Thursday, 20 August 2015

"I think I am going crazy, mad, psychotic - what should I do?" The best general answer may be: Sedation, Sedation, Sedation - Sleep, Sleep, Sleep

The commonest cause of psychosis is Brief Psychotic Disorder

Which may be provoked by lack of sleep; from over work, stress, drugs, drug withdrawal...

The cure is sleep - a few days of sleeping plenty of hours.

Since sleep will not come naturally; this usually requires sedation

So if you suspect you are going crazy, and have not been sleeping much, there may be a window of opportunity when you could self-treat by sedation and sleep (before you will be admitted to a hospital and treated by sedation).

Most sedative drugs are only available with a prescription, which takes time - but there are some antihistamines that are available without prescription (over the counter) that should work just as well.

Indeed, these drugs are and have often been used in hospitals for sedating acutely psychotic people.They are old drugs, discovered in the 1940s, and generally regarded as among the safest of drugs for most people (e.g. they are often used in pregnancy):

Promethazine (e.g. Phenergan), Diphenhydramine (e.g. Benylin), Chlorpheniramine (e.g. Piriton), and Alimemazine (e.g. Vallergan) are some examples of sedative antihistamines which may be available without a prescription.

The hospital experience is that just a few days of effective sedation and sleep are enough completely to cure a Brief Psychotic breakdown - and the same would be expected when self medicating to abort such an attack before it gets severe enough to require hospitalization.

More explanation, references and detail are in my book from 2000, Psychiatry and the Human Condition at: -
Be aware that in this book, Brief Psychotic Disorder is discussed under the heading of Mania.


Nicholas Fulford said...

I have never hit that wall, and I feel for people that do.

I know that severe sleep deprivation and sometimes just moderate chronic sleep deprivation creates an "unreality" that makes the mental landscape *peculiar*. Add other stressors, and especially fear, and the environment is primed for an explosive manifestation. I remember a few times where with limited sleep at school - pulling an all-nighter - I made a stupid mistake that wiped out my work on a computer. The prof walked into the lab while I was having a fit over having just lost the work, and gave me a 12 hour extension. He said, to go home and sleep for 6 hours, and come back to the lab. I thought he was nuts, but did what he suggested. The sleep restored me enough that when I went back to the lab the work poured out of me, and I had the project finished 5 hours later.

Sleep is deeply restorative, and many of us are sleep deprived. I am sure it leads to a lot of problems when combined with all the stressors that are part of the day to day grind of life in the modern urban existence.

One of things I love about my backcountry hikes. I work like stink, and then I sleep for 10 hours, before getting up and starting again. The combination of all that exercise and sleep is transformative - until back in the urban unreality things gradually returns to their sick state once again. Why do we live this way? Because we are addicts, and most of us don't have a clue that we are addicted. It has just permeated our lives to such an extent that we don't even realise how sick we are, until we do something to shock us out of that state for awhile. But somehow for some reason that escapes me, we go back to it - over and over - until death or a long enough departure from being unwell enables us to draw a line which we finally do not cross again. I hope to do that; I need to do that; I must do that.

Bruce Charlton said...

@Nicholas - Good luck with your plan!

Adam G. said...

The common brand name in the US is 'benadryl,' and it works like a charm for knocking you out. Can be useful for kids when traveling to, or so I've heard . . . ;)

stephen c said...

Benadryl and similar sedatives do, in fact, work like a charm, but there are side effects - if you have any type of glandular problem, Benadryl may exacerbate that problem (basically, as I understand it, Benadryl works by overstimulation of certain protective bodily functions, but when those functions reside in a gland unrelated to the targeted problem, discomfort can result). Whether the resulting pain or discomfort is worth the separate beneficial effects is something to think about. Also, the two or three times I have used sedatives, I have experienced potentially troubling vivid dreams; anyone who uses sedatives for health reasons may need to resolve to discount the negative aspects of vivid dreams. Finally, and this may sound like the stupidest sentence you have ever heard, clothing that is too tight or too loose, over the course of a long work-day, may be almost as noxious as a lack of sleep. A change to better fitting clothing may be almost as effective as a decision to allow oneself sufficient rest. (In my experience, a change to good posture from bad posture, and to good caffeine and snacking habits from bad caffeine and snacking habits, may be similarly positive...)

