Author: Gary Jackson

Drug-Induced Schizophrenia: What It Is and More I Psych Central

The idea that the psychotic state induced by LSD resulted from actions at serotonin receptors led to the suggestion that LSD provides a “model psychosis” and to the serotonin hypothesis of schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) classifies schizophrenia as a psychotic disorder with symptoms that can include hallucinations, delusions, disorganized thinking, and negative symptoms (symptoms indicating a loss of ability). People living with a mental health condition such as schizophrenia may turn to substances as a way to cope with what they’re experiencing. While they may require medical attention, symptoms tend to resolve after withdrawal or at the end of intoxication.

What to know about drug-induced schizophrenia

Research from 2016 suggests that the neurobiology that may predispose you to substance misuse may also be the same thing that increases the chances of experiencing schizophrenia. A 2018 review found that 42% of people living with schizophrenia were also living with substance use disorder. But substance use and misuse can be a double-edged sword, both complicating the symptoms of schizophrenia and potentially increasing the chances you may experience or worsen symptoms. Not everyone who experiences drug-induced psychosis will go on to develop schizophrenia. You may need to undergo rehabilitation to stop using any substances or medications that worsen your condition. Substances can interfere with schizophrenia treatment, so treating one requires treating the other.

Why does schizophrenia and substance misuse often co-occur?

At low doses, the receptor pharmacology of CBD involves pharmacological antagonism of CB1 agonists (despite low affinity for the orthosteric site of CB1 receptors) and inhibition of adenosine re-uptake. CBD also inhibits the degradation of the endocannabinoid molecule anandamide and acts at a “third” cannabis receptor termed GPR55 (Pertwee, 2007). A single head-to-head trial of CBD vs amisulpride in 42 schizophrenic patients found equivalent efficacy (Leweke, 2007), but further data, particularly over the longer term, is required before we can definitely conclude that these antipsychotic effects are real. In turn, eCBs act in a so-called retrograde fashion to inhibit neighboring GABA and glutamate terminals (Gerdeman et al., 2002; Robbe et al., 2002; Freiman et al., 2006; Adermark et al., 2009). There is accumulating evidence that a number of key physiological processes within the striatum depend upon D2 → eCB → CB1 signaling and the subsequent modification of fast amino-acid based transmission (Calabresi et al., 2007; Kreitzer and Malenka, 2008).

Does schizophrenia cause drug misuse?

Another caveat is that the dopamine model can probably no longer be considered in isolation from the emerging endocannabinoid model. Earlier we utilized the relatively simple concept of a D2 → eCB → CB1 axis to describe the known physiological relations of the two neurochemical systems within the striatum (Kreitzer and Malenka, 2008). Notably, opposing pharmacological manipulations at CB1 receptors can also elicit bi-directional responses, either pro- or antipsychotic.

1. For example, neither cigaret smoking, nor use of opiates induce psychotic symptoms.
2. The DSM-5-TR defines substance-induced psychotic disorder as a psychiatric disease that features delusions, hallucinations, or both during or soon after substance intoxication or withdrawal.
3. This can make it difficult to distinguish between drug-induced psychosis and underlying schizophrenia in a person with a substance use disorder.
4. There are lower rates of transition from drug-induced psychosis to drug-induced schizophrenia for opioids, alcohol, and sedatives.
5. In most cases, symptoms of drug-induced psychosis resolve quickly on their own, with or without treatment.

Treatment & Support

Because many people with schizophrenia don’t know they have a mental health condition and may not believe they need treatment, many research studies have examined the results of untreated psychosis. People who have psychosis that is not treated often have more-severe symptoms, more stays in a hospital, poorer thinking and processing skills and social outcomes, injuries, and even death. On the other hand, early treatment often helps control symptoms before serious complications arise, making the long-term outlook better. One environmental factor which has been curiously neglected is the evidence that certain drugs can contribute to the onset of schizophrenia-like psychosis.

The DSM-5 indicates drug-induced psychosis is the presence of delusions or hallucinations soon after substance intoxication or withdrawal. Drug-induced schizophrenia is a condition that develops after substance use. Instead, it is likely a combination of factors, including drug use, family history, and other underlying concerns, according to research from 2018. If you develop it, you will likely experience symptoms for the remainder of your life.

One testable hypothesis which arises is whether the psychotomimetic properties of THC in humans are mediated via excess dopamine release. Bossong et al. (2009) used a dopamine D2/D3 receptor tracer (raclopride) and positron emission tomography, to examine striatal synaptic dopamine release. The tracer binding was significantly reduced in the ventral striatum and the precommissural dorsal putamen after inhalation of THC compared to placebo, implying an increased release of endogenous dopamine in these regions. However, the increase is modest compared to that obtained with amphetamine and cocaine, and two other studies have failed to find such clear-cut results (Stokes et al., 2009).

What’s interesting is that the LSD psychotics did not differ from individuals with schizophrenia in incidence of psychosis or suicide among the parents. In other words, family history was pretty similar in regards to psychotic symptoms and suicide history. However, parents of the LSD psychotics had significantly high rates of alcoholism – far more than schizophrenics as well as the general population. Some would argue that chronic LSD usage could eventually trigger schizophrenia in an individual that may be prone to the disease. This is where things get tricky and subjective opinions come into play.

What Is Drug-Induced Schizophrenia and How You Can Address It?

This illustrates the general theme of this paper; determining the neurochemical differences between those drugs whose effects do and which do not mimic particular aspects of schizophrenia is worthy of investigation in humans as well as in animals. Cannabis has been linked to the development of psychotic symptoms since time immemorial. In the mid-nineteenth century the French psychiatrist Moreau de Tour noted the phenomenological similarities between drug-induced states and psychosis.

Studies show that up to one in four people hospitalized with psychosis for the first time have substance-induced symptoms. In diagnosis, it is important to differentiate substance-induced psychotic disorder from schizophrenia. Mental health professionals use the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) to diagnose psychiatric conditions such as schizophrenia. To be diagnosed with schizophrenia, a person must experience at least one of the symptoms of hallucinations, delusions, or disorganized speech. Keep in mind that there is some crossover between people who are predisposed to substance use disorders and those who are predisposed to psychiatric conditions like schizophrenia.

Schizophrenia vs. psychosis

The reason for this could be that the activation of the nicotinic acetylcholine receptor leads to a subjective soothing effect, temporarily calming or soothing symptoms. You can even misuse something generally considered “good for you” such as vitamins or supplements. If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988. Drugs can change levels of neurotransmitters in the brain, causing the brain to process information in atypical ways.

For example, a person who believes the government is following them may become very suspicious or obsess over home security. Read on to learn more about drug-induced psychosis, including the causes, symptoms, and treatment methods. People may use the term drug-induced schizophrenia to refer to psychosis due to drug use. This condition is not actually schizophrenia but is drug-induced psychosis. Most people who use LSD use it on a recreational basis as a means of experimentation.