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.