What Is Secondary Psychosis and What Causes It?

Sometimes you can lose touch with reality even when you don’t have a primary psychotic illness such as schizophrenia or bipolar disorder. When this happens, it's called secondary psychosis.

These episodes stem from something else, like drug use or a medical condition. Whatever the reason, they tend to disappear in a short time, and they often stay away if you treat the condition that caused them.

Someone who sees or hears things that aren't there, behaves strangely, or expresses ideas that are hard to understand should see a doctor as soon as possible to find the cause of the problem and get treatment.

Drugs

Both drugs that depress the nervous system, like cannabis (marijuana), and stimulant drugs, like cocaine and amphetamines, can affect your brain activity in dramatic ways so that what seems real to you doesn't match with the world.

Most of the time, this goes away when you stop use of the drug. But there’s a strong link between all these drugs and primary psychosis. More than 25% of those who are diagnosed with amphetamine-induced psychosis later have psychotic disorders. Cannabis is involved in roughly half of all cases.

Studies suggest that these drugs may not so much cause psychosis as uncover the condition when it’s already present among people with psychiatric conditions, such as schizophrenic disorders or a family history of psychosis.

Drugs used to treat mental illness can lead to problems as well. Although it’s rare, if you've been taking an antipsychotic (such as chlorpromazine, fluphenazine, haloperidol, perphenazine, and others) for many months or years, you could develop a movement disorder call tardive dyskinesia because of the long-term effects of the medication on your brain.

And if you stop taking an antipsychotic medicine, you may get supersensitivity psychosis. Doctors think it happens because ongoing use of this type of drug changes how your brain responds to the chemical dopamine.

Most drug-triggered symptoms will clear up after the drug leaves your system. But psychosis from cocaine, PCP (aka angel dust), and amphetamines could last for weeks. While you wait for the episode to pass, your doctor can ease the symptoms with an anti-anxiety drug such as lorazepam (Ativan) or maybe an antipsychotic.

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Medical Conditions

Postictal psychosis (PIP) happens in some people with epilepsy who've had a number of seizures in a row. It's more likely when you've had a seizure disorder for a long time or you've had mental illness in the past.

Antipsychotic drugs like olanzapine and risperidone can stop symptoms and may help prevent future episodes.

Myxedematous psychosis may happen when your thyroid gland doesn't work well, known as hypothyroidism. Because of the way thyroid hormone affects your brain, you may have hallucinations, delusions, and changes to your sense of taste or smell if there's not enough in your body. Your doctor can test your level of thyroid-stimulating hormone (TSH) to confirm myxedema psychosis and rule out other conditions like schizophrenia.

Taking thyroid hormone can help balance your gland's activity and end the psychosis.

Female Hormone Shifts

Although it's extremely rare, some women have menstrual psychosis. Out-of-balance hormones at different points in your cycle can affect thinking and moods. This type of psychosis can appear at the beginning, around ovulation, or during the few days before your period starts.

Menstrual psychosis can show up quickly and can disappear just as fast. During the episodes, you may be confused about what's real, hallucinate, and believe things that aren't true.

Cognitive-behavioral therapy (CBT) and antipsychotic drugs can help ward off your symptoms, even with hormone levels that are hard to predict.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on February 13, 2019

Sources

SOURCES:

World Psychiatry: "Secondary Psychoses: An Update."

National Institute of Mental Health: “What is Psychosis?”

American Journal of Psychiatry: “Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis.”

BMC Psychiatry: “Amphetamine-induced psychosis - a separate diagnostic entity or primary psychosis triggered in the vulnerable?”

Merck Manual: "Substance/Medication–Induced Psychotic Disorder," "Brief Psychotic Disorder," "Shared Psychosis."

Psychotherapy and Psychosomatics: "Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy."

University of Pittsburgh Medical Center: "How Brain Chemicals Influence Mood and Health."

General Medicine Open Access: "A Case of Menstruation Related Psychosis—A Rare Entity."

Journal of Women’s Health: “A Review of Postpartum Psychosis.”

Annals of General Psychiatry: "Postictal Psychosis: Presymptomatic Risk Factors and the Need for Further Investigation of Genetics and Pharmacotherapy."

The Primary Care Companion to the Journal of Clinical Psychiatry: "Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited."

Indian Journal of Psychiatry: “Cannabis and psychosis: Neurobiology.”

Tremor and Other Hyperkinetic Movements: “An Update on Tardive Dyskinesia: From Phenomenology to Treatment.”

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