind and quantity of the substance consumed, a person's personality, and any underlying mental health conditions. Substance-induced psychosis frequently resolves after a few days to a few weeks of ceasing to use the substance. However, in some situations, it might persist for a longer time.

Prioritizing the person's safety and well-being is crucial throughout the duration of a substance-induced psychotic episode. Medical intervention can be required in extreme circumstances where the symptoms worsen or persist. This may entail a stay in the hospital for close observation, the administration of medications to treat symptoms, and supportive therapy to address underlying problems. To prevent recurrence and advance long-term recovery, it is also crucial to address the underlying causes of substance abuse once the acute period of substance-induced psychosis has passed.

Risk Factors for Developing Substance/Medication-Induced Psychotic Disorder

Substance/Medication-Induced Psychotic Disorder can arise due to multiple risk factors, each contributing to an individual's vulnerability. Understanding these can help in prevention and early intervention.

1. Family History

Genetic Predisposition: A family history of schizophrenia or other psychotic disorders significantly increases the likelihood of developing psychosis in response to substance use. This genetic vulnerability means that the brain may be more susceptible to the effects of certain drugs.

2. Early and Heavy Drug Use

Age of Initiation: Starting drug use at an early age is another critical risk factor. Young brains are still developing, making them more susceptible to the harmful effects of substances.

High Frequency and Quantity: Heavy use, especially over extended periods, heightens the risk. The more frequent and larger the doses, the greater the potential for psychotic responses.

3. Evolution of Drugs

New, Potent Substances: The landscape of drug abuse is continuously evolving. New synthetic drugs are being created, often in clandestine labs. These substances are designed to be potent, frequently affecting neurotransmitter receptors that are linked to psychotic symptoms.

Chemical Composition: Many of these new drugs have toxic effects, further increasing the risk of prolonged psychosis. Synthetic cannabinoids, for example, are known to cause more severe and extended psychotic episodes compared to natural marijuana.

4. Legal Loopholes

Regulatory Evasion: While regulatory bodies ban many harmful substances, manufacturers continually develop new variants to skirt these bans. These untested substances pose significant risks as their effects may be unknown and potentially more dangerous.

Key Takeaways

• Genetic Factors: Family history matters.
• Usage Patterns: Early and heavy use increases risks.
• Drug Potency: New, powerful substances raise the stakes.
• Regulatory Challenges: Loopholes in bans allow dangerous variants to enter the market.

By being aware of these risk factors, individuals and healthcare providers can better navigate the complexities of substance use and its potential to induce psychotic disorders.

Distinguishing Substance-Induced Psychosis from Primary Psychosis

Clinicians face the complex challenge of differentiating substance-induced psychosis from primary psychotic disorders. This distinction is crucial for determining the appropriate treatment approach.

Key Characteristics

Substance-Induced Psychosis:

• Onset and Duration: Symptoms typically appear suddenly and intensely following substance use. These can last a few hours to days, depending on the substance and amount used.
• Symptoms: Common symptoms include severe paranoia, hallucinations, and delusions. These often manifest violently or with significant agitation.
• Behavioral Indicators: Individuals may exhibit disorganized speech, rapid talking, and incoherence. They might also engage in dangerous behaviors prompted by their delusions.
• Common Substances: Amphetamines, cocaine, cannabis, and certain prescribed medications like steroids are typical triggers.

Primary Psychosis:

• Onset and Duration: Symptoms generally develop more gradually and can persist indefinitely without treatment.
• Symptoms: While similar to substance-induced psychosis, the symptoms of primary psychosis often include a broader range of cognitive deficits and persistent dysfunction.
• Behavioral Indicators: Continuous disorganized thinking, a long history of unusual behaviors, and cognitive impairments are more indicative of a primary psychotic disorder.
• Substance Use: While substance use may be present, it does not cause the psychosis but may exacerbate pre-existing symptoms.

Diagnostic Approach

1. Detailed Patient History:

• Clinicians gather comprehensive information about the patient's substance use history.
• They check for the timing of symptom onset in relation to substance use.

2. Physical and Mental Health Assessment:

• Physical exams and lab tests help rule out medical conditions that could mimic psychosis.
• Mental health evaluations ascertain the persistence and nature of psychotic symptoms.

3. Observation of Symptom Timeline:

• Reviewing patterns over time helps identify whether symptoms are short-lived (substance-induced) or protracted (primary psychosis).

4. Collateral Information:

• Information from family members, friends, and other healthcare providers offers additional context that supports an accurate diagnosis.

By meticulously assessing symptom onset, conducting detailed evaluations, and gathering collateral information, clinicians can better distinguish between substance-induced psychosis and primary psychotic disorders. This distinction is vital for implementing effective treatment plans and improving patient outcomes.

Can the Brain Heal from Psychosis?

Psychosis can lead to significant changes in brain structure and function. Research shows that primary psychotic episodes can result in shrinkage in specific brain areas and disruptions in connectivity. These changes can affect processing speed and cognitive abilities.

Effects of Transient Psychosis

For transient psychosis, particularly those induced by substances, evidence suggests that most individuals experience no lasting brain damage. However, the situation becomes more complex depending on the context:

• Substance Use: Long-term or early-age use of substances can potentially alter brain functions, increasing the risk of chronic conditions like schizophrenia or bipolar disorder.
• Synthetic Substances: The long-term impact of highly potent, illicit synthetic substances on brain health remains unclear due to limited research. Nonetheless, caution is advised.

Predisposition and Vulnerability

An episode of substance-induced psychosis can reveal an underlying predisposition to schizophrenia, particularly in individuals with a family history of mental illness. It's important to note that while the substance might trigger psychosis, it does not directly cause schizophrenia. Instead, it activates a genetic vulnerability.

Healing and Recovery

The potential for the brain to heal from psychosis depends on various factors, including the nature and duration of the psychosis, the individual's overall health, and the presence of any underlying vulnerabilities. The brain has a remarkable ability to recover, especially with proper medical treatment, lifestyle changes, and support.

In summary, the brain can often heal from psychosis, but the extent of recovery varies based on individual circumstances and the specific causes of the episode.