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Psychotic mania induced by diffuse meditation

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Letter to the Editor
Psychotic mania induced by diuse 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 suering
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
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 diuse 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, aective disorder, psychosis, psychotic, and schizophrenia. Fifteen case reports, all identied in a review article by Kuijpers
et al. (Kuijpers et al., 2007), described dierent 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 benets 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 specic object of focus, diuse 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 eects of the dierent forms of
meditation on individuals suering from severe mental illness is warranted before considering meditation as an innocuous well-being practice for
all individuals.
Chan-Ob, T., Bonyanaruthee, V., 1999. Meditation is association with psychosis. J. Med. Assoc. Thail. 82, 925930.
Kuijpers, H.J., van der Heijden, F.M., Tuinier, S., Verhoeven, W.M., 2007. Meditation-induced psychosis. Psychopathology 40, 461464.
Leung, N.T., Lo, M.M., Lee, T.M., 2014. Potential therapeutic eects of meditation for treating aective 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, 163169.
Mehrmann, C., Karmacharya, R., 2013. Principles and neurobiological correlates of concentrative, diuse, and insight meditation. Harv. Rev. Psychiatry 4, 205218.
Yorston, G.A., 2001. Mania precipitated by meditation: a case report and literature review. Ment. Health, Relig., Cult. 4, 209213.
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:
Received 3 June 2016Received in revised form 21 December 2016Accepted 24 December 2016
Corresponding author.
Psychiatry Research (xxxx) xxxx–xxxx
0165-1781/ © 2017 Elsevier B.V. All rights reserved.
... Adverse effects of meditation practice have been documented in several cases (e.g., Anderson et al. 2019;Cebolla et al. 2017;Dyga and Stupak 2015;Lomas et al. 2015;Schlosser et al. 2019;Sherrill et al. 2017). The effects of mindfulnessrelated practices are clearly not invariably beneficial (Britton 2019;Lindahl et al. 2017). ...
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The insight knowledges, descriptive of meditative experiences in Theravāda vipassanā meditation, are the outcome of a historical development and are specific to this Buddhist tradition; the challenging experiences they describe are not representative of conceptions of the path to awakening in early Buddhism and are of no direct relevance to mindfulness-based interventions. Adverse effects of meditation are recognized in early Buddhism, where the response to a drastic case of mental imbalance leading to suicidal tendencies takes the form of recommending the cultivation of mindfulness. In fact, adverse effects can occur with a range of different meditation practices, which need not have any relationship to mindfulness. Although the practice of mindfulness is clearly not a panacea and in case of trauma and mental illness requires being combined with professional assistance, it has a potential to support and facilitate the facing of difficult emotions.
... Even long term meditators have reported adverse effects [147]. There have been some reports of psychosis and mania triggered by meditation in the scientific literature [148][149][150] [151] and in lay publications [152]. Further examples include depersonalization [153], and case reports of brain activity correlated with seizures [154,155]. ...
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The science of meditation has grown tremendously in the last two decades. Most studies have focused on evaluating the clinical effectiveness of mindfulness-based interventions, neural and other physiological correlates of meditation, and individual cognitive and emotional aspects of meditation. Far less research has been conducted on more challenging domains to measure, such as group and relational, transpersonal and mystical, and difficult aspects of meditation; anomalous or extraordinary phenomena related to meditation; and post-conventional stages of development associated with meditation. However, these components of meditation may be crucial to people’s psychological and spiritual development, could represent important mediators and/or mechanisms by which meditation confers benefits, and could themselves be important outcomes of meditation practices. In addition, since large numbers of novices are being introduced to meditation, it is helpful to investigate experiences they may encounter that are not well understood. Over the last four years, a task force of meditation researchers and teachers met regularly to develop recommendations for expanding the current meditation research field to include these important yet often neglected topics. These meetings led to a cross-sectional online survey to investigate the prevalence of a wide range of experiences in 1120 meditators. Results show that the majority of respondents report having had many of these anomalous and extraordinary experiences. While some of the topics are potentially controversial, they can be subjected to rigorous scientific investigation. These arenas represent largely uncharted scientific terrain and provide excellent opportunities for both new and experienced researchers. We provide suggestions for future directions, with accompanying online materials to encourage such research.
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Background: Meditation is associated with health benefits; however, there are reports that it may trigger or exacerbate psychotic states. In this review, we aim to collate case reports of psychotic disorders occurring in association with meditative practice and to discuss the relationship between psychosis and meditation. Methodology: We performed case-based analysis of all the existing studies published in English language using PubMed, PsycINFO, Cochrane, Scopus, EMBASE, CINAHL and Google Scholar with the search terms; ‘Psychosis’ OR ‘Psychotic Symptoms’ OR ‘Schizophrenia’ AND ‘Meditation.’ Results: A total of 19 studies and 28 cases were included in the review. The patients described had an age range of 18–57 years; there was equal distribution of males and females. The diagnoses included acute psychosis in 14 cases, schizophrenia in 7 cases, mania with psychotic symptoms in 3 cases, and schizoaffective disorder in 1 case. The types of meditation described were Transcendent, Mindfulness, Buddhist Meditation like Qigong, Zen, and Theraveda, and others like Bikram yoga, Pranic Healing, and Hindustan Type meditation. Of the 28 cases reported, 14 patients had certain precipitating factors like insomnia, lack of food intake, history of mental illness, stress, and psychoactive substance use. Conclusion: There are case reports of psychotic disorder arising in association with meditative practice; however, it is difficult to attribute a causal relationship between the two. At the same time, there is a body of research describing the beneficial effect of meditative practice in clinical settings for patients with psychotic disorders. Appropriately designed studies are needed to further investigate the relationship between meditative practice and psychosis.
Conference Paper
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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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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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.
Full-text available
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.
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.
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
June 2016Received in revised form 21 December 2016Accepted 24 December 2016 ⁎ Corresponding author. Psychiatry Research (xxxx) xxxx–xxxx 0165-1781/ © 2017 Elsevier B.V. All rights reserved.
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:
Ricardo Cáceda Psychiatric Research Institute, University of Arkansas for Medical Sciences 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: