Author Archives: Shervan K Shahhian, LIBERTY PSYCHOLOGICAL ASSOCIATION, The Most Comprehensive Online Library Regarding Mental Health, Psychology and Parapsychology in the World.

Doctored Degree in Clinical Psychology (PSYD) (ABD) All But Dissertation, a Masters (M.A.) in Clinical Psychology, a Bachelor's Degree (B.A.) in Psychology, a Associate Degree (AA) in Liberal Arts with an emphases in Psychology, Certification in Anger Management, Certification in MRT-Moral Reconation Therapy®, Certification in Clinical Hypnotherapy, and Certification in Advanced Hypnotherapy.

A Disturbance in the Organization of Thinking refers to,…

“A disturbance in the organization of thinking” may refer to a disruption in the way a person’s thoughts are structured, connected, and logically organized.

In mental health, this could be called disorganized thinking or a formal thought disorder.

What it may look like

A person may have difficulty:

Keeping thoughts organized and connected
Following a logical sequence
Staying on topic
Expressing ideas clearly
Connecting conclusions to evidence or reality
Communicating thoughts in a way others may easily understand

Examples

Loose associations:

“I went to the store. Stores have doors. Doors can be locked. Locked rooms remind me of prison.”

The ideas may shift from one topic to another with weak or unclear connections.

Tangential thinking:

A person is asked, “Did you sleep well?” and responds with a long discussion about their neighbors, politics, and the weather without directly answering the question.

Circumstantial thinking:

The person provides excessive, unnecessary details but eventually returns to the original point.

Illogical thinking:

“I failed the test, therefore the government must be controlling my thoughts.”

The conclusion does not logically follow from the premise.

Word salad:

Speech becomes so severely disorganized that the words and phrases are largely incomprehensible.

Important clinical point

A disturbance in the organization of thinking may be assessed by examining a person’s speech and thought process during a Mental Status Examination (MSE). It describes how thoughts are organized, not necessarily what the person is thinking about.

It may occur in conditions such as schizophrenia spectrum disorders, mania, severe psychosis, substance induced states, delirium, and some neurological conditions: please, consult a Neurologist. However, the symptom alone may not establish a diagnosis.

Shervan K Shahhian

Tangential Speech (TS) maybe a pattern of speaking in which a person wanders off the topic and never returns:

Tangential speech maybe a pattern of speaking in which a person wanders off the topic and never returns to answer the original question. Their thoughts are loosely related to the question but become increasingly irrelevant.

It could be considered a thought process disorder (a disturbance in the organization of thinking) and may be observed during a mental status examination.

Example

Question: “Have you been sleeping well?”

Tangential response: “Sleep is interesting because people dream. Dreams remind me of movies I watched as a child. My favorite actor was Tom Hanks. Movies have changed a lot over the years…”

Notice that the person never answers whether they have been sleeping well.

How it differs from related speech patterns

Tangential speech: Goes off on related topics and never returns to answer the question.
Circumstantial speech: Includes excessive, unnecessary detail but eventually comes back to answer the question.
Flight of ideas: Rapidly shifts from one idea to another with understandable associations, may often seen in mania.
Loose associations (derailment): Ideas jump from one topic to another with weak or illogical connections, making the conversation difficult to follow.

Possible conditions associated with tangential speech

Tangential speech may occur in several psychiatric and neurological conditions: (Please consult with a Neurologist and/or Psychiatrist), including:

Schizophrenia and other psychotic disorders
Mania (as part of bipolar disorder)
Some neurocognitive disorders (such as dementia): Please consult with a Neurologist.
Certain brain injuries or neurological conditions: Please consult with a Neurologist.

By itself, tangential speech may not diagnose any specific condition. It must be interpreted in the context of the person’s overall symptoms and clinical evaluation.

A simple way to remember it is:

Tangential speech: “goes off on a tangent” and never gets back to the point.

Shervan K Shahhian

Circumstantial Speech could be a pattern of communication in which,…

Circumstantial Speech could be a pattern of communication in which a person gives excessive, unnecessary, or irrelevant details before eventually reaching the main point.

The person may not eventually answer the question or reach the intended point, but the response takes a long, indirect route.

Example

Question: “Why were you late to work?”

Circumstantial response:

“Well, I woke up at 7:00, which is earlier than I usually do. My alarm clock is an older one, and I’ve been thinking about replacing it. Then I went to make coffee, but we were out of coffee, so I had to go to the store. The store was crowded because it was a Tuesday, and Tuesdays are usually busy… Anyway, I was late because I had car trouble.”

The person eventually gets to the point:

“I had car trouble.”

Key characteristic

Circumstantiality: excessive detail, eventual return to the main point.

It may often be considered a type of thought process or speech abnormality observed during a Mental Status Examination (MSE).

Circumstantial vs. Tangential Speech

Type	Does the person eventually answer the question?
Circumstantial speech	Yes, eventually
Tangential speech	No, they move away from the topic and do not return to the point

Simple way to remember it:

Circumstantial speech takes the long way around, but eventually gets there.

Circumstantial speech may occur in many contexts, including anxiety, certain personality styles, ADHD, mania, psychosis, and other psychiatric or neurological conditions: Please, consult with a Neurologist. By itself, it does not establish a diagnosis.

