Drug-induced psychosis is a common and usually temporary mental health symptom. Psychosis is a disconnection from reality that may cause false beliefs called delusions, or false sensory experiences called hallucinations. Psychosis may appear while a person is using drugs or as part of the drug withdrawal process.

The psychotic symptoms associated with drug use can be intense and tend to come on more suddenly and aggressively than psychosis associated with a mental health diagnosis such as schizophrenia.

It can be challenging to distinguish drug-induced psychosis from other forms of psychosis. This is because many people with diagnoses that cause psychosis may also use drugs.

A 2009 study found that 5.2% to 100% of users of amphetamine, cannabis, cocaine, and opioids experienced psychosis. More frequent users and those with more serious drug dependencies were more likely to experience psychosis.

Symptoms of Drug-Induced Psychosis

Many drugs, especially hallucinogens such as LSD, cause hallucinations and delusions. Drug-induced psychosis is a more severe form of these hallucinations. It may appear suddenly in a drug user who has never before experienced psychosis, or it can steadily get worse over time. Psychosis can also occur during drug withdrawal, especially in users with a long history of abuse and dependence.

Any drug that changes brain chemistry, including drugs that don’t typically cause hallucinations as part of the “high,” can cause psychosis. This includes prescription and over-the-counter drugs as well as illicit drugs. Even widely used drugs such as non-steroidal anti-inflammatory drugs can sometimes trigger a psychotic reaction.

Alcohol, amphetamines, phencyclidine (PCP), cocaine, and hallucinogens are among the most common causes of drug-induced psychosis. Symptoms of drug psychosis include:

• Paranoia and terror
• Hallucinations. A person might see, smell, or hear things that aren’t there.
• Delusions. A person may adopt demonstrably false beliefs, such as that a demon is pursuing them.
• Dangerous behavior. A person might attempt to fly, harm themselves because a voice told them to do so, or become a danger to others. Some people who experience psychosis become aggressive.
• Disconnection from other people or from reality. A person may appear catatonic or totally withdrawn.

Drug-related psychosis is distinct from other forms of psychosis in a few ways:

• It appears while under the influence of or withdrawing from a drug.
• It comes on suddenly.
• It is typically more intense than other forms of psychosis.

After the psychosis has passed, treatment may center around helping the person recover from drug abuse and dependency.

Some people experience mixed psychosis. This is when a person has a condition that causes psychosis, such as schizophrenia, and then develops psychotic symptoms from drug use. It can be difficult to treat this form of psychosis, and doctors may struggle to determine which symptoms are due to drugs and which are due to an underlying mental health condition.

People with an underlying condition that can cause psychosis may be more likely to experience drug-related psychosis.

How Long Does Drug-Induced Psychosis Last?

Drug-induced psychosis typically only lasts until the drug has cleared from the body. So heavy drug users may experience longer lasting symptoms because there is more of the drug in their body. In most cases, the psychosis lasts less than a day.

When amphetamines, PCP, or cocaine trigger psychosis, symptoms may last longer—sometimes for several weeks. Long-lasting psychosis may also be due to an underlying mental health condition, such as schizophrenia or bipolar.

Rarely, drugs can change the brain by damaging neurons or altering neurotransmitter levels. This may cause mental health diagnoses such as bipolar or schizophrenia. The mechanism through which drugs cause mental health disorders linked to psychosis is poorly understood. Moreover, because many people with mental health diagnoses use drugs, it is difficult for researchers to assess which mental health conditions merely appear following drug use and which are the result of drug use.

Treating Drug-Induced Psychosis: Recovery

Treatment for drug-induced psychosis usually involves stopping the drug that caused the psychosis and then monitoring the person in a safe and calm environment. Anti-anxiety drugs such as benzodiazepines can help with many symptoms of drug-induced psychosis. Antipsychotics can also help, especially when dopamine-stimulating drugs such as amphetamines trigger a psychotic episode.

It’s not always necessary to give a person medication to counteract psychosis. As long as they are in a safe environment, watchful waiting is sometimes the best strategy, especially when a person has taken a hallucinogenic drug such as LSD or psilocybin mushrooms. Cyndi Turner, LCSW, LSATP, MAC emphasizes the importance of safety when evaluating a situation that involves drug-induced psychosis and explains how to help someone who could be experiencing it:

Safety is the most important factor to consider when someone is experiencing a drug induced psychosis. We need to assess the person’s risk: What are they seeing, hearing, or experiencing? Are they going to hurt themselves? Is there any health risk like elevated heart rate or seizure? Who can stay with them until the effects of the drug have passed? Validate how scared the individual may be and let him or her know that this is unlikely to be a permanent state. While it may feel real to them, it is not actually happening. Once the drug clears their system, they usually go back to normal functioning.

