Drug induced Psychosis ( * psychosis - psychotic - see at the end )

This editor believes this is schizophrenia brought forward by cannabis.

Not so much a diagnosis as a compressed description of a current state of mind.

Curiously, often considered more socially acceptable than schizophrenia or manic-depression.

An abnormal state of mind of some duration due to a drug.

When temporary the psychosis is directly the effect of the drug and arrives concurrently - the test for the presence of drug should be positive.

When illness continues after the time allowed for concurrent present of drugs should have worn off, then a tag of drug induced psychosis may be applied.

There is a clear cut connection between the continued use of amphetamine drugs and the production of a condition identical to some kinds of schizophrenia. The exhibition of neuroleptic medications of the kinds used succesfully to neutralise schizophrenia, are also effective in relieving that psychosis. So long as the neuro-leptic is being taken , the amphetamine influence is neutralised. Cocaine usage can be like amphetamine usage in this rspect.

The drug alcohol warrants a separate description

The situation with cannabis is different, and custom not so clear - the tradition here is recent. The neuro-leptic medication does not prevent the deleterious effect of cannabis on the schizophrenia process. Here there is a change in consciousness - an intoxication, a change in attentiveness , to a degree which changes the perception of reality.

In schizophrenia what the sufferer describes is the same as an observer perceives , but the interpretation and belief is different and the belief not understandable by an observer seeing the same thing, nor accountable by a disturbed and altered consciousness.

Some think that cannabis use can leave behind a psychosis which continues after the drug has left the system, but then will itself die away in the absence of further misuse.

The clearest argument against the extended use of cannabis causing a schizophrenia which then persists or is sustained by continued cannabis use, is the absence of any change in incidence in schizophrenia despite the very great increase in the usage of cannabis.

This editor believes cannabis use 'brings forward' schizophrenia which would have come along later, anyway. Perhaps there is a case for continuing anti-schizophrenia medication, when drug induced 'psychois is diagnosed ,even if the current episode subsides, to prevent schizophrenia in the future. Using drud induced psychosis as a warning .

The increase in the use of the diagnostic assessment 'drug induced psychosis' is likely to be based on the hurried nature of observation where there is a rapid throughput of patients, an overcrowding with a much higher admissions due to schizophrenia, admissions largely florid and under Section, florid because the overfull admission wards, leads to delay in a more organised admission; but also and particularly a higher usage by custom in some cultures .

[ ... A label of drug induced psychosis is likely to be made when the florid nature of schizophrenia subsides promptly before it could be expected that resumed medication would have time to work. Schizophrenia itself may be brief and florid if the illness has become florid because of a stressful environmental change - the high ecpressed and unresolvable emotion is left behind by the admission, The patient is taken out of the condition which has provoked it, and those day to day matters which then became too much, are taken over by the ward routines.

Unresolvable anxiety situations -high emotional expression which cannot be avoided or dealt with at once by Index will break down schizophrenia, and removal from the tension, that change itself will reduce the illness., only for it to be vulnerable if discharge is made to an unchged situation,

( high EE exposure as it is sometimes tagged )

People with residual schizophrenia cannot always 'decide' straightaway - needing time to gather in the relevant associations which ordinarily come into play at once in normality. Whereas giving a vulnerable time or separation space, time -without immediate pressure - the next day or so - will bring about the ordinary conclusion. A patient needs to be left with a problem rather than fbe forced to cometo a reply in professional interview pressure. In situations of conversational constraint - in professional stilted interviews , at the Benefits Agency, at the Job Centre, at the police station , a sufferer who is 'better' will often say what is agreeable, but not the 'truth' - to end the ongoing uncertainty in the interview context..... ]

There is a greater use of cannabis, amphetamines and cocaine, in those suffering from schizophrenia, due to their exposure to the modern street community environments amongst which they are obliged to live, and their exposure to people who will exploit their passivity in extracting money from them for street drugs. - sometimes waiting outside the Benefits Agency door.
Their lives are left empty enough of occupational direction for them to fall in with the company of others in the same predicament - as to how to pass the day.

