The Unpredictability of Psychosis

Grayscale photo of psychotic woman holding belt around neck

0-60 In a Heartbeat

One thing to keep in mind with psychotic patients is that their behavior is very unpredictable. They can literally be having a pleasant conversation with you for 5-10 minutes, and 15 minutes later, they are yelling, cursing, agitated, banging on the walls and demanding medications! You scratch your head and wonder, “What in the world? I was just talking to them and everything seemed to be going well!” Psychosis could care less if everything was going well; when it wants its patient to terrorize, it will unleash all of hell’s dogs to get its fix. This does not mean that you should always expect psychotic patients to become dysregulated and violent; just be aware that the chances of that happening are higher than with other patients.

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I Am Free Of Psychosis

Bald man in Adidas jumpsuit holding burning umbrella

Positive Affirmation: Psychosis

“I am free of psychosis because I listen to my psychiatrist and take my medications consistently, attend my outpatient appointments on time, make an effort to better myself by giving it my all in therapy, all while staying clear of alcohol and drugs and remaining physically healthy by exercising and maintaining a good diet!”

Psychotically Sheltered

Psychotic Indian man wearing glasses sticking tongue out

Three Blunts Later

Many psychotic patients have lost everything or never had much to begin with. Their home is the shelter or a psychiatric supportive house where they spend their days doing whatever they want. Many don’t have any requirements; they can sleep all day, create music, go to work . . . it’s up to them. Many continue to abuse drugs on the streets: popular ones in New York City are crack, cocaine and heroin; don’t count out marijuana.

But this is the problem with these shelters: they don’t drug test and even if they did, would they just kick out psychotic residents? They would all just turn homeless and nothing productive would be accomplished. So they continue to abuse drugs and take advantage of the free room and board. The problem with psychotic patients is that drugs impair their judgment and insight.

In the moment while they’re getting high, they’ll report to you that they feel better and that their symptoms have calmed down, depending on which drug they are using. If it’s crack or meth, their symptoms tend to get worse: they become paranoid, start hearing voices commanding them to commit violent acts and may even start experiencing visual hallucinations.

If it’s marijuana, many psychotic patients will report that the weed relaxes them and clears their mind. It may very well do that, but marijuana is prone to cause and worsen psychosis, especially the highly potent strains going around these days. Three blunts later and many of these patients start hallucinating, experiencing disorganized thoughts and behavior and freaking out.

Keep in mind that many psychotic patients are noncompliant with medications because they believe that they don’t have a mental illness. Add three blunts a day on top of poor insight and it turns into a recipe for a mental health disaster. It’s not usually the patient that brings himself into the hospital; it’s the residents or staff at the shelter that escalate the process due to their disruptive and dysregulated behavior.

There is no psychotic patient or mental health patient who I have met that benefited from drug use, including marijuana. They may tell me that they like weed and it calms them down, but then why are they in the hospital in the first place? What’s surprising is that many schizophrenic patients inform me that they’ll probably go back to using marijuana despite being hospitalized.

This is how powerful drugs are and we must continue to spread awareness for drug addiction and advocate for more resources devoted to the treatment and healing of drug addicts. But first we must continue to call on all the drug addicts to come out of the shadows and provide them with a safe and supportive environment and this platform is known as The DSM Ready Community.

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Chronically Disorganized

Psychotic black man sitting on sidewalk next to garbage on ground

When No Other World Exists Besides Psychosis

There are many psychiatric patients who are chronically psychotic. They have been through the system numerous times, whether that is through temporary inpatient psychiatric stays or state hospitalizations for years at a time. But just because a patient is chronically psychotic does not mean that they cannot function in society, especially when room and board are given to them; in other words, supportive psychiatric housing.

The worst part about these chronic psychotic patients is that many refuse to believe that they have a mental illness. Try asking them a question and they often irritably reply, “No psych stuff! I’m not crazy! Get the fuck outta here.” They are either in denial or have a poor insight; the latter is oftentimes the case. Schizophrenia can impair a patient’s insight to the point of them not realizing that they are psychotic.

So what happens when a chronic psychotic patient has a poor insight? They oftentimes refuse medications, allowing their psychosis to flourish. So how are they not hospitalized you may ask? Well, just because someone is psychotic does not mean that they cannot function; they become used to their psychosis and live under its presence. And when shelter is provided . . . well, even better.

Shelter and support help a lot because it allows the psychotic patient to be relieved of their stress and worry of going homeless. When food and shelter are provided, who needs medications is the thought process. And to add to the mix, many of these patients continue to abuse substances such as K2, marijuana, cocaine, crack (the hardened form of cocaine), heroin, etc. Unfortunately, this is how the system works for some: shelter, food, drugs, psychosis but no medications.