After the psychosis has passed, treatment centers around helping the person recover from drug abuse and dependency. Inpatient addiction treatment, support groups, therapy, medication for underlying mental health conditions, and a supportive drug-free environment can help a person quit using drugs and avoid future episodes of drug-induced psychosis.

When prescription drugs cause drug-induced psychosis, it’s important to find an alternative medication—especially when the drug in question manages a serious medical condition such as a cardiovascular disorder. People with a history of drug-induced psychosis should tell doctors and pharmacists about their history, since one psychotic episode could mean a person is at risk of having future episodes.

A Mental Health Approach to Drug-Induced Psychosis

For many, drug-induced psychosis is a short-term state. It can be frightening, and it may even harm relationships, especially if a person makes rash decisions or becomes abusive because of psychosis. Therapy can help people repair the damage of drug-induced psychosis.

The right therapist can also help a person talk through the issues that led to their drug use. For example, a person might use amphetamines to cope with the low motivation of depression or rely on cocaine to numb the pain of trauma. Therapy can also help people overcome drug addictions and find healthier coping mechanisms.

Occasionally, drug-induced psychosis signals a serious underlying psychotic disorder, such as schizophrenia. When psychotic symptoms don’t disappear within a day or two, it’s important to see a psychiatrist or neurologist who can assess a patient for mental health conditions, neurological disorders, and other diagnoses that may lead to psychosis. Management of these conditions usually means a combination of medication, lifestyle changes, and therapy. In therapy, a person may learn to interrogate their delusions and hallucinations, ground themselves in reality, and cope with any relationship and career challenges of living with psychosis.

References:

1. Ambizas, E. M. (2014, November 17). Nonpsychotropic medication-induced psychosis. U.S. Pharmacist, 39(11). Retrieved from https://www.uspharmacist.com/article/nonpsychotropic-medicationinduced-psychosis
2. Khan, M. A., & Akella, S. (2009). Cannabis-induced bipolar disorder with psychotic features: A case report. Psychiatry (Edgmont), 6(12), 44-48. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144
3. Smith, M. J., Thirthalli, J., Abdallah, A. B., Murray, R. M., & Cottler, L. B. (2009). Prevalence of psychotic symptoms in substance users: A comparison across substances. Comprehensive Psychiatry, 50(3), 245-250. doi: 10.1016/j.comppsych.2008.07.009
4. Tamminga, C. (2018). Substance/medication-induced psychotic disorder. Retrieved from https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/substance-medication%E2%80%93induced-psychotic-disorder
5. What are the long-term effects of methamphetamine abuse? (n.d.). Retrieved from https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-abuse

Schizophrenia is often diagnosed after someone has a psychotic episode. When someone who has had a psychotic episode initially seeks treatment, however, he or she may have had a prolonged duration of untreated psychosis (DUP). This period of time has been theorized to significantly impact later symptom severity and even progression, prognosis, and outcome.

Surprisingly, even though this theory has been introduced and explored, few studies have looked at the relationship between DUP and symptoms via a long-term follow-up. Therefore, Dr. Wing Chung Chang of the Department of Psychiatry at the University of Hong Kong in China recently led a study examining the long-term effects of DUP on executive function in a sample of 93 adults with schizophrenia.

The participants ranged in age between 18 and 55, and were evaluated extensively when they first presented for treatment for psychosis. They were followed up with several other assessments over the course of the next three years. Chang measured executive functions and looked at various aspects of cognitive function and memory.

The results revealed that when compared to nonpsychotic control participants, the participants with psychosis had large deficits in areas of memory. Chang found that visual memory was especially impaired in the participants with psychosis and that verbal memory continued to experience deficits over the three-year period. Additionally, the length of DUP was directly predictive of symptom severity and outcome at three years.

Chang believes this study supports other research that demonstrates a link between DUP and illness outcome. The longer an individual experiences psychosis, the more likely they are to have a worse illness trajectory, more severe symptoms, and more impairment to cognitive capacities. Chang said, “Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes.”

In sum, this study extends existing research into this topic by demonstrating the long-term negative effects of psychosis on cognitive function, especially verbal memory. Future work could fortify this area of research by extending the study duration even further and by examining particular shifts in cognitive deficits and how they relate to DUP.

