Psychosis is a term applied to a specific group of symptoms that indicate a person has lost contact with the real world. It is not a diagnosis in itself. Numerous different types of disorders are associated with the development of psychosis.
What Is Psychosis?
Any person diagnosed with any form of psychosis is undergoing a serious change in their emotional and mental functioning, but a diagnosis of psychosis is always associated with a diagnosis of some other physical or mental health condition that is believed to be causing the psychotic state. The primary symptoms of psychosis include the experience of hallucinations and delusions.
Hallucinations are the perception of different types of sensory stimulation when that sensory stimulation does not exist. For instance, individuals who suffer from hallucinations will often hear, see, or feel things that are not really present. The hallucinations that occur as a result of stimulant use and abuse can occur in any modality but will very often be visual hallucinations or auditory hallucinations.
Delusions refer to very rigid and fixed beliefs that are most likely not true. In some cases, there may be some truth to delusions, but they become so exaggerated that they are unrealistic. For example, somebody with a somatic delusion may actually have some type of physical condition (see below), but the delusion exaggerates any real condition significantly.
There are a number of different categories of delusions.
- Paranoid delusions are of a persecutory nature, such that the person believes someone is abusing them in some manner.
- Grandiose delusions involve beliefs of having some exceptional ability or personal quality, such as having extreme wealth, being royalty, or being all-knowing.
- Referential delusions are fixed beliefs that events in the environment are directed at the person. The person may believe that the TV or radio is talking to them, other people are talking about them, or news headlines are about them.
- Somatic delusions are delusions of a physical nature, such as a person thinks they have some disease or that bugs may be crawling on their skin.
Very often, people experiencing any form of psychosis are not aware that these beliefs or sensations are not real. This even occurs in individuals who are using drugs, although in some individuals, there may be a period where the person recognizes that voices, visions, or beliefs are the result of their drug-related activity.
The development of psychosis in individuals who use different types of drugs is relatively more common than most people believe, even in people who use certain drugs for medicinal reasons. The American Psychiatric Association (APA) has different types of diagnostic criteria for the different types of psychosis that can be induced by drugs.
For instance, according to APA’s diagnostic criteria, an individual who is experiencing psychotic symptoms but is able to recognize that the symptoms are due to their use of drugs or other medications is more likely to be diagnosed with psychosis due to the intoxicationassociated with the substance or due to undergoing withdrawal from the substance. These individuals would be diagnosed with intoxication or withdrawal due to the particular substance involved (e.g., stimulant-induced intoxication or stimulant withdrawal). Individuals who recognize that the experiences they are having are occurring a result of their use of drugs are typically at far less risk than individuals who do not recognize that these experiences result from the use of drugs.
APA reports that the overall prevalence of substance/medication-induced psychotic disorder is not actually known, but it is estimated that between 7% and 25% of individuals who present with psychosis have the disorder.
When the person is not able to ascertain that their psychotic experiences are due to their drug use, they would be diagnosed with a substance/medication-induced psychotic disorder. The features of this disorder include having hallucinations and/or delusions, experiencing symptoms either during the intoxication or withdrawal phase of the stimulant abuse, and that the symptoms are not due to some other conditions, such as another medical disorder or psychiatric condition (e.g., schizophrenia).
Research studies have suggested that the prevalence of psychosis symptoms induced by the use of stimulant drugs may be as high as 50% in individuals who take stimulants recreationally or even for medicinal purposes.
What Substances Cause Stimulant-Induced Psychosis?
The use and abuse of stimulant drugs is known to have the potential to induce psychosis in individuals. The psychosis associated with the use of stimulants like amphetamine has served as a model for understanding severe psychotic disorders, such as schizophrenia. There may be some slight variation in the types of psychotic symptoms that are more commonly produced by different substances, but all stimulants are capable of producing psychotic effects that include issues with hallucinations, delusions, mania, acting erratically, and aggressiveness.
Some of the most common stimulant drugs that produce psychosis are outlined below:
- Amphetamines: The psychosis associated with amphetamine use and abuse has been labeled as amphetamine psychosis. As mentioned above, it has served as a model to understand other psychotic disorders, such as schizophrenia. Some of the drugs classified as amphetamines include drugs that are abused like MDMA, methamphetamine, dextroamphetamine, cathinone, and ephedrine.The more common symptoms of amphetamine psychosis include visual and auditory hallucinations, paranoid delusions, delusions of reference, feelings of grandiosity, mania or hyperactivity, and extreme agitation or erratic behavior. Although most people recover from amphetamine-induced psychosis, research indicates that a small percentage may fail to make a complete recovery.
- Cocaine: Cocaine has the potential to produce temporary psychosis, and research studies suggest that more than half of cocaine users experience some psychotic symptoms. Cocaine users often experience paranoid delusions that are centered on their drug use (e.g., believing that people are watching them use drugs or that they are about to get busted), visual and auditory hallucinations, and feeling like their skin is crawling with bugs (delusional parasitosis with formication, or more commonly known as “cocaine bugs”).
