FactSheet

DruginducedPsychosis
AddictionandMentalHealthResearchLaboratory(AMHRL)

Whatispsychosis?
Psychosisisadisorderinwhichapersonsmentalstateorsenseofrealityisimpaired(QueenslandHealth,n.d.).The conditionisasymptomofseveralmentalillnessesforexampleschizophrenia,depression,andbipolardisorder(Canadian MentalHealthAssociation,2000).

Whatisdruginducedpsychosis?
Druginducedpsychosis,alsocalledsubstanceinducedpsychoticdisorder,isaconditionwherepsychoticsymptomsarise asaresultofdruguse.Symptomsusuallyoccurwhenapersonisintoxicated,butstopwhenthedrugisnolongerinthe body(Poole&Brabbins,1996,p.136).However,symptomsmaylastforseveraldaysorweeksdependingonthetypeof drugthatisused(Poole&Brabbins,1996).Psychoticsymptomsmaypersistorreappearduringperiodsofhigh Termsinbold stressinanindividualslife(Sweeting&Dore,1996).

arefoundin theglossaryon Psychoticeffectscanoccurduringintoxication,withdrawal,andafterwithdrawalsymptomshaveended.The phaseinwhichsymptomsoccurisdependentonwhichdrugsareused(Freudenreich,2007).Frequencyand page3.

durationofdruguseaffectsthelikelihoodofdevelopingdruginducedpsychosis.Prolongeddruguseissaidtobe themaincauseofthedisorder;however,researchershavefoundevidencethatdruginducedpsychosiscanoccurwith moderateandlittleuse(Crieghton,Black,&Hyde,1991,p.714;FraserHealth,2006).

Whichdrugscauseit?
Manydrugscanleadtopsychosisorcausearelapseofexistingpsychoticillness;however,stimulantsandcannabisare oftenassociatedwithpsychosis(seeTable1onpage2).Drugscanalsotriggertheillnessinindividualswhoarevulnerable todevelopingpsychosis(Poole&Brabbings,1996;FraserHealthAuthority,2006).Studieshaveshownthatdruginduced psychosismayoccurbecauseofabiologicalorcognitivevulnerabilitytothecondition(Lichlyteretal.,2008).

Whatarethesymptoms,features,andeffects?
Druginducedpsychosishasthesamesymptomsofnaturallyoccurringpsychosisbutislikeparanoidschizophreniaand sometimesmania(Dore&Sweeting,2006,p.86;seeTable2onpage2).Theonsetofsymptomsisusuallygradualbutcan occursuddenly(FraserHealthAuthority,2006). Thediagnosticcriteriaare(AmericanPsychologicalAssociationDSMIVTR,2000): Hallucinationsordelusionswithinamonthofintoxicationorwithdrawal. Symptomsarenotexplainedbyapsychoticdisorderthatisnotrelatedtodruguse. Symptomsdonotonlyhappenduringdelirium

Themainclinicalfeaturesarehallucinationsordelusionsdirectlycausedbydruguse(DSMIVTR,2000).Increasedriskof relapseanddevelopingotherillnesseslikedepression,anxiety,andmemoryproblemsmayalsooccurasaresultofthe disorder.Longtermsymptomsincludefeaturesofschizophrenia:emotionalblunting,whichisachangeintheabilityto showemotion(Lemon,1992,p.10);andvolitionaldisturbances,whicharechangesthataffectapersonsfreewilland abilitytomakechoices(Dore&Sweeting,2006).

