Not so much a diagnosis as a lazy and compressed description of a current state of mind. Curiously, often considered more socially acceptable than schizophrenia or manic-depression.
When temporary the psychosis is directly the effect of the drug and arrives concurrently - the test for the presence of drug should be positive. Here there is a change in consciousness - an intoxication, a change in attentiveness , to a degree which changes the perception of reality.
When illness continues after the time allowed for concurrent present of drugs to have worn off, then a tag of drug induced psychosis may be applied. It is not a diagnosis and requires further evidence and reflection, which it rarely gets. It also leads to premature closure from mental health teamwork, and carries no aftercare observation or reconsideration.
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 respect.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.
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.
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; and an assumption of a greater usage in some ethnic background cultures.
[ ... A label of drug induced psychosis is also 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, which it may well do when 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, itself will reduce the illness.
( 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 Index time -without immediate pressure - the next day or so - will bring about the ordinary conclusion. Index needs to be left with a problem rather thn forced to confirm a reply in conversational interview. In situations of conversational constraint - in professional stilted interviews , at the Benefits Agency, at the Job Centre, at the police station , Index will often say what is agreeable, but not the 'truth' - to end the uncertainty in the interview context..... and to get out and away from this unfamiliar place ]
There is also 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. 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.
But 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 'drug induced psychosis' is that those getting the label are discahrged too quickly, and any more serious ilness is overlooked. Most will have schizophrenia. Observing illness at a time when testing for cannabis shows that at that time cannabis was not there, the working diagnosis is schizophrenuia 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.The problems come when the greater danger - that this is schizophrenia obscured by drug usage - is left out in the provision of continuing care.
In 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 relationships are not there. T
The cores are there but do not connect as the situation demands.Go back to 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.
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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 an illness diagnosis with that consequence for the future - a lazy label that has some meaning, one often put down to drug intoxications, but is not a diagnosis - diagnosis carries comments on, story before onset, duration, likely course of outcome, treatment options and so forth
2. .... having a psychiatric illness in a way analogous to physical illness
e.g schizophrenia, affective illness such as manic-depressive disorder, brain damage illness such as senile psychosis - now alzheimers. Although less in degree equally dangerous but not so clearly manifest. 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. 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 avoided.(
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