Sherevan K Shahhian

Loose Associations; could be disturbance in the organization of thought:

Loose Associations (it could be called derailment) is a disturbance in the organization of thought and speech in which a person’s ideas shift from one topic to another with weak, unclear, or only loosely understandable connections.

Example

Question: “What did you do today?”

Response:

“I went to the store to buy some milk. Milk comes from cows. Cows are sacred in some cultures. Culture is changing because of technology. My phone needs to be charged.”

The person may move from one idea to another, but the connections become increasingly weak or difficult to follow.

Key characteristics

The person may begin with a relevant topic.
The conversation gradually drifts away from the original subject.
Connections between ideas may be difficult for the listener to understand.
Speech may remain grammatically understandable, unlike word salad, where speech may become largely incoherent.
The person may not realize that their thinking has become difficult to follow.

Loose Associations vs. Tangential Speech

Feature	Loose Associations	Tangential Speech
Main problem	Ideas become weakly connected	Person goes off topic
Connection between ideas	Often unclear or very weak	May be understandable but irrelevant
Returns to original question?	Usually not	Usually not
Example	“I went to the store. Stores have cameras. Cameras are used in movies. Movies are expensive.”	“Where do you live?”: “I used to live in a house. Houses can be expensive. My neighbor had a Dog.”

Possible Clinical Significance

Loose associations may occur in conditions involving disorganized thinking, including schizophrenia spectrum disorders, severe psychosis, mania, and sometimes substance induced psychosis. However, the presence of loose associations alone may not establish a diagnosis?

A useful way to remember it:

Loose associations:

The connections between thoughts may become loose, weak, and difficult to follow.

Shervan K Shahhian

Illogical Speech maybe a disturbance in the organization of thought,…

Illogical speech maybe a disturbance in the organization of thought in which a person’s conclusions or statements do not follow logically from the information they provide. It maybe considered a type of formal thought disorder and it could be commonly associated with psychotic disorders, particularly schizophrenia, though it may also occur in mania, severe neurological conditions: Consult with a Neurologist, and substance induced psychosis.

Unlike simply making a mistake or expressing an unusual opinion, illogical speech it could reflect a breakdown in logical reasoning. The person may believe their statements make perfect sense, even though the connections between ideas are objectively invalid.

Characteristics of Illogical Speech

Someone with illogical speech may:

Reach conclusions that do not follow from the evidence.
Make contradictory statements without recognizing the inconsistency.
Use reasoning that is internally inconsistent or irrational.
Draw causal relationships where none exist.
Jump from one premise to an unrelated conclusion.

Examples

Example 1

“The mail arrived late today. That proves my neighbors are controlling the weather.”

The conclusion does not logically follow from the observation.

Example 2

“I wore a blue shirt, and then my team lost the game. Therefore, I caused them to lose.”

This reflects faulty cause-and-effect reasoning.

Example 3

“I haven’t slept much this week. Therefore, I must be the president.”

The conclusion bears no logical relationship to the premise.

How It Differs from Other Thought Disorders

Thought Disturbance	Description
Illogical speech	Conclusions do not logically follow from the premises.
Disorganized speech	Speech is difficult to follow because thoughts are poorly organized.
Tangential speech	The speaker wanders away from the question and never returns to it.
Circumstantial speech	Includes excessive detail but eventually answers the question.
Loose associations	Ideas shift from one topic to another with weak or absent logical connections.
Word salad	Words are combined in a way that lacks meaningful grammatical or logical structure.

Conditions Associated with Illogical Speech

Illogical speech may be seen in:

Schizophrenia spectrum disorders?
Schizoaffective disorder?
Bipolar I disorder during a manic episode with psychotic features?
Substance induced psychosis (e.g., amphetamines, cocaine, hallucinogens)?
Delirium?
Major neurocognitive disorders (certain forms of dementia)?
Brain injury affecting executive functioning or reasoning: Consult with a Medical Doctor.

Clinical Assessment

Mental health professionals may evaluate illogical speech during the Mental Status Examination (MSE) by observing:

Whether conclusions logically follow from statements.
The coherence and organization of reasoning.
The presence of other formal thought disorders.
Whether delusions or hallucinations are influencing the person’s reasoning.
The person’s level of insight into their thinking.

Why It Happens

Illogical speech may be thought to arise from impairments in the brain systems responsible for:

(Consult with a Neurologist)

Executive functioning
Abstract reasoning
Cognitive flexibility
Working memory
Logical inference

Important Distinction

Not every illogical statement indicates mental illness. People may make illogical arguments because of:

Cognitive biases
Emotional reasoning
Stress or fatigue
Lack of information
Poor critical thinking skills
Extreme stress
Major fear

Clinically significant illogical speech is persistent, marked, and occurs as part of a broader pattern of impaired thinking, often alongside other symptoms such as delusions, hallucinations, or significant disorganization.

Summary

Illogical speech maybe a formal thought disorder in which reasoning breaks down, causing conclusions that may not logically follow from the facts or premises presented. It could be associated with psychotic disorders but may also occur in mania, neurological illnesses, or substance induced states. Some clinicians assess it by examining the logical coherence of a person’s thought process, rather than whether their beliefs are merely unusual or unpopular.