Bruce Charlton said...

@Stephen - Thank you for your comments.

I do not want to get into specifics with my blog - All drugs have side effects, all drugs can have severe side effects, all drugs may interact with other drugs, and other diseases, to produce adverse effects.

My point here is that some people need sedation, and they need it urgently - within a few hours - if they are to avoid hospitalization.

And nowadays, hospitalization may lead to *life-long* treatment with dangerous psychiatric drugs, and increasingly with multi-drug cocktails of dangerous drugs (for 'Bipolar Disorder') - Life-long because the plain fact is that ALL psychiatric drugs create dependence, and are difficult/ dangerous to stop.

A Brief Psychosis may be severe, that person may be very crazy, but it may be cured within days by sedation, and the person may never have another episode. Nowadays, that person may end up taking a cocktail of antipsychotics, antidepressants, mood stabilizers, tranquillizers etc for the rest of their lives - suffering multiple impairments and side effects (including increased suicidality and increased rates of sudden death) for the rest of their lives. They will become a 'patient' (and a drug consumer) permanently.

Yet it may be possible to avoid this terrible outcome by avoiding hospitalization - by self-treatment with sedation and sleep, or by accepting this kind of treatment from a family member or friend who knows about it.

Adam G. said...

Nicholas Fulford,
that combination of hard work and prolonged sleep sounds deeply attractive. I'll have to give it a try.

harold said...

Sleeping goes hand in hand with not eating. There is some experimental evidence that fasting alleviates depression. In Roman times people who were possessed by demons (epilepsy) were put in a dark cellar without food, within a few days the demons went away. Even today there is a treatment for epilepsy in youths with a ketogenic diet (metabolically similar to fasting).
But I like the Sleep-Sleep-Sleep idea better than the Sleep-Fast-(Sensory Deprivation) one.

Bruce Charlton said...

@harold - I suspect that sleep deprivation and fasting do different things. People with melancholia/ endogenous depression will starve themselves, sometimes to death - and experience early morning awakening (ie disordered sleeping); but overactive, manic psychotics will almost stop sleeping altogether, but will usually eat reasonably normally.

harold said...

I have just watched the last episode of All Creatures Great & Small, series One volume Two. In it James Herriot uses the Sleep, Sleep, Sleep method two times. First he administers a sleeping medication to a sheep hoping to put it to "sleep" before the knackerman arrives. The animal gets well after sleeping for two days. Then he uses it intentionally as a treatment in a small dog who does not respond to medication, this time in two 24 hour doses, the dog recovers from it's ailment. And I vaguely remember that he treats a pig in a similar way later in the series. Anecdotal N=1 is not science, but just saying.

Bruce Charlton said...

@Harold - Interestingly, I too watched this episode recently, having bought the DVD set of the first series. (Generally regarded as the best Sunday evening family TV series the BBC ever produced, with astonishingly high viewing figures sustained over several seasons - it is hard to disagree!)

My impression was that this episode was probably autobiographical for the author - real name Alf Wight.

There is a distinction between anaesthetic-induced sedation, and natural sleep - they do not have the same physiological effect. Nonetheless, there have been periods in recent history when psychiatric disease was treated by prolonged anaesthetic sedation - 'deep-sleep therapy' for example having people asleep almost all the time with barbiturates but woken once a day to eat and drink and go to the toilet.

Healy and Shorter's evaluation (in their book Shock Therapy) was that the treatment probably was effective - perhaps by reducing suffering until the patient naturally healed or the illness remitted - about as effective as insulin coma therapy; but (again like insulin coma therapy) the mortality rate was high, due to having people bedridden for long periods, pneumonia etc.