Psychological disorders such as schizophrenia and mania or the use of hallucinogenic drugs and noradrenergic agonists can cause hypervigilance, i.e. the pathological increase in the level of consciousness, which causes a subjective feeling of lucidity but also distractibility.

In this article we will describe what hypervigilance is and what its main causes are .

What is hypervigilance?

We can define hypervigilance as a phenomenon that consists in the increase of the level of alert, attention and consciousness . Although the concept is often associated with psychopathology, in particular with the spectrum of psychosis and the episodes of mania typical of bipolar disorder, hypervigilance can also occur in people without such alterations.

However, in general the term is used to talk about psychopathological facts. In this sense, hypervigilance has been described above all as a prodrome of the development of certain psychological disorders, related both to conscious mental activity and to the temporary or permanent alteration of its biological base: the central nervous system.

From a conceptual point of view, hypervigilance falls within the category of disorders of consciousness. More specifically, it is the most representative phenomenon of positive (or amplifying) alterations of consciousness . On the other hand, the decrease in the level of alert forms part of the disorders of the consciousness.

People who experience hypervigilance often report a subjective feeling of increased clarity of consciousness accompanied by an increase in the number of movements , including those necessary for spoken language; in relation to this last point hypervigilance is associated with tachypsicity (acceleration of mental activity).

However, studies reveal that the increase in the level of consciousness does not imply an improvement in attention tasks: hypervigilance experiences usually occur simultaneously with a state of distractibility, by which subjects have an increased facility to change the focus of attention in response to not necessarily relevant stimuli.

Causes of this disorder of consciousness

There are two main sets of causes that can lead to hypervigilance. The first includes two groups of psychological disorders with a clear biological basis: psychotic disorders and manic episodes.

The other major cause of hypervigilance is the use of psychoactive substances such as cocaine, amphetamine and hallucinogens.

1. Schizophrenia and other psychoses

According to the DSM diagnostic manuals, psychotic disorders are characterized by the presence of hallucinations (which are usually auditory in functional disorders), rigid delusional ideas, disorganization of language (manifested for example in flight of ideas) and behavior, as well as negative symptoms such as emotional flattening.

Psychotic breaks are episodes in which there is a break in contact with reality, usually due to intense stress and/or substance use , especially if they have hallucinogenic effects to some degree (which includes cannabis). Hypervigilance sometimes occurs in the context of an outbreak, which may or may not precede a diagnosis of schizophrenia.

2. Manic episodes

Mania is defined as a pathological increase in energy levels, alertness and brain activation , as well as mood. When repeated manic episodes occur in the same person, the diagnosis of bipolar disorder is used; for this, the appearance of mania is more key than that of depression, which is also characteristic.

Hypervigilance is one of the most obvious signs of manic episodes. In these cases it is very common for the person to show hyperactive and unreflective behaviour, an increase in the rhythm of thought and speech, distractibility to the appearance of irrelevant external stimuli or a reduction in the subjective need for sleep.

3. Hallucinogenic substances

Hallucinogens, psychedelics or psychotomimetics are a group of psychoactive substances that cause significant alterations in perception, cognition and emotion. Their name is misleading, since they rarely cause true hallucinations; for example, many hallucinogens cause an increase in visual sensitivity or distort it.

The most characteristic substance of this group is the lysergic acid or LSD , which was very popular in the middle of the 20th century. The mechanism of action of this drug is related to its ability to interact with dopamine, adrenaline and serotonin receptors, and its use usually generates a feeling of euphoria and increased awareness of the self.

Other well-known hallucinogens include mescaline (obtained from the peyote cactus), ayahuasca (associated with experiences of personal significance), psilocybin (commonly known as “hallucinogenic mushrooms”) and ecstasy or MDMA, a synthetic drug that remains popular in nightlife settings today.

4. Noradrenaline agonists

Noradrenaline is one of the most important neurotransmitters in the human central nervous system, in addition to acting as a hormone in the endocrine system. Its functions are related to brain excitation (or activation); among these we find the maintenance of wakefulness, attention focus management or fight and flight responses.

The two main psychoactive substances with agonist effects in noradrenaline are cocaine and amphetamine. Cocaine blocks the reuptake of noradrenaline , as well as dopamine, serotonin and adrenaline, by presynaptic terminals; amphetamine has similar effects but also enhances dopamine release.

On the other hand, there are also several drugs that have been approved for use that, because they enhance noradrenergic activity, may cause hypervigilance if consumed in excessive doses. Antidepressants such as MAOIs, tricyclics or reboxetine (the main selective noradrenaline reuptake inhibitor) are good examples of this.