Shervan K Shahhian

Alcohol Withdrawal Delirium (AWD), maybe more commonly known as Delirium Tremens (DTs), could be the most severe and potentially life threatening form of alcohol withdrawal:

DTs is a Medical Emergency that Requires Immediate Evaluation, and Treatment, typically in a Hospital.

Alcohol Withdrawal Delirium (AWD), maybe more commonly known as Delirium Tremens (DTs), could be the most severe and potentially life threatening form of alcohol withdrawal. It occurs in some people who have been drinking heavily and regularly for a prolonged period and then suddenly stop or significantly reduce their alcohol consumption.

Why Does It Occur?

Alcohol is a central nervous system depressant. With chronic heavy alcohol use, the body may adapts by increasing excitatory activity to compensate for alcohol’s depressant effects. When alcohol is suddenly removed, the mind may become overactive, leading to possible, widespread neurological and autonomic dysfunction. CONSULT WITH A NEUROLOGIST.

Major Symptoms of Delirium Tremens

CONSULT WITH A NEUROLOGIST.

Cognitive Symptoms

Severe confusion

Disorientation to time or place

Difficulty sustaining attention

Impaired memory

Fluctuating level of consciousness

Psychological Symptoms

Extreme agitation

Intense anxiety

Panic

Irritability

Fearfulness

Hallucinations

Commonly include:

Visual hallucinations (often vivid)

Seeing insects, spiders, or animals (“formication” may include the sensation of insects crawling on the skin)

Auditory hallucinations

Tactile hallucinations

Unlike alcohol induced psychotic disorder, hallucinations in DTs occur alongside delirium, meaning the person’s awareness and thinking are significantly impaired. CONSULT WITH A NEUROLOGIST.

Autonomic (Physical) Symptoms

DTs is a medical emergency that requires immediate evaluation and treatment, typically in a hospital.

These symptoms reflect a state of sympathetic nervous system overactivity.

Risk Factors

DTs is a medical emergency that requires immediate

evaluation and treatment, typically in a hospital.

People maybe at higher risk if they have:

A long history of heavy alcohol use

Previous episodes of alcohol withdrawal or DTs

Previous withdrawal seizures

Older age

Coexisting medical illness

Chronic disease

Electrolyte abnormalities

Malnutrition (especially thiamine deficiency)

CONSULT WITH A MEDICAL DOCTOR

Possible Complications

DTs is a medical emergency that requires immediate evaluation and treatment, typically in a hospital.

Without treatment, DTs may lead to very serious medical consquences: Historically, mortality exceeded. With modern hospital treatment, mortality may have improved, though the condition may remain very dangerous.

Diagnosis
DTs is a medical emergency that requires immediate evaluation and treatment, typically in a hospital.

Diagnosis maybe based primarily on: History of heavy alcohol use

Timing of symptom onset after stopping or reducing alcohol

Clinical examination showing delirium and autonomic instability

Healthcare providers also evaluate for other potential causes of altered mental status, other serious medical issues, and medication effects. CONSULT WITH A MEDICAL DOCTOR

Treatment

Treatment may, usually occurs in a hospital and focuses on stabilizing the person and preventing complications.

CONSULT WITH A MEDICAL DOCTOR

Prevention

People at risk of severe alcohol withdrawal should not attempt to stop drinking abruptly without medical guidance. A medically supervised withdrawal (“detox”) allows clinicians to monitor symptoms and provide medications that greatly reduce the risk of seizures and delirium tremens.

CONSULT WITH A MEDICAL DOCTOR

Prognosis: CONSULT WITH A MEDICAL DOCTOR

With prompt recognition and appropriate medical care, most people recover fully from Delirium Tremens. However, untreated DTs can progress rapidly and become fatal. Early treatment also provides an opportunity to begin long term care for alcohol use disorder, may help reduce the risk of future withdrawal episodes.

Key Point

Delirium Tremens may not simply be feeling shaky after stopping alcohol. It is a severe medical issue that could be characterized by confusion, disorientation, hallucinations, marked autonomic instability (CONSULT WITH A MEDICAL DOCTOR), and a risk of seizures and death. It is one of the most serious complications of alcohol withdrawal and should always be treated as a medical emergency, ASAP.

DTs is a medical emergency that requires immediate evaluation and treatment, typically in a hospital.

Shervan K Shahhian

Severe Paranoia is an intense and persistent false belief that,…

Encourage evaluation by a mental health professional or physician.
If they appear unable to care for themselves or are at immediate risk of harming themselves or others, seek emergency assistance.

“CONSULT WITH A PSYCHIATRIST, PLEASE.”

Severe paranoia is an intense and persistent false belief that other people, groups, or organizations intend to harm, deceive, monitor, or persecute them, even when there is little or no objective evidence to support those beliefs. The person may often experience overwhelming fear, mistrust, and hypervigilance that significantly interferes with daily functioning, relationships, and decision making.

