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The American Psychiatric Associate defines psychosis as a period when someone is

experiencing both hallucinations and delusions. Hallucinations are what happens


when you have the perception that something is there when it isn�t. For example,
you may see something that�s not there, and along with drug use, some of the other
reasons people may experience hallucinations include mental illnesses like
schizophrenia.
When you hallucinate, you might not just visualize things that aren�t there, but
you can hear voices which is called an auditory hallucination, or you might smell
things and think they�re around you or that you�re emitting the phantom odors.

It�s also possible to have gustatory hallucinations, which are thinking that you�re
tasting things, and tactile hallucinations mean you feel like something is touching
you that isn�t.

Also part of meth psychosis, as was touched on, is the presence of delusions at the
same time as hallucinations. Delusions refer to a person having beliefs that aren�t
true. There are different categories of delusions which include persecutory
delusions. This means that you think you�re being tortured, tricked, made fun of or
spied on. Referential delusions refer to a situation where someone thinks that
something from a song lyric or a TV show as an example is directed at them.

An example of a common delusion people experience is thinking they are being


followed by the police when they�re not.

When people use meth, particularly for a prolonged period, they�re at risk of
psychosis. During this time they lose touch with reality, and in addition to
delusions and hallucinations, a meth psychosis can also include general paranoia
and obsessive compulsive behavior.

During meth psychosis, the addict may start to believe that people are out to get
them, and they may think that run-of-the-mill objects are watching them or equipped
with surveillance equipment.

Another sign of meth psychosis is increased aggression, which occurs as the brain
loses the ability to manage impulses. When people use meth, specifically
chronically, they tend to lose their ability to respond rationally to what�s
happening around them, and this is what leads to aggression or violence.

Regarding obsessive compulsive behaviors, when people are prolonged meth abusers,
they may start to do things over and over again, such as cleaning at a mad pace or
washing their hands over and over again. This can also be why people have sores on
their skin, because they scratch at it, or bald patches from pulling hair out.

When someone experiences meth psychosis, it may end when they come down from the
drug, but in some cases, it could last longer than the high of meth. For some, it
can last for days, but unfortunately, meth damage can mean that some people have
permanent psychosis, or it occurs when they�re no longer using the drug.

According to the American Psychiatric Association, a psychosis happens when both


hallucinations and delusions are present. A lot of people who abuse substances have
underlying mental health conditions, which is known as a dual diagnosis. It is
possible to have a meth-induced psychosis, but this must be determined by a urine
drug screen, a physical exam, studying of medical history and �reality testing�. It
can be very difficult to determine whether someone is having a schizophrenic
psychosis or a meth induced psychosis. Someone who is psychotic does not have the
ability to tell you their history. This is why it is so important to work together
with their significant others.
Meth Induced Psychosis
Meth users have their own terminology. Within their culture, someone who is �spun�
is someone who has had a meth overdose, which induced a psychotic state. It is very
important that these people are immediately assessed. As a psychosis involves both
hallucinations and delusions, these should both be looked into.

Meth Hallucinations
Hallucinations can be associated with each of the five senses. Hence, our staff at
Creative Care will look for:

Auditory hallucinations. Here, the users will hear sounds that aren�t there. In
most cases, the sounds are voices that command them to do things, usually negative
and dangerous things.
Visual hallucinations. The user will see things (inanimate or living) that aren�t
actually there.
Olfactory hallucinations. Some meth users report smelling things, which are often
very unpleasant. One common olfactory hallucination during a psychosis caused by
meth is smelling the brain rot.
Tactile hallucinations. This happens when people feel something that isn�t there,
usually underneath the skin. With meth psychosis, formication is particularly
common. This is where the user believes there are bugs under their skin. As a
result, they start to scratch their skin to try and remove them. Many meth users
have scars on their arms because they experienced �crank bugs�.
Gustatory hallucinations. This is the false perception of taste. Many meth users
become paranoid and believe their food has been poisoned, which they can taste.
However, this is also common on paranoid schizophrenia.
It is very difficult to determine whether a psychosis is the result of meth abuse,
meth addiction or of schizophrenia, not in the least because many schizophrenics
use meth. However, MacKenzie and Heischober have determined that schizophrenics
have mainly auditory hallucinations, whereas meth users suffer from visual and
tactile hallucinations. Furthermore, psychotic disorders induced by meth tend to
not include alogia, which is an inability to speak.

Meth Delusions
The other determining factor in whether or not someone is going through a psychosis
is the presence of delusions. These are false personal beliefs that cannot be
corrected simply by reasoning with the person. A number of delusions are common in
meth-induced psychosis, including:

Persecution, which is a fear of being harmed. This is also present in paranoid


schizophrenics.
Grandeur, which means that the user feels as if they are somehow special above all
other people.
Reference, which means that important events actually have a direct relation to
them, such as secret messages in news bulletins.
Control, believing that they are being brainwashed for instance.
Somatic, which happens when the patient believes their body is being changed and
their brain is rotting for example.
Other Key Traits in Meth Induced Psychosis
Most people who experience a psychosis will also have extreme paranoia. This makes
it incredibly difficult to treat them, as they will believe medical staff is there
to harm them, rather than help them. Furthermore, they also regularly have
compulsions and obsessions. Some of these compulsions include washing hands,
pulling hair, formication and compulsive sexual behavior.