- Methylphenidate: Methylphenidate is the active ingredient in Ritalin and Concerta. It has been used to treat ADHD and other disorders such as narcolepsy. Chronic use of methylphenidate and abuse of the drug can lead to psychosis, which often presents as auditory and visual hallucinations, anxiety, paranoid delusions, confusion, irritability, aggression, and even urges to harm oneself.
- Caffeine: There is evidence that using very high doses of caffeine may lead to stimulant-induced psychosis in some people.
- Others: Some energy drinks, herbal stimulants, and other central nervous system stimulants can lead to stimulant-induced psychosis.
Stimulant-induced psychosis will often demonstrate sensitization, which means that as a person abuses the drug more often or in higher amounts, the psychosis is more likely and often becomes more intense. According to APA and other sources, there may be some other risk factors that can increase the potential to develop stimulant-induced psychosis:
- Age: Elderly individuals are at risk to develop stimulant-induced psychosis because they are often frailer than younger individuals, have a higher potential to overdose on smaller amounts of stimulant medications, and have other coexisting conditions, such as taking numerous medications for various medical conditions or being prone to dementia.
- Drug abusers: Obviously, individuals who abuse drugs will often take them in amounts that are far above recommended dosages for medicinal use, and they will also use very potent dangerous drugs of abuse. Among those who abuse stimulant drugs, many will experience some psychotic symptoms at one time or another during intoxication, withdrawal, or as a result of mixing drugs. Mixing alcohol and stimulants is likely to result in psychotic symptoms.
- Diagnosed mental illness: People who have a diagnosed mental health disorder and abuse stimulant drugs are at an increased risk to develop stimulant-induced psychosis.
- Prior episodes of psychosis due to stimulant use: Once a person has had the experience of psychosis as a result of stimulant use or abuse, any further use of the drug will increase the risk that the person will experience additional psychotic episodes. These will most likely become increasingly more severe as the individual continues to engage in repeated use of the stimulant. Previous psychotic episodes as a result of using stimulant drugs is the strongest risk factor for the development of future psychotic symptoms associated with stimulants.
For many years, it was believed that the primary cause of any form of psychosis was related to increased levels of dopamine in the brain. Most of the evidence for the dopamine hypothesis of psychosis came from treating schizophrenia with drugs that decreased levels of dopamine in the brain and treating Parkinson’s disease with drugs that increase these levels, resulting in individuals developing hallucinations and/or delusions. However, as it turns out, other neurotransmitters may also be involved in psychosis, including serotonin and acetylcholine. Formal treatment of any form of psychosis now addresses numerous different neurotransmitters.
When a person who has been using stimulants begins to experience psychotic symptoms, such as visual or auditory hallucinations, delusional thoughts, manic behavior, and aggression, and they recognize that these symptoms are the result of their use of drugs, they should take the following steps:
- Stop. Stop using whatever drug they have been taking.
- Get help. Immediately seek professional assistance. Call 911.
- Reduce activity and stimulation. Get to an area that is quiet. Stimulating environments exacerbate psychosis, and people who are experiencing psychosis become overstimulated very easily.
- Hydrate. Drink fluids, but avoid alcoholic beverages, caffeine, or beverages with any kind of medication or drug.
- Increase ventilation. Remaining in a stuffy area may exacerbate the condition. Try to remain cool.
One should never attempt to self-medicate by using other drugs, such as alcohol or other types of central nervous system depressants, in order to counteract the effects of stimulants. In addition, the experience of psychotic symptoms as a result of stimulant use is serious, and professional help is needed.
Although the development of psychotic-like symptoms as a result of recreational use of any stimulant drug is not a formal diagnostic sign of a stimulant use disorder, it is very likely that anyone who develops psychotic symptoms has been using dangerously high amounts of the drug, been using it for significant length of time, or both. Individuals who mix other drugs with stimulants are likely to experience psychotic effects, and polysubstance abuse is extremely serious.
Formal treatment for drug-induced psychosis is the use of antipsychotic medications. Physicians will attempt to use an antipsychotic that addresses the particular neurotransmitter the stimulant is acting on, such as dopamine. Physicians will also attempt to give fluids, lower body temperature, control blood pressure, reduce stimulation, and let the person’s natural detoxification process eliminate the drug. Most stimulants are eliminated from an individual’s system due to the normal detoxification process rather quickly. After this occurs, participation in an evidence-based rehab program is recommended.
Finally, it is interesting to note that recent research has suggested that certain types of drug-induced psychosis are associated with an increased risk for the development of severe psychosis in the form of a schizophrenia spectrum disorder later in life. For instance, individuals suffering from cannabis-induced psychosis appeared to have nearly a 30% increased risk to be diagnosed with schizophrenia later. However, the number of individuals diagnosed with amphetamine-induced psychosis that later go on to be diagnosed with schizophrenia was much smaller at only 5%. Studies like these suggest that certain drugs aren’t likely to produce schizophrenia, but individuals who may have a genetic propensity to develop schizophrenia may be more likely to abuse certain types of drugs, particularly early in adolescence.