drug psychosis

Drug-induced Psychosis: A Complex Condition

Drug-induced psychosis, also known as substance-induced psychotic disorder, is a type of psychotic episode that occurs due to the use of an intoxicant or withdrawal from it. This condition can manifest in various ways, depending on the substance used and individual factors.

Symptoms of Drug-Induced Psychosis

The symptoms of drug-induced psychosis can be severe and include:

• Paranoia
• Delusions
• Auditory and visual hallucinations
• Olfactory (smell) hallucinations
• Anti-social behavior

These symptoms can appear while the individual is intoxicated or during withdrawal from the substance. In some cases, they may persist even after stopping substance use.

Causes of Drug-Induced Psychosis

The occurrence of drug-induced psychosis seems to be related to several pathogenetic mechanisms, including:

• Higher levels of central dopamine, especially for hallucinogens or psychedelic substances
• A cannabinoid CB1-receptor agonist, in particular for cannabis-related substances
• 5HT2A-receptor agonist for hallucinogenic plants and latest phenethylamines

Substances Associated with Drug-Induced Psychosis

Episodes of substance-induced psychosis are common in emergency departments and crisis centers. The following substances have been linked to this condition:

• Alcohol
• Amphetamines
• Cannabis (marijuana)
• Hallucinogens
• Opioids
• Phencyclidine (PCP)
• Sedative/hypnotics

Diagnosis of Drug-Induced Psychosis

Drug-induced psychosis is diagnosed by the presence of delusions and/or hallucinations that have been a result of substance use. A thorough medical evaluation, including a review of the individual's substance use history, is essential for accurate diagnosis.

Recovery from Drug-Induced Psychosis

In many cases, symptoms of drug-induced psychosis disappear when substance use stops and withdrawal ends. However, in some instances, symptoms may persist after stopping substance use. Treatment options, such as counseling and medication, can help manage the condition and promote recovery.

References:

• [1] Substance-induced psychotic disorder is a type of psychosis created by use of alcohol or other drugs.
• [2-3] Symptoms of drug-induced psychosis include paranoia, delusions, auditory and visual hallucinations, olfactory (smell) hallucinations, and anti-social behavior.
• [4-5] The occurrence of drug-induced psychosis seems to be related to several pathogenetic mechanisms, including higher levels of central dopamine, a cannabinoid CB1-receptor agonist, and 5HT2A-receptor agonist.
• [6-7] Episodes of substance-induced psychosis are common in emergency departments and crisis centers, and the following substances have been linked to this condition: alcohol, amphetamines, cannabis (marijuana), hallucinogens, opioids, phencyclidine (PCP), and sedative/hypnotics.
• [8-9] Drug-induced psychosis is diagnosed by the presence of delusions and/or hallucinations that have been a result of substance use.

Common Signs and Symptoms of Drug Psychosis

Drug-induced psychosis, also known as substance-induced psychotic disorder, can manifest in various ways depending on the substance involved. The following are some common signs and symptoms:

• Delusions: False beliefs that may involve thinking someone is out to get them when that's not true [11].
• Hallucinations: Seeing, hearing, or feeling things that aren't there [11]. Hallucinations can be violent in nature.
• Paranoia: Feeling like you're being pursued or watched.
• Incoherent or nonsense speech: Difficulty speaking clearly and coherently.
• Disconnection from reality: A disconnection from the world around you, which can manifest as a lack of interest in daily activities or a feeling of detachment.

These symptoms can be grouped into three categories:

1. Thoughts:
   • Delusions: thinking you have special powers or being paranoid that someone is following you.
   • Hallucinations: sensory experiences that aren't based in reality.
2. Emotional Symptoms:
   • Paranoia
   • Anxiety
3. Behavioral Symptoms:
   • Incoherent or nonsense speech
   • Disconnection from reality

It's essential to note that these symptoms can vary depending on the substance involved and the individual's underlying mental health conditions.

