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Substance-induced psychosis

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Substance-induced psychosis
Other namesSubstance-induced psychotic disorder, drug-induced psychosis, substance/medication-induced psychotic disorder, toxic psychosis
SpecialtyPsychiatry, addiction psychiatry

Substance-induced psychosis (commonly known as toxic psychosis or drug-induced psychosis) is a form of psychosis that is attributed to substance intoxication, withdrawal or recent consumption of psychoactive drugs. It is a psychosis that results from the effects of various substances, such as medicinal and nonmedicinal substances, legal and illegal drugs, chemicals, and plants. Various psychoactive substances have been implicated in causing or worsening psychosis in users.[1]

Signs and symptoms

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Main article: Psychosis

Psychosis manifests as disorientation, visual hallucinations and/or haptic hallucinations.[2] It is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the capacity to deal with life's demands.[3] While there are many types of psychosis, the cause of substance-induced psychosis can be pinpointed to intake of specific chemicals. To properly diagnose Substance-Induced Psychotic Disorder, one must conclude that exhibited hallucinations or delusions began during intoxication, withdrawal, or within a month after use of the substance and the symptoms are not related to a non-substance-induced psychotic disorder.[4]

Treatment

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Because substance-induced psychosis results from the consumption of a substance or combination of substances, treatment practices heavily rely on detoxification and discontinuation of the substance(s). [1] Detox and addiction treatment centers may often provide rehabilitation programs, including inpatient and outpatient treatment options, support groups, and extended treatment plans. Substance-induced psychosis may persist for hours, days, or weeks, but typically resolves within a month of sobriety. [1] Treating psychosis involves a very thorough evaluation, including medical history, family background, symptoms, and other potential causes.[5] Treatment prioritizes emergent symptoms, evaluates for underlying mental illnesses, and focuses on behavioral and preventative measures against substance use.[1]

Substance use and schizophrenia

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Rates of drug use amongst people with schizophrenia are higher than the general population; 50% of those diagnosed with schizophrenia use substances over their life.[6]: 495, 496  There is a model that suggests this arises because those with schizophrenia self-medicate with psychoactive drugs.[6]: 500 

Transition to schizophrenia

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A 2019 systematic review and meta-analysis found that 25% (18–38%) of people diagnosed with substance-induced psychosis went on to be diagnosed with schizophrenia, compared with 36% (30–43%) for brief, atypical and not otherwise specified psychoses.[7] The substance present was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (34% (25–46%)), hallucinogens (26% (14–43%)) and amphetamines (22% (14–34%)). Lower rates were reported for opioid– (12% (8–18%)), alcohol– (9% (6–15%)) and sedative– (10% (7–15%)) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.[7]

Class of substance Number of studies Rates of transition to schizophrenia
Estimate Lower bound Upper bound
Brief, atypical and NOS 34 36% 30% 43%
Combined - 25% 18% 38%
Cannabis 6 34% 25% 46%
Hallucinogens 3 26% 14% 43%
Amphetamines 5 22% 14% 34%
Opioid 3 12% 8% 18%
Sedative 3 10% 7% 15%
Alcohol 9 9% 6% 15%

Substances

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Psychotic states may occur after using a variety of legal and illegal substances. Substances whose use or withdrawal is implicated in psychosis include the following:

International Classification of Diseases

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Psychoactive substance-induced psychotic disorders outlined within the ICD-10 codes F10.5—F19.5:

F17.5 is reserved for tobacco-induced psychosis, but is traditionally not associated with the induction of psychosis.

The code F15.5 also includes caffeine-induced psychosis, despite not being specifically listed in the DSM-IV. However, there is evidence that caffeine, in extreme acute doses or when taken in excess for long periods of time, may induce psychosis.[34][35]

Medication

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Other drugs illicit in America

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Other drugs illegal in America (not listed above), including:

Plants

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Plants:

Nonmedicinal substances

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See also: Particulates § Cognitive hazards and mental health

Substances chiefly nonmedicinal as to source:

See also

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References

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