Can LSD trigger a psychotic episode?


Brief overview

  • What is psychosis? Collective term for various mental disorders. Affected people lose touch with reality. Your personality changes without you realizing it yourself. The first signs show at a young age, often during puberty.
  • Symptoms: At the beginning, concentration disorders, thought disorders, listlessness and inner emptiness, loss of performance, sleep disorders, declining zest for life, depression, fears. Later, for example, irrational thoughts (obsessive-compulsive thoughts), sudden, strong interest in religion, mysticism or magic, as well as mistrust, hostility / aggression towards others, strong reference to the ego, hallucinations, ego disorders, emotional and / or motor changes.
  • Causes: Organically conditioned psychosis results from altered brain functions as a result of underlying physical illnesses (dementia, epilepsy, multiple sclerosis), medication (e.g. against Parkinson's disease) or drugs (LSD, cannabis). Non-organic psychosis develops due to underlying mental illnesses (schizophrenia, depression, bipolar disorder) or birth stress (postpartum psychosis, postpartum psychosis).
  • Diagnosis: Doctor-patient discussion to collect the medical history (anamnesis), physical examination, psychological diagnosis using questionnaires based on international classification catalogs
  • Treatment: Medicinal with antipsychotics, in addition, if necessary, mood stabilizers such as lithium, antidepressants. Supplementary psychotherapeutic treatment (psychoeducation, cognitive behavioral therapy).
  • Forecast: With early diagnosis and appropriate, consequent treatment, a favorable course with good chances of recovery.

What is a psychosis?

The collective term psychosis includes various mental disorders that have one thing in common: In all cases, patients lose touch with themselves and their environment. The personality of those affected changes without them realizing it themselves. On the contrary - psychotics believe that it is not themselves but their environment that is changing.

Psychosis can manifest itself in many ways, and symptoms can vary from patient to patient. That is why the definition of psychosis has changed again and again over time. Today we know that psychoses can be part of various diseases - from dementia to mental disorders such as schizophrenia. Drugs, certain medications and specific life situations such as the phase after the birth can also trigger psychosis.

About one to two percent of the population develops psychosis at one point in their life. Women are just as often affected as men. The symptoms often show up at a young age, often for the first time between the ages of 15 and 25.

Raster search for psychoses
Psychosis is announced by early warning signs - but these are difficult to interpret. This could change soon. From Christiane Fux

Organic and non-organic psychosis

Usually many different factors play together in the development of a psychosis. Basically, however, a distinction is made between organically conditioned and non-organically conditioned psychosis (formerly: endogenous and exogenous psychosis):

Organically conditioned psychoses can occur, for example, with dementia or brain damage as a result of drug abuse and in connection with certain medications. Non-organic psychoses can arise in the context of mental illnesses such as schizophrenia or bipolar disorder.

Psychosis: symptoms

The symptoms of psychosis vary greatly from person to person and depend on the particular triggers.

Mental Illnesses - The Nine Most Common Disorders

  • Anxiety disorders

    Anxiety disorders are the most common forms of mental disorders in Germany. 22 percent of women and almost ten percent of men suffer from it. Your feelings of fear are so strong that they severely limit everyday life in many areas. You are afraid in dealing with people (social phobia), afraid of open, wide spaces (agoraphobia) or panic at the sight of spiders or blood. Undirected fears that have no specific trigger are also common. (Source: RKI)
  • depressions

    Depression: 11.4 percent of women and around five percent of men suffer from depression that requires treatment. It goes hand in hand with deep depression and listlessness. In addition, there are physical symptoms such as sleep or digestive disorders. Young adults between the ages of 18 and 29 are particularly often depressed. (Source: RKI / Statista)
  • Addictions

    More than ten percent of people in Germany suffer from an addiction: the most common is still nicotine addiction. 5.5 million not only smoke, but are dependent on the smoldering stick. In second place: drug addiction. 1.9 million are affected - especially women who are dependent on sedatives or painkillers. Another 1.8 million are alcoholics - here four out of five are men. There are also illegal drugs and behavioral addictions such as gambling and shopping addiction. (Source: DHS)
  • Obsessive-compulsive disorder

    4.2 percent of women and 3.5 percent of men in Germany suffer from obsessive-compulsive disorder. For example, they are persecuted by obsessive thoughts or are under internal pressure to have to perform certain actions again and again in a ritualized form. This can be the compulsion to wash according to a certain pattern or to count things. In extreme cases, the compulsions can consume so much time that a reasonably normal life is no longer possible. (Source: RKI / Statista)
  • Bipolar disorder

