Substance-induced psychosis

Substance-induced psychosis (commonly known as toxic psychosis or drug-induced psychosis) is a form of psychosis that is attributed to substance use. It is a psychosis that results from the effects of chemicals or drugs, including those produced by the body itself. Various psychoactive substances have been implicated in causing or worsening psychosis in users.

Substance-induced psychosis
Other namesSubstance-induced psychotic disorder, drug-induced psychosis, substance/medication-induced psychotic disorder, toxic psychosis
SpecialtyPsychiatry, addiction psychiatry

Signs and symptoms

Psychosis manifests as disorientation, visual hallucinations and/or haptic hallucinations.[1] 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 demands.[2] While there are many types of psychosis, substance-induced psychosis can be pinpointed to specific chemicals.

Substance use and schizophrenia

Rates of drug use amongst people with schizophrenia are higher than the general population; 50% of those diagnosed with schizophrenia use substances over their life.[3]:495,496 There is a model that this arises because those with schizophrenia self-medicate with psychoactive drugs.[3]:500

Transition to schizophrenia

A 2019 systematic review and meta-analysis found that the 25% (1838%) of people diagnosed with substance-induced psychosis went on to be diagnosed with schizophrenia, compared with 36% (3043%) for brief, atypical and not otherwise specified psychoses.[4] The substance present was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (34% (2546%)), hallucinogen (26% (1443%)) and amphetamines (22% (1434%)). Lower rates were reported for opioid-(12% (818%)), alcohol- (9% (615%)) and sedative- (10% (715%)) 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.[4]

Class of substance Number of studies Rates of transition to schizophrenia
Estimate Lower bound Upper bound
Brief, atypical and NOS 34 36% 30% 43%
Combined - 25% 18% 38%
Cannabis 6 34% 25% 46%
Hallucinogens 3 26% 14% 43%
Amphetamines 5 22% 14% 34%
Opioid 3 12% 8% 18%
Sedative 3 10% 7% 15%
Alcohol 5 9% 6% 15%

Substances

Psychotic states may occur after using a variety of legal and illegal substances. Substances whose use or withdrawal are implicated in psychosis include the following:

International Classification of Diseases

Psychoactive substance-induced psychotic disorders outlined within the ICD-10 codes F10.5—F19.5:

F17.5 is reserved for tobacco-induced psychosis, but is traditionally not associated with the induction of psychosis.

The code F15.5 also includes caffeine-induced psychosis, despite not being specifically listed in the DSM-IV. However, there is evidence that caffeine, in extreme acute doses or when taken in excess for long periods of time, may induce psychosis.[31][32]

Medication

Other drugs illicit in America

Other drugs illegal in America (not listed above), including:

Plants

Plants:

  • Hawaiian baby woodrose (contains ergine)
  • Morning glory seeds (contains ergine)
  • Jimson weed[66] (Datura, angel's trumpet, thorn apple)
  • Belladonna (deadly nightshade)
  • Salvia divinorum[67]

Nonmedicinal substances

Substances chiefly nonmedicinal as to source:

References

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