Undiagnosed Drug-induced Psychosis Resulting In Ptsd

[TheShawn]

Anthony, Criterion H does not necessary negate the possibility of PTSD. Consider these two hypothetical situations:

1. A person presents with symptoms of PTSD, but has substances in the body or recently used substances. PTSD would not be diagnosed.

2. A person presents with symptoms of PTSD and substances have not been in the body for several years. The diagnosis of PTSD is a possibility because the disturbance is not due to substance use at that point; it is due to a traumatic event that just happened to involve a narcotic.

It doesn’t make sense to say a current disturbance is due to substance use when a person hasn’t used a substance for several years. I understand that an LSD trip is quite different from a real experience, but it really isn’t very different for the person who has a bad LSD trip. It is very real and very traumatic for that person and it can affect the brain in the same way.

 

[anthony]

I understand what you're saying, but I think you're skipping a key word in the criterion, being "attributable."

The disturbance is not attributable to the physiological effects of a substance...

The diagnosis does not refer to present tense, but instead that the trauma itself is not attributable to a substance. The definition for attributable is, to regard as resulting from a specified cause; consider as caused by something indicated. Basically, criterion H is a sub-type to criterion A, being the trauma cannot result from the physiological effects of a substance (aka: bad drug trip).

 

[TheShawn]

I appreciate your response and I also understand what you are saying.

It seems that “The disturbance” refers to symptoms listed in criteria B through E, so it does refer to the present. The symptoms being presented are not “physiological effects of a substance” if a person has not used a substance for many years. They are attributable to a traumatic event. The DSM specifies that “The disturbance is not attributable to the physiological effects of a substance..." but does not say the traumatic event cannot be attributable to a substance.

 

[anthony]

Interesting argument... and I would have to agree that that is absolutely an interpretative aspect which one would not be incorrect regardless of the choice taken.

Interesting rebuttal... which certainly now has my mind wandering along on a different path about this trauma type.

 

[Kintsugi]

The symptoms being presented are not “physiological effects of a substance” if a person has not used a substance for many years. They are attributable to a traumatic event. The DSM specifies that “The disturbance is not attributable to the physiological effects of a substance..." but does not say the traumatic event cannot be attributable to a substance.

This may be getting a bit too philosophical, but I would like to assert that hallucinogens are not like most substances, and it's my impression that we don't fully understand how LSD in particular seems to have after-effects long after it is fully metabolized. The DSM has the diagnosis Hallucinogenic Persisting Perception Disorder, which to me is validation that the effects of hallucinogens can persist years past when it was last used.

Is it a physiological effect? I don't know. I would think it would count. Who's to say the people with HPPD haven't had their serotonin receptors somehow become damaged or different as a result of the LSD? Maybe it's just a psychological effect. Regardless, this occurs in people who had both very good and very bad trips, so it's not some weird result of trauma.

I thought I wanted this thread to stay buried, because I felt we didn't need a bunch of freaked out people coming here to say they had a really bad trip last weekend, they think they have PTSD, etc. But now I'm really curious to work this out.

My main complaint with the idea of someone being traumatized for life by a trip is that research (though compared to other substances, not nearly enough) has been done with subjects who have experienced bad trips on all manner of different hallucinogens, and I've never heard of this possibility. And, well, let's just say I've read a lot of the major research done about hallucinogens, particularly LSD and DMT.

 

[anthony]

The DSM has the diagnosis Hallucinogenic Persisting Perception Disorder, which to me is validation that the effects of hallucinogens can persist years past when it was last used.

Yes, along with others.

Your argument peaked my curiosity to go read up some diagnostic application within the DSM V under PTSD, and there is a single factor which I believe validates criterion H, which the diagnosis applies both present and past tense, being the trauma itself: Emotional reactions are no longer valid for criterion A. (Diagnostic features, pg 274, DSM V).

I would honestly place a drug induced psychotic trip under a number of other disorders, ruling out PTSD as an emotional reaction to a drug induced event, because the event is not "actual" in the sense of physical threat, and is emotional (perceived hallucination).

Every disorder within the DSM also states that the most befitting diagnosis be used, and with drugs and hallucinations there are more befitting diagnoses than PTSD for the after effects of such bad drug trip, or such physiological effect.

This comes back to the old adage that PTSD endured in the DSM IV, being people were trying to "fit" every and any type of trauma within the PTSD diagnosis, which was never the intent of the diagnosis. It was always reserved for the "worst" of the worst trauma. Being in a car accident and suffering anxiety and such is not significant enough. Being in a car accident where you were stuck in the car, had to be cut out and likely spent time in hospital as a result of injuries sustained, then befits PTSD, as expressed within the diagnostic features, which further explain PTSD.

I think there is merit in arguing validity, but PTSD excludes emotional events alone, and a drug trip is an emotional event without a preceding traumatic event.

 

[TheShawn]

Simply Simon, thanks for your response.