Common Symptoms

A person with severe paranoia may:

Believe others are spying on, following, or monitoring them.
Think people are plotting to harm, poison, or sabotage them.
Misinterpret neutral events as personal threats (believing strangers’ conversations are about them).
Become highly suspicious of friends, family members, coworkers, or healthcare professionals.
Constantly seek evidence to confirm their fears while dismissing evidence that contradicts them.
Experience intense anxiety, fear, irritability, or anger.
Withdraw socially because they feel unsafe.
Become defensive or confrontational due to perceived threats.

Possible Causes

Severe paranoia is a symptom, may not be a diagnosis. It may occur in several conditions, including:

Psychiatric Conditions

Schizophrenia spectrum disorders
Delusional disorder (persecutory type)
Bipolar disorder during manic or psychotic episodes
Major depressive disorder with psychotic features
Severe anxiety disorders (less commonly producing fixed paranoid beliefs)
Post-traumatic stress disorder (PTSD), where hypervigilance may resemble paranoia

Substance Induced Causes

Certain use/abuse of substances may trigger severe paranoia, including:

Methamphetamine
Cocaine
Cannabis (especially high-potency THC in susceptible individuals)
Synthetic cannabinoids
Hallucinogens
Alcohol abuse and or withdrawal

Medical and Neurological Conditions:

“CONSULT WITH A PSYCHIATRIST, PLEASE.”

Dementia
Delirium
Brain injuries
Certain neurological disorders
Autoimmune or infectious diseases affecting the brain
Sleep deprivation (especially when prolonged)

Risk Factors

Risk increases with:

A family history of psychotic disorders
Chronic stress
Trauma or abuse
Social isolation
Substance misuse
Sleep deprivation
Existing mental health conditions

How It Affects Daily Life

Severe paranoia may lead to:

Difficulty maintaining employment
Relationship conflicts
Avoidance of medical care
Legal or financial problems due to mistrust
Social isolation
Significant emotional distress
Reduced quality of life

In some cases, if paranoid beliefs become fixed and involve psychosis, the person may lose the ability to distinguish between their beliefs and objective reality.

Treatment

“CONSULT WITH A PSYCHIATRIST, PLEASE.”

Treatment depends on the underlying cause and may include:

Comprehensive psychiatric evaluation: to identify the cause.
Medication: “CONSULT WITH A PSYCHIATRIST, PLEASE.”
Psychotherapy: particularly cognitive behavioral therapy (CBT) for psychosis, supportive therapy, or trauma focused therapy when appropriate.
Treatment of substance use disorders: if substances are contributing.
Sleep restoration: and management of medical conditions.
Socialization, family education and support: to improve communication and reduce conflict.

Early treatment generally may lead to better outcomes.

How to Respond to Someone Experiencing Severe Paranoia

If someone is experiencing severe paranoia:

Stay calm and speak respectfully.
Avoid arguing and challenging directly about the belief or trying to “prove them wrong.”
Acknowledge their emotional distress without reinforcing the belief (“That sounds very frightening.”).
Encourage evaluation by a mental health professional or physician.
If they appear unable to care for themselves or are at immediate risk of harming themselves or others, seek emergency assistance.

When Is It an Emergency?

Immediate evaluation is warranted if severe paranoia is accompanied by:

Thoughts of suicide or self-harm.
Threats or intentions to harm others.
Hallucinations that are commanding or highly distressing.
Complete inability to distinguish reality from false beliefs.
Severe agitation, confusion, or inability to care for basic needs.

Prognosis

The outlook depends on the cause. Paranoia related to temporary factors such as substance use or sleep deprivation may improve once those factors are addressed. When associated with disorders such as schizophrenia or bipolar disorder, many people experience significant improvement with appropriate treatment, which often combines medication, psychotherapy, and ongoing support.

Importantly, paranoia exists on a spectrum. Many people occasionally feel suspicious under stress, but severe paranoia is distinguished by its persistence, intensity, and impact on functioning. When paranoid beliefs become fixed, highly distressing, or interfere with daily life, a thorough clinical assessment is recommended.

Encourage evaluation by a mental health professional or physician.

If they appear unable to care for themselves or are at immediate risk of harming themselves or others, seek emergency assistance.

“CONSULT WITH A PSYCHIATRIST, PLEASE.”

Shervan K Shahhian

Alcohol-Induced Psychosis (AIP) is a mental health condition in which a person experiences a loss of contact with reality due to,…

“Immediate Medical Evaluation is Warranted if Someone is Experiencing Possible Alcohol Induced Psychosis.”

Substance-Induced Psychosis (SIP) is a mental health condition in which a person may experience a loss of contact with reality due to the effects of alcohol, drugs, medications, or toxins. Unlike primary psychotic disorders such as schizophrenia, the psychotic symptoms are directly caused by the substance itself or by withdrawal from the substance.

The condition maybe frightening for both the individual and those around them, but with Prompt Medical Attention, many people recover completely once the substance is removed and appropriate treatment is provided.

What Is Psychosis?

Psychosis is a syndrome characterized by significant impairment in reality testing. During psychosis, a person may have difficulty distinguishing what is real from what is not.

Common symptoms may include:

Hallucinations: Seeing, hearing, smelling, tasting, or feeling things that are not actually present.

Auditory hallucinations (hearing voices) could be common.

Delusions: Strongly held false beliefs despite clear evidence to the contrary.

Persecutory (“People are following me.”)

Grandiose (“I have supernatural powers.”)

