by Oishani Chakraborty
Credits: Maya Twersky
What is Drug Induced Psychosis?
Drug-induced psychosis is a severe mental health condition that occurs as a direct result of substance abuse. This condition temporarily alters a person’s interpretation of the world, leading to experiences that are far removed from reality. According to Ham et al.[1] symptoms frequently elicited by patients with psychosis are hallucination, anhedonia (the inability to feel enjoyment or pleasure), and disruptive executive functions. Disruptive executive functioning relates to the disruption of higher brain functions like planning, attention, motor control etc.
How is it triggered?
Drug-induced psychosis can be triggered by the misuse of various substances, including cocaine, amphetamines, methamphetamines, mephedrone, MDMA, cannabis, LSD, psilocybin, and ketamine. It can occur due to an adverse reaction from mixing different substances, withdrawing from a drug, or taking too much of a certain drug. Psychosis due to substance abuse is a common issue in clinical practice and the propensity to develop psychosis seems to be associated with the severity of use and dependence [2].
Symptoms?
The symptoms of drug-induced psychosis often appear suddenly and intensely and include paranoia and delusions. These symptoms can be more dangerous as the frequency and dosage of the drug increase with dependency. If a person has an underlying mental health condition, then the use of psychoactive drugs will likely worsen their symptoms, resulting in extreme paranoia, and speeding up the likelihood of psychotic disorders such as bipolar disorder and schizophrenia.
What happens in the brain?
It’s thought psychosis may be linked to increased activity of neurotransmitters in the brain. Chronic use of methamphetamine often leads to psychosis, sharing similarities with schizophrenia. This condition, known as methamphetamine induced psychosis (MAP), can persist and may later be diagnosed as schizophrenia. Studies on schizophrenia have shown problems with cortical GABAergic function. A substance is GABAergic if it produces its effects using interactions with the GABA system, such as by causing or blocking neurotransmission. Gamma-aminobutyric acid (GABA) is an amino acid that functions as the main neurotransmitter for the central nervous system (CNS) of the brain. It functions to reduce neuronal excitability.
Although methamphetamine psychosis is a well-studied model for schizophrenia, there is limited research on how methamphetamine affects cortical GABAergic function in this model, and the neurobiology of MAP remains unclear. Yet, there are many propositions for this.
One renowned theory is that excessive glutamate in the cortex harms GABAergic interneurons. Glutamate is a chemical messenger in the brain that plays a crucial role in learning and memory. It is proposed that GABAergic interneurons in the cortex are prone to damage from excess glutamate due to the location of certain receptors, called NMDA receptors, on these interneurons. Impairment of cortical GABAergic function could disrupt cortical signals, leading to psychosis as the cortex is responsible for higher order cognitive functions including perception, memory and decision making. This reinforces the idea that MAP acts as a model for schizophrenia. Recent studies,which estimated effective connectivity from functional magnetic resonance imaging (fMRI) data, reported abnormal patterns of neural activity within specific brain regions and disrupted communication between these regions. [3]
Treatment for Drug-Induced Psychosis
Thirty years ago, schizophrenia patients had to put up with the severe extrapyramidal side effects ( group of movement-related symptoms that can occur when taking certain drugs) since psychiatrists had limited options when it came to old neuroleptics, which are now known as conventional or typical antipsychotics. Modern therapies are more comprehensive, focusing on quality of life and social reintegration in addition to psychotic symptom relief. Early diagnosis started to be crucial to the treatment plan, and curiosity about how long it took for someone to start experiencing symptoms and whether or not that period of untreated psychosis was linked to the course of their illness was growing. Perkins et al.discovered that the degree of negative symptoms on first therapy and the patient's reaction to antipsychotic medication both declined with the length of time the patient went untreated [4]. Since various aberrant brain alterations like increases in white matter volumes, disruption of cortical signals have recently been linked to antipsychotic treatment, using MRI to monitor and identify partial and full resistance to medicine is another intriguing area.
Treatment for drug-induced psychosis often involves a combination of medication and therapy. Antipsychotic medications can help manage psychosis symptoms, while cognitive-behavioral therapy (CBT) can help individuals understand their thoughts and behaviors better. Detoxification and rehabilitation programs can also be beneficial for those struggling with substance abuse. It’s crucial to seek professional help if you or someone you know is experiencing symptoms of drug-induced psychosis. Early intervention can significantly improve the prognosis and help individuals lead healthier lives.
Conclusion
Drug-induced psychosis is a serious condition that can have profound effects on an individual’s life. However, with the right treatment and support, recovery is possible.
Citations:
[1] Ham S, Kim TK, Chung S, Im HI. Drug abuse and psychosis: new insights into drug-induced psychosis. Experimental neurobiology. 2017 Feb;26(1):11.
[2] Jupe T, Myslimi E, Giannopoulos I, Zenelaj B. Drug-Induced Psychosis: Causes, Symptoms, and Treatment. European Psychiatry. 2023 Mar;66(S1):S677-.
[3] Schmidt A, Smieskova R, Aston J, Simon A, Allen P, Fusar-Poli P, McGuire PK, Riecher-Rössler A, Stephan KE, Borgwardt S. Brain connectivity abnormalities predating the onset of psychosis: correlation with the effect of medication. JAMA psychiatry. 2013 Sep 1;70(9):903-12.
[4] Perkins, D. O., Gu, H., Boteva, K., & Lieberman, J. A. (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The American journal of psychiatry, 162(10), 1785–1804. https://doi.org/10.1176/appi.ajp.162.10.1785
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