I would say that PTSD should not be diagnosed when symptoms include hallucinations. I experienced hallucinations as part of flashbacks a couple years after the bad LSD trip and I haven’t hallucinated since then. That was about 17 years ago. As a side note, I mention only one bad trip because it was the most severe – I had one other on LSD, one on meth, and one on mushrooms. I was a stupid teenager.

The OP “had plenty of flashbacks over the years” but didn’t mention hallucinations. It’s likely that the flashbacks included pervasive thoughts and feelings, like the event is being experienced again, but without hallucinations. In short, I am talking about the long-term effects of a traumatic event that do not include hallucinations.

Anthony, there actually can be real physical threat when someone experiences a bad trip. While there are no documented deaths from LSD, people die from using methamphetamine. I think the important factor, though, is how an event affects the brain.

"Explanations of PTSD focus primarily on the way that the mind is affected by traumatic experiences. Theorists speculate upon facing overwhelming trauma, the mind is unable to process information and feelings in a normal way. It is as if the thoughts and feelings at the time of the traumatic event take on a life of their own, later intruding into consciousness and causing distress" (PsychCentral, What Causes PTSD?).

Consider that "LSD is physiologically well tolerated and there is no evidence for long-lasting effects on brain and other parts of the human organism" (The Pharmacology of Lysergic Acid Diethylamide: A Review). When someone reports long-term negative effects that can be traced back to a bad LSD trip, it is not the LSD itself causing the disturbance, it is the traumatic event.

If someone's "mind is unable to process information and feelings in a normal way" and "the thoughts and feelings at the time of the traumatic event" are "intruding into consciousness and causing distress," then the even being real or merely perceived as such does not make a difference, in my opinion.

We are not going to agree on every aspect of this, and that's okay. I only hope that there will be no further suggestions that a bad LSD trip is not a real traumatic experience, and maybe we can agree that it's not impossible for someone to be diagnosed with PTSD as a result of a traumatic event that occurred while on LSD.

I tried linking to sources, but wasn't allowed.

 

[digger]

(PsychCentral, What Causes PTSD?).

I would be cautious of where you source your information. PsychCentral lists 'normal stress response' as a 'type of PTSD' on one of it's other pages, so perhaps not the most reliable of sources to be quoting from if you want to validate your argument.

 

[anthony]

I only hope that there will be no further suggestions that a bad LSD trip is not a real traumatic experience

I don't think the trauma is the issue, based on perception, though trauma and PTSD diagnosis are two very different things, and this is honestly IMO where a lot of people get confused. You just did it yourself, you linked a traumatic event to PTSD, which isn't correct.

There are diagnoses for traumatic events, various types. PTSD is reserved for specific types and levels of trauma, it isn't a free for all in that all trauma befits a PTSD diagnosis. Suffering trauma and being diagnosed with PTSD are factually different things. You can endure trauma and have all the symptoms of PTSD, yet not be diagnosed with PTSD, and instead be diagnosed with specific and individual disorders, or other trauma and stressor disorder, because you don't meet the requirements for PTSD diagnosis.

This is the issue at hand. A bad LSD trip, however traumatic for the person, does not meet the diagnostic requirements for PTSD diagnosis. We don't get to makeup our own rules and fit things into diagnoses.

 

[TheShawn]

I'll drop the issue. I appreciate the dialogue and wish you all well.

 

[anthony]

You make valid points @TheShawn, don't get me wrong, but I think those points need to be decided by the psychiatrists and board of the DSM and ICD respectively, as it is they who dictate what makes a diagnosis, and what does not.

One could argue such topics till blue in the face here, but at the end of the day we only get to use what the diagnosis states, and not what we would like it to be used for. Until changed... some outcomes are really just mute.

 

[Kintsugi]

Okay, @anthony , I want this thread to die, but I really want to ask a question about the below quote. PMing seemed a bit much (plus there is no benefit to broader readership) and making a new thread seemed ridiculous as I am asking you specifically.

SO, here I am. Below you state that PTSD is reserved for the "'worst' of the worst trauma," but my understanding is that the severity of trauma has less to do with PTSD than the victim's vulnerability to PTSD. For example, because the bulk of my trauma happened before age 7, I was much more likely to come out with PTSD.

This comes back to the old adage that PTSD endured in the DSM IV, being people were trying to "fit" every and any type of trauma within the PTSD diagnosis, which was never the intent of the diagnosis. It was always reserved for the "worst" of the worst trauma. Being in a car accident and suffering anxiety and such is not significant enough. Being in a car accident where you were stuck in the car, had to be cut out and likely spent time in hospital as a result of injuries sustained, then befits PTSD, as expressed within the diagnostic features, which further explain PTSD.

In summary, which is more important? How prone an individual is to developing PTSD, or the severity of trauma? I thought people could endure a car accident and develop PTSD symptoms, and if they thought their life was in jeopardy and the symptoms last past six months... boom, PTSD diagnosis.

I frankly feel that the defensive nature of the complex PTSD debate comes down to the feeling that some people's trauma is worse than others', and people who suffered complex trauma over years don't want to be lumped in with people who were mugged at gunpoint.