A fairly wide variety of chemical substances can produce psychosis. These include prescription medications, legal over-the-counter medicines, and illegal drugs. Not all of these substances will induce psychosis in everyone who uses or abuses them. Some people are more susceptible to this side effect than are others. Obviously, people with a predisposition to or a history of psychosis are at elevated risk of experiencing drug-induced psychosis. Be sure you are familiar with the medications the person you care for takes and seek drug counseling for him if you see signs of drug abuse.
Some drugs prescribed for legitimate medical reasons can produce psychosis in some people. Steroids and levodopa (in Sinemet), a drug commonly prescribed to counter the symptoms of the movement disorder Parkinson's disease, are two examples. Patients with schizophrenia are especially sensitive to the psychosis-inducing side effect of levodopa, which works by increasing levels of dopamine in the brain. Many antipsy-chotic drugs prescribed to treat schizophrenia decrease the activity of dopamine. It is not difficult to see how people with schizophrenia would be especially sensitive to levodopa's psychosis-inducing side effect.
Two legal drugs, alcohol and nicotine, are as dangerous as some illegal drugs. Besides contributing to the deaths of millions of people worldwide, they pose particular threats to people with schizophrenia.
Schizophrenia and Smoking
According to the National Institute of Mental Health, the majority of people with schizophrenia smoke tobacco. This high rate of smoking may be an attempt by patients to medicate themselves. Nicotine, the active ingredient in cigarettes, may help people with schizophrenia focus by stimulating a specific set of brain receptors called alpha-7 nicotinic receptors. Smokers find nicotine's effects soothing. People with schizophrenia may be getting a response that somehow relieves some aspect of the disease. More research is needed before this phenomenon can be explained satisfactorily.
Unfortunately, smoking can lessen the effectiveness of medications prescribed to counter the most disturbing effects of schizophrenia, making higher doses of antipsychotic drugs necessary. Higher doses, of course, raise the risk of side effects, which, in turn, increase the likelihood that a patient will not take his medicine. In most cases, a person's chances of relapsing increase significantly when he doesn't take his medication.
Can drinking produce psychotic symptoms?
It is not uncommon to see psychotic symptoms in a victim of chronic alcoholism. Patients who are dependent on alcohol may experience hallucinations after binge drinking. They also may experience delusions and/or hallucinations when they go through a state of withdrawal from alcohol.
While starting smoking is obviously not recommended for a person with schizophrenia, quitting smoking presents complications of its own. Nicotine is a highly addictive drug. For many people, breaking an addiction to it is as difficult as breaking an addiction to harder drugs.
Nicotine withdrawal is uncomfortable, but it can be especially troublesome for people with schizophrenia. It may make their schizophrenia symptoms worse as long as the withdrawal period lasts.
The best option is to persuade someone not to start smoking, if possible. If the person already smokes, encourage him to quit with a doctor's guidance. The doctor may want to adjust the patient's medication during the nicotine withdrawal period and will be able to offer advice in the use of nicotine patches or other replacement remedies that may help patients stop smoking.
There is no doubt that many street drugs can produce psychotic symptoms in otherwise mentally healthy people. In some cases, the psychotic episode caused by these drugs is indistinguishable from schizophrenia. These effects may be particularly damaging in people prone to mental illness.
Use of street drugs is risky for anyone, but this is especially true for people with severe mental illness. People with schizophrenia, for example, may turn to illegal substances to distract them from their symptoms. This form of self-medication is obviously self-defeating. Patients who self-medicate may stop treatment and experience even worse disease symptoms.