There is also the presence of cannabis use in institutional care - on NHS admission wards and in the prison culture, and amongst the caring professional people themselves.

Cannabis use - and cocaine, and probably one off use of amphetamine and maybe 'ecstasy' - blows a quiescent schizophrenia into a florid one. Some who have schizophrenia and benefit from neuroleptic medication do recognise this.

But the main argument against labelling 'drug induced psychosis' is seeing illness behaviour at a time when testing for cannabis shows that at that time cannabis was not there.
If schizophrenia seems to be fluctuating in its course sufficiently acutely to be thought attributable to cannabis amphetamine or cocaine taking , then it is mandatory, for that diagnotic conclusion to be established with a positive testing for the drug. Cannabis testing can be +ve for up to five days. If the illness indications are there with a -ve cannabis testing , then the illness is schizophrenia as the working problem to be attended to, and not drug induced psychosis.

The diagnosis of drug induced psychosis remains provisional until the relationship with drugs tests out. Problems come when the greater danger - that this is schizophrenia obscured by drug usage - is left out in the provision of continuing care.

In the homicide Inquiry Etherton; 'TK' the consultant confirmed the working diagnosis was provisional, that is subject to ruminative review, if other information comes along.
This did not come about because the application of community care - community observation- was not properly in place. The trouble is that the determination of that does not now seem to lie easily and straightforwardly with the clinical lead for direction, but is dependent on the effective placement of aftercare arrangement and after care collection of information - a decisive contingency which the lead consultant cannot now insist on or rely upon.

In these circumstances of poor delivery of aftercare observation and information exchange, the safe thing to do is to make the principal worry the possible presence of schizophrenia , and to tell the other two core services -nurse and social service, this is schizophrenia until your observations report facts that go otherwise in clinical judgement. Unfortunately, the core team relationships are not there. T

The cores are separately there but do not connect as the situation demands.

Go back to homicide Inquiry Raymond Sinclair again - the consultant , the social worker , the community nurse , met weekly at out-patients and updated each other naturally and regularly. After re-organisation the three went their different ways, and the natural companionship dissipated.

Management changes destroyed something that was essential to the care of long-term serious mental illnesses, the victims of which were not in a position to recognise the deficiency and reclaim their right care.

Now it is time to put the three core working practices together again under common commitment and leadership.

( * )

The term psychosis is used in at least four ways

1. .... in the lay sense of obviously 'mad'- out of mind, out of touch, and out of control; not making sense but without enough evidence to make a diagnosis of illness with that consequence for the future - a lazy label that has some meaning, one often put down to drug intoxications, but it is not a diagnosis - diagnosis carries comments on duration, likely course of outcome, treatment options and so forth

2. .... a psychiatric illness in a way analogous to physical illness

e.g schizophrenia
brain damage illness such as senile psychosis - now alzheimers.
affective illness such as manic-depressive disorder, or a depression running on,

Distinguishing by this label, those who are not reacting to some circumstance but have an infdependent abnormalstate, which may be mildor fluctuate so that it sems to reflect some matter, but actually thwere is a condition running on in its own path, autonomously - like a physical illness.
Although such an illness can be 'mild', less in degree, it is equally dangerous because overlooked as something requiring treatment.
Likely to be seen as a natural consequence - put down to ordinary acceptable explanations and vicissitudes. A general feeling of being run down, out of sorts, overreacting to loss and change of support. But it goes on and on.
It is still recognisable as psychiatric illness by its pattern; the accompanying sleep disturbance , the generality of lost interest to personal inclinations, the duration being disproportionate, and the pattern often showing the same diurnal evening lifting and morning return.

3. ..... severity - psychotic - the severe form of psychiatric illness; e.g delusional depression, florid schizophrenia, florid hypomania - the excited states; as opposed to the quieter modes

4. .

5. Finally a simple substitute for the diagnosis schizophrenia. where that word is to be politely avoided.

cannabis and schizophrenia