Referential (“The television is sending me secret messages.”)

Disorganized thinking

Jumping from topic to topic

Illogical speech

Difficulty organizing thoughts

Disorganized or bizarre behavior

Agitation or aggression

Poor insight

Confusion and impaired judgment

How Substance Induced Psychosis Develops

Psychoactive substances affect the brain’s communication systems (neurotransmitters), particularly:

(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Dopamine

Glutamate

Serotonin

GABA

Norepinephrine

When these systems become excessively stimulated, or disrupted during withdrawal, the mind may temporarily lose its ability to accurately interpret reality.

Think of it as the mind’s “reality filter” becoming overwhelmed.

Causes

Substance Induced Psychosis may occur from:

Intoxication

While actively using a substance.

Examples:

Methamphetamine

Cocaine

PCP

Ketamine

LSD

Psilocybin

High-potency cannabis

MDMA (ecstasy)

Withdrawal

Psychosis may also occur after abruptly stopping certain substances.

Examples include:

Alcohol withdrawal (especially delirium tremens)

Benzodiazepine withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Severe sedative withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Withdrawal psychosis is considered a medical emergency.

Medication Induced

Certain prescribed medications may rarely cause psychosis, especially at high doses or in susceptible individuals.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Examples: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Some Prescribed stimulants (usually at high doses or if misused)

Certain Prescription Medications

Common Substances that Maybe Associated with Psychosis

Stimulants

Methamphetamine

Cocaine

Amphetamine

Symptoms often include: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Extreme paranoia

Feeling watched

Auditory hallucinations

Delusions

Violent agitation

Sleep deprivation

Methamphetamine induced psychosis is among the most well studied forms.

Cannabis

High potency cannabis (especially products with high THC content) may trigger psychosis in vulnerable individuals.

Risk factors include:

Daily use

High THC concentrations

Early age of first use

Family history of psychosis

Not everyone who uses cannabis develops psychosis.

Hallucinogens

Examples:

LSD

Psilocybin

PCP

Ketamine

These substances may cause:

Visual hallucinations

Distorted perceptions

Altered sense of time

Delusions

Symptoms usually resolve as the drug wears off, although complications can occur.

Alcohol

Heavy alcohol use may produce psychosis during:

Severe intoxication (less common)

Withdrawal (more common)

Alcohol withdrawal delirium (delirium tremens) often includes:

Confusion

Hallucinations

Tremors

Fever

Autonomic instability

This requires emergency treatment: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Risk Factors

Certain individuals are more vulnerable.

Risk factors include: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Family history of schizophrenia

Previous psychotic episode

Heavy substance use

Sleep deprivation

Chronic stress

Trauma

Young adulthood

Multiple substance use (polysubstance use)

Symptoms

Symptoms may or may not appear suddenly.

Positive Symptoms

Hallucinations

Delusions

Suspiciousness

Paranoia

Agitation

Racing thoughts

Cognitive Symptoms

Confusion

Poor concentration

Memory impairment

Disorganized thinking

Behavioral Symptoms

Aggression

Social withdrawal

Fearfulness

Odd behaviors

Emotional instability

How Is It Different From Schizophrenia?

Sometimes the distinction is not immediately clear. If psychotic symptoms continue well beyond the expected effects of intoxication or withdrawal, clinicians evaluate for a primary psychotic disorder or a substance induced episode that has uncovered an underlying vulnerability.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis involves determining whether the symptoms are primarily due to substance use/abuse rather than another medical or psychiatric condition. Clinicians may consider:

Detailed history of substance use

Timing of symptom onset

Physical and neurological examination

Mental status examination

Laboratory testing (including toxicology when appropriate)

Review of medications

Assessment for other medical causes of psychosis

Psychiatric evaluation

Treatment: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Treatment may depend on the severity of symptoms and the substance involved.

Immediate Priorities

Ensure the person’s safety and the safety of others.

Treat any medical emergencies.

Manage intoxication or withdrawal.

Medications: (Consult with a Medical Doctor/Psychiatrist)

Depending on the situation, treatment may include:

Certain prescribed pain medications

Certain prescribed medications (commonly used for severe alcohol or substance withdrawal, and sometimes for stimulant related agitation under medical supervision)

Intravenous fluids

Supportive medical care

Long-Term Care: (Consult with a Medical Doctor/Psychiatrist)

After stabilization, treatment may focuses on preventing recurrence:

Substance use treatment

Individual psychotherapy

Motivational Interviewing

Cognitive Behavioral Therapy (CBT)

Relapse prevention planning

Family education and support

Peer support groups when appropriate

Ongoing psychiatric follow up if symptoms persist

Prognosis: (Consult with a Medical Doctor/Psychiatrist)

Some people may fully recover, particularly when:

The substance is discontinued.

Treatment begins early.

There is no underlying psychotic disorder.

They remain abstinent from the substance that triggered the episode.

However, recurrent episodes increase the risk of lasting difficulties. In some individuals especially those with a genetic or biological vulnerability, a substance induced psychotic episode may precede the development of a primary psychotic disorder, though most people who experience substance induced psychosis do not go on to develop schizophrenia.(Consult with a Medical Doctor/Psychiatrist)

When to Seek Emergency Help

(Call 911, and also Consult with a Medical Doctor/Psychiatrist)

Immediate medical evaluation is warranted if someone experiencing possible substance induced psychosis:

Is unable to distinguish reality from hallucinations or delusions.

