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Psychotic mania induced by diffuse meditation

January 2017

DOI:10.1016/j.psychres.2016.12.035

Authors:

Holly N. Sherrill

John Sherrill

University of Arkansas for Medical Sciences

Ricardo Caceda

Stony Brook University/Northport VAMC

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Psychiatry Research

journal homepage: www.elsevier.com/locate/psychres

Letter to the Editor

Psychotic mania induced by diﬀuse meditation

To the Editor.

Increasing evidence supports the view of meditation and mindfulness as favorable to well-being in the general population and in those suﬀering

from mental illness (Leung et al., 2014;Mehrmann and Karmacharya, 2013). Little is known, however, regarding the role of its potential negative

consequences, such as meditation triggered mania or psychosis. We report an interesting case which suggests meditation may not always be

beneﬁcial.

Ms. D is a 28-year-old white female with a history of multiple episodes of mania with psychosis following meditative practices who presented to

the emergency department in January 2015 for bizarre, aggressive, and hypersexual behavior which began after meditating at a secluded Buddhist

retreat center. Prior to her presentation, she was found meditating in her shrine room at home wearing formal regalia of a Buddhist practitioner and

later attacked her friends, both violently and sexually. Upon examination in the Emergency Department, the patient exhibited waxing and waning

catatonic symptoms, grandiosity, pressured speech, thought blocking, disorganization, inappropriate giggling, and paranoia. She endorsed auditory

and visual hallucinations of her Buddhist teachers and was noted to be responding to internal stimuli. Later she reported decreased need for sleep

during the previous week. She denied regular use of over-the-counter medications, and her only prescription medication was the oral contraceptive

desogestrel-ethinyl estradiol/ethinyl estradiol.

Ms. D reported three previous similar episodes, all while in India and Nepal studying Buddhist meditation in more depth. On one occasion, she

exhibited disorganized and hypersexual behavior which led to hospitalization at a local institution and initiation of a mood stabilizer. However, Ms.

D discontinued the medication after discharge, believing that her altered state was a natural consequence of deep meditation. Noteworthy, the

patient's Buddhist mentor had previously advised her to refrain from any further meditative practices. Further investigation into our patient's

practices revealed engagement in mostly diﬀuse meditation and deity yoga, the latter involving the practitioner self-identifying with a deity.

Ms. D was admitted to our inpatient facility involuntarily, and a diagnosis of bipolar disorder, type 1, was made. Electroencephalogram, head

computerized tomography, and laboratory tests including urine drug screen did not reveal any abnormalities. Lithium and low dose haloperidol

were initiated which resolved her symptoms within two days. Upon discharge, Ms. D displayed excellent insight and willingness to comply with

treatment, including recommendation for refraining from further meditation practices. Of note, she later remembered attempting to show her

friends that she indeed was a Buddhist deity, which led her to engage in the bizarre behaviors she demonstrated.

Previous literature shows sparse information regarding meditation triggering mania and/or psychosis. PubMed was utilized to search for all

previous reports available in English with the following keywords in various combinations: meditation, mindfulness, Buddhism, Buddhist, mania,

bipolar, mood disorder, aﬀective disorder, psychosis, psychotic, and schizophrenia. Fifteen case reports, all identiﬁed in a review article by Kuijpers

et al. (Kuijpers et al., 2007), described diﬀerent types of primary psychotic disorders associated with meditation (Kuijpers et al., 2007), and only two

reported bipolar disorder (Chan-Ob and Bonyanaruthee, 1999; Yorston, 2001).

This case illustrates that despite the growing data of the beneﬁts associated with meditation, it may also trigger mania or psychosis in susceptible

individuals. Because of their intense cognitive demands of prolonged nonreactive monitoring of the ongoing stream of experience from moment to

moment (Lutz et al., 2008) without a speciﬁc object of focus, diﬀuse meditation and deity yoga may be overwhelming to individuals prone to

psychosis or mania who may already have limited sensorimotor gating abilities. Further exploration of the eﬀects of the diﬀerent forms of

meditation on individuals suﬀering from severe mental illness is warranted before considering meditation as an innocuous well-being practice for

all individuals.

References

Chan-Ob, T., Bonyanaruthee, V., 1999. Meditation is association with psychosis. J. Med. Assoc. Thail. 82, 925–930.

Kuijpers, H.J., van der Heijden, F.M., Tuinier, S., Verhoeven, W.M., 2007. Meditation-induced psychosis. Psychopathology 40, 461–464.

Leung, N.T., Lo, M.M., Lee, T.M., 2014. Potential therapeutic eﬀects of meditation for treating aﬀective dysregulation. Evid.-Based Complement. Altern. Med. 2014, 402718.

Lutz, A., Slagter, H.A., Dunne, J.D., Davidson, R.J., 2008. Attention regulation and monitoring in meditation. Trends Cogn. Sci. 12, 163–169.

Mehrmann, C., Karmacharya, R., 2013. Principles and neurobiological correlates of concentrative, diﬀuse, and insight meditation. Harv. Rev. Psychiatry 4, 205–218.

Yorston, G.A., 2001. Mania precipitated by meditation: a case report and literature review. Ment. Health, Relig., Cult. 4, 209–213.

Holly N. Sherrill, John Sherrill, Ricardo Cáceda

Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot #554, Little Rock, AR 72205, USA

E-mail address: hsherrill@uams.edu

http://dx.doi.org/10.1016/j.psychres.2016.12.035

Received 3 June 2016Received in revised form 21 December 2016Accepted 24 December 2016

⁎

Corresponding author.