The problem is not access to medications. They are hospitalized countless times during their life with many opportunities to better themselves and follow up with outpatient psychiatric services; but they refuse. They refuse because it’s either too difficult for them to follow up, are not motivated or simply do not care enough to improve their mental health. And when they also have a poor insight because of their mental illness, attending their psychiatric appointments becomes more difficult than teaching a dog how to urinate and defecate in the backyard and not in the house.

This is what chronic mental illness does to many who are noncompliant with medications, abuse drugs and do not care about their health. But we must not give up as psychiatrists and humanity as a whole. The DSM Ready Community will always keep fighting on because we are based on love, unity, peace and openness.

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Thought Blocked By Psychosis

Psychotic person holding hands on head with mouth open

When Schizophrenia Chips Away At Your Sanity

Just because a patient was diagnosed with schizophrenia over ten years ago does not mean that symptoms will never return. There are many factors at play as to why symptoms may reoccur but one big factor is medication noncompliance. Many psychiatric patients have a strong desire to eventually stop medications. If you’ve ever been on psychiatric medications, then you most likely know what I’m talking about!

When I used to be on Prozac, I used to think to myself if there would ever be a day when I could stop the medication. After many months on Prozac, panic attacks eventually vanished; they weren’t part of my life any longer. So I thought to myself, “Thank God! I can live again. But now how much longer do I have to be on Prozac?” There is no right answer when it comes to continuing psychiatric medications.

For patients who have experienced more than one episode of psychosis, the answer likely is “lifetime.” That’s because each episode of psychosis increases the chances of experiencing a future episode. Even if you are experiencing a strong desire to stop your medications, never do so on your own; always talk with your doctor before making any changes to your medications.

Believe it or not, there are many schizophrenics who continue to take medications and still experience auditory hallucinations at random times, requiring an inpatient psychiatric admission. These patients may appear as thought blocked: in the middle of a sentence, they suddenly stop and can no longer find their words or they make take a little longer to form a sentence in the first place.

Can you imagine trying to have a normal conversation with someone and not be able to find the right words, as if someone or something is holding your tongue back in place? Can you imagine how depressing it must be to not be able to speak freely because of your psychosis? Do you understand why many people suffering from a mental illness also experience suicidal ideations?

There is no cure for schizophrenia or any mental illness; only remission. Remission is when a patient stops experiencing symptoms but this does not mean that the disease is no longer present. It just means that it’s controlled by therapy, medications or both. Psychiatric medications do not cure a mental illness in the same way that high blood pressure medications or insulin do not cure hypertension or diabetes.

We must continue to remind ourselves that there is nothing wrong with being on psychiatric medications. The end goal is to live a normal life without allowing a mental illness to control your sanity and wellbeing. If this means that you must continue medications until 97, then so be it. You’ll be much better off free of symptoms while on medications than stopping them and relapsing; some people don’t ever recover from a relapse.

Don’t take that chance. Maintain a strong alliance with your psychiatrist and always come up with a plan together.

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Substance-Induced Psychotic Disorder

Three same female faces with red glitter under eyes

Holding On To Drugs

Substance abuse, mental illness and medical complications go hand in hand; rarely do you have one without the other in the psychiatric world. In other words, a psychiatric illness without a medical comorbidity is possible, but oftentimes, there’s something at play behind the scenes, even if it’s something as common as high blood pressure. Don’t automatically assume that someone who abuses drugs does not have a medical illness; sometimes the drugs are there to mask the physical symptoms or even the psychiatric symptoms!

And don’t assume that someone who has a psychiatric condition does not abuse drugs; the psychiatric condition can be secondary to drugs. This is the case with substance-induced depressive or psychotic disorder. Substances are capable of inducing temporary psychiatric illnesses such as anxiety, panic disorder, depressive disorder or a psychotic episode.

The key word is “temporary” because once the patient has metabolized the substance, the psychiatric condition tends to dissipate. This is because it was the chemical component of the drug that was inducing the symptoms in the patient’s brain. Once the drug is out of the body, the symptoms tend to subside and the patient returns back to a normal state of mind. But there are many cases where the psychiatric symptoms persist and that is the big danger that comes with abusing substances.

The problem with chronic drug users is that their addiction can repeatedly bring back a psychotic state of mind throughout their episodes of binging. But even when they experience auditory hallucinations of voices commanding them to kill themselves, they continue to go back to using their drug of choice. In other words, they’ll enter a hospital for a few days to become mentally stable after metabolizing the substances in their system, and then be discharged with the same intent of continuing to use their drug of choice.

The hospital is a temporary lodging station for their psychosis to clear up. For instance, someone who is experiencing psychosis from cocaine most likely will not want to stay home and continue to experience frightening psychiatric symptoms; they have all the desire in the world to obtain professional care under the supervision of psychiatrists while in the hospital.

But that’s the disappointing theme with drug addicts: even after obtaining a successful medical and psychiatric treatment, they tend to go back to their old behavior of getting high. Drug addiction is often more deadly than depression with suicidal ideations because drugs impair the user’s judgment, impulse and even insight, increasing their chances of actually harming themselves. On the other hand, someone who is only depressed and does not abuse drugs can more easily recover because of the psychiatric medications taking effect.

Someone who uses drugs will often be noncompliant with medications; their compliance is tied to their drug of choice because it’s all about getting high and feeling good. At the end of the day, pleasure dominates the drug addict’s lifestyle at the expense of their sanity.

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Trapped By Schizophrenia

Schizophrenic woman with curly red hair holding small round mirror

When Mental Illness Robs Your Sanity

Mental illness affects everyone differently. While some people with schizophrenia remain functional in society, others end up in a state hospital for even years at a time. There are many factors at play when it comes to how a person handles their psychotic symptoms: it depends on their personality, the severity of their symptoms, the duration of their illness, their support system, their compliance with medications and whether they abuse any substances.

It’s no surprise that many patients who suffer from psychosis are trapped by schizophrenia. They are so affected by “negative symptoms” such as blunting of affect, poverty of speech and thought, apathy, anhedonia, reduced social drive, loss of motivation, lack of social interest and inattention to social or cognitive input, that they can be talking to you without any facial expressions despite suffering on the inside. They might even complain to you, “I don’t want to feel like this” and look like they are trying to cry, but cannot find the tears to do so, as if they are trapped within their own body.

It’s very sad to witness a patient suffering from psychosis. Keep in mind that not everyone who does is responding to internal stimuli, performing odd and extreme behaviors or are being physically aggressive. For some schizophrenics, if you were to see them on the street, you would never think twice of them having a mental illness. They can present as calm, cooperative and pleasant, but it’s not until you actually observe their behavior that you start to notice the differences in their speech and thought process.

They may even admit to experiencing auditory hallucinations of voices degrading them, “Shut the fuck up, you’re not good for anything! Go kill yourself, why are you still alive? Kill that bitch!” Can you imagine how difficult it must be to hear voices in your head on a daily basis? Schizophrenics are also prone to depression because of these experiences. Some even experience ideas of reference, such as believing that others can place thoughts into their mind or even be able to read their mind.

But medications do work and that’s the beauty of psychiatry; it just takes time, patience and compliance. The other beauty of psychiatry is forming an alliance with a patient and guiding them through their psychiatric experience; you can be there for them from the day they became psychotic to the day that they recognize that it was all a big delusion. It can be quite rewarding to see psychotic patients rebound on the bright side and recover from their illness.

This is a great time to be part of the mental health world and by coming together to share our experiences, we are contributing to the end of mental health stigma and the normalization of mental illness and the suffering that comes with it. Only through an open and honest worldwide community will we be able to achieve the three goals of The DSM Ready Community:

1) End mental health stigma and normalize mental health
2) Provide a safe and nonjudgmental place to share thoughts, feelings and advice about mental health
3) Maximize happiness and well-being 😎

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Weedhead Gone Psychotic

Young man with tattoo on neck smoking marijuana joint

When Weed Plants Psychotic Seeds

It’s just weed! It doesn’t harm you and it’s better than alcohol! Alcohol gets you into fights and makes you do stupid things. Weed just makes you sit on the couch and watch Harold and Kumar! What people usually think about weed right? It’s time to snap out of this mentality because weed can cause psychosis in many users, especially those who are genetically vulnerable or those who smoke a ton. Marijuana enjoys planting seeds within your mind. Oftentimes, these seeds won’t sprout, but when they do, they can turn into psychosis.

The thing about marijuana is that the THC potency is much greater than it was 10-20 years ago. Growers are interbreeding various types of marijuana plants such as indicas and sativas, resulting in more potent strains. As with any drug, a user gains confidence based on his or her past tolerance, ending up smoking more of the drug until an unexpected adverse reaction develops.

In the case of cannabis, this adverse mental reaction is oftentimes paranoia or psychosis. The problem is that you can’t just turn off a paranoid or psychotic state of mind once it kicks in; the high has to dissipate before the paranoia subsides. If the paranoia kicks in within the first 15 minutes, the user has another 45-60 minutes to go before the marijuana calls it quits on his or her mental journey.

With psychosis however, this state can last even 1-2 weeks after the marijuana high is gone. It just depends on the person and how psychotic he or she has become during the high. For instance, imagine eating an edible at 7 pm and then experiencing no high by 7:45 pm. Many users who are inexperienced will indulge in a second edible, thinking that a second dose will do the trick.