Treating Meth Psychosis


The drug of choice to treat people going through a methamphetamine psychosis is
Haldol, but it is important to be very careful with this. Haldol has a number of
dangerous and unpleasant side effects, including anticholinergic manifestations,
stomach problems, skin issues, extrapyramidal symptoms, neuroleptic malignant
syndrome and tardive dyskinesia for instance.

If you are worried about someone who may have entered a methamphetamine induced
psychosis, you must seek meth treatment help immediately. Please contact Creative
Care to see how we can help and whether Haldol may be an appropriate form of
treatment.

Alcohol-related psychosis is a secondary psychosis that manifests as prominent


hallucinations and delusions occurring in a variety of alcohol-related conditions.
For patients with alcohol use disorder, previously known as alcohol abuse and
alcohol dependence, psychosis can occur during phases of acute intoxication or
withdrawal, with or without delirium tremens. In addition, alcohol hallucinosis and
alcoholic paranoia are 2 uncommon alcohol-induced psychotic disorders, which are
seen only in chronic alcoholics who have years of severe and heavy drinking. [1]
Lastly, psychosis can also occur during alcohol intoxication, also known as
pathologic intoxication, an uncommon condition the diagnosis of which is considered
controversial. [2, 3]

In chronic alcoholic patients, lack of thiamine is a common condition. Thiamine


deficiency is known to lead to Wernicke-Korsakoff syndrome, which is characterized
by neurological findings on examination and a confusional-apathetic state.
Korsakoff psychosis (or Korsakoff amnesic- or amnesic-confabulatory state) refers
to a state that memory and learning are affected out of proportion to other
cognitive functions in an otherwise alert and responsive patient. [4]

Alcohol is a neurotoxin that damages the brain in a complex manner through


prolonged exposure and repeated withdrawal, resulting in significant morbidity and
mortality. Alcohol-related psychosis is often an indication of chronic alcoholism;
thus, it is associated with medical, neurological, and psychosocial complications.

Alcohol-related psychosis spontaneously clears with discontinuation of alcohol use


and may resume during repeated alcohol exposure. Distinguishing alcohol-related
psychosis from schizophrenia or other primary psychotic disorders through clinical
presentation often is difficult. It is generally accepted that alcohol-related
psychosis remits with abstinence, unlike schizophrenia. If persistent psychosis
develops, diagnostic confusion can result. Comorbid psychotic disorders (eg,
schizophrenia spectrum and other psychotic disorders) and severe mood disorder with
psychosis may exist, resulting in the psychosis being attributed to the wrong
etiology.

Some characteristics that may help differentiate alcohol-induced psychosis from


schizophrenia are that alcohol-induced psychosis shows later onset of psychosis,
higher levels of depressive and anxiety symptoms, fewer negative and disorganized
symptoms, better insight and judgment towards psychotic symptoms, and less
functional impairment. [5]

Alcohol idiosyncratic intoxication is an unusual condition that occurs when a small


amount of alcohol produces intoxication that results in aggression, impaired
consciousness, prolonged sleep, transient hallucinations, illusions, and delusions.
These episodes occur rapidly, can last from only a few minutes to hours, and are
followed by amnesia. Alcohol idiosyncratic intoxication often occurs in elderly
persons and those with impaired impulse control.

Unlike alcoholism, alcohol-related psychosis lacks the in-depth research needed to


understand its pathophysiology, demographics, characteristics, and treatment. This
article attempts to provide as much possible information for adequate knowledge of
alcohol-related psychosis and the most up-to-date treatment.
Case examples
Case 1: A 37-year-old white male infantryman stationed in Iraq arrived at a field
hospital complaining that his superior officer placed poisonous ants in his helmet.
His face is covered with excoriations from persistent scratching. On further
examination, he is stuporous and has mildly slurred speech, tremor, and mint odor
to his breath. Later his troop leader mentioned that his Humvee was littered with
empty bottles of mouthwash and that the man has been reprimanded for falling asleep
at his post. After a night of rest, he discussed his excessive use of mouthwash in
place of alcohol, which is the only available form of alcohol in Iraq.

Case 2: At 5 pm you are asked to consult on a 44-year-old white female who is 2


days postsurgical hysterectomy. She is complaining of rabbits running across the
room and demands the nurses stop intruding "every minute of every hour." She is
tremulous, disoriented to time and place, and irritable. A review of her laboratory
data shows an elevated gamma-glutamyl transferase (GGT) and slightly elevated liver
function test values. White blood cell count is normal. Urinalysis is normal and
blood alcohol level is 0.01. Her medications, which were held prior to the surgery,
included acamprosate 666 mg three times daily and clonazepam 1 mg 4 times a day.
Her sister later informs the nursing staff that this woman is usually on her fourth
Manhattan cocktail by this hour of the day.