Blog 13 4/28/2024
Drug-Induced Psychosis
This type of psychosis comes with abuse of substances. When street marijuana is combined with alcohol, the effects are magnified. This combination can result in psychosis symptoms of voices, paranoia, and visual hallucinations. Incidents of participants were worse if they started abuse in adolescence and continued into young adulthood.
Research into drug abuse and psychosis has determined that there are genetic loadings that initiate psychosis. The National Institute of Health (NIH, 2022) published an article that examined twins who had genetic tracers for schizophrenia, schizoaffective disorder, and bipolar disorder. The overlapping genes found between disorders were indicated at 0.6. Those who have a family history of these disorders carry a risk factor that can influence the presentation of symptoms from drug abuse.
The National Institute of Drug and Alcohol (NIDA) indicates that the amount of drug used, age, and genetics can influence the damage to the brain. Marijuana and other drugs have been linked to psychiatric disorders, especially with those who have a genetic vulnerability (National Institute of Health, 2022)
Drugs and in particular marijuana interact with neurochemicals in the blood that affect brain activities and alter them. These changes result in mental illnesses. Acute psychotic reactions have been found in those who don’t have schizophrenia, but for those who do have schizophrenia, it made it worse.
Participants who abuse substances over the years develop an addiction pattern. Brain images from Magnetic Resonance Imaging (MRI) show holes in the brain and shrinkage when compared with another who is sober. Brain scans show damage after substance abuse for over one year. Different parts of the brain are affected by substance use, most commonly the pre-frontal cortex which helps plan and make decisions. (NIH, 2022)
Sober participants talked about the after-effects of their addiction. Street marijuana was compared to the past and participants were amazed at how much stronger the three types were on the street. One participant stated “Oh come on, it’s just marijuana. It’s safe.” The group discussed how marijuana caused their voices to get louder and the paranoia to get more intense.
One participant nodded in agreement to experiencing paranoia, hallucinations, and delusions. Some participants had visual hallucinations that were scary. A participant who had experiences of long-term drug abuse that included marijuana developed catatonia and was an inpatient in the mental health unit for an extended period.
Another participant who used medical marijuana for pain treatment had social anxiety. “I feel like people will judge me if I go to the neighborhood potluck.” This high level of anxiety climbs into paranoia. This is a difficult area for treatment, as people seek pain relief and then encounter paranoia, a different symptom that they didn’t anticipate.
Catatonia
Catatonia is a rare neurological occurrence that affects behaviors and motor functions. It’s a collection of symptoms that affect movement, the five senses, motivation, memory and concentration, emotions, judgment, and self-control. People can become agitated without being provoked and without reason. Alertness or awareness appears to be dulled and some may not express pain if pinched.
Changes in movement include repetitive actions such as hand or finger swirls, or constant rubbing on the body. Sometimes people appear to freeze and hold body or facial positions and are unable to initiate movement to move. Other symptoms may be exaggerated movements not typical of the usual action.
It can affect voice where they may become mute or may mimic the sounds or movements of another person. Mutism occurs voluntarily and is not associated with aphasia.
Treatment for catatonia includes medications, and emergency ECT can be used to stop the process. Education about the disease, medications, and coordination of care with a psychiatrist are helpful for stabilization. Therapy may be introduced to help manage symptoms.
Psychosis and Cannabis:
Some people have genetics that can cause them to develop psychosis when they use cannabis regularly. “Only a few specific gene-environment combinations that lead to increased risk of psychosis have been identified to date. An example of replicable gene-environment interaction is a common polymorphism in the AKT1 gene that makes its carriers sensitive to developing psychosis with regular cannabis use” (Zwicker, Denovan-Wright, & Uher, (2018).
Psychosis and Sleep:
By definition, hallucinations occur only in the full waking state. There are similar hallucinations that occur during sleep-related states of mind. These experiences are hypnagogic and hypnopompic hallucinations, dreams, and parasomnias. The majority of hallucinations depend on Rapid Eye Movement (REM) processes or REM intrusions into waking consciousness. (Waters, Blom, Dang-Vu, Cheyne, Alderson-Day, Woodruff, & Collerton 2016).
