Substance/Medication-Induced Psychotic Disorder

Definition

When prescription medications, recreational drugs, or excessive alcohol provoke psychotic symptoms, the condition is diagnosed as Substance/Medication-Induced Psychotic Disorder. Anyone with an established mental health problem, or who is prone to psychosis, is at a higher risk of developing a psychotic disorder from over-intoxication, abuse of or withdrawal from a legal or illegal substance. About 7 to 25 percent of patients experiencing initial psychosis are Substance/Medication-Induced Psychotic Disorder related.

Symptoms

As with any other psychotic conditions, the primary symptoms of Substance/Medication-Induced Psychotic Disorder are hallucinations and delusions that are more severe than what may be considered routine symptoms of intoxication or withdrawal. Signs of psychosis include unusual and suspicious beliefs, or delusions of persecution that are unlikely to be true, such as "people are out to get me" or "people are spying on me." Hallucinations involve hearing or seeing things that aren't actually there. These symptoms are often accompanied by insomnia, aggressive behavior, agitation, mood swings ranging from euphoria to deep fear, and suicidal thoughts. Symptoms of Substance/Medication-Induced Psychotic Disorder are generally acute, lasting only until the substance or medication is cleared from the body. In some cases, however, depending on the type of substance or medication involved, psychotic symptoms may continue for up to several weeks. 

Causes

Substance/Medication-Induced Psychotic Disorder can occur with the use of, or during withdrawal from, alcohol, recreational drugs, and even prescription medications such as opioids and sedatives/hypnotics. Other substances that can trigger a psychotic event include cocaine, amphetamines, phencyclidine (PCP) and alcohol. Psychosis that results from the use of amphetamines, PCP or cocaine may last for several weeks. More than half of methamphetamine users have experienced short- or long-term psychosis. Studies have found that chronic use of cannabis (marijuana or hashish) can also induce psychotic disorders in some people.

Treatments

Substance/Medication-Induced Psychosis incidents are often seen in hospital emergency rooms and mental health crisis intervention centers. Since patients with mental health disorders can also have medication overuse or substance abuse problems, the physician must first determine if psychotic symptoms are due to a condition, such as schizophrenia or bipolar disorder, or to the substance itself. Antipsychotic or antianxiety medication such as benzodiazepine is often administered to reduce symptoms, especially in the case of psychosis due to amphetamines or other dopamine-stimulating drugs. Depending on the type of substance that triggered the psychotic event, treatment may simply consist of monitoring the patient in a calm, quiet environment. The outcome is generally worse for those with psychotic mental health disorders who also experience substance-induced psychosis.

References

Schulz SC. Merck Manual website. Substance/Medication Induced Psychotic Disorder.  Last reviewed July 2016. Accessed June 1, 2016.

Hides L, Dawe S, McKetin R, et al. Primary and substance-induced psychotic disorders in methamphetamine users. Psychiatry Research. 30 March 2015;226(1):91-96.

Bloomfield MAP, Morgan CJA, Egerton A, et al. Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biological Psychiatry. 15 March 2014;75(6):470-478.

Last reviewed 10/05/2017