Reference:
Chang, W. C., et al. (2013). Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: A 3-year prospective follow-up study. Psychological Medicine 43.9 (2013): 1883-93. ProQuest. Web.

One of the first signs of schizophrenia is a psychotic episode. Symptoms of psychosis can appear weeks, months, or even years before a psychotic episode requiring medical attention. Because psychotic symptoms can appear suddenly or more subtly, the duration of untreated psychosis (DUP) varies from individual to individual. Likewise, the acute onset or subtle onset of symptoms can also impact whether symptoms become severe (SC) or persist as less severe (NonSC). Schizophrenia can be difficult to treat, but many people who receive care for symptoms are able to achieve remission within the first few months. However, relapse is not uncommon and estimates point to a nearly 75% relapse rate within the first five years of treatment.

Nobuhiso Kanahara of the Department of Psychiatry at the Graduate School of Medicine at Chiba University in Japan wanted to explore how symptom severity, DUP, and mode of onset (MoO) of symptoms, either subtle or acute, affect long-term illness prognosis. To do this, Kanahara conducted a 10-year study involving several hundred participants treated for psychosis at a psychiatric hospital. The participants were assessed at initial intake for symptom severity, MoO and DUP. These factors were evaluated and measured against treatment outcomes and future diagnoses of schizophrenia.

The results revealed that although the DUP did not differ significantly between participants with SC and NonSC participants, those with acute onset had much shorter DUPs than those with more subtle MoOs. Further, those with subtle MoO, although they did not have more severe symptoms than acute MoO participants, did have poorer overall global functioning in the long-term. In other words, the subtle MoO participants had both longer DUPs and poorer illness prognoses than those with acute MoO.

Kanahara believes that acute and sudden psychosis can lead to more prompt medical attention and therefore, better treatment outcome. Individuals with more insidious MoO, on the other hand, may have symptoms that go unnoticed for a long period of time. In fact, in this study, the DUP for MoO was over three years at its longest, suggesting a chronic psychotic state than can lead to poorer overall outcomes.

Kanahara said, “Taken together, these results indicate that the initial positive symptoms do not act definitively as a prognosis predictor.” However, DUP and MoO appear to be strong indicators of overall illness outcome and therefore, should be examined more closely in clinical assessments and trials.

Reference:
Kanahara, N., Yoshida, T., Oda, Y., Yamanaka, H., Moriyama, T., et al. (2013). Onset pattern and long-term prognosis in schizophrenia: 10-year longitudinal follow-up study. PLoS ONE 8(6): e67273. doi:10.1371/journal.pone.0067273

When a psychiatric client is in remission, it usually means that he or she is no longer experiencing clinical levels of symptoms related to the original issue. For instance, people with depression may be classified as being in remission when they have more periods of positive affect than negative affect, when they do not ruminate and when their eating and sleeping patterns return to normal. However, according to a recent study led by Rico S. C. Lee of the Clinical Research Unit of the Brain and Mind Research Institute at the University of Sydney in Australia, individuals who meet clinical thresholds of remission may not simultaneously achieve cognitive levels of remission.

Research in the area of cognitive remission is scant. Some studies show that cognitive deficits rebound at the same time symptoms decrease, while others reveal that clients who are in remission from symptoms still report feeling impaired in specific areas of their lives. To determine if cognitive deficits persisted in the absence of clinical symptoms, Lee assessed the cognitive capacities of 93 young adults with psychosis, depression, or bipolar at baseline and approximately two years later. The results revealed a direct relationship between cognitive and functioning and later impairment. In this study, the participants who had stronger cognitive abilities at baseline had higher rates of employment, better qualities of life, fewer disabilities, and more satisfaction in relationships than those who had cognitive impairments.

Visuospatial, working, and verbal memory, along with the ability to switch attention at baseline, were all predictive of better global functioning two years later. Lee noted that cognitive functioning at baseline did not predict symptomology at baseline or later on, and baseline symptoms did not predict later symptom severity or cognitive functioning. This suggests that clinical symptoms and cognitive functioning affect the course of these illness in unique and independent ways. Lee added, “Taken together, these results strongly suggest that a traditional, or sole, focus on symptom factors is inadequate in characterizing prognosis and recovery.”

