Psychotic states

Lithium. In the lithium carbonate treatment of certain psychotic states, a low incidence (3.6%) of hypothyroidism and goiter production have been observed as side effects (6,36) (see Psychopharmacologicalagents). It has been proposed that the mechanism of this action is the inhibition of adenyl cyclase. Lithium salts have not found general acceptance in the treatment of hyperthyroidism (see Lithiumand lithium compounds). 

Toxic psychosis Several monoamine stimulants including cocaine are known to produce a temporary or even a lasting psychotic state after heavy use. Reviews of numerous clinical case reports have shown amphetamine to produce a chronic psychotic state, sometimes persisting for months after cessation. There appears to be a sensitization effect in this regard, because after recovery, psychotic states may recur with minimal use of amphetamine or alcohol. When compared to schizophrenic patients, people with amphetamine-induced psychosis demonstrate fewer negative symptoms (Boutros and Bowers 1996). 

When brief psychotic disorder is diagnosed, treatment with antipsychotic medication and supportive therapy should be instituted. During treatment, however, the patient should be frequently reassessed for the presence of a mood disorder that was not easily recognizable in the initial agitated and psychotic state. 

Dreaming is a state of consciousness which has attracted considerable theoretical interest, perhaps mainly due to its phenomenological resemblance to some psychotic states. 

Visual unformed flashes, shapes, colours formed grotesque faces, animals, people LiUiputian little people, animals - LSD, MDMA, cannabis - anticholinergics, alcohol withdrawal, drug induced deliria and psychotic states. - alcohol withdrawal... 

Gustatory, olfactory - benzodiazepine or alcohol withdrawal, drug-induced psychotic states... 

Because of its sedative properties, reserpine offers special benefit to hypertensive patients who exhibit symptoms of agitated psychotic states and who may be unable to tolerate therapy with phenothiazine derivatives. 

Adverse effects include skin rash, nervousness, dizziness, drowsiness, vertigo, tremors, convulsions and psychotic state. 

Antipsychotics have long since replaced ECT for the treatment of schizophrenia. Several studies, however, have found ECT equal in efficacy to these agents, while one large-sample, controlled trial found it less effective than drugs, but more effective than psychotherapy ( 406). Some clinicians believe that selected patients may benefit when ECT is given concurrently with an antipsychotic. One controlled study, for example, found that ECT in combination with a phenothiazine led to a more rapid remission than the phenothiazine alone ( 407). Clinical experience has clearly documented an important role for ECT in catatonic excitement or withdrawal, as well as for other severe, life-endangering psychotic states. More recently, ECT combined with novel antipsychotics has been reported to benefit previously poorly responsive psychotic patients and was well tolerated (106, 408, 409). 

Dwight et al. (291) reported their experience with risperidone in eight patients with schizoaffective disorder (six bipolar type two depressive type). All six bipolar type patients showed the onset of or an increase in mania shortly after starting risperidone (mean number of treatment days = 7 3 mean dose = 7 1 mg/day). In this context, O Croinin et al. (292) reported on a chronic paranoid schizophrenic patient who was admitted in an acute psychotic state unresponsive to thioridazine or CPZ. Risperidone was started (6mg/day by day 3), but by the end of the first week she was displaying hypomanic symptoms. When risperidone was discontinued and haloperidol introduced, her hypomanic symptoms resolved. 

Whereas the development of classic disorders such as schizophrenia in a dying patient with no previous history is an unlikely occurrence, many symptoms, such as hallucinations, delusions, and disordered thinking, are commonly encountered. Some episodes may be reversible and, when the causative source is recognized, can be readily treated by the physician. For example, high-dose steroids are often used to manage metastatic brain lesions, but it is also well known that they can induce a psychotic state. Simply reducing the dose, when possible, may quickly abort a psychotic episode. 

Similarly, BZDs are used for insomnia but are best reserved for short-term use. They are also used to assist withdrawal from alcohol, where a long elimination half-life drug is best. In acute psychotic states short-term use of a high-potency drug, such as lorazepam, can be helpful in managing acute agitation or aggression. 

Lysergic acid diethylamide Central nervous system (CNS) 5-HT2and dopamine agonist 5-HT2 antagonist in periphery Hallucinations psychotomimetic None widely abused Oral duration several hours Toxicity Prolonged psychotic state, flashbacks... 

In the earliest research with DET and the related dialkyltryptamines, the chemistry of metabolism was studied for any clues that could explain the activity of these materials. It must be remembered that this was in the heyday of the concept of psychotomimesis, the search for drugs that would imitate the psychotic state. What an appealing concept, that there might be a drug that could produce the syndrome of mental illness and thus be an accepted model for designing some treatment for it. There was a delicious search made at that time (the 1950 s) for names that could be given to these remarkable substances that would obscure any spiritual or positive aspects, so that one could present one s findings into the orthodox medical literature. 

These CNS stimulants have sometimes been referred to as hallucinogens but are more appropriately referred to as psychomimetics because few, if any, cause an absence of reality, that is, a hallucination. Psychomimetics distort or heighten sensory input, produce dream-like states, and can be psychologically addictive. There is no consistent evidence that they can produce tolerance or physical dependence. This is not to imply that these drugs are innocuous. The distortions of reality can lead to panic, anxiety, lack of concentration, and psychotic states to say the least. 

LSD first became available for experimental use at about the same time that work on the mechanisms of REM sleep came under scientific scrutiny. Based upon casual reasoning, some predicted that because LSD produced psychotic states, the drug would increase REM sleep and dreaming. But just the opposite happened. Pre-sleep administration of LSD resulted in a dose dependent suppression of REM and a reciprocally marked increase in waking. This experimental insomnia matches the insomnia reported clinically. 

The most important effect of the drug for me was directly experiencing a psychotic state. Although I had had much clinical experience working with schizophrenics as well as academic preparation in clinical psychology and two years of psychoanalytically oriented psychotherapy, new vistas and... 

Goldstein, L., Murphree, H. B., Sugerman, A. A, Pfeiffer, C. O, and Jenny, E. H. "Quantitative Electroencephalographic Analysis of Naturally Occurring (Schizophrenic) and Drug-induced Psychotic States in Human Males," Clinical Pharmacology and Therapeutics 4, 10—21,1963. 

Almost every society has found some bark, skin, leaf, vine, berry, fungus, or weed that contains "hallucinogenic" materials, but neither hallucinations nor psychotic states are typically induced by these drugs. The more recent "club drugs" including MDMA have also been considered to be like hallucinogens, but club drugs are better considered as related to either stimulants (MDMA) or sedatives (GHB). 

Because of the terror and awe they produce, recognition is difficult. Yet in a way it is also easier in that, since these negative hallucinations command all attention, the mind is alert and therefore through trying to escape from fear and terror, people get involved in psychotic states and suffer. But with the aid of this manual and the presence of a guide, the voyager will recognize these hell visions as soon as he sees them, and welcome them like old friends. 

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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