2.1 The vicious circle, in which schizophrenia and substance use disorders exacerbate each other
When schizophrenia and substance use disorders go hand in hand, they create a more challenging clinical picture and lead to less favorable outcomes compared to when each condition occurs alone.
People with schizophrenia who also use drugs or alcohol often experience a unique form of mental illness. These individuals, commonly referred to as having “dual disorder“, generally face more severe symptoms and challenges than those who don’t use substances.
Importantly, this isn’t a rare condition. If including issues like smoking and other substance use problems, most people with schizophrenia are dealing with a dual disorder.
Schizophrenia and substance use disorders very often have negative impacts on emotions, thinking, and behavior. The severity and duration of symptoms can vary based on the specific characteristics of each condition, as well as the duration, and time interval when these disorders overlap.
For many individuals, for whom these two serious disorders coexist, several clinical aspects are amplified compared to the situations in which these disorders exist separately. Among the critical clinical implications are:
It’s crucial for mental health professionals, caregivers, and society to fully understand these issues and to address substance use disorders and schizophrenia symptoms jointly. Their combined efforts are essential for providing comprehensive support and improving outcomes for those affected.
DECODING PSYCHOSIS: KEY TERMS AND THEIR SIGNIFICANCE
Schizophrenia is a long-term condition that can last for many years, often needing ongoing care. During the lifelong course of the disease, individuals with schizophrenia may go through psychotic episodes, which are intense flare-ups of symptoms.
These episodes resemble a hypertensive crisis in chronic high blood pressure patients or a diabetic coma in those suffering from diabetes, requiring prompt specialized medical attention.
What is a psychotic episode?
The word “psychosis” is used to describe conditions that affect the brain and mind, where there has been some loss of contact with reality. When someone becomes ill in this way, it is called a “psychotic episode”.
During a psychotic episode, individuals experience significant disturbances in their thoughts and perceptions, blurring the line between what is real and what is not.
Spotting the symptoms of psychosis
Psychosis can impact emotions, physical sensations, thinking patterns, and behavior.
THOUGHTS: Disorganised or jumbled thoughts
DELUSIONS: Having false beliefs often involving misinterpretations of experiences or perceptions (e.g., believing someone is after you, thinking you have special powers, or interpreting newspaper passages as having special meanings directed at you)
HALLUCINATIONS: Being able to see, hear, smell, sense, or taste things that others would not. In the case of schizophrenia or chronic psychosis, the most relevant hallucinations are auditory hallucinations.
FEELINGS: Experiencing confusion, agitation, fear, reduced interest in activities.
BEHAVIORS: Experiencing changes in behaviour, such as: having difficulties maintaining or tracking conversations, difficulty with upkeeping personal hygiene and daily activities, struggling to remember things, behaving inappropriately (being silly or laughing with no context), getting upset or angry without a clear reason, becoming very lethargic or generally inactive, becoming entirely not aware of the surrounding environment.
What sparks psychosis?
There is no one specific cause of psychosis. Psychosis may be a symptom of a mental illness, such as schizophrenia or bipolar disorder. However, a person may experience psychotic symptoms and never be diagnosed with schizophrenia or any other mental disorder.
There are other causes of psychosis: some medical conditions, such as hypoglycemia, Alzheimer’s disease, lupus, Parkinson’s disease, etc, sleep deprivation, and the use of substances such as hallucinogens.
A mental illness, for instance schizophrenia, is typically diagnosed by excluding all the other causes of psychosis.
The development of psychosis or psychotic disorders is generally influenced by multiple factors, such as:
Genetic predisposition, where having a family history of psychosis or severe mental disorders plays a role.
Neurobiological factors involving brain dysfunction in terms of circuits and neurotransmitters.
Intense life experiences, like stressful events or illness, which can trigger vulnerability in some individuals.
Use of substances, such as cannabis or stimulants, that can exacerbate psychosis in susceptible individuals.
These factors, whether individually or in combination, contribute to the complex nature of psychotic disorders.
What are the telltale signs of psychosis?
Typically, there are noticeable shifts in behavior preceding psychosis onset.
