Psychotic Episodes

There is great variability in how drugs affect people, from person to person and from time to time in the same person. This is due to the variabilities of set and setting.14 Set is the expectation of what the drug will do, in the context of personality. For example, someone expecting to be out of control from taking a drug, probably will be. Setting is the environment, physical and social, in which the drug is taken. For example, someone trying out LSD in an unfamiliar group to which there is no feeling of trust attached may feel paranoid and have a bad trip. Occasionally, with less experienced users, one is given a substance that is not an actual drug, but is believed to be. A placebo effect may occur, causing the user to be "overdramatic" in his experience.

There are three types of drug-related psychological disasters a nurse may encounter: 14

1) a rare and temporary toxic psychosis that occurs in people predisposed to brain toxicity. It manifests as confusion, disorientation and unpleasant hallucinations,

2) a panic reaction interpreted that one is dying or losing one’s mind, a self-perpetuating experience most likely in novices or those who have been given drugs involuntarily or unknowingly, and

3) a true psychosis that is precipitated by, rather than caused by, drug experience in people predisposed to schizophrenia.