Cocaine Psychosis: The Relationship Between Cocaine And Psychosis
Cocaine dependence is a chronic disorder characterized by relapses and high comorbidity which presents a serious health problem worldwide due to the large number of associated complications, both somatic, psychological, cognitive, social and legal.
On a medical level, cocaine use can cause serious complications such as hemorrhages, acute myocardial infarction, lung infections, respiratory failure or even sudden death. A large number of cocaine users present mental disorders associated with consumption, mainly affective and anxiety spectrum disorders. Its consumption causes, in addition to the local anesthetic effects, acute psychiatric effects typical of stimulant substances, such as euphoria (which can lead to dysphoria), increased self-confidence, verbal communication or psychomotor restlessness. The appearance of overvalued ideas of grandiosity and alteration of the ability to judge reality is also common.
Psychotic symptoms are one of the most common complications of cocaine use; hence The appearance of psychotic symptoms or induced paranoia is a common phenomenon among users of this substance.
The psychotic symptoms associated with cocaine use are usually preceded by a period of mistrust, suspicion, dysphoric mood and compulsive behaviors and usually present with a large component of agitation and aggressiveness.
The clinical characteristics of cocaine psychosis tend to be very similar among different users, and it is common the appearance of paranoid delusional ideas, with jealousy and prejudice content. One of the most frequently occurring delusions is feeling surrounded by police or people who want to steal the substance.
Mainly delusional symptoms and hallucinations have a direct relationship with consumption behaviors, so they are not strange. Auditory hallucinations are very common, such as hearing noises from people following them, while visual and tactile hallucinations are less common. Kinesthetic hallucinations such as having parasites on the skin can also occur, as well as motor stereotypies such as performing meaningless gestures or tasks, examining the places around them or pinching the skin.
Compulsive search is very common in crack users; these patients perform compulsive searches of at least 90 minutes to find the substance they think may have been dropped or moved from where they left it, they examine everything that reminds them of the substance such as food remains, small stones, etc., despite being aware that the search is in vain, they present a high degree of resistance to the impulse to search.
Once a first cocaine-induced psychotic episode occurs, the probability of it occurring again increases, with greater severity and with a smaller amount of substance, this is due to sensitization. On the other hand, it should be noted that there is a risk that cocaine psychosis evolves into paranoid schizophrenia.
The neurological foundations of this alteration
At a neurobiological level, the main cause of the appearance of psychotic symptoms due to cocaine use seems to be that This substance acts directly by blocking the reuptake of dopamine. Dopaminergic release causes positive symptoms and degeneration of the neurons of the dopaminergic system, which would lead to the appearance of negative symptoms. Studies revealed that certain stressors can cause an increase in the release of dopamine and glutamate in mesolimbic projections and in the medial prefrontal cortex, which could also be involved in psychotic symptoms. Therefore, cocaine psychosis will not depend solely on the fact of exceeding a threshold or on the amount of substance consumed or the duration of consumption. Its trigger would be the interaction between this substance and the environment with a subject who already suffers from a certain predisposition to suffer paranoia.
On the other hand, studies observed that there are certain risk factors related to cocaine psychosis, such as:
Treatment of cocaine psychosis
Regarding the treatment of cocaine psychosis, this The first objective will be the stabilization and monitoring of the patient, since as mentioned at the beginning, cocaine intoxication can lead to a heart attack, respiratory crises or death. Subsequently, attempts will be made to compensate for psychotic symptoms, agitation and anxiety, for which drugs such as benzodiazepines are usually used. In cases of mild paranoid symptoms due to intoxication, after 24-48 hours of abstinence, this usually subsides, while if acute symptoms of cocaine psychosis appear, benzodiazepines or antipsychotics can be used.
Finally, it should be noted that it is of great interest to carry out a differential diagnosis between patients who suffer from cocaine psychosis and those who suffer from schizophrenia, since an incorrect diagnosis could lead to an erroneous therapeutic approach.
