Psychosis long-term

Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Rubner 0, Kummerhoff PW, Haase H. (1997). [An unusual case of psychosis caused by long-term administration of a scopolamine membrane patch. Paranoid hallucinogenic and delusional symptoms]. 

In the era of modern psychiatry, the treatment of schizophrenia has undergone two revolutions. The first revolution began in the 1950s with the debut of the typical antipsychotics, the first proven effective treatments for psychosis. These medications enabled patients who in years past would have been relegated to long-term hospitalization to return to the community. 

Adverse reactions of corticosteroids are frequent with the long-term immunosuppressive regimens which are often needed and include an increased risk of infections, Cushing-like symptoms, hypertension, hyperglycemia, osteoporosis, growth retardation in children and mental reactions such as dysphoria, psychosis and depression. 

Chronic stimulant abuse alters the personality of the abuser. These and related changes are the result of neurotoxicity and are not characterized as either acute drug effects or withdrawal signs. Individuals have delusions of being pursued or persecuted and therefore become suspicious and paranoid. They become self-occupied and hostile toward others. Long-term abuse can produce toxic psychosis that closely resembles schizophrenia and must be treated with neuroleptic drugs (haloperidol, chlorpromazine). This psychosis can develop even within 1 to 2 weeks if the person is on a run of very high doses of stimulants. 

Given the available data, it is extremely important that clinicians evaluate patients with major depression for features of psychosis, because the failure to do so may result in inadequate treatment for the patient. A practical problem encountered by clinicians, however, is the subtlety of delusions. For example, it is not unusual in geriatric depression for patients to present with a somatic preoccupation that borders on delusional. These so-called near delusions may put the patient into the arena of psychotic depression. Some evidence exists that patients with depression with near delusions may respond more favorably to combinations of antidepressants and antipsychotics or ECT. Once the presence of both major depression and psychosis is determined, other psychotic disorders including bipolar disorder and schizophrenic spectrum illness must also be ruled out because this may influence long-term treatment decisions. 

The use of cannabis is widespread and in all parts of society in long term and heavy use has been thought to cause various organic changes which have never been fully evaluated. In vulnerable individuals a cannabis induced psychosis can occur which can be long lasting and difficult to treat even in spite of intensive pharmacological treatment. 

Hallucinogens and NMDA antagonists, even if they do not produce dependence or addiction, can still have long-term effects. Flashbacks of altered perception can occur years after LSD use. Moreover, chronic use of PCP may lead to an irreversible schizophrenia-like psychosis. 

COCAINE PSYCHOSIS A mental illness characterized by paranoia, disorientation, and severe depression. It is often the result of long-term cocaine abuse. 

Though it is clear that hallucinogen use alters mental function, is not known whether the changes are permanent or if they will disappear after use is stopped. After long-term hallucinogen use, some individuals may experience prolonged psychosis and may require therapy or institutionalization. It is not known whether these drugs cause this condition or merely expose a previous tendency to psychosis. 

There are two major long-term risks of taking LSD—flash backs and LSD psychosis. 

Another long-term health effect of psychedelic use is persistent or drug-induced psychosis, in which former users can fall into a long-lasting psychotic-like state. They can appear severely depressed, have mood swings, and have hallucinations and visual disturbances. Like HPPD, persistent psychosis can last for years. Often it occurs in people who have no previous history of psychological problems. 

Ingesting Psilocybe mushrooms has been known to precipitate long-term mental illness including paranoia, depression, and psychosis. It is uncertain as to whether the user would have eventually developed these conditions in the absence of psilocybin. However, there does appear to be an increased risk of developing chronic mental problems after the use of psilocybin if the user has a family history of mental illness. 

A continuing psychosis triggered by hallucinogen use should be treated in the same manner as any other ongoing psychotic disorder. Hospitalization may be required to stabilize the patient s condition, to initiate treatment, or to prevent injury to the patient or others. Long-term use of antipsychotic medications may be necessary, as well as continuing involvement in programs of mental health treatment and rehabilitation. 

Sato, M., Chen, C. C., Akiyama, K., and Otsuki, S. (1983). Acute exacerbation of paranoid psychotic state after long-term abstinence in patients with previous methamphetamine psychosis. Biol. Psychiatry 18, 429-440. 

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