Psychiatry Research (xxxx) xxxx–xxxx

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R.R. Yarmolyuk

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Article

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Jan 2015

Objectives: Meditation is believed to have many health benefits apart from enhancing spiritual health. However, there is some evidence that it may lead to certain psychiatric disorders too. Some researchers have reported that meditation may even lead to psychosis or worsen it in some cases. On the other hand, it has also been proposed to alleviate even severe psychiatric symptoms among psychotic patients. Hence, there is a need to review the existing literature to clarify on this controversy of whether meditation is overall harmful or beneficial in patients with psychosis. Methodology: We performed a systematic review of all the existing studies using PubMed and Google Scholar using following search terms: ‘Psychosis’, ‘Schizophrenia’, ‘Meditation’ & ‘Spirituality’. We gathered all the studies since inception of the databases and total of 163 articles. Studies available in non-English language were excluded. Two of the authors did the literature review independently to ensure that no relevant article is missed. Results: There is scarcity of data in this field. Of all the available studies, there was a majority of case series and case reports describing association of psychosis with meditation. Various types of meditative techniques were mentioned in the studies, viz. Mindfulness based meditation, Transcendental Meditation, Bikram Yoga etc. Mindfulness based meditation studies were found to be beneficial to patients with psychosis. There were some evidences to point the precipitation or worsening of psychotic symptoms in patients already at risk of developing psychosis. Conclusion: Overall, there is inconclusive evidence for or against benefit of meditation in patients with psychosis. Most of the subjects who developed psychosis with meditation were already at the increased risk. Some of the factors proposed are dehydration, sleep deprivation, sensory deprivation and hypoglycemia. Future studies using longitudinal follow up design should be able to throw more light on this issue.

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Full-text available

Aug 2014
EVID-BASED COMPL ALT

Affective dysregulation is at the root of many psychopathologies, including stress induced disorders, anxiety disorders, and depression. The root of these disorders appears to be an attenuated, top-down cognitive control from the prefrontal cortices over the maladaptive subcortical emotional processing. A form of mental training, long-term meditation practice can trigger meditation-specific neuroplastic changes in the brain regions underlying cognitive control and affective regulation, suggesting that meditation can act as a kind of mental exercise to foster affective regulation and possibly a cost-effective intervention in mood disorders. Increasing research has suggested that the cultivation of awareness and acceptance along with a nonjudgmental attitude via meditation promotes adaptive affective regulation. This review examined the concepts of affective regulation and meditation and discussed behavioral and neural evidence of the potential clinical application of meditation. Lately, there has been a growing trend toward incorporating the "mindfulness" component into existing psychotherapeutic treatment. Promising results have been observed thus far. Future studies may consider exploring the possibility of integrating the element of "compassion" into current psychotherapeutic approaches.

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Article

Full-text available

Nov 2001
Ment Health Relig Cult

Graeme Yorston

Meditation is a popular method of relaxation and dealing with everyday stress. Meditative techniques have been used in the management of a number of psychiatric and physical illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized however. This paper reports a case in which two separate manic episodes arose after meditation using techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated by meditation and mystical speculation reported in the literature are discussed.

Meditation in association with psychosis

Article

Full-text available

Oct 1999

This study analysed the correlation between contemplation and psychosis from three cases of patients presenting psychotic symptoms subsequent to practising meditation. Sleep loss following a wrong doing in meditation was found to be the main cause in the first two cases, and drug withdrawal was found to be the principal factor in causing a psychotic eruption in the third case. In this last case, sleep deprivation subsequent to meditation was only a minor influence. Discussion regarding the correlation between meditation and psychosis is presented in this study.

Principles and Neurobiological Correlates of Concentrative, Diffuse, and Insight Meditation

Article

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HARVARD REV PSYCHIAT

Meditation-Induced Psychosis

Article

Feb 2007
PSYCHOPATHOLOGY

Meditation is a self-regulatory psychological strategy that is frequently applied in Western as well as non-Western countries for different purposes; little is known about adverse events. A male patient is described who developed an acute and transient psychosis with polymorphic symptomatology after meditating. A literature search for psychotic states related to meditation was carried out on PubMed, Embase and PsycInfo. In the case presented a diagnosis of acute polymorphic psychotic disorder was made. Other case reports dealt with either a relapse of a pre-existent psychotic disorder or with a brief psychotic reaction in patients without a psychiatric history. Meditation can act as a stressor in vulnerable patients who may develop a transient psychosis with polymorphic symptomatology. The syndrome is not culture bound but sometimes classified in culture-bound taxonomies like Qi-gong Psychotic Reaction.

Attention Regulation and Monitoring in Meditation

Article

May 2008
TRENDS COGN SCI

Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. Among these various practices, there are two styles that are commonly studied. One style, focused attention meditation, entails the voluntary focusing of attention on a chosen object. The other style, open monitoring meditation, involves nonreactive monitoring of the content of experience from moment to moment. The potential regulatory functions of these practices on attention and emotion processes could have a long-term impact on the brain and behavior.

⁎ Corresponding author

Jul 2016

Ricardo Cáceda Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot #554, Little Rock, AR 72205, USA E-mail address: hsherrill@uams

N Holly
John Sherrill
Sherrill

Holly N. Sherrill, John Sherrill, Ricardo Cáceda Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot #554, Little Rock, AR 72205, USA E-mail address: hsherrill@uams.edu http://dx.doi.org/10.1016/j.psychres.2016.12.035

Ricardo Cáceda Psychiatric Research Institute, University of Arkansas for Medical Sciences E-mail address: hsherrill@uams

N Holly
John Sherrill
Sherrill

Psychotic mania induced by diffuse meditation

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