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LSD and ketamine in schizoaffective paranoid psychosis involving childhood and war trauma—a retrospective case study

Mika Turkia

August 5, 2024 preprint DOI: 10.31234/osf.io/5azpy (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case report
Sample size 1
Population A person with paranoid psychosis and schizoaffective disorder
Interventions LSD Ketamine Aripiprazole
Dose higher-dose LSD; psycholytic doses of LSD (daily for four weeks); ketamine (self-administered, dose not specified); aripiprazole (dose not specified)
Duration One session for high-dose LSD; four weeks of daily psycholytic LSD; two months follow-up after antipsychotic discontinuation
Topics Esketamine Ketamine LSD
Keywords Paranoia Psychosis Aripiprazole Antipsychotic Clinical psychology Quetiapine Schizophrenia object-oriented programming
Key findings A high-dose LSD experience resolved paranoid psychotic symptoms in one session, and later, ketamine-assisted grounding followed by daily psycholytic LSD doses enabled discontinuation of aripiprazole without psychotic symptom return over two months. The authors suggest chronic LSD may induce tolerance to psychedelic effects but not to other effects, potentially related to mood enhancement.

Abstract

Currently, documentation on the effects of psychedelics on psychosis appears scarce. In the present case, a higher-dose LSD experience during acute paranoid psychosis before the initiation of antipsychotics induced feelings of love, which resolved the majority of the symptoms of the paranoid psychosis in one session, leading the person to reconnect with his family and seek treatment in a psychiatric hospital. The session did not resolve schizoaffective disorder, however. More than a decade later, while using the antipsychotic aripiprazole, concurrent self-administration of ketamine induced psychedelic effects that appeared to allow for practicing 'grounding' of psychotic thoughts. Immediately afterwards, daily self-administration of psycholytic doses of LSD for four weeks caused a mood-enhancing effect that enabled the patient to successfully discontinue aripiprazole without the return of psychotic symptoms. No psychotic or other noticeable symptoms could be observed during two interviews conducted in the two months following the discontinuation of the antipsychotic. The mechanisms of action remain unexplored, and their possible generalizability to other cases remains unclear, but the observations may serve as a basis for further research. It may, for example, be that chronic use of LSD induces a tolerance to its psychedelic effects but not to its anti-inflammatory or other possibly unknown effects, which may be related to the observed mood-enhancing effect. A preclinical study from 1971 appeared consistent with the claimed effect. In the present case, paranoia, i.e., the hypersensitivity to potential threats, was partly due to childhood trauma, partly intentionally induced by military training, and partly accentuated by war experiences. It could not be 'turned off'. Fear related to the uncertainty of survival formed the core of psychosis; without the fear, psychosis would likely not have existed. Paranoid psychosis presented itself as a biased estimation of probabilities of possible adverse outcomes, as a mismatch between the past and the present.

Comparable studies

Other case reports and case series on LSD, most cited first.

Study Year Design Participants
Lasting Neuropsychiatric Sequelae of (??)Methylenedioxymethamphetamine (???Ecstasy???) in Recreational Users Persons who ingested large doses of MDMA 1991 Case study n = 2
Further Studies in the Therapeutic Value of Lysergic Acid Diethylamide in Mental Illness Patients with mental illness 1957 Case series
Coma, Hyperthermia, and Bleeding Associated with Massive LSD Overdose a Report of Eight Cases People who self-administered large amounts of pure LSD powder intranasally 1975 Case series n = 8
Using a MDMA- and LSD-Group Therapy Model in Clinical Practice in Switzerland and Highlighting the Treatment of Trauma-Related Disorders Patients with chronic complex post-traumatic stress disorder (c-PTSD), dissociative,... 2022 Case series
Persistent Palinopsia Following Ingestion of Lysergic Acid Diethylamide (LSD) Patients who developed persistent palinopsia after LSD ingestion 1996 Case series n = 3

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Esketamine Ketamine LSD