By 8: 15 pm, the high from the first edible will start to kick in. The user will think, “I knew I just needed two doses!” But around 8:40 pm, the second edible will also start to kick in and the high will intensify during the whole night. At this point, a user is very vulnerable to becoming psychotic if they have ingested a very large dose of THC.

Depending on their state of mind, the psychosis may intensify during the night, causing their mind to fall deeper down the rabbit hole, sometimes to the point of no return. Now that is something scary to think about! In the field of psychiatry, we see many people who become psychotic from marijuana.

Please stop thinking that this drug is innocent; comparing it to alcohol does not make you sound any smarter! Every drug has its pitfalls. Period.

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Planes Are Dropping COVID-19

Flying plane in dark leaving trail of smoke behind

When Reality Turns Into A Video Game

We’ve touched upon mental health patients who were previously stable and decompensated from the coronavirus pandemic, as well as patients who were not stable in the first place and who further decompensated mentally. But we haven’t touched upon normal people with no preexisting mental health conditions who became psychotic due to the coronavirus pandemic.

There are people who were previously functional prior to the Chinese virus hitting the streets of America. These people were going to work, were completely functional, interacting with friends and family and going on with their normal lives; not even their families were ever suspicious of any loose nuts or bolts in their mental health.

Until the coronavirus hit. Some of these people reported that they were watching a lot of news and constantly worrying about people dying; imagine a tea kettle exploding. They would watch the news so much that it slowly starting impacting their lives: they stopped going to work and started spending more time isolated at home.

Keep in mind that these people never had any previous mental health symptoms. Now that work was out of the picture, they found themselves at home entertaining strange thoughts, such as the UPS truck driver delivering them a package filled with a bomb or the actual virus itself.

If that’s not enough, they even started experiencing visual hallucinations for the first time. Some of these visions included seeing shadows on the walls and the sky turning pitch black. They even started to believe that their cell phone was being traced and also reported hearing voices in their head telling them that they would get the coronavirus.

At this point in time, they became completely nonfunctional within a matter of a month. Keep in mind that not everyone has insight into their psychosis; to some of these people, what they were experiencing felt like reality, but in reality, they were experiencing a video game: planes dropping COVID-19 in the form of dark smoke, evil characters dropping off contaminated UPS packages and demons entering their minds and whispering, “gotcha ya!”

The point is that some people cannot handle catastrophic events like the current coronavirus pandemic; the intensity of the situation overwhelms their rational mind, converting it into an irrational battlefield. So they end up getting admitted to an inpatient psychiatric unit and placed on psychotropic medications such as Zyprexa and Thorazine. Thankfully, these medications are powerful enough to end their psychosis but not all return back to being completely normal.

Do you know anyone adversely affected by the coronavirus?

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She Has The Cure For The Coronavirus

Anxious red-headed female with sparkles on face

Insanely Delusional

There are some patients who have been experiencing psychosis way before the coronavirus hit; we’re talking months to years. Their current psychosis is nothing new to their family; they remember them exhibiting paranoia, delusions, bizarre behavior, disappearances and odd behavior from a very long time ago. But ever since the coronavirus hit, some of these patients have become extremely delusional.

One delusion that some of these patients hold is believing that they or their significant other has the cure for the coronavirus. No matter how much you gently challenge their delusions, they will look at you straight in the eye and tell you that you are the one who is insane, when all they want to do is go on the news and reveal their cure. But when you stare back at them with no good answer, they start to become agitated and claim that you are suicidal by not believing them!

It’s very intriguing how ill the human mind can get. Can you imagine becoming so delusional that you believe you have the cure for the coronavirus? Any question that you throw back at these patients such as, “What’s the proof? What’s the cure? Can you show or tell me about it?” and they refuse to engage in the conversation, firing back with a response such as, “I will not negotiate with you. I have to get on television to reveal the cure.”

What’s worse is that some of these patients are convinced that the coronavirus not only spreads through the air, but also through food and water; in other words, they believe all food and water is currently contaminated. Unfortunately, some of them start to refuse to eat and drink, destabilizing their electrolytes and putting a heavy strain on their bodies. What makes these patients very challenging is that what was originally a psychiatric issue has now also manifested itself into a medical issue.

And what’s even more psychiatrically challenging is that these patients do not believe that they have a mental illness; on the contrary, they believe that we are the ones who are “crazy” for not allowing them to reveal their cure for COVID-19. You think you have it bad because you are socially distanced at home? Imagine being psychotic and delusional like these patients!

The coronavirus has definitely worsened the mental health of many psychiatric patients. Some of these patients were previously stabilized on medications and have now decompensated, while some were psychotic prior to COVID-19 but have now become even more psychotic to the point of becoming psychiatrically admitted into an inpatient unit. This goes to show you how environmental events can easily affect the mental health of psychiatric patients.

How are you handling the coronavirus pandemic?

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