October 2005

What exactly is Psychosis and can drug use lead to psychosis in teenagers?

Psychosis is a mental disorder in which there is a significant disturbance in a person's ability to think clearly, respond emotionally, communicate effectively, understand reality, and behave appropriately. The individual experiences symptoms such as delusions, hallucinations, or disordered thinking that indicate impairment in their sense of reality.

• Delusion: A false, fixed, odd, or unusual belief firmly held by the individual. The belief is not ordinarily accepted by other members of the person’s culture or subculture. There are delusions of paranoia (others are plotting against them), grandiose delusions (exaggerated ideas of one's importance or identity), and somatic delusions (a healthy person believing that he/she has a terminal illness) 1.
• Hallucination: Hearing, feeling, smelling or tasting something that is not actually there.
• Thought Disorder: Confused or blocked thinking. The person may have difficulty concentrating, following a conversation, or remembering things. Thoughts sometimes seem to race or slow down.

Approximately one percent of the general population and at least two percent of adolescents suffer from psychosis 2. Psychotic symptoms can be seen in teenagers with a number of serious mental illnesses, including depression, bipolar disorder (manic-depression), and schizophrenia.

Psychosis can also occur following some forms of drug abuse. When psychotic symptoms result from the use of a substance, the condition is called “substance-induced” psychosis. Amphetamines, LSD, and marijuana are among the substances associated with the occurrence of psychotic symptoms in adolescents. Also, recent research has also found that the link between drug use and psychosis is much stronger in young people who have a predisposition for developing psychotic illness 3. These findings are disturbing given the fact that substance abuse becomes much more frequent during adolescence.

How do you know whether psychosis is substance-induced?

Diagnosing substance-induced psychosis can be challenging. It is often difficult to determine whether the symptoms are the result of drug use or whether they stem from an underlying psychotic illness such as schizophrenia. A doctor may determine that the individual is experiencing a substance-induced psychosis if:

• the individual experienced psychotic symptoms within a month after using the substance,
• the symptoms were not present before the substance was taken,
• the severity of the symptoms are consistent with the amount of substance taken,
• the psychotic episode is relatively short (i.e. it does not continue for more than a month after withdrawal of the substance).

 What is the treatment for substance-induced psychosis?

Treatment for substance-induced psychosis involves a combination of medication and psychotherapy. Antipsychotic medications should be started as soon as possible to help the most disturbing symptoms. Anti-depressant and anti-anxiety medications are also available for treating any accompanying anxiety, stress, or depression. It may be necessary to continue medication for such accompanying issues once the psychotic symptoms are gone. In addition, medications to treat substance withdrawal may be needed, depending on the individual’s substance use history.

Cognitive Behavioral Therapy (CBT) is another important treatment that can be used in combination with medication or on its own. CBT can be useful for treating delusions; discussing contradictory evidence for a false belief with the individual might help him or her overcome the delusion. CBT is also used widely to treat substance dependency. Substance abuse counseling may also be a crucial treatment component, particularly if the individual has a history of drug abuse. Lastly, family therapy can be an important part of the treatment package.

What can parents and other family members do to help?

If you are with a person when they are psychotic and behaving strangely, you may feel frightened or frustrated. It is important to remember that this person is still your son, daughter, brother, sister, wife, husband, or partner. The Early Psychosis Prevention and Intervention Centre (EPPIC) 4 suggests the following guidelines to help you when interacting with a person who is psychotic:

• Be yourself.
• Gain information and understand that the person may be behaving and talking differently due to the psychotic symptoms.
• Understand that psychotic symptoms are stressful for everyone and that you may have a range of feelings – shock, fear, sadness, anger, frustration, despair.
• Talking with other people will help you to deal with these feelings. Believe the person will recover – even if it takes time. Be patient.
• When the person is in an acute stage they may seem child-like. Sometimes they need to be in a safe, comforting environment and sometimes they need others to help with decisions.
• Try not to take it personally if the person says hurtful words to you when they are unwell.
• When a person has acute psychotic symptoms they may be fixed in their beliefs and ideas. Don’t get involved in a long disagreement, but listen with interest to gain an understanding of the current reality – to show sympathy and for future reference to discuss when they are better
• Take care of yourself. There is a balance between care and concern and not getting too run down yourself.

References:

1. American Academy of Child and Adolescent Psychiatry (AACAP) (2001). Psychosis. Glossary of Symptoms and Mental Illnesses Affecting Teenagers. Retrieved September, 2005 from http://www.aacap.org/about/glossary/Psychos.htm
2. PsychDirect. Early Psychosis: Detection, Assessment and Treatment. Hamilton, Ontario: McMaster University, Department of Psychiatry and Behavioral Neurosciences. Retrieved September, 2005 from http://www.psychdirect.com/psychosis/psy-firstepisode-pro.htm
3. Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R., Wittchen, H., van Os, J. (2004). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ: British Medical Journal, 330(7481):11. Retrieved September, 2005 from http://bmj.bmjjournals.com/cgi/content/full/330/7481/11
4. Early Psychosis Prevention and Intervention Centre (EPPIC) Information sheet 4: how can I help someone with psychosis? Retrieved September, 2005 from http://www.eppic.org.au/pdfs/info4.pdf