Episodes of substance-induced psychosis are common in emergency departments and crisis centers. There are many precipitating substances, including alcohol Alcohol Toxicity and Withdrawal Alcohol (ethanol) is a central nervous system depressant. Large amounts consumed rapidly can cause
respiratory depression, coma, and death. Large amounts chronically consumed damage the liver... read more , amphetamines
Amphetamines Amphetamines are sympathomimetic drugs with central nervous system stimulant and euphoriant properties whose toxic adverse effects include delirium, hypertension, seizures, and hyperthermia... read more ,
cannabis
Marijuana (Cannabis) Marijuana is a euphoriant that can cause sedation or dysphoria in some users. Psychologic dependence can develop with chronic use, but very little physical dependence is clinically apparent... read more ,
cocaine
Cocaine Cocaine is a sympathomimetic drug with central nervous system stimulant and euphoriant properties. High doses can cause panic, schizophrenic-like symptoms, seizures, hyperthermia, hypertension... read more ,
hallucinogens
Hallucinogens Hallucinogens are a diverse group of drugs that can cause highly unpredictable, idiosyncratic reactions. Intoxication typically causes hallucinations, with altered perception, impaired judgment... read more ,
opioids
Opioid Toxicity and Withdrawal Opioids are euphoriants that, in high doses, cause sedation and respiratory depression. Respiratory depression can be managed with specific antidotes (eg, naloxone) or with endotracheal intubation... read more ,
phencyclidine
Ketamine and Phencyclidine (PCP) Ketamine and phencyclidine are dissociative anesthetics that can cause intoxication, sometimes with confusion or a catatonic state. Overdose can cause coma and, rarely, death. Ketamine and phencyclidine... read more (PCP), and
sedative/hypnotics
Anxiolytics and Sedatives Anxiolytics and sedatives include benzodiazepines, barbiturates, and related drugs. High doses can cause stupor and respiratory depression, which is managed with intubation and mechanical ventilation... read more . To be considered substance-induced psychosis, the
hallucinations and delusions should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient may also be intoxicated or withdrawing. Symptoms are often brief, resolving shortly after the causative drug is cleared, but psychosis triggered by amphetamines, cocaine, or PCP may persist for many weeks. Because some young people with prodromal or early-stage
schizophrenia use substances that can induce psychosis, it is important to obtain a thorough history, particularly to seek evidence of prior mental symptoms before concluding that acute psychosis is due solely to substance use. A calm environment Often a benzodiazepine or
antipsychotic For psychosis due to dopamine-stimulating drugs such as amphetamine, an antipsychotic drug is most effective. For psychosis due to drugs such as lysergic acid diethylamide (LSD), quiet observation may be all that is needed. For substances with actions that do not involve dopamine, observation may be all that is needed, or an anxiolytic may help. Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. What Is Substance/Medication-Induced Psychotic Disorder?Substance/medication-induced psychotic disorder, also known as toxic psychosis, alcohol-induced psychosis, and drug-induced psychosis, is the diagnostic name for a specific mental health condition where an individual experiences hallucinations, delusions, or both within a month of using or withdrawing from prescription drugs, illegal drugs, and/or alcohol. According to the Diagnostic and Statistical Manual (DSM-5), 7% to 25% of patients treated for their first psychotic episode are reported to have substance/medication-induced psychotic disorder. If you or a loved one are experiencing symptoms of substance/medication-induced psychotic disorder, know that there are many treatment options and resources available to support you. SymptomsSymptoms of substance/medication-induced psychotic disorder include experiencing delusions, hallucinations, or both. Individuals experiencing these symptoms may or may not have insight into whether their delusions and/or hallucinations are real. DelusionsDelusions are thoughts and beliefs that are not based in reality. Types of delusions include:
For example, a persecutory delusion may be "my former company is monitoring my every move and is out to get me." An example of an erotomanic delusion may be "Tom Hanks is madly in love with me." HallucinationsIf you have a hallucination, you are experiencing something with one or multiple senses that isn't based in reality. If an individual has substance/medication-induced psychosis and their hallucinations are due to drugs and/or alcohol, this symptom does not count toward their diagnostic criteria. Types of hallucinations include:
For example, with an auditory hallucination, an individual may hear a voice telling them to run away or that they are being followed. With a visual hallucination, an individual may see someone following them who isn't really there. How Long Does It Last?An individual's medical history, when a particular substance was ingested, and how much was ingested can all impact how long symptoms of substance/medication-induced psychosis may persist. While symptoms may decrease and stop shortly after a substance has been eliminated from the body, other substances may cause symptoms that last for weeks.
