Substance/Medication-Induced Psychotic Disorder

When alcohol, drugs or medications affect your perceptions

Model poses as a man with substance/medication-induced psychotic disorder
Substance/medication-induced psychotic disorder can be confusing and distressing. Claudia Burlotti / Getty Images

Substance/Medication-Induced Psychotic Disorder is the diagnostic name for alcohol or drug-induced psychosis. Psychosis is a serious mental condition that involves the person's losing contact with reality, to a greater or lesser extent, and is most often associated with certain mental illnesses like schizophrenia. While there are similarities between the symptoms of substance-induced psychosis and psychosis associated with mental illness, they are different conditions, with different causes and treatments.

Symptoms 

Substance or medication-induced psychotic disorder has two major symptoms, delusions and hallucinations. People with substance-induced psychosis might have delusions, hallucinations, or both. People with substance-induced hallucinations and delusions may or may not have insight into whether they are real.

Other symptoms that may be involved in substance-induced psychosis but are not required for the diagnosis are abnormal psychomotor behavior and negative symptoms. Negative symptoms involve the absence of a normal psychological experience, such as experiencing the normal range of emotions. Instead, the person will be emotionally flat and lack in emotional expression.

When physicians or psychologists give a diagnosis of substance/medication-induced psychotic disorder, they check to make sure that the psychosis wasn't there before the use of alcohol, drugs or medications thought to be responsible.

This is because there are different types of psychotic disorders, and if the symptoms were there before the substance use, it isn't usually the substance/medication-induced type of psychosis. Sometimes a person with a past history of a primary psychotic disorder can still be diagnosed with substance-induced psychosis if the psychotic symptoms are better accounted for by the substance use.

However, if the psychotic symptoms persist for a substantial period of time, say, a month or more, after the person stops using the intoxicating drug or medication, or they have a prior history of the recurrent psychotic disorder, the diagnosis will probably not be a substance-induced psychotic disorder.

How Soon After Taking the Drug Can Psychosis be Induced?

In some cases, almost immediately. There is even a category "with onset during intoxication," which means that the psychotic episode actually begins when the individual is high on the drug. It can also occur during withdrawal.

The substance-induced psychotic disorder is different from the disturbances of consciousness that occur during an episode of delirium, which can also be substance or medication-induced.

Finally, for the diagnosis of Substance/Medication-Induced Psychotic Disorder to be given, there has to be some sort of significant impact that the psychotic symptoms are having on the person's life, either by causing a great deal of distress, or by impairing some aspect of their life, such as their social life, their employment situation, or another part of their life that is important to them.

Drugs That Cause Substance/Medication-Induced Psychotic Disorder

A wide variety of psychoactive substances can cause substance-induced psychotic disorder, including:

  • Alcohol-induced psychotic disorder
  • Cannabis-induced psychotic disorder
  • Phencyclidine-induced psychotic disorder
  • Other hallucinogen-induced psychotic disorder
  • Inhalant-induced psychotic disorder
  • Sedative-induced psychotic disorder
  • Hypnotic-induced psychotic disorder
  • Anxiolytic-induced psychotic disorder
  • Amphetamine-induced psychotic disorder
  • Other stimulant-induced psychotic disorder
  • Cocaine-induced psychotic disorder
  • Other substance-induced psychotic disorder
  • Unknown substance-induced psychotic disorder

Medications known to cause substance-induced psychotic disorder include:

  • Anesthetic-induced psychotic disorder
  • Analgesic-induced psychotic disorder
  • Anticholinergic-induced psychotic disorder
  • Anticonvulsant-induced psychotic disorder
  • Antihistamine-induced psychotic disorder
  • Antihypertensive-induced psychotic disorder
  • Cardiovascular medication-induced psychotic disorder
  • Antimicrobial medication-induced psychotic disorder
  • Antiparkinsonian medication-induced psychotic disorder
  • Chemotherapeutic agent-induced psychotic disorder
  • Corticosteroid-induced psychotic disorder
  • Gastrointestinal medication-induced psychotic disorder
  • Muscle relaxant-induced psychotic disorder
  • Nonsteroidal anti-inflammatory medication-induced psychotic disorder
  • Over-the-counter medication-induced psychotic disorder, including OTC medications such as phenylephrine and pseudoephedrine
  • Antidepressant medication-induced psychotic disorder
  • Disulfiram-induced psychotic disorder

Toxins that have been reported to induce psychotic disorders include anticholinesterase, organophosphate insecticides, sarin and other nerve gases, carbon monoxide, carbon monoxide, carbon dioxide and volatile substances such as fuel or paint.

Source

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.

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