    In the case of bipolar disorder, formerly also known as manic-depressive illness, those affected suffer from extreme mood swings. Your mood fluctuates between deep depression and manic phases, which can be accompanied by an overly cheerful mood, restlessness and megalomania. 2.8 percent of men and 3.1 percent of women suffer from bipolar disorder. (Source: RKI / Statista)
  • Psychoses

    Psychoses are characterized by delusional ideas. For example, those affected suffer from paranoia, have halucinations, develop conspiracy theories or have the idea that aliens have implanted transmitters in their heads. Such delusions are particularly typical for people who suffer from schizophrenia. Psychosis occurs in three percent of women and 1.8 percent of men. (Source: RKI / Statista)
  • Somatoform disorders

    Some people experience pain and other physical symptoms for no organic cause. Doctors refer to this as somatoform disorders. They affect around 1.7 percent of men and 4.9 percent of women. (Source: RKI / Statista)
  • Post-traumatic stress disorder

    Post-traumatic stress disorder can occur after traumatic experiences. It is associated with fear and panic reactions. So-called flashbacks are typical, during which those affected relive their traumatic experiences in their minds. About 0.9 percent of men and 3.8 percent of women have post-traumatic stress disorder. (Source: RKI / Statista)
  • eating disorder

    Eating disorders: Anorexia or anorexia affects about 0.2 percent of men and 1.2 percent of women. However, it is much more common among young women between the ages of 11 and 17. Of them, 20 to 30 percent suffer from eating disorders such as anorexia and bulimia. Of the boys in this age group, it is 12 to 20 percent. (Source: KiGGS study / Statista / RKI)

Psychosis: first signs

Years before a psychosis manifests itself, the first signs of the onset of the disease can point to it. This includes:

  • Difficulty concentrating: People at risk of psychosis are often nervous, restless and have trouble concentrating. They are easily distracted and often cannot pay attention to several things at the same time.
  • Thought disorders: So-called thought interference and blockages can also be early signs of the onset of psychosis. With those affected, incoherent thoughts occur again and again, which slip between other thoughts and are difficult to shake off. Some also suffer from a sudden flood of thoughts that can hardly be channeled.
  • Listlessness and inner emptiness: People at risk of psychosis are often unmotivated, indifferent and feel empty inside. Many withdraw from family, friends and acquaintances and avoid social contacts.
  • Slump in performance: The academic or professional performance can decrease significantly. However, this symptom is not typical of an emerging psychosis, but can also indicate the onset of depression.
  • sleep disorders
  • declining zest for life
  • depressions
  • fears

A psychosis develops often in their teens. However, the symptoms are often misinterpreted as typical puberty problems. In contrast to this, however, a psychosis cannot "grow out". On the contrary - the symptoms become more and more pronounced over time.

Tip: This is why you should consult a doctor (family doctor or psychiatrist) if your child has the slightest suspicion of a psychotic illness. You should also take vague signs of other family members suffering from psychosis particularly seriously.

Psychosis: symptoms in the further course

Over time, clearer symptoms develop that can indicate an impending psychosis. This includes:

  • irrational thoughts (for example obsessive-compulsive thoughts)
  • sudden, strong interest in religion, magic, or mysticism
  • Suspicion, hostility and aggression towards others
  • Strong self-reference, actions of others (including strangers) are inappropriately related to oneself
  • Hallucinations
  • Thought disorders
  • Ego disorders
  • emotional changes

Psychosis symptoms: hallucinations

Many psychotic patients suffer from hallucinations. In principle, all senses can be affected, but the most common are acousticHallucinations. Those affected typically hear voices commenting on their behavior or giving them orders. Usually these voices are perceived as threatening. Other patients see objects, people, colors or faces (optical hallucinations) that do not exist in reality. Sometimes it happens too olfactory or sensory hallucinationswhere the patient perceives non-existent smells or touches.

Psychosis symptoms: thought disorders

Thinking disorders are another typical sign of psychosis. A distinction is made between mental disorders of a content-related and a formal nature. To the substantive thought disorders include delusions such as paranoia and relationship delusions, megalomania and delusions of guilt:

  • Patients with Paranoia For example, feel persecuted by aliens or believe that other people are trying to harm them.
  • Patients who are under Relationship mania suffer, relate general events to themselves or interpret certain objects or people as a threat. A typical sign is, for example, when those affected believe that speakers on television or radio are conveying secret messages to them.
  • Megalomania is when someone believes, for example, to be a famous personality or a misunderstood genius.
  • At the Delusions of guilt those affected are convinced that they are responsible for the suffering of others, although objectively there is no reason to do so.