These behavioral “red flags” include:
Sudden declines in school or work performance
New struggles with clear thinking or concentration
Heightened suspiciousness, paranoia, or discomfort in social settings
Increased social withdrawal, spending more time alone
Unusual, intense, or absent emotions, along with peculiar new ideas
Neglect of personal hygiene and self-care
Difficulty differentiating between reality and fantasy
Confusion in speech or communication challenges.
Anyone experiencing such symptoms is advised to consult a mental health professional!
Psychotic disorders explained:
what you need to know
Psychotic disorders include various conditions characterized by the type and duration of symptoms experienced. Some individuals have brief episodes of psychosis lasting a few days or weeks, while others, like those with schizophrenia, endure longer episodes.
Psychotic symptoms can also occur in individuals with major depressive disorder, bipolar disorder, or substance use, however, the following are classified as psychotic disorders:
Brief psychotic disorder. This disorder involves an individual experiencing psychotic symptoms for less than one month, usually triggered by a highly stressful event (e.g., a loved one passing away).
Schizoaf fective disorder. This disorder involves experiencing symptoms of schizophrenia alongside symptoms of a mood disorder, like depression or mania.
Schizophrenia. Schizophrenia is diagnosed when an individual has experienced psychotic symptoms for a minimum of six months. Key symptoms include delusions, hallucinations, and disorganized thoughts. Additionally, individuals may struggle with concentration and memory, lose motivation for ever yday activities, experience a significant reduction in emotional expression, and withdraw from social interactions and personal relationships.
What is substance-induced psychosis?
Substance-induced psychosis is a type of psychosis triggered by and experienced while under the effects of certain substances. Depending on the substance involved, these episodes could occur during substance usage (such as with cannabis) or withdrawal (like with alcohol).
Drugs can change how our brain cells, called neurons, communicate with each other. Normally, brain cells send, receive, and process signals using chemicals known as neurotransmitters. But when drugs enter the brain, they can mess with this process in different ways.
For instance, drugs like marijuana and heroin have structural similarities to natural neurotransmitters in the brain. This similarity lets them attach to neurons and activate them. However, even though they mimic natural chemicals, they don’t activate neurons in the same way, leading to mixed-up messages in the brain’s communication system.
On the other hand, drugs such as amphetamines and cocaine cause neurons to release too much of their natural neurotransmitters or stop these chemicals from being recycled properly. This overloads or disrupts the usual flow of information between neurons, causing further confusion in the brain’s messaging network.
Can drug-induced psychosis turn into a psychotic disorder?
Substances can impact people differently. Considering that some individuals are at “ultra-high risk (UHR) for psychosis” adolescents who consume certain substances may experience sudden psychotic episodes.
Symptoms typically appear rapidly and disappear within a few days to weeks, though another psychotic episode may occur if the substance is used again.
Although substance-induced psychosis is usually short-lived, drug use can lead to longerlasting psychotic disorders in individuals predisposed to them.
There is strong evidence suggesting that individuals who initially present with substance-induced psychotic disorders in mental health services are at significant risk of later transitioning to schizophrenia or another chronic psychotic disorder.
Among those who experienced cannabisinduced psychosis, a substantial number later developed either schizophrenia or bipolar disorder.
Are psychotic symptoms a red flag for immediate medical attention?
Psychotic symptoms are a signal of alarm and urgent need for treatment, regardless of the cause and conditions in which they appeared.
EARLY INTERVENTION CAN PREVENT the symptoms from getting worse and stop the development of more serious mental health issues.
IF LEFT UNTREATED, PSYCHOSIS CAN LEAD TO DANGEROUS BEHAVIORS due to the distorted perceptions and delusional thoughts that come with it. This can include self-harm or harm to others. Starting treatment early helps stabilize the person’s mental state and creates a safer environment for recovery.
Moreover, GETTING TREATMENT AS SOON AS POSSIBLE CAN SIGNIFICANTLY IMPROVE LONG-TERM OUTCOMES. Studies show that early treatment reduces the severity and frequency of psychotic episodes, helping people stay engaged in their social lives, education, and work. This not only prevents long-term disability but also supports a better overall recovery.
In short, acting quickly to treat psychotic symptoms is essential for ensuring safety, improving quality of life, and achieving the best long-term health outcomes.