Becomes violent or threatens harm to themselves or others.

Is extremely confused or difficult to awaken.

Has seizures, a high fever, severe tremors, chest pain, or trouble breathing.

Is experiencing severe alcohol or sedative withdrawal symptoms.

Psychosis related to substance use is a medical emergency because it may lead to accidental injury, self-harm, violence, dehydration, or life threatening complications depending on the underlying cause.

Key Takeaways: (Consult with a Medical Doctor/Psychiatrist)

Substance Induced Psychosis: Could be a temporary or sometimes prolonged psychotic state caused by intoxication with, or withdrawal from, alcohol, drugs, medications, or toxins.

Common symptoms include hallucinations, delusions, paranoia, confusion, and disorganized thinking.

Stimulants (especially methamphetamine and cocaine), high potency cannabis, hallucinogens, and alcohol withdrawal are among the most common causes.

Prompt medical assessment is important to identify the cause, ensure safety, and begin appropriate treatment.

Most individuals improve significantly with abstinence and appropriate medical and psychological care, although some may require ongoing psychiatric follow ups if symptoms persist or reveal an underlying vulnerability to psychotic disorders.

Shervan K Shahhian

Drug Induced Psychosis (DIP) is a mental health condition in which a person experiences a loss of contact with reality due to,…

“Immediate Medical Evaluation is Warranted if Someone is Experiencing Possible Drug Induced Psychosis.”

What Is Psychosis?

Psychosis is a syndrome characterized by significant impairment in reality testing. During psychosis, a person may have difficulty distinguishing what is real from what is not.

Common symptoms may include:

Hallucinations: Seeing, hearing, smelling, tasting, or feeling things that are not actually present.
- Auditory hallucinations (hearing voices) could be common.
Delusions: Strongly held false beliefs despite clear evidence to the contrary.
- Persecutory (“People are following me.”)
- Grandiose (“I have supernatural powers.”)
- Referential (“The television is sending me secret messages.”)
Disorganized thinking
- Jumping from topic to topic
- Illogical speech
- Difficulty organizing thoughts
Disorganized or bizarre behavior
Agitation or aggression
Poor insight
Confusion and impaired judgment

How Substance Induced Psychosis Develops

Psychoactive substances affect the brain’s communication systems (neurotransmitters), particularly:

(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Dopamine
Glutamate
Serotonin
GABA
Norepinephrine

When these systems become excessively stimulated, or disrupted during withdrawal, the mind may temporarily lose its ability to accurately interpret reality.

Think of it as the mind’s “reality filter” becoming overwhelmed.

Causes

Substance Induced Psychosis may occur from:

1. Intoxication

While actively using a substance.

Examples:

Methamphetamine
Cocaine
PCP
Ketamine
LSD
Psilocybin
High-potency cannabis
MDMA (ecstasy)

2. Withdrawal

Psychosis may also occur after abruptly stopping certain substances.

Examples include:

Alcohol withdrawal (especially delirium tremens)
Benzodiazepine withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)
Severe sedative withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Withdrawal psychosis is considered a medical emergency.

3. Medication Induced

Certain prescribed medications may rarely cause psychosis, especially at high doses or in susceptible individuals.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Examples: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Some Priscribed stimulants (usually at high doses or if misused)
Certain Priscription Medications

Common Substances that Maybe Associated with Psychosis

Stimulants

Methamphetamine
Cocaine
Amphetamine

Symptoms often include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Extreme paranoia
Feeling watched
Auditory hallucinations
Delusions
Violent agitation
Sleep deprivation

Methamphetamine induced psychosis is among the most well studied forms.

Cannabis

High potency cannabis (especially products with high THC content) may trigger psychosis in vulnerable individuals.

Risk factors include:

Daily use
High THC concentrations
Early age of first use
Family history of psychosis

Not everyone who uses cannabis develops psychosis.

Hallucinogens

Examples:

LSD
Psilocybin
PCP
Ketamine

These substances may cause:

Visual hallucinations
Distorted perceptions
Altered sense of time
Delusions

Symptoms usually resolve as the drug wears off, although complications can occur.

Alcohol

Heavy alcohol use may produce psychosis during:

Severe intoxication (less common)
Withdrawal (more common)

Alcohol withdrawal delirium (delirium tremens) often includes:

Confusion
Hallucinations
Tremors
Fever
Autonomic instability

This requires emergency treatment: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Risk Factors

Certain individuals are more vulnerable.

Risk factors include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Family history of schizophrenia
Previous psychotic episode
Heavy substance use
Sleep deprivation
Chronic stress
Trauma
Young adulthood
Multiple substance use (polysubstance use)

Symptoms

Symptoms may or may not appear suddenly.

Positive Symptoms

Hallucinations
Delusions
Suspiciousness
Paranoia
Agitation
Racing thoughts

Cognitive Symptoms

Confusion
Poor concentration
Memory impairment
Disorganized thinking

Behavioral Symptoms

Aggression
Social withdrawal
Fearfulness
Odd behaviors
Emotional instability

How Is It Different From Schizophrenia?