DiagnosisFor the diagnosis of substance/medication-induced psychotic disorder to be made, symptoms must have a significant impact on your quality of life. While it can be difficult to differentiate substance/medication-induced psychotic disorder from schizophrenia spectrum and other psychotic disorders, there are some key factors to note. With substance/medication-induced psychosis:
Onset During IntoxicationSymptoms of substance/medication-induced psychotic disorder can begin almost immediately after ingesting certain substances. When diagnosing an individual, the treating physician or mental health professional will determine if the symptoms began while the substance was still present in the individual's system. Such a case is known as an onset during intoxication. Onset During WithdrawalSymptoms of substance/medication-induced psychotic disorder can also occur during withdrawal. Your treating clinician will monitor how long your symptoms persist to ensure that other mental health disorders don't need to be ruled out. If symptoms last longer than a month and the substance has cleared your body, they may collect more information to see if another mental health disorder, such as substance-induced mood disorder, better fits your symptom experience. CausesThere is a high incidence of having a co-occurring mental health disorder alongside a diagnosis of substance use disorder. While substances alone do not directly cause substance/medication-induced psychotic disorder, someone who is at a greater risk for psychosis can be triggered by certain substances. In a longitudinal study of individuals who presented with substance-induced psychotic disorder due to cannabis, opiates, stimulants, or multiple drugs, risk factors included:
These individuals weren't only at risk for substance-induced psychotic disorder, but were also more prone to developing schizophrenia within the next few years. Psychoactive SubstancesA wide variety of psychoactive substances can trigger substance-induced psychotic disorder including:
MedicationsMedications that may trigger substance/medication-induced psychotic disorder include:
TreatmentTreatment for substance/medication-induced psychotic disorder will vary depending on the specific patient and their unique needs. In many cases, stopping the triggering substance and closely monitoring the patient in a safe environment may be enough. However, different substances, such as alcohol, may require more intensive treatment. While it's critical to remove the substance from the individual's system (acute), it's equally important to treat any underlying mental health conditions (long-term). In some cases, combining acute and long-term care may prevent the individual from experiencing substance/medication-induced psychosis in the future. MedicationMedications may be used to help reduce symptoms of substance/medication-induced psychosis and stabilize the individual's mood. Medications that may be used include:
PsychotherapyLong-term, it's important to treat any underlying mental health conditions to reduce the chances of experiencing substance/medication-induced psychosis again. Treatment options may include:
Alcohol-Induced Psychotic Disorder ConsiderationsWithdrawing from alcohol may require more monitoring compared to other substances and medications. In serious cases, which can be fatal, the individual may experience delirium tremens (DTs), symptoms of alcohol-induced psychosis, and bodily function failure. Treatment options and care may include:
Once withdrawal is complete and the patient is stabilized, beginning inpatient or outpatient treatment can be incredibly helpful. Support groups may also be beneficial in addition to psychotherapy. CopingIf you or a loved one are experiencing symptoms of substance/medication-induced psychosis, it's important to prioritize self-care. In addition to seeking professional care, you may also:
A Word From VerywellAlthough it can feel incredibly frightening to experience symptoms of psychosis, keep in mind that they may be directly related to a substance or medication, which can be addressed. Be sure to contact a medical professional if you or a loved one are experiencing any symptoms of psychosis so you can receive appropriate care. What is the difference between psychosis and drugPsychosis is a mental health problem which temporarily causes someone to interpret the world differently from those around them. Drug-induced psychosis happens when you experience episodes of psychosis, such as delusions or hallucinations, as a direct result of substance abuse.
What is substanceA substance-induced psychotic disorder is a mental health condition in which the onset of your psychotic episodes or psychotic disorder symptoms can be traced to starting or stopping using alcohol or a drug (onset during intoxication or onset during withdrawal).
What is the major difference between psychotic and nonpsychotic disorders?Psychotic disorders, such as schizophrenia and bipolar disorder, can cause delusions, hallucinations, and other symptoms of psychosis. Non-psychotic disorders, which used to be called neuroses, include depressive disorders and anxiety disorders like phobias, panic attacks, and obsessive-compulsive disorder (OCD).
What is the difference between substance intoxication and substanceTo be considered substance-induced psychosis, the hallucinations and delusions should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient may also be intoxicated or withdrawing.
|