First, what is psychosis? Psychosis is a term used to describe when a person interprets or perceives reality in a different way than those around them. Psychosis may be a symptom of mental illness, but that is not always the case. Nobody knows exactly what causes psychosis.
May 11, 2022
Suzi visited her mom, Val Thursday after work. Suzi checks in on her about twice a week. Val is 70, active with high cholesterol, high blood pressure. arthritis, and mild depression. Val takes her medication regularly and as directed. Suzi notices that her mom is not quite herself. Val cannot follow the conversation and does not seem to be able to concentrate.
The first thing Suzi thinks is, an UTI. Possible dehydration. They go to the Dr., but the urine test comes back clean. No infection and her electrolytes are all in the normal range. Hmm. Now what? Nobody seems to know what to do next, but wait and see.
It is now a week later and Val is not better and in fact she is a little worse. She cannot remember if she has taken her meds or not. She is unsure of what has happened over the last three days. Suzi is getting more and more concerned. This is not normal and her mom has never been this way before. Suzi wonders if her mom is developing dementia, Alzheimer’s disease or mild cognitive impairment.
In this particular case, her physician looked at her medications and had a consult with her pharmacist. They determined that most likely it was her blood pressure medication and/or her arthritis medication. Outside chance it could be anti-depressant med, but not likely. They began a withdrawal of HBP medication and started a different one. Val was some better, but not back to normal. It was not her arthritis medication; it was her anti-depressant medication. She was slowly weaned off of that and they did a wait-and-see approach to see if she needed to be on an anti-depressant anymore. Her mind cleared and she was back to her normal self.
While this case was a success, many more are not. No one thinks to check the medications. Why? Well, their thought processes go along these lines – She has been on these meds for three years or more. It came on suddenly, it must be a UTI or dehydration or she does indeed have the beginnings of mild cognitive impairment or a dementia.
Medications are not without risks and problems over time. As we age, our metabolization and kidney function decrease. We cannot clear meds as quickly or as easily as we once did. You know when your loved one is “not right.” You may not know what it is, but you know that something is wrong. Push for answers, never accept it is “just old age,” dementia, or other assumptions. Blood tests and urine tests need to be done. Medications need to be checked. Hydration and nutrition need to be addressed. We want to rule out any fixable problems.
Psychosis can be:
- Due to stressful life experiences or trauma
- Part of a neurological condition such as dementia. Alzheimer’s disease, or Parkinson’s disease
- Triggered due to a brain injury
- Medication side effects
- Effects of illicit or illegal drugs such as marijuana or cannabis
- Effects of alcohol withdrawal
- Triggered by menopause
- Triggered during times of severe stress or anxiety
As you can see, it is not black and white. Many things can trigger a psychosis. By the way, marijuana is not the gateway drug to addiction. Trauma is the gateway to addiction. The self-medication, whether it is alcohol, marijuana, cocaine, hydrocodone, heroin, etc., becomes the problem due to another problem. We have to deal with the primary problems first! Yeah, I know, we chased a rabbit there.
We don’t think about medications as causing a psychosis or a psychotic episode, but they sure can. Too often, we assume that it is a mental health issue. Maybe it is, but, we need to find out and rule out other fixable causes.
Understand that some classes of drugs can cause psychosis.
Classes of meds that may cause psychosis:
- Muscle relaxants
- Cardiovascular medications
- Antihypertensive medications
- Antiparkinsonian medications
- Chemotherapy agents
From the list above, you can see that the possibility is real that the psychosis is from a medication and not mental illness. Alcohol abuse or misuse is another inducer of psychosis.
Drug-induced psychosis usually only lasts until the medication/drug has cleared the body. Depending on the drug, the metabolization and clearing may take from 1 day to several weeks (if it is from a stimulant medication).
A healthcare professional needs to be contacted. They can decide where the safest place to “come-off” the medication will be. Drugs can affect different people in different ways. What causes a psychotic episode in one person may not cause a psychotic episode in another person. Genetics plays a part. Life experiences play a part. Pre-disposition to mental illness plays a part. Remember, mental health disorders can cause substance use or misuse on its own. The mental health disorder can be exacerbated or intensified by medication use, abuse or misuse, but it is not caused by the meds.
We should note that schizophrenia is not caused by drug use, abuse or mis-use. It may trigger schizophrenia symptoms in those people susceptible to schizophrenia.
Common signs and symptoms of psychosis includes:
Hallucinations – when you see, hear, feel or taste things that other people don’t
- Hearing voices or sounds that others don’t
- Seeing things that others do not see
- Tasting things when you haven’t had or eaten anything
- Feeling someone touching you who is not there
- Smelling things which other people cannot smell
Delusions – unusual beliefs that other people in your “community” do not share, even though they feel real to you
You may worry:
- That you are being followed by secret agents or members of the public
- People are out to get you or to kill you (may be strangers or people that you know)
- That a chip has been implanted in your brain to monitor your thoughts
- That your food or water is being poisoned
- That you are a powerful person or God
Cognitive impairments – these relate to mental action (learning, remembering, functioning)
- Problems concentrating
- Memory problems
- Difficulties understanding new information
- Having a difficult time making decisions
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.
Illicit/Illegal Drugs that most commonly cause substance-induced psychosis:
Ketamine (this is a Rx drug, but is used illicitly)
This overview is so that you know and understand that medications can cause psychotic episodes. What signs and symptoms to look for? Contact your healthcare provider for withdrawal and monitoring needs.