Substance Induced Psychosis	Schizophrenia
Triggered by substances	Not caused by substances
May begins suddenly	Usually develops gradually
May improve after stopping the substance	Might persists without treatment
Symptoms maybe closely tied to intoxication or withdrawal	Symptoms occur independently of substance use
Recovery maybe complete	It requires long term treatment

Diagnosis: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis involves determining whether the symptoms are primarily due to substance use/abuse rather than another medical or psychiatric condition. Clinicians may consider:

Detailed history of substance use
Timing of symptom onset
Physical and neurological examination
Mental status examination
Laboratory testing (including toxicology when appropriate)
Review of medications
Assessment for other medical causes of psychosis
Psychiatric evaluation

Treatment(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Treatment may depend on the severity of symptoms and the substance involved.

Immediate Priorities

Ensure the person’s safety and the safety of others.
Treat any medical emergencies.
Manage intoxication or withdrawal.

Medications: (Consult with a Medical Doctor/Psychiatrist)

Depending on the situation, treatment may include:

Certain priscribed pain medications
Certain priscribed medications (commonly used for severe alcohol or substance withdrawal, and sometimes for stimulant-related agitation under medical supervision)
Intravenous fluids
Supportive medical care

Long-Term Care: (Consult with a Medical Doctor/Psychiatrist)

After stabilization, treatment may focuses on preventing recurrence:

Substance use treatment
Individual psychotherapy
Motivational Interviewing
Cognitive Behavioral Therapy (CBT)
Relapse prevention planning
Family education and support
Peer support groups when appropriate
Ongoing psychiatric follow-up if symptoms persist

Prognosis: (Consult with a Medical Doctor/Psychiatrist)

Some people may fully recover, particularly when:

The substance is discontinued.
Treatment begins early.
There is no underlying psychotic disorder.
They remain abstinent from the substance that triggered the episode.

When to Seek Emergency Help

(Call 911, and also Consult with a Medical Doctor/Psychiatrist)

Immediate medical evaluation is warranted if someone experiencing possible substance induced psychosis:

Is unable to distinguish reality from hallucinations or delusions.
Becomes violent or threatens harm to themselves or others.
Is extremely confused or difficult to awaken.
Has seizures, a high fever, severe tremors, chest pain, or trouble breathing.
Is experiencing severe alcohol or sedative withdrawal symptoms.

Key Takeaways: (Consult with a Medical Doctor/Psychiatrist)

Substance Induced Psychosis: Could be a temporary or sometimes prolonged psychotic state caused by intoxication with, or withdrawal from, alcohol, drugs, medications, or toxins.
Common symptoms include hallucinations, delusions, paranoia, confusion, and disorganized thinking.
Stimulants (especially methamphetamine and cocaine), high potency cannabis, hallucinogens, and alcohol withdrawal are among the most common causes.
Prompt medical assessment is important to identify the cause, ensure safety, and begin appropriate treatment.
Most individuals improve significantly with abstinence and appropriate medical and psychological care, although some may require ongoing psychiatric follow ups if symptoms persist or reveal an underlying vulnerability to psychotic disorders.

Shervan K Shahhian

Substance-Induced Psychosis (SIP) is a mental health condition in which a person experiences a loss of contact with reality due to,…

“Immediate Medical Evaluation is Warranted if Someone is Experiencing Possible Substance Induced Psychosis.”

The condition can be frightening for both the individual and those around them, but with Prompt Medical Attention, many people recover completely once the substance is removed and appropriate treatment is provided.

What Is Psychosis?

Psychosis is a syndrome characterized by significant impairment in reality testing. During psychosis, a person may have difficulty distinguishing what is real from what is not.

Common symptoms may include:

Hallucinations: Seeing, hearing, smelling, tasting, or feeling things that are not actually present.
- Auditory hallucinations (hearing voices) could be common.
Delusions: Strongly held false beliefs despite clear evidence to the contrary.
- Persecutory (“People are following me.”)
- Grandiose (“I have supernatural powers.”)
- Referential (“The television is sending me secret messages.”)
Disorganized thinking
- Jumping from topic to topic
- Illogical speech
- Difficulty organizing thoughts
Disorganized or bizarre behavior
Agitation or aggression
Poor insight
Confusion and impaired judgment

How Substance Induced Psychosis Develops

Psychoactive substances affect the brain’s communication systems (neurotransmitters), particularly:

(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Dopamine
Glutamate
Serotonin
GABA
Norepinephrine

When these systems become excessively stimulated, or disrupted during withdrawal, the mind may temporarily lose its ability to accurately interpret reality.

Think of it as the mind’s “reality filter” becoming overwhelmed.

Causes

Substance Induced Psychosis may occur from:

1. Intoxication

While actively using a substance.

Examples:

Methamphetamine
Cocaine
PCP
Ketamine
LSD
Psilocybin
High-potency cannabis
MDMA (ecstasy)

2. Withdrawal

Psychosis may also occur after abruptly stopping certain substances.

Examples include:

Alcohol withdrawal (especially delirium tremens)
Benzodiazepine withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)
Severe sedative withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Withdrawal psychosis is considered a medical emergency.

