Substance-induced psychosis (commonly known astoxic psychosis ordrug-induced psychosis) is a form ofpsychosis that is attributed tosubstance 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 worseningpsychosis in users.[1]
Psychosis manifests asdisorientation,visual hallucinations and/orhaptic 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 ordelusions 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]
Because substance-induced psychosis results from the consumption of a substance or combination of substances, treatment practices heavily rely ondetoxification and discontinuation of the substance(s).[1] Detox andaddiction 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]
Rates of drug use amongst people withschizophrenia 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 schizophreniaself-medicate with psychoactive drugs.[6]: 500
A 2019 systematic review and meta-analysis found that25% (18–38%) of people diagnosed with substance-induced psychosis went on to be diagnosed withschizophrenia, compared with36% (30–43%) forbrief, 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 withcannabis (34% (25–46%)),hallucinogens (26% (14–43%)) andamphetamines (22% (14–34%)). Lower rates were reported foropioid– (12% (8–18%)),alcohol– (9% (6–15%)) andsedative– (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]
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:
Psychoactive substance-induced psychotic disorders outlined within theICD-10 codes F10.5—F19.5:
F10.5alcohol:[8][9][10] Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions.[8] Research has shown thatexcessive alcohol use causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women.[11][12] While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent.[8] Alcoholic psychosis is sometimes misdiagnosed as another mental illness such asschizophrenia.[13]
F11.5opioid: Studies show stronger opioids such asfentanyl are more likely to cause psychosis and hallucinations[14]
F12.5cannabinoid: Some studies indicate thatcannabis may trigger full-blown psychosis.[15] Recent[when?] studies have found an increase in risk for psychosis in cannabis users.[16]
F17.5 is reserved for tobacco-induced psychosis, but is traditionally not associated with the induction of psychosis.
The code F15.5 also includescaffeine-induced psychosis, despite not being specifically listed in theDSM-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]
JWH-018 and some othersynthetic cannabinoids, or mixtures containing them (e.g. "Spice", "Kronic", "MNG" or "Mr. Nice Guy", "Relaxinol", etc.).[66] Various "JWH-..." compounds in "Spice" or "Incense" have also been found and have been found to cause psychosis in some people.[67][68][69]
^Pitts, Ferris N; Allen, Robert E; Aniline, Orm; Burgoyne, Rodney W (August 1982). "The Dilemma of the Toxic Psychosis: Differential Diagnosis and the PCP Psychosis".Psychiatric Annals.12 (8):762–8.doi:10.3928/0048-5713-19820801-07.OCLC5584879101.
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^White MC, Silverman JJ, Harbison JW (February 1982). "Psychosis associated with clonazepam therapy for blepharospasm".The Journal of Nervous and Mental Disease.170 (2):117–9.doi:10.1097/00005053-198202000-00010.PMID7057171.
^Hallberg RJ, Lessler K, Kane FJ (August 1964). "Korsakoff-Like Psychosis Associated With Benzodiazepine Overdosage".The American Journal of Psychiatry.121 (2):188–9.doi:10.1176/ajp.121.2.188.PMID14194223.
^Brady, K. T.; R. B. Lydiard; R. Malcolm; J. C. Ballenger (December 1991). "Cocaine-induced psychosis".Journal of Clinical Psychiatry.52 (12):509–512.PMID1752853.
^Wada K, Nakayama K, Koishikawa H, Katayama M, Hirai S, Yabana T, et al. (2005)."揮発性溶剤誘発性精神病の症候学的構造 「溶剤性精神病」は識別可能な症候群か?" [Symptomatological structure of volatile solvent-induced psychosis: is "solvent psychosis" a discernible syndrome?].日本アルコール・薬物医学会雑誌 = [Japanese Journal of Alcohol Studies & Drug Dependence] (in Japanese).40 (5):471–484.PMID16316074.
^Jung IK, Lee HJ, Cho BH (December 2004). "Persistent psychotic disorder in an adolescent with a past history of butane gas dependence".European Psychiatry.19 (8):519–20.doi:10.1016/j.eurpsy.2004.09.010.PMID15589716.S2CID46068168.
^Hernandez-Avila, Carlos A.; Hector A. Ortega-Soto; Antonio Jasso; Cecilia A. Hasfura-Buenaga; Henry R. Kranzler (1998). "Treatment of Inhalant-Induced Psychotic Disorder With Carbamazepine Versus Haloperidol".Psychiatric Services.49 (6):812–815.doi:10.1176/ps.49.6.812.PMID9634163.
^Cerimele JM, Stern AP, Jutras-Aswad D (March 2010). "Psychosis following excessive ingestion of energy drinks in a patient with schizophrenia".The American Journal of Psychiatry.167 (3): 353.doi:10.1176/appi.ajp.2009.09101456.PMID20194494.
^Christie MJ, Wong K, Ting RH, Tam PY, Sikaneta TG (May 2005). "Generalized seizure and toxic epidermal necrolysis following levofloxacin exposure".Ann Pharmacother.39 (5):953–5.doi:10.1345/aph.1E587.PMID15827068.S2CID8470095.
^Marsepoil T, Petithory J, Faucher JM, Ho P, Viriot E, Benaiche F (1993). "[Encephalopathy and memory disorders during treatments with mefloquine]".Rev Méd Interne (in French).14 (8):788–91.doi:10.1016/S0248-8663(05)81426-2.PMID8191092.
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^Müller H, et al. (2010). "The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes".Schizophr. Res.118 (1–3):309–10.doi:10.1016/j.schres.2009.12.001.PMID20056392.S2CID205066297.