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Table1 Drugtypes,actions,andeffects
(Freudenreich,2007,Table4.1DrugInducedPsychosisp.30;DSMIVTR,2000;GovernmentofCanada,2000;CanadianMentalHealthAssociation,2000)

DrugType

Psychosis During Intoxication Yes

Psychosis During Withdrawal No

Psychosis after Abstinence NotUsually

ActionsandEffects

Cannabis: Marijuana,Hashish,Hashoil, Tetrahydrocannabinol(THC)

Flashbacksmimickingthefeaturesofdrugintoxication afterstoppinguse.Thesearetruehallucinationsthat arelikerealperceptions(Poole&Brabbins,1996; Tucker,2009) Actsbyprecipitatingrelapseofanexistingpsychotic illnessortriggeringpsychosisinvulnerableindividuals (Poole&Brabbins,1996;FraserHealthAuthority,

DepressantsandSedatives Alcohol,Barbiturates, Benzodiazepines,Inhalants/ Solvents Hallucinogens: Lysergicacid(LSD), Phenylethylamine(MDMA, Ecstasy),Phenylcyclidine (PCP) Opioids: Codeine,Heroin,Morphine Stimulants: Amphetamines,Cocaine

Yes

Yes

Yes

Alcoholhallucinosisinclearconsciousnesswithstrong auditoryhallucinations. Deliriumtremensduringwithdrawal(Poole&Brabbins, 1996). Flashbacks

Yes

No

NotUsually (YesPCP)

Notusually Yes

Notusually No

Notusually Yes

None Chronicpsychoticsymptomsthatpersistafterperiods ofabstinence. Likelyoccursinthepresenceofvulnerabilitywitham phetamines(Tucker,2009). Predispositiontofurtherepisodesofpsychosiswith moremethamphetamineuse(Dore&Sweeting,2006)

Table2 Symptomsofpsychosis
(CanadianMentalHealthAssociation,2000;Dore&Sweeting,2006,p.86)

Confusedthoughts Hallucinations:hearing,touch,sight, taste,orsmell Extremesuspiciousness

Fear,panickyoraggressivebehaviour(as areactiontoexperiences)

Believingthattheyarebeingwatched, followed,orpersecutedbyothers Believingthatpeopleareplottingagainst them;actingaggressivelytodefend againstperceivedthreats

Delusionsaboutbeingpersecutedevenin aconsciousmentalstate Cloudedconsciousness,confusion, Disorientation

Feelingthoughtshavespeduporslowed down(CanadianMentalHealthAssocia tion(2000)

Whattreatmentsareavailable?
Antipsychoticsareusedtopreventpsychosisandmaybepairedwithpsychosocialtreatments,likecounselling,tohelppeople learntochangeaddictivebehaviours(Dore&Sweeting,2006,p.86;Greenfield&Hennessy,2008).Somedrugsnegativelyinteract withpsychosismedications;thisputsrecoveringindividualsatriskforcomplicationsandinterruptstreatmentforthedisorder. Therefore,interventiontechniquesshouldincludemonitoringpatientssubstanceuseandeducatingthemabouttheconsequences ofdruginteraction.

Formoreinformation:
Tolearnmore,seeourwebsiteatwww.knowmo.caorvisittheCentreforAddictionandMentalHealthwebsiteatwww.camh.net. 2009AddictionandMentalHealthResearchLaboratory. 2

Terms
Alcoholhallucinosisaconditionthatoccursin310%ofpeoplewithseverewithdrawal;canincludeauditory,visual,ortactile hallucinationsinthepresenceofclearsensorium(Leamonetal.,2008). Amphetaminesasynthetictypeofstimulantdrugthatwasdevelopedtotreatdepressionandobesity.Theyareusedtotreat narcolepsy,ADHD,andParkinsonsdiseaseandincludedextroamphetamineandmethamphetamine(meth).Othertypesinclude khat(anaturaldrugusedrecreationallyinthemiddleeastandAfrica,andmethcathinoneadrugmadeinillegallaboratories (GovernmentofCanada,2000). Barbituratesadrugthatcausesfeelingsofcalm,drowsiness,andwellbeing.Athigherdoses,theycanproducesevereintoxica tion,unconsciousness,coma,anddeath,comparedwithanotherCNSdepressantdrug,theirusecanbelifethreatening(Government
ofCanada,2000,p.15).