Contentual thought disorders can also take the form of fixIdeas express - experts speak of overvalue ideas here. It is characteristic of the fact that the sick mentally only revolve around one and the same topic. Also Obsessive thoughts (such as the conviction that you have to repeat a certain action over and over again) belong to the content-related thought disorders.

At formal thought disorders on the other hand, the flow of thoughts is disturbed. This can be expressed in:

  • indistinct, confused, incomprehensible language
  • frequent, incomprehensible leaps in thought
  • sudden tearing off of thoughts (tearing off thoughts)
  • slowed thinking
  • inventing new terms and word combinations (neologisms)
  • the bypassing of the actual topic
  • Brooding
  • the constant repetition of the same sentences and thoughts
  • distracted thinking, incoherent sentences (incoherent thinking)
  • the inability to separate the important from the unimportant (awkward thinking)
  • a limited vocabulary as well as restricted thinking that is limited to a few topics (lack of thoughts)
  • the feeling that certain thoughts impose themselves (thought-pressing)

Psychosis symptoms: ego disorders

With an ego disorder the line between the self and the outside world becomes blurred. Sufferers are convinced that their thoughts can be heard by others (thoughts expressed), that others withdraw their thoughts from them (withdrawal of thoughts) or that their thoughts and actions are controlled and influenced by other people. Some perceive their environment as unreal (derealization) or are strangers to themselves. For example, these patients do not experience their own arm as part of their body (depersonalization).

Psychosis Symptoms: Emotional Changes

Psychotics experience emotions differently than healthy people. Often their emotions are less intense, so that they appear almost emotionless. Some patients are very irritable during acute psychosis. Sometimes those affected react inappropriately, for example by starting to laugh in a sad situation.

Other symptoms of psychosis

A psychosis can be too motor changes to lead. Those affected then suffer from severe restlessness and an extreme urge to move or, in contrast, can freeze completely and remain motionless.

Many people with psychosis withdraw completely. They neglect their appearance and no longer devote themselves to their previous interests. They break off their social contacts and can no longer cope with everyday life alone, let alone exercise a job. Some don't leave the house anymore.

It rarely happens violent acts against yourself or others.

Psychosis: causes and risk factors

The exact causes of psychosis are not known. However, it appears to be closely related to dysfunction in the brain. Psychoses can arise due to brain injuries, changes in the nervous system or metabolic disorders. Medicines and drugs can also cause the disease. In addition, psychoses can occur in certain mental disorders. Experts speak of one multifactorial causal eventswhere biological and psychosocial factors interact.

Physical illness

Certain underlying physical illnesses can change brain functions and trigger psychosis. This includes:

  • Dementia: Structures in the brain change in dementia patients. These changes can lead to psychotic disorders. Alzheimer's dementia in particular is often accompanied by hallucinations and delusional symptoms.
  • epilepsy: During an epileptic seizure, the nerve cells in the brain discharge in an uncontrolled manner. Sometimes psychosis occurs before and during it. Most often, however, psychotic symptoms show up immediately after an epileptic seizure.
  • multiple sclerosis: In this disease, the protective covering of nerve fibers (myelin layer) is gradually destroyed, which can impair brain function. Psychotic symptoms can result.


Sometimes drugs can also temporarily cause psychotic symptoms, such as severe confusion or hallucinations. The most common drug-induced psychosis triggers are Parkinson's medication.

In Parkinson's disease, certain nerve cells in the brain gradually die, which leads to a dopamine deficiency. This triggers the typical Parkinson's symptoms such as slowed movements, muscle stiffness (rigidity) and tremors (tremor). Parkinson's medication increases the level of dopamine in the patient's blood. If the dopamine content is then too high, however, psychological problems such as psychosis can arise. Very old Parkinson's patients are particularly often affected. Stress and lack of fluids can make symptoms worse.

Very rarely is a psychosis based on Cortisone supplementswhich - in high doses - can have a euphoric effect. However, the likelihood that this will cause psychosis is very small. Symptoms are temporary, if any.


LSD can trigger a so-called drug psychosis with hallucinations and delusions (LSD psychosis or amphetamine psychosis). Depending on how much and what type of drug was consumed, the symptoms disappear after a few hours or persist for a few days.

It is striking that about half of all psychosis patients like substances Alcohol, cocaine, or cannabis consume. It is not always clear whether the symptoms were present before or were caused by drug abuse. However, experts emphasize that drugs can significantly worsen the course of a psychosis. Current research results show that cannabis users with a genetic susceptibility to psychosis have a significantly higher risk of developing this same mental disorder (Cannabis psychosis).