References:

[11] Signs and Symptoms of Drug-Induced Psychosis. The signs and symptoms of psychosis typically involve: 5 Delusions, which are false beliefs. This may entail thinking that someone is out to get them when that is, in fact, not true. Hallucinations, which may include seeing, hearing, or feeling things that aren’t there. Incoherent or nonsense speech. [14] Symptoms of Drug-Induced Psychosis. Drug-induced psychosis symptoms can be grouped into 3 categories: 1. Thoughts Someone experiencing psychosis might have delusions like thinking they have special powers, or being paranoid that someone is following them. Hallucinations—sensory experiences that aren’t based in reality—are also very common.

Diagnostic Tests for Drug Psychosis

Drug-induced psychosis, also known as substance-induced psychosis (SIP), can be challenging to diagnose due to its similarities with primary psychotic disorders. However, several diagnostic tests and evaluations can help distinguish SIP from other conditions.

• Physical Examination: A thorough physical examination is essential to rule out underlying medical conditions that may be causing the psychosis. This includes assessing vital signs, checking for any signs of substance use or withdrawal, and performing a complete neurological examination [13].
• Laboratory Work-up: A laboratory work-up is necessary to identify any underlying medical conditions that may be contributing to the psychosis. This may include blood tests, urine tests, and imaging studies such as CT or MRI scans [3].
• Psychiatric Evaluation: A comprehensive psychiatric evaluation is crucial to assess the individual's mental health history, including any previous episodes of psychosis, substance use disorders, or other mental health conditions [13].
• Substance Use History: Assessing the individual's substance use history, including the type and amount of substances used, can help determine if SIP is a contributing factor to the psychosis [15].
• Collateral Information: Gathering collateral information from family members, friends, or healthcare providers can provide valuable insights into the individual's mental health history and any potential substance use issues [15].

Key Differentiators

When diagnosing SIP, it's essential to consider the following key differentiators:

• Substance timing: The timing of substance use in relation to the onset of psychosis is crucial. If the psychosis occurs shortly after substance use, it may indicate SIP [15].
• Symptom type and duration: The type and duration of symptoms can also help distinguish SIP from primary psychotic disorders. For example, if the individual experiences a sudden onset of hallucinations or delusions following substance use, it may suggest SIP [15].

References

[13] - Patients with psychosis secondary to drug use or medical causes often present with altered vital signs, visual hallucinations, and severe cognitive impairment, including confusion or disorientation. The assessment of psychosis includes a physical examination, a complete psychiatric and medical history, and a laboratory work-up.

[3] - Jun 30, 2022 — Drug-induced schizophrenia is not related to schizophrenia. In fact, the correct term is drug-induced psychosis, and it occurs when drug use leads to psychotic symptoms.

[15] - Substance-induced psychosis (SIP) presents diagnostic challenges in distinguishing it from primary psychotic disorders, with substance timing, symptom type, and duration being key differentiators.

The differential diagnosis of drug-induced psychosis involves identifying other potential causes of psychotic symptoms, aside from substance use. According to various sources [4, 7, 9, 10], the following conditions should be considered:

• Mood disorders: Major depression and bipolar disorder with psychotic features can present with similar symptoms to drug-induced psychosis.
• Schizophrenia spectrum disorders: Unspecified schizophrenia spectrum and other psychotic disorders may also exhibit psychotic symptoms.
• Medical causes: Illicit drug use is a common medical cause of acute psychosis, but other medical conditions such as infections, neurological disorders, or metabolic imbalances can also lead to psychotic symptoms [1, 14].
• Substance-induced psychotic disorder: This condition is characterized by the development of psychotic symptoms due to substance use, and it should be distinguished from primary psychotic disorders.
• Other psychiatric conditions: Psychosis may also be a manifestation of other psychiatric conditions, such as severe affective disorders or anxiety disorders.

To determine the cause of psychosis, a comprehensive evaluation is necessary, including:

• A physical exam
• A complete psychiatric and medical history
• Laboratory work-up to rule out underlying medical causes

It's essential to consider these differential diagnoses when evaluating patients with psychotic symptoms, as they can have significant implications for treatment and management [3, 6].