These hallucinations can involve many different senses in a dream-like state of mind, where people might see or hear something, or experience something unusual. Participants talked about different types of hallucinations and their physical health symptoms.
Hypnopompic Hallucinations: Awaking from Sleep
A hypnopompic state is the state of consciousness leading out of sleep. Hypnopompic hallucinations contain images or situations, mostly from the state of dreaming, which are confusing, frightening, or nonsensical. These hallucinations can last from seconds to minutes, including the paralysis state, and can cause panic attacks.
Hypnogogic Hallucinations: Going to Sleep
Hypnogogic hallucinations describe vivid dreamlike auditory, visual, or tactile sensations, which are often accompanied by sleep paralysis and experienced when falling asleep. Hypnogogic is the experience of the transitional state from wakefulness to sleep: the hypnagogic state of consciousness, during the onset of sleep.
Hallucinations that may occur during this "threshold consciousness" phase include lucid thought, lucid dreaming, hallucinations, and sleep paralysis. Sleep paralysis and lucid dreaming are separate sleep conditions that are sometimes experienced during the hypnagogic state (Suprakash 2010); (De Leede-Smith, Barkus 2013).
Auditory Hallucinations
The group discussed hallucinations that they noticed over the years and compared their memories to each other. Participants talked about drug-induced psychosis and trauma that created hallucinations. Conversations around grief and loss included hallucinations.
Hallucinations and specifically hearing voices can be a normal experience and be potentially experienced by anyone. (Morrison, 1998). Hallucinations can occur from drug-induced confusion states such as LSD, cocaine, alcohol withdrawal, and others (Kingdon & Turkington, 1994). Auditory hallucinations have started in connection with sexual abuse. (Read & Argyle, 1999).
Traumatic events experienced in war or combat are associated with hearing voices and include being held hostage (Siegal, 1984), sleep deprivation (Oswald, 1974), sensory deprivation (Vernon, 1963), and solitary confinement (Grassian, 1983). A large minority of college students (37-39%) reported experiencing such phenomena (Barrett & Etheridge, 1992). From studies of bereavement in older adults, (Elsaesser, Roe, Cooper, E& Lorimer, D. (2021) found that 82% experienced hallucinations or illusions in the first month following bereavement. Surveys done by Romme, Honig, Noorthoorn, & Escher (1992) in the Netherlands found that 39% of those responding to a TV request for subjects experiencing auditory hallucinations were not under the care of a psychiatrist when 173 people responded to their request (Morrison 2004).
Positive and Negative Symptoms of Schizophrenia and Schizoaffective Disorder
Schizophrenia and Schizoaffective Disorder have two classes of symptoms. Positive symptoms include active hallucinations, delusions, or paranoia. These are part of the psychosis that require a reality check, medications, and a supportive team.
Negative symptoms can be disabling and are difficult to treat with medications. The disease characteristics can change over a lifetime. Therapy skills have helped with reducing the negative symptoms. Knowledge of these symptoms is helpful to work against the negative symptoms and to reduce their impact on daily living skills. The negative symptoms are poorly understood, and people may think a person just has low energy or is apathetic.
The group discussed how they experienced negative symptoms. They compared their medications and skills with others and got ideas of how to manage the negative symptoms.
Alogia: impoverished speech, lack of expression, loss of ability to generate thoughts and speech
Anhedonia: unable to feel pleasure, enjoyment, or interest
Avolition: unable to initiate actions
Asocial: no interest in social or community activities
Anosognosia: no acknowledgment of psychosis symptoms or neurological deficits
Amotivation: no desire to do any self-care or chores
Other mental illnesses can also show the negative symptoms. When people get clinically depressed, they slow down, have low motivation, and interest, and have no desire to initiate actions. They have difficulty doing their self-care: basic hygiene like taking a shower or brushing their teeth; and doing regular chores around the house. This can occur with Major Depression, Bipolar Disorder, and schizoaffective disorder.