Reference:
Lee, R.S.C., Hermens, D.F., Redoblado-Hodge, M.A., Naismith, S.L., Porter, M.A., et al. (2013). Neuropsychological and socio-occupational functioning in young psychiatric outpatients: A longitudinal investigation. PLoS ONE 8(3): e58176. doi:10.1371/journal.pone.0058176

There are several unique symptoms that occur in psychosis and schizophrenia. People with these psychological problems often report being hypersensitive to sounds and scenes. Their cognitive resources become distracted and aroused by seemingly mundane background noise and they have difficulty focusing on visual cues and performing relatively easy cognitive tasks as a result. This aspect of schizophrenia has just now begun to be explored in depth. In an effort to extend the existing research, Jason Smucny of the Neuroscience Program at the University of Colorado recently conducted a study measuring the neurological processes that occur during an easy and difficult task among 21 participants with schizophrenia and 23 with no history of psychosis.

All of the participants underwent magnetic resonance imaging (MRIs) while they performed both easy and difficult tasks that required varying degrees of visual and cognitive attention. While they were completing their tasks, the participants were also exposed to what would be considered normal urban sounds, such as the sound of a train or cars on the streets. The results revealed that the participants with schizophrenia had increased neural activation in specific brain regions that impaired their ability to focus on even the easy tasks. They performed far worse on both sets of tasks than the participants without psychosis. Additionally, the schizophrenic group had slower reaction times as a direct result of the auditory distraction.

Sensory overload, such as the kind evidenced in this study, can have a significant impact on the global functioning and quality of life for people with schizophrenia. They may be unable to perform normal activities, especially in social environments, such as reading street signs, following directions, or communicating with others. These deficits can encroach on other domains required to function at optimal levels, further impairing quality of life. Smucny said, “This work is the first to demonstrate that previously reported auditory processing abnormalities may be associated with neural response changes during cross-modal, visual attention tasks in schizophrenia.” Future work should examine ways to minimize auditory distractions that occur in psychosis and schizophrenia.

Reference:
Smucny J, Rojas DC, Eichman LC, Tregellas JR (2013). Neural effects of auditory distraction on visual attention in schizophrenia. PLoS ONE 8(4): e60606. doi:10.1371/journal.pone.0060606

In recent years, support of psychodynamic psychotherapy for the treatment of schizophrenia spectrum and other forms of psychosis has diminished. This is not entirely a result of lack of validity or efficacy, but rather an investigative shift from traditional methods of therapy to more novel approaches. However, according to a recent study led by Bent Rosenbaum of the Department of Psychology at the University of Copenhagen in Denmark, psychodynamic therapy is still one of the most effective forms of treatment.

Rosenbaum compared treatment as usual (TaU) to TaU with supportive psychodynamic psychotherapy (SPP) in a sample of 269 adults admitted for psychosis. The participants were measured for global functioning and symptom severity before, during, and after the two-year treatment period. Rosenbaum found that the SPP group improved far more than the TaU group with respect to all levels of functioning and symptoms of psychosis. Over the course of two years of treatment, there were significant gains on social functioning and significant decreases on maladaptive symptoms for the participants in the SPP group.

These findings demonstrate that psychodynamic therapy and the core elements associated with that approach can still adequately serve the needs of many individuals with schizophrenia and other psychotic issues. Rosenbaum believes that when working with psychotic clients, clinicians should focus on the fundamental aspects of psychodynamic therapy. This includes overcoming obstacles to emotional processing, mental functioning relating to sense of self, and the development and maintenance of relational bonds. Cognitive development and attention to the present should also be incorporated to ensure maximum benefits for clients who struggle with these issues.

Rosenbaum hopes that this research will bring clinicians back to SPP and approaches of that kind. “It furthers recovery when it is used as a supplement to medical and social treatment modalities.” He added, “SPP should thus be taken into account as a modality in future research and treatment.” Doing so will open avenues of treatment for clients with varying levels of mental illness.

Reference:
Rosenbaum, Bent, Susanne Harder, Per Knudsen, Anne Koster, Anne Lindhardt, Matilde Lajer, Kristian Valbak, and Gerda Winther. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes 75.4 (2012): 331-41. Print

My last piece on focusing ended with a definition of felt sensing as a “temporary wave, from the sea of being” (Madison, G.). What is meant by a temporary wave from the sea of being?

It is time to introduce Gendlin’s conception of human being. Note that I said “human being,” not “a human being.” For Gendlin, human being is “interbeing”—what we think of as an individual being is a “livings in the world, and living with” (Gendlin, 1978-79). He calls this principle Interaction First.

