Summary about Disease
Substance-Induced Psychotic Disorder is characterized by the presence of psychosis (hallucinations, delusions, disorganized thinking) that is directly caused by the physiological effects of a substance, such as drugs of abuse, medications, or toxins. The psychosis is not better explained by a primary psychotic disorder like schizophrenia. The symptoms typically resolve once the substance is removed from the body.
Symptoms
Hallucinations: Experiencing sensory perceptions (seeing, hearing, smelling, feeling, or tasting things) that aren't real. Auditory hallucinations (hearing voices) are common.
Delusions: Holding fixed, false beliefs that are not based in reality and are resistant to rational argument.
Disorganized Thinking (Speech): Difficulty organizing thoughts, which manifests as rambling, incoherent speech or frequent topic changes (tangentiality).
Disorganized or Catatonic Behavior: Unusual behaviors, such as agitation, restlessness, odd movements, or a significant decrease in reactivity to the environment.
Negative Symptoms: (Less commonly seen) May include reduced emotional expression (flat affect), poverty of speech, or lack of motivation.
Causes
The direct physiological effects of a substance cause the psychotic symptoms. Common substances include:
Stimulants (e.g., cocaine, amphetamines, methamphetamine)
Alcohol
Hallucinogens (e.g., LSD, psilocybin)
Cannabis (especially high-potency forms)
Inhalants
Sedatives, hypnotics, or anxiolytics (e.g., benzodiazepines, barbiturates) (withdrawal can cause psychosis)
Anabolic-androgenic steroids
Some prescription medications (e.g., corticosteroids, some antidepressants, antiparkinsonian drugs)
Toxins (e.g., carbon monoxide, nerve gas)
Medicine Used
Antipsychotics: Medications like haloperidol, risperidone, olanzapine, quetiapine, and aripiprazole are used to manage hallucinations, delusions, and disorganized thinking. The choice of antipsychotic depends on the specific symptoms, side effect profile, and individual patient factors.
Benzodiazepines: (Sometimes) May be used short-term to manage agitation or anxiety associated with the psychosis. Careful monitoring is needed due to the potential for dependence.
Supportive Care: Intravenous fluids, nutritional support, and monitoring of vital signs. Management of withdrawal symptoms, if present, may require additional medications.
Is Communicable
No. Substance-induced psychotic disorder is not communicable. It is caused by the direct effect of a substance on the brain.
Precautions
Avoid Substance Use: The most important precaution is to avoid using the substance that triggered the psychosis. This may require substance abuse treatment, including detoxification, therapy, and support groups.
Medication Adherence: If prescribed antipsychotic medications, take them as directed by a healthcare professional.
Mental Health Treatment: Ongoing mental health treatment, including therapy and monitoring by a psychiatrist, is important to prevent relapse and manage any underlying mental health issues.
Support System: Build a strong support system of family, friends, and/or support groups to help maintain sobriety and manage mental health.
Safe Environment: Ensuring a safe environment that reduces access to substances of abuse is crucial.
How long does an outbreak last?
The duration of a substance-induced psychotic episode is typically short-lived. Symptoms usually begin within hours or days of substance use and resolve within days to weeks after the substance is stopped and cleared from the body. However, in some cases, symptoms may persist for a longer period, particularly with chronic or heavy substance use, or if there is an underlying vulnerability to psychosis.
How is it diagnosed?
Diagnosis involves:
Clinical Interview: A thorough psychiatric evaluation to assess symptoms, substance use history, medical history, and family history.
Physical Examination: To rule out medical conditions that could be causing the symptoms.
Urine/Blood Drug Screen: To detect the presence of substances in the body.
Mental Status Examination: To assess cognitive function, thought processes, mood, and behavior.
Differential Diagnosis: Ruling out other psychotic disorders, such as schizophrenia, schizoaffective disorder, and psychotic disorder due to another medical condition. Crucially, the psychosis must be judged to be directly caused by the substance, meaning it started during or soon after substance use or withdrawal, and is not better explained by a pre-existing condition.
DSM-5 Criteria: Using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for substance-induced psychotic disorder.
Timeline of Symptoms
Onset: Symptoms typically begin during or within a short period after substance intoxication or withdrawal.
Peak: Symptoms reach their peak intensity relatively quickly, often within hours to days of onset.
Resolution: Symptoms usually resolve within days to weeks after cessation of substance use. In some cases, particularly with chronic or heavy substance use, symptoms may take longer to resolve. If symptoms persist for more than a month after substance cessation, a primary psychotic disorder should be considered.
Important Considerations
Co-occurring Disorders: Individuals with substance-induced psychotic disorder often have co-occurring substance use disorders and/or other mental health conditions (e.g., depression, anxiety). Addressing these co-occurring disorders is crucial for successful treatment.
Relapse Prevention: Preventing relapse to substance use is essential to prevent future psychotic episodes.
Risk of Harm: Individuals experiencing psychosis may be at increased risk of harm to themselves or others, especially if they are agitated, delusional, or having hallucinations. Careful monitoring and intervention may be necessary.
Medical Complications: Substance use can lead to various medical complications that need to be addressed in addition to the psychotic symptoms.
Long-term Outcomes: With appropriate treatment and ongoing support, individuals with substance-induced psychotic disorder can often achieve recovery and maintain a stable mental state. However, relapse to substance use is a common challenge.