Hypervigilia: what is it and what are its causes?

Psychological disorders such as schizophrenia and mania or the consumption of hallucinogenic drugs and noradrenergic agonists can cause hypervigilia, that is, the pathological increase in the level of consciousness, which causes a subjective sense of lucidity but also distractibility.

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

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What is hypervigilia?

We can define hypervigilia as a phenomenon that consists of the increase in the level of alertness, attention and awareness . Although the concept is often associated with psychopathology, particularly the spectrum of psychosis and episodes of mania characteristic of bipolar disorder, hypervigilia can also occur in people without alterations of this type.

However, in general the term is used to talk about psychopathological facts. In this sense, hypervigilia has been described above all as a prodrome in 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, hypervigilia is framed within the category of disorders of consciousness. More specifically, it is the most representative phenomenon of positive alterations (or enlargement) of consciousness . On the other hand, the decrease in the alert level is part of the deficit disorders of the conscience.

People who experience hypervigillity usually report a subjective sensation of increased clarity of consciousness accompanied by an increase in the number of movements , including those that are necessary for spoken language; in relation to this last point, hypervigilia is associated with tachypsychia (acceleration of mental activity).

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

Causes of this disorder of consciousness

There are two sets of main causes that can cause hypervigilia. The first of them includes two groups of psychological alterations with a clear biological basis: psychotic disorders and manic episodes.

The other great cause of hypervigilia is the consumption of psychoactive substances like 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 alterations), rigid delusions, disorganization of language (manifested, for example, in the flight of ideas) and behavior, as well as by negative symptoms such as affective flattening.

Psychotic outbreaks are episodes in which there is a rupture of contact with reality, normally due to intense stress and / or substance use , especially if they have hallucinogenic effects to some degree (which includes cannabis). Sometimes hypervigilia 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 the state of mind. 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 depression, which is also characteristic.

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

3. Hallucinogenic substances

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

The most characteristic substance of this group is 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 consumption generally generates a feeling of euphoria and increased self-awareness.

Other well-known hallucinogens are mescaline (which is obtained from the peyote cactus), ayahuasca (associated with experiences of personal transcendence), psilocybin (usually known by the name "hallucinogenic mushrooms") and ecstasy or MDMA, a synthetic drug that It is still popular today in nightlife environments.

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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 cerebral arousal (or activation); among these we find the maintenance of the waking state, the management of the focus of attention or the fight and flight responses.

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

On the other hand, there are also several medications whose use has been approved and which, since they enhance the noradrenergic activity, could cause hypervigillia if consumed in excessive doses. Antidepressants such as MAOIs, tricyclics or reboxetine (the main selective inhibitor of noradrenaline reuptake) are good examples of this.