Benzodiazepinesdrugsthatproduceasenseofcalmandwellbeingatlowerdoses.Atveryhighdoses,theycancauseeffects similartobarbiturates(e.g.,valium).Theyareprescribedforanxiety,sleepproblems,asmusclerelaxants,todecreasesymptoms ofalcoholwithdrawal,andtocontrolseizures(GovernmentofCanada,2000,p.15). Cannabisahallucinogenthatproducesdepressanteffects(GovernmentofCanada,2000,p.15). Druginducedpsychosisaconditionwherepsychoticsymptomsoccurasaresultofdruguse(Poole&Brabbins,1996,p.136). Deliriumanacutelydisorderedstateofmindincludingincoherentspeech,hallucinations,andfrenziedexcitement,occurringin metabolicdisorders,intoxication,fever,etc.(TheCanadianOxfordDictionary,1998). DeliriumTremens(alcoholwithdrawaldelirium)agitation,tremulousness,autonomicinstability,fevers,auditoryandvisual hallucinations,anddisorientation;develops24daysfromthepersonslastdrink,andtheaveragedurationislessthan1 week(Leamonetal.,2008). Delusionsfalsebeliefsorimpressionsthatarenotbasedonreality(TheCanadianOxfordDictionary,1998). Depressantsandsedativesdrugsthatcauseaslowingdownofthecentralnervoussystem.Atlowdoses,theyproducefeelings ofcalm,drowsiness,andwellbeing.Athigherdoses,someCNSdepressantscanproducesevereintoxication,unconsciousnessand death(GovernmentofCanada,2000,p.14). Emotionalbluntingamarkedreductionintheintensityofemotionalexpression(Lemon,1992,p.10). Flashbacksrecurrenceofthefeaturesofdrugintoxicationaftercessationofdruguse.Thesearetruehallucinations,havingthe qualityoftrueperceptions(Poole&Brabbins,1996,p.136). Hallucinationperceptionofanobjectthatisnotactuallypresent(TheCanadianOxfordDictionary,1998). Hallucinogensdrugsthataffectperceptions,emotions,andmentalprocesses.Theydistortthesensesandcancausehallucina tions(GovernmentofCanada,2000,p.14). Inhalantsdrugsthatproducefeelingsofeuphoria,lightheadedness,exhilaration,andvividfantasies,andalsoslowdownbody functionssuchasbreathing(GovernmentofCanada,2000,p.14). Intoxicationaconditionresultingfromdrugusethatcausesdisturbancesofconsciousness,cognition,perception,affectorbe haviour(Colman,2009). Maniamentalillnessmarkedbyperiodsofgreatexcitementorviolence(TheCanadianOxfordDictionary,1998). Opioidsatypeofdepressantdrugsthatisusedasapainkiller,andcauseseuphoria,mentalclouding,senseofwellbeing,relaxa tion,drowsiness,nausea,contractionsofpupils,decreasedurination,constipation,sweating,itchyskinandslowedbreathing (GovernmentofCanada,2000,p.26). Paranoidschizophreniaatypeofschizophreniacharacterizedbyhallucinations,delusions(Minzenbergetal.,2008). Stimulantsdrugsthatexciteorspeedupthenervoussystem(GovernmentofCanada,2000,p.15). Volitionaldisturbancesmentaldisturbancesthataffectapersonsfeewillorabilitytomakechoices(Dore&Sweeting,2006). Withdrawaltheprocessofceasingtotakeanaddictivedrug,oftenassociatedwithunpleasantandsometimeslifethreatening physicalreactions(TheCanadianOxfordDictionary,1998).

2009AddictionandMentalHealthResearchLaboratory.

Tocitethisarticle:
AddictionandMentalHealthResearchLaboratory.(2009).Druginducedpsychosis.Edmonton,AB.Addictionand MentalHealthResearchLaboratory,UniversityofAlberta.Factsheet.

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