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Drug-Induced and Other Acute Psychoses in an Emergency-Room Setting
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
There are two other important points about this case. First, this patient, who had no history of psychosis, was floridly psychotic, likely precipitated by abuse and overuse of methamphetamine. Drug-induced psychosis can be quite severe and, in certain individuals so predisposed, occur after even one dose of a substance, depending on the size of the dose. Here, the patient had been using methamphetamine for several days. Drug-induced psychosis can be every bit or even more severe than psychosis not involving an illicit drug and often manifests as acute episodes involving severe delusions, hallucinations, and agitation. Individuals with drug-induced psychosis can be particularly difficult to manage, not only because of the severity of their symptoms, but also because they become inordinately strong, almost in a superhuman way. It is very common for people experiencing a drug-induced psychosis to lose their inhibitions and develop such strength, as exhibited when this patient required several large guards to hold him down so that injectable medications could be administered.
Stimulants and mental health
Published in David B Cooper, Practice in Mental Health—Substance Use, 2018
Richard Orr McLeod, Philip D Cooper
It may be helpful to clarify the differences between substance-induced psychosis and serious and enduring mental illness, as both require different approaches. People using stimulants may experience drug-induced psychosis and will display the usual symptoms of a psychotic episode, but will make a good recovery following reduction of stimulants and the introduction of antipsychotic medication, usually within a few days. The antipsychotic prescription can subsequently be discontinued once symptoms have receded. However, reinstatement of stimulant use may cause a rapid relapse into substance-induced psychosis. In comparison, with serious and enduring mental illness, there is no quick resolution of psychotic symptoms following the abstinence of the substances and the prescription of antipsychotic medication. Both positive and negative symptoms of psychotic illness may also be present and the clinical picture is generally more complex.
Predictors of treatment satisfaction in antipsychotic-naïve and previously medicated patients with acute-phase psychosis
Published in Nordic Journal of Psychiatry, 2019
Lena Antonsen Stabell, Rolf Gjestad, Rune A. Kroken, Else-Marie Løberg, Hugo A. Jørgensen, Erik Johnsen
The participants were recruited from the Division of Psychiatry at Haukeland University Hospital. Inclusion criteria were as follows: Adults acutely admitted for symptoms of psychosis equivalent to ≥4 on one or more of the items delusions, hallucinatory behaviour, grandiosity, suspiciousness/persecution or unusual thought content in The Positive and Negative Syndrome Scale (PANSS) [25]. In addition, an indication for treatment with oral antipsychotic medication had to be present. All included patients met the ICD-10 diagnostic criteria for schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic episode, delusional disorder, drug-induced psychosis and major depressive disorder with psychotic features. Diagnoses were set by experienced clinicians at discharge. Exclusion criteria were: Inability to use oral antipsychotics, a diagnosis of manic psychosis, inability to cooperate reliably during investigations, inability to understand spoken Norwegian language, candidacy for electroconvulsive therapy or being medicated with clozapine on admittance. When diagnosed with drug-induced psychosis, the patients were only included when antipsychotic drug therapy was indicated as their condition did not resolve within a few days after admission. Participants were defined as antipsychotic-naïve if they had not previously been exposed to antipsychotic medication. Participants who were previously exposed to antipsychotic medication are referred to as previously medicated. In this study, being antipsychotic-naïve was considered as a proxy for FEP.
The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service
Published in Issues in Mental Health Nursing, 2018
Adam Searby, Phillip Maude, Ian McGrath
Often, participants described using AOD as being fundamental to their daily lives despite the consequences. For example, one participant described a substantive period of time where he was finally hospitalised for drug-induced psychosis. Despite recognising this as abnormal behaviour, he described continuing to use substances heavily: I started turning into some sort of maniac. I turned into a bloody idiot after a while. Year in, year out, there I am. Roaring out abuse. And primalling [sic] everywhere I went like a maniac… I used to take my football and run through the Botanic Gardens roaring out, like primalling [sic], you know. (P3)
The use of new psychoactive substances (NPS) in young people and their role in mental health care: a systematic review
Published in Expert Review of Neurotherapeutics, 2019
Laura Orsolini, Stefania Chiappini, John M. Corkery, Amira Guirguis, Duccio Papanti, Fabrizio Schifano
A study by Martinotti et al. [36] compared the prevalence of NPS intake between a population of healthy Italian young adults (n = 2,615; aged 18–26-years old) and a psychiatric patient sample (n = 206). They demonstrated that NPS intake (mainly synthetic cannabinoids) was significantly higher amongst the psychotic and bipolar disorder patients. The authors concluded that NPS intake may be a likely factor to facilitate the occurrence of a full-blown development of a psychiatric disorder; alternatively, psychiatric patients may be more prone to approach NPS compounds because these molecules are being perceived as ‘legal’ self-medicating agents [36]. In Japan, a multicentre retrospective survey of NPS products’ poisoning events emphasized the involvement of youngsters; data were relating to 589 patients from 85 emergency facilities. Indeed, most patients were male (89.6%) and young (median age: 30 years; age range: 15–67 years-old). Amongst those hospitalized, approximately 5.3% of patients reported psychosis (hallucinations and delusions), 11% anxiety, 27.3% agitation and irritability; and 1.9% panic attacks [52]. A retrospective review of 388 electronic discharge letters relating to patients released from the Royal Edinburgh Hospital general adult psychiatric wards was carried out [53]. NPS were identified in 22.2% of admissions, determining psychiatric symptoms in 59.3% of the sample. When compared with non-NPS users (mean age 42.5 years old), NPS (mostly synthetic cannabinoids) users appeared to be younger (mean age: 36.1), males and more likely to present with a forensic history. Furthermore, the diagnosis of drug-induced psychosis was significantly more likely in NPS, vs non-NPS, users (p < .001; OR = 18.7, 95% CI 8.1 to 43.0) [53]. A multicentre observational study investigated the prevalence of NPS intake in a youngsters’ (aged 18–26 years) Italian psychiatric sample (n = 617) [53]. About 8.2% (n = 55) of the subjects had ingested NPS at least once in their lifetime, whilst 2.2% (n = 15) had consumed one, or more, NPS over the previous 3 months. Most popular NPS were synthetic cannabinoids (4.5%; n = 30 subjects), and the three most represented psychiatric diagnoses included bipolar (23.1%; n = 15), personality (11.8%; n = 13), and schizophrenia/psychotic-related disorders (11.6%; n = 13) [54]. The mental health issues associated with the use of NPS in a sample of 90, mainly <30 years-old, users admitted to the Ibiza Can Misses Hospital Psychiatric Unit were formally assessed with the help of a range of psychometric scales. Most cases were characterized by poly-substance use (67%), whilst reporting a previous psychiatric history. Both positive (e.g. delusions and hallucinations) symptoms and hostility/aggression issues were frequent among tetrahydrocannabinol (THC) users, whilst anxiety symptoms were more prevalent in the group of sedatives’ users [55]. Finally, a survey-based study was carried out to obtain information on the prevalence of ‘drunkorexia’ (e.g. self-imposed weight control measures combined with alcohol abuse) combined with drug, including NPS, intake in an Italian youngster (aged 18–26) sample (n = 4,275). A significant correlation was described between food restriction, binge drinking behavior, use of cocaine, and NPS use [41].