Substance-or-Medication-Induced Psychotic Disorder

Psychosis induced by illegal substances is a common, and psychosis may develop after intoxication, withdrawal, or exposure to the substance. Prescription medications can also cause psychosis, but this is less common. Because illegal substance use is more common among people with psychiatric disorders, like schizophrenia and bipolar disorder, it can be difficult to determine whether the symptoms are secondary to the substance or the psychiatric disorder. People with schizophrenia are more than twice as likely to have a substance use disorder compared to the general population.

Many with substance or medication-induced psychotic disorder eventually go on to develop schizophrenia.

Etiology

Many substances can precipitate Substance-/Medication-Induced Psychotic Disorder:

• Recreational substances
  • Alcohol
  • Amphetamines
  • Cannabis
  • Cocaine
  • Hallucinogens
  • Opioids
  • Anabolic steroids
• Prescription medications
  • Sedative/hypnotics (benzodiazepines and the like)
  • Anticholinergics
  • Corticosteroids

Clinical features

Symptoms may be brief, resolving shortly after the substance is eliminated from the body, but in case of psychosis triggered by amphetamines or cocaine, psychosis may persist for many weeks.The symptoms typically resolve with abstinence, but recovery may be incomplete.

Diagnosis and evaluation

The diagnosis is clinical and is made when psychotic symptoms occur in a person having been exposed to a substance known to cause psychosis. The symptoms must not have been present before the first exposure, and they must not persist for a substantial period of time after the last exposure (>1 month).

Management

Treatment is as for psychosis in general, but includes working to ensure abstinence.