Gendlin conceives of human beings experientially not as separate “things” in interaction with each other. More radically, he sees our environments and us as a continuous co-creative process. We are not “inside our skins, but are our living-in the world, and living-with others” (Gendlin, 1978-79). Even our physical being is a continuous process with its inner and outer environments. Hence, in his view, it is impossible to conceive of human being as a separate entity. We are interbeing.

What is a living body such that it has the intricacy of our situations? … With the old concepts, people might say that Focusing is “subjective.” But clearly, if the situation is carried in the body, then a felt sense is not subjective. Objective then? No, also not, since “objective” means the units and patterns to which science limits anything it studies. We could fashion a new sentence that is neither subjective, nor objective, nor both: The body IS an interaction process with the environment, and therefore the body IS its situations. The body isn’t just a sealed thing here, with an external situation over there, which it merely interprets. Rather, even before we think and speak, the living body is already one interaction process with its situation. The situation is not out there, nor inside. The external “things” and the subjective “entities” are derived from one single life-interaction process (which they always bring along with them). (Gendlin 2004)

This is a radical view and paradigm shift that is difficult to absorb. We are used to thinking about ourselves and the environment “around us” through the lens and language of a Cartesian world. We are imbued with philosophical assumptions idealizing objectivity and neutrality and a mechanistic relationship of mind over body. For example, we may have heard of such concepts as the “observer effect,” yet we go about living in a way that leaves context out of the equation.

For Gendlin, the making of meaning is a pluralistic, contextual, constructed process; it is changing and dynamic, not static and eternal (Mitchell, 1993). Our lived bodily sense of things is a function of our interbeing, and our capacity for felt sensing extends us beyond the confines of our delimited physical body.

Recall that I started my first piece by saying that you have within you—“beneath” your everyday practical use of language—another dimension, an inner language that is an imagistic dialogue between you and your immediate experiencing. It is you speaking to yourself (and listening to yourself) in your own code. Gendlin calls it the zigzag between the everyday use of language and the way we may actually hold our experiencing in a bodily felt way.

Gendlin says that this kind of processing exists preconceptually, beneath our everyday use of language and concepts and the assumptions we have about how the world works. In focusing, we find our own language and meaning that is in fact much more specific and precise than our usual use of language. We find language from the sea of our being.

A client with a traumatic history sits quietly, with eyes lowered, pausing to find a way to articulate why his time in boarding school (60 years ago!) is still so meaningful to him. His life before boarding school was consumed by his father’s collapse into psychosis. He is sensing into the situation regarding boarding school—without any explicit reference to his catastrophic childhood history. After a full few minutes of silence, he finds one word that fits: Life at boarding school was “manageable.” At the point that he says “manageable,” tears come to his eyes. He doesn’t know why, but his felt sense tells him, preconceptually, that “manageable” feels right.

The therapist, attuning to her client, takes in “manageable” and acknowledges it. As it resonates within her, she realizes how much is contained in this word “manageable” for her client. Then she drifts into her own felt sense of his childhood and finds ‘unmanageable’ experientially embedded in the world of her client’s meaning making, the therapist quietly offers the newly emerging word “unmanageable” without any reference to his history, and the client considers it.

A few moments later, the client’s full catastrophe of life with his father’s illness impacts him, but in a different way. His therapist has offered a word that touches into his world precisely and with great specificity. What is captured here in two words—manageable and unmanageable—is much more than the common meaning of these words. The client is referring to the experiential world of living-with and living-in his father’s psychosis, as well as to the emergent significance of what boarding school provided for him. The unmanageable and the manageable.

 Notice that the felt sensing came first. With “manageable,” he has begun to capture the world of his experiencing—the profound relief of finding himself for the first time in a world that he could handle (boarding school). Then “unmanageable” is intoned, and he resonates with the years of struggling with the catastrophe of his father’s psychosis. “Manageable” arose as a temporary wave from the sea of being. “Unmanageable” emerged from their shared sea of being.

And this shared moment deepens their therapeutic journey.

References

1. Gendlin. E. T. (1978-79). Befindlichkeit: Heidegger and the philosophy of psychology. Review of Existential Psychology & Psychiatry 16, 43-71.
2. Gendlin, E.T. (2004). Five philosophical talking points to communicate with colleagues who don’t yet know focusing. Staying in Focus. The Focusing Institute Newsletter, 4 (1), 5-8. From http://www.focusing.org/gendlin/docs/gol_2187.html
3. Madison, G., www.gregmadison.net.focusing_way_being.
4. Mitchell, Stephen A. (1993). Hope and dread in psychoanalysis. New York: Basic Books, pp. 285.