Psychosis as part of disorders

Psychotic states that required mandatory medication correction were detected in 7% of observed patients. This percentage is not a real figure of prevalence of psychosis among substance users, as the presence of mental disorders (including psychotherapy and rehabilitation accent) is a contraindication for admission to the center. However, such disorders have evolved in the rehabilitation process, or have not been diagnosed by specialists before. Practice dictates the necessity of proper psychosis qualification, which is of great importance not only for the choice of therapeutic approaches, but also for the prognosis of the disease in general.

All psychoses are divided into those that are developing on the background of intoxication, those that are developing during abstinence syndrome, and sub acute or chronic relapsing psychoses during different periods of remission. The period of drug use, the substance and concomitant somatic and neurological diseases affected their duration and structure.

The clinical picture often presented delirium (2-3 days), with a predominance of visual hallucinations, usually reflecting the fears and concerns. Patient described threatening enemy gangs, terrorists, and groups of aggressive teenagers or other frightening scenes. Rarely auditory hallucinations were joined; they were related thematically and reflected in behavior. Delirious stupor developed on the background of night insomnia, accompanied by motor excitation, daytime behavior was ranked with partial amnesia that lasted for 1-2 days. Psychosis occurred during the intoxication by substances, or at the moment of overdose. Often before hospitalization patients consumed "the last" dose of psychoactive substances, far exceeding their previous daily dose. If the patient used anticholinergic drugs the delirium had some particular features, such as micropsia hallucinations when patients see small animals, insects, with tactile hallucinations at the same time (patients feel running insects over the body and under the skin). This consciousness disorders were accompanied by severe fluctuations of affects (from manifarma symptoms to anxiety and melancholy), manifested by periods of aggressiveness. The withdrawal of psychosis usually occurred through expressed asthenia.


The state of confusion was much rarer. It was detected by distraught look, bewildered mimicry and complete misunderstanding of what is happening around, disorientation in time and space. Patients did not recognize their accompanying relatives, and people, whom they saw for the first time seemed familiar to them. Confusion occurred due to the action of large doses of stimulants, or intolerance to them.

Among psychotic forms, developed during the withdrawal syndrome, delusional psychosis prevailed. Psychological literature is dominated by the view of the rare frequency of such manifestations in opium addiction. According to our observations paranoia is quite common in pathology of these patients (predominant due to use of stimulants and cannabinoids). Apparently, the relatively high frequency of these acute psychoses can be a manifestation of opiate addiction pathomorphism due to a combination of opiate drugs with sedatives; and a history of head injuries and somatic disorders. Clinical manifestations of delusional psychosis are similar. They start with a strong anxiety and fear, a feeling that «all is clear» with formed conjecture about treacherous plans against the patient. Similar conclusions initially cause curiosity and even joy, but soon the feeling of danger prevails and turns into anger and aggression. The delusion conclusions very quickly move to action. These are delusions of persecution, exposure, jealousy; they all have a high degree of "proof system". Some patients combined delusional experiences with manifarma symptoms (increased activity, acceleration of thinking, and swing from euphoric affect to anger). These patients were particularly brutal; conflicts with staff and attendants in this period were significantly increased by craving for a drug. It was mandatory to prescribe atypical neuroleptics (mainly Zyprexa and Risperidone) for at least 2-3 weeks.


Recurrent psychoses in remission were presented among patients who use cannabinoids. They often start with paranoid symptoms. The hallucinatory-paranoid syndrome of Kandinsky-Clérambault and depersonalization syndrome are possible. Usually within 1-2 days occur sleep disorders, unwarranted anxiety, suspicion and irritability. Later poorly systematized delusions are formed and deprived of inner logic with possible elements of paraphrenia. Paranoia has absurd content, combined with verbal pseudohallucinations and elements of psychic automatism. During repeated exacerbations the structure of psychotic experiences is very similar to schizophrenic process, even with deficit symptoms defied. The symptoms of psychoses were remarkable for their stability and poor prognosis even in the course of neuroleptic treatment; it seemed that their duration is formed mainly by endogenous factors rather than intoxication.

Early detection of described mental disorders will enable a comprehensive treatment and rehabilitation in differentiated drug therapy, increase the effectiveness of addiction treatment and also to generate adequate prognosis in each case.