DRUGS AND PSYCHOSIS with Dr. Dawn Barker

Dr. Dawn Barker

Dr. Dawn Barker

Dr. Dawn Barker is a child and adolescent psychiatric expert. She’s also a writer and a friend of mine. We’re both intrigued by the workings of the mind and feel deeply for those who suffer from mental illness and those who love them. Dawn’s new book Fractured weaves a suspenseful tale about a young woman suffering post-natal depression. It’s just been released by Hachette Australia and I can’t wait to read it.

I’ve done some research about the link between cannabis use and schizophrenia, but I’m no expert, so I asked Dawn to write an article detailing the most recent findings. Please use the comments section to ask Dawn any questions you may have. I will be!

 

Thrill Seekers

Thrill Seekers

 

Drug Abuse and Psychosis

Dr. Dawn Barker, Child & Adolescent Psychiatrist. MBChB, FRANZCP, Cert C&A Psychiatry

 

In Thrill Seekers, we meet a group of adolescents who – like many teenagers − use drugs recreationally. One of the main characters, Douggie, then becomes psychotic and develops schizophrenia. Many of us know a friend or family member who’s had a similar illness after drug use and are left wondering: what is the relationship between drug use and psychosis?

 

What is psychosis?

 

Psychosis refers to a group of symptoms mainly characterized by hallucinations and delusions. Hallucinations are abnormal sensory perceptions: hearing, seeing, tasting, feeling or smelling something that isn’t actually there. The sufferer might hear voices talking about them, feel insects crawling on their skin, or see faces on the wall. Delusions are abnormal, false beliefs that are held with unshakeable conviction. A deluded person may believe that they are someone special, that they are being followed, or are guilty of something terrible. A psychotic person’s speech can be difficult to follow as their thoughts are disordered, and they lose insight, that is, they are not aware that their beliefs or sensations are abnormal. This can make it very difficult to persuade a patient to seek help and accept treatment.

 

Most people think of schizophrenia when they think of psychosis, but that’s not necessarily the case: psychotic symptoms can occur briefly and transiently (when using drugs, or when medically unwell), or can occur as part of another psychiatric illness such as depression or bipolar disorder. If the symptoms aren’t secondary to anything and become chronic and disabling, the diagnosis changes to schizophrenia.

 

Drug use and psychosis

 

There is no doubt that drugs can cause psychosis. Some drugs – the hallucinogens like LSD and ‘magic mushrooms’ – are used to deliberately alter sensory perceptions. However, psychosis is often an unwanted reaction. As a psychiatrist, I’ve seen hundreds of patients brought into emergency departments − often by the police − with distressing, acute psychosis after abusing drugs such as amphetamines, cocaine or cannabis. Thankfully, most of these patients recover when the drug is out of their system after a few hours or days – we call this a substance-induced psychosis.

What is more worrying is the patient whose psychosis persists even after the acute effects of the drug have worn off. Some of these patients are eventually diagnosed with schizophrenia. Are drugs responsible for this?

 

The relationship between illicit drug use – particularly cannabis – and schizophrenia is a controversial one. Many patients with schizophrenia have used drugs, but many have not. And of course, the majority of people who use cannabis don’t develop schizophrenia. We know that people with a psychotic illness have a higher rate of cannabis use than the general population, but this could be explained by them being drawn to drug use as a way to cope with their symptoms.

 

As more long-term studies are analyzed, the links are becoming clearer and the most recent evidence is this:

  • If you have a psychotic illness and used cannabis in adolescence, you develop the illness 2-3 years earlier than those who didn’t use cannabis. This is significant, as we know that an earlier age of onset is associated with a poorer outcome. Using cannabis in adolescence makes you up to twice as likely to be diagnosed with schizophrenia in adulthood, and this is a dose effect: the more you use, the more likely the diagnosis is.
  • Using the drug at a younger age is most risky: cannabis use at the age of 15, but not age 18, is associated with the higher rates of schizophrenia. It’s possible that one of the chemicals released in the brain when using cannabis, dopamine, is the culprit. We use drugs that block dopamine to treat schizophrenia.
  • Cannabis use comes before psychotic symptoms appear, rather than the illness leading to more drug use.

 

Some people have a gene that, if present, appears to interact with adolescent cannabis use to cause psychosis. Thankfully, schizophrenia is rare, occurring in approximately 1% of the population. Cannabis use in adolescence is just one of several factors that interact to cause the illness, but it’s a significant factor that, if taken out of the equation, could reduce the rates of schizophrenia by 8%.

 

It’s unrealistic to expect young people to stop using cannabis completely. But we need to understand that its use in the teenage years does increase the risk of developing schizophrenia and we have no way of knowing which young person will be affected. As anyone who has suffered from – or watched someone go through − this illness will agree with, preventing even one case would make a huge difference to many lives.

 

For more information or if you, or a love one, need help, please contact:

 

1. Your local doctor or emergency department

  1. 2.  Lifeline: 131114
  2. 3.  Kids Helpline: www.kidshelpline.com.au 1800 551800
  3. 4.  Headspace: www.headspace.org.au

 

 References

Large M et al. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. (2011). Arch Gen Psychiatry 68(6):555-61.

 

Arseneault et al. Causal association between cannabis and psychosis:

examination of the evidence. (2004).  British Journal of Psychiatry 184:110-117

 

http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/C22A31B6C742DFE5CA25767E00122541/$File/m684.pdf Accessed 22/01/2013

 

FRACTURED by Dawn Barker

FRACTURED by Dawn Barker

CREATING A CHARACTER – DOUGGIE

 

Thrill Seekers

Thrill Seekers

 

When Ransom Publishing first sent me the cover image for Thrill Seekers I burst into tears. Not just because my book was finally coming to life but because the young man in the picture looked so much like my brother Matty, who was the inspiration for the character of Douggie. The expression on his face, his eyebrows, even the shirt he’s wearing.  An old friend who’d known Matty thought it WAS a photo of him. It was scary. I knew then that as a writer I’d done something right, that the person who had created or chosen this image had the same vision of Douggie that I did.

When starting to write Thrill Seekers I knew I wanted to have some sections from Matty’s perspective. But I was a middle-aged woman. How could I get inside the head of a young man with schizophrenia?

Luckily I had few old notebooks of Matty’s where he’d written some poetry and diary entires. I used his own words in the story “Douggie and the Paparazzi”.

 “And now I”m going to sing a happy song.”

Using Matty’s own words as inspiration, I found that once I started writing in first person, I soon found a voice other than my own coming through. Matty’s obsessions about his looks and stardom were easy and fun to write about. More difficult to witness, and to write, were his battles with deep despair when he wasn’t flying so high and realised his predicament as someone with a serious mental illness.

Writing Douggie’s stories helped me understand Matty better and also allowed me to share my soft-hearted, courageous brother with the world. Because he was brave, and funny, but mostly brave. In the face of a crippling illness he never gave up. I hope that his spirit of resilience shines through in the book.

The best part about writing Thrill Seekers was using the power of fiction to change the ending. In my story, Douggie, and through him Matty, lives on.

Matty

Matty at thirteen