3. Medication Induced: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Certain prescribed medications may rarely cause psychosis, especially at high doses or in susceptible individuals.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Examples:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Some Priscribed stimulants (usually at high doses or if misused)
Certain Priscription Medications

Common Substances that Maybe Associated with Psychosis

Stimulants

Methamphetamine
Cocaine
Amphetamine

Symptoms often include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Extreme paranoia
Feeling watched
Auditory hallucinations
Delusions
Violent agitation
Sleep deprivation

Methamphetamine induced psychosis is among the most well studied forms.

Cannabis

High potency cannabis (especially products with high THC content) may trigger psychosis in vulnerable individuals.

Risk factors include:

Daily use
High THC concentrations
Early age of first use
Family history of psychosis

Not everyone who uses cannabis develops psychosis.

Hallucinogens

Examples:

LSD
Psilocybin
PCP
Ketamine

These substances may cause:

Visual hallucinations
Distorted perceptions
Altered sense of time
Delusions

Symptoms usually resolve as the drug wears off, although complications can occur.

Alcohol

Heavy alcohol use may produce psychosis during:

Severe intoxication (less common)
Withdrawal (more common)

Alcohol withdrawal delirium (delirium tremens) often includes:

Confusion
Hallucinations
Tremors
Fever
Autonomic instability

This requires emergency treatment: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Risk Factors

Certain individuals are more vulnerable.

Risk factors include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Family history of schizophrenia
Previous psychotic episode
Heavy substance use
Sleep deprivation
Chronic stress
Trauma
Young adulthood
Multiple substance use (polysubstance use)

Symptoms

Symptoms may or may not appear suddenly.

Positive Symptoms

Hallucinations
Delusions
Suspiciousness
Paranoia
Agitation
Racing thoughts

Cognitive Symptoms

Confusion
Poor concentration
Memory impairment
Disorganized thinking

Behavioral Symptoms

Aggression
Social withdrawal
Fearfulness
Odd behaviors
Emotional instability

How Is It Different From Schizophrenia?

Substance Induced Psychosis	Schizophrenia
Triggered by substances	Not caused by substances
May begins suddenly	Usually develops gradually
May improve after stopping the substance	Might persists without treatment
Symptoms maybe closely tied to intoxication or withdrawal	Symptoms occur independently of substance use
Recovery maybe complete	It requires long term treatment

Diagnosis: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis involves determining whether the symptoms are primarily due to substance use/abuse rather than another medical or psychiatric condition. Clinicians may consider:

Detailed history of substance use
Timing of symptom onset
Physical and neurological examination
Mental status examination
Laboratory testing (including toxicology when appropriate)
Review of medications
Assessment for other medical causes of psychosis
Psychiatric evaluation

Treatment: (Consult with a Medical Doctor/Psychiatrist/ Neurologist)

Treatment may depend on the severity of symptoms and the substance involved.

Immediate Priorities

Ensure the person’s safety and the safety of others.
Treat any medical emergencies.
Manage intoxication or withdrawal.

Medications: (Consult with a Medical Doctor/Psychiatrist)

Depending on the situation, treatment may include:

Certain priscribed pain medications
Certain priscribed medications (commonly used for severe alcohol or substance withdrawal, and sometimes for stimulant-related agitation under medical supervision)
Intravenous fluids
Supportive medical care

Long-Term Care: (Consult with a Medical Doctor/Psychiatrist)

After stabilization, treatment may focuses on preventing recurrence:

Substance use treatment
Individual psychotherapy
Motivational Interviewing
Cognitive Behavioral Therapy (CBT)
Relapse prevention planning
Family education and support
Peer support groups when appropriate
Ongoing psychiatric follow-up if symptoms persist

Prognosis: (Consult with a Medical Doctor/Psychiatrist)

Some people may fully recover, particularly when:

The substance is discontinued.
Treatment begins early.
There is no underlying psychotic disorder.
They remain abstinent from the substance that triggered the episode.

When to Seek Emergency Help

(Call 911, and also Consult with a Medical Doctor/Psychiatrist)

Immediate medical evaluation is warranted if someone experiencing possible substance induced psychosis:

Is unable to distinguish reality from hallucinations or delusions.
Becomes violent or threatens harm to themselves or others.
Is extremely confused or difficult to awaken.
Has seizures, a high fever, severe tremors, chest pain, or trouble breathing.
Is experiencing severe alcohol or sedative withdrawal symptoms.

Key Takeaways: (Consult with a Medical Doctor/Psychiatrist)

Substance Induced Psychosis: Could be a temporary or sometimes prolonged psychotic state caused by intoxication with, or withdrawal from, alcohol, drugs, medications, or toxins.
Common symptoms include hallucinations, delusions, paranoia, confusion, and disorganized thinking.
Stimulants (especially methamphetamine and cocaine), high potency cannabis, hallucinogens, and alcohol withdrawal are among the most common causes.
Prompt medical assessment is important to identify the cause, ensure safety, and begin appropriate treatment.
Most individuals improve significantly with abstinence and appropriate medical and psychological care, although some may require ongoing psychiatric follow ups if symptoms persist or reveal an underlying vulnerability to psychotic disorders.

Shervan K Shahhian