Anxiety Induces Verbal Hallucinations
Chronic levels of stress and anxiety can activate psychosis symptoms and are linked to hearing voices. A participant talked about experiencing abuse over the years and how hallucinations developed. Anxiety triggers the voices and shapes their content. The voices heard are aggravated by anxiety and it alienates the person from the actual message. Voices can become more critical and insulting, creating more distress. The voices are perceived as sometimes hearing and sometimes as thinking them.
Depression and anxiety are usually present first before the onset of the voices. Anxiety is the most common emotion present when people hear voices. Increases in anxiety started the voices of participants in a research study by Ratcliffe & Wilkinson (2015). When anxiety begins, the person experiences a highly charged perception of the thought and pays attention to it more than a regular, mundane thought. The person feels powerless over the voices and their negative self-evaluations.
Heightened anxiety levels increase the stress hormone cortisol. The body has fluctuations in cortisol throughout the day and different parts of the brain help regulate it. When chronic stress and anxiety continue, it can affect mental and physical health. Ongoing stress creates burnout, depression, and PTSD. Chronic anxiety and stress impair physical health and create disorders such as chronic fatigue, high blood pressure, heart disease, and lowered immunity systems. The body becomes unable to monitor the stress-related cortisol level.
Anticipation of one’s thoughts can generate a feeling of them being “alien.” Anxiety increases an unfamiliar state where misperceptions begin. With higher levels of distress, people reported that the voices threatened and insulted. These experiences occur in schizophrenia, but also with other disorders such as social anxiety.
Anticipation of the voices becomes problematic when the person creates a habit of reacting in a distressful manner. Anticipation and response results in different presentations of the voices. Participants talked with others about multiple psychosis symptoms that occurred with voices or thought insertions, both due to anxiety Ratcliffe & Wilkinson (2015).
Anxiety interrupts and aggravates the interpretation of emotions and intentions. This causes more distress because anxiety suddenly and unexpectedly appears, and it interferes with the thought process. Stronger feelings of anxiety or memories associated with shame can be accompanied by voices that insult and criticize. Participants talked about feeling helpless and yelling or screaming at voices or sleeping all day long.
The participants explained how their voices grew louder when they were stressed and overwhelmed. The voices can be explained as an experience between thinking and hearing something internal in origin (Ratcliffe & Wilkinson 2015). One person described the voices as sounding like demons with robotic voices. The person described how the voices told them they were evil.
Many emotions can be associated with the voice-hearing event including fear, excitement, curiosity, or hope. Emotions are intentional states where one is making a judgment. Voices can be perceived as something immensely powerful to people. They can be negative, emotional, and intrusive.
Thought insertion is the idea that one’s thoughts are not their own but belong to someone else. Some participants have described voices inside their brains, but the voices are not their thoughts. Others described it as telepathy and a knowing of the content of the thoughts. The phenomenon is similar to voices. The perception of the voices and the thought insertion is not imagination, but real for them. Sometimes it’s related to past trauma.
Comforting Voices
The participant talked with the group about conversing with their voices and being able to anticipate the conversation. One participant said they conversed with their voices when they were alone and felt comforted. Another talked about not wanting some medications because the voices helped them feel at ease. Another participant said that they had comforting voices and liked them.
A participant talked about a relative who reminded them that others couldn’t hear the entire conversation and stopped. The group discussed anxiety and mindfulness and how the practice helped lower anxiety. The group talked about anxiety levels weeks after practicing mindfulness and how they felt calmer after practicing for weeks and months.
Being aware of past shame, guilt, humiliation, threats, and helplessness can explain the presence of voices. Working through shame and guilt with an individual therapist can help decrease trauma issues and affect psychosis symptoms.
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