Cigarettes increase the risk of psychosis
Not only cannabis use can promote the onset of psychosis. Regular cigarettes also appear to increase the risk for young smokers. From Christiane Fux

Mental disorders

Psychosis often occurs with severe mental illness. Most often, schizophrenia patients suffer from psychosis. But people with bipolar disorder or depression can also experience psychotic symptoms. So can a schizoaffective psychosis occur in a hybrid of schizophrenia and mood disorder such as depression or bipolar disorder. A paranoid psychosis can accompany paranoid schizophrenia (the most common form of schizophrenia).

The exact relationships have not been fully explored. However, experts assume that mental illnesses arise when the Messenger metabolism in the brain is not working properly. The messenger substances dopamine, serotonin and glutamate are presumably involved.

Also one genetic predisposition (Disposition) probably plays a role. In some families, psychoses occur more frequently: Certain genes seem to increase emotional vulnerability and thus also the risk of developing psychosis.

Usually, however, the disease only breaks out when stressful external factors to be added. Stress is one of the most important risk factors. Stressful experiences such as a separation or difficult phases in life such as puberty can favor the onset of psychosis.

But whether such experiences actually lead to a psychosis varies greatly from person to person. Some people develop a psychosis only after massive emotional trauma, while others develop it after a comparatively moderate stress.

Postpartum psychosis

Postpartum psychosis will also occur Postpartum psychosis called. It occurs in the first few weeks after giving birth. Researchers suspect that the extreme sleep deprivation of the new mother favors the onset of the disease.

Postpartum psychosis must be treated immediately by a doctor, as the mother's loss of reality can endanger both herself and the child.

Psychosis: examinations and diagnosis

If you suspect a psychosis, you should urgently consult a doctor. Losing the connection to reality carries the risk of endangering yourself or others. The first person to contact if you are suspected of having a psychosis is Family doctor. He will take you to a resident if necessary psychiatrist or in a psychiatricclinic transfers.

To get an idea, the doctor will give you a Initial interview (anamnesis) For example, ask the following questions:

  • Do you hear voices or see things that others cannot hear or see?
  • Do you feel like you are being followed?
  • Do you have a lot of contact with family members and / or friends?
  • Have you been unusually irritable lately?
  • Do you often feel depressed or excited?

After the initial interview, there will be a physical examination. If necessary, it can provide clues to an organic cause of the psychosis. Based on Blood and urine samples the doctor can determine whether drug abuse, inflammation, or metabolic disorders may be behind the symptoms. With the help of neurological tests diseases of the nervous system such as multiple sclerosis and epilepsy can be diagnosed.

If the doctor cannot determine an organic cause, they will examine you for possible mental illnesses such as schizophrenia, bipolar disorder and depression. Because psychoses often develop as a result of these underlying diseases. For the diagnosis use psychologists and psychiatrists clinical questionnaireswhich are based on the classification systems of mental disorders.

Psychosis: treatment

What the psychosis treatment looks like in the individual case depends on the causes. If possible, the trigger (underlying illness such as depression, bipolar disorder, drug addiction, etc.) is treated. In addition, the symptoms of psychosis can be alleviated with the help of medication.


Psychoses are associated with so-called Antipsychotics (formerly: neuroleptics) treated like haloperidol. These medicines work very well for hallucinations and delusions, but they have strong ones Side effects. The most common include:

  • fatigue
  • Listlessness
  • Weight gain
  • Movement disorders
  • Muscle twitching

In order to avoid these side effects, so-called atypical antipsychotics prescribed. They are usually better tolerated, but in individual cases can also lead to fatigue and weight gain.

Despite the possible side effects, it is very important that the patient consistently takes the prescribed antipsychotics - for as long as the doctor has prescribed. That prevents relapses too. Some patients also have to be treated with drugs for the rest of their lives.

Patients whose psychosis is based on bipolar disorder are also treated with Mood stabilizers treated like lithium. If the psychosis goes hand in hand with depression, help Antidepressants.


In addition to drug treatment, psychotherapy can further stabilize the patient. Two methods are particularly suitable for psychotherapy: The Psychoeducation and the cognitive behavioral therapy.


The diagnosis of "psychosis" can make patients and relatives very insecure and afraid. The targeted, comprehensive education about the illness (psychoeducation) helps those affected to cope with their fears and to reduce prejudices, misconceptions and feelings of guilt. In addition, patients and relatives are trained to recognize the first signs of psychosis in order to be aware of any relapses at an early stage.

Cognitive behavioral therapy

Patients learn special techniques with which they can control delusions and reduce depressive symptoms, fears and stress. Because even drugs cannot always protect against a new flare-up.

In addition, the patients train their social skills to reduce stress, strengthen social contacts and deal more calmly with stressful situations.

Read more about the therapies

Read more about therapies that can help here:

Psychosis: disease course and prognosis