Substance/Medication-Induced Psychotic Disorder

Substance/medication-induced psychotic disorder is also known as alcohol-induced psychosis, drug-induced psychosis and toxic psychosis. The condition occurs when an individual experiences hallucinations or delusions within a month of using or withdrawing from prescribed drugs, illegal drugs, or alcohol.

In the Diagnostic and Statistical Manual (DSM-5), it is estimated that 7 to 25% of patients treated for their first psychotic episode have substance/medication-induced psychotic disorder.

There are many treatment options and resources available to you or a loved one experiencing symptoms of substance/medication-induced psychotic disorder.

Symptoms

Delusions, hallucinations or both can be a symptom of substance/medication-induced psychosis. The people who experience these symptoms might or might not be able to determine whether their hallucinations and/or delusions are real.

Delusions

Delusions are false beliefs and thoughts. There are several types of delusions:

  • Persecutory: A feeling that someone, including an organization, is out to snag you or is spying on you.
  • Grandiose: Belief that you are better than others, you are exceptional, special, and gifted.
  • Referential: You believe that signals from individuals and the environment communicate with you through hidden meanings.
  • Erotomanic: Belief that you are in love with someone or multiple people despite contrary evidence to the contrary.
  • Nihilistic: Imagining that something terrible is going to happen.
  • Somatic: The belief that you have a medical problem.

As an example of a persecutory delusion, “my former company is monitoring my every step and is out to destroy me.” As an example of an erotomanic delusion, “Tom Hanks loves me madly.”

Hallucinations

Hallucinations occur when you experience something that is not based on reality through one or more of your senses.

Hallucinations caused by drugs and/or alcohol do not count as a diagnostic symptom for substance/medication-induced psychosis.

There are several types of hallucinations, including:

  • Auditory: A sound or voice that doesn’t really exist.
  • Visual: It’s hard to tell what is real and what isn’t.
  • Olfactory: Being able to smell scents that only you can smell.
  • Tactile: You feel touched even though you do not have anyone or anything on you.
  • Gustatory: Trying something when you don’t have anything in your mouth.

For instance, when an individual experiences an auditory hallucination, they may hear a voice telling them to run or that they are being followed. When someone has a visual hallucination, they may see someone following them who really isn’t there.

Do you know how long it lasts?

Various factors, including the individual’s medical history, when a particular substance was consumed, and how much they consumed, can affect how long they may experience substance/medication-induced psychosis symptoms.

Other substances may produce symptoms that last for weeks after they are eliminated from the body, or the symptoms may decrease and stop shortly after removal.

It may take up to a week for individuals taking certain pain medications to recover from the effects of substances and medications that cause psychosis.

It is possible for people taking amphetamines, such as methamphetamine, to experience symptoms for weeks at a time. The use of amphetamine is also linked to schizophrenia in some patients (more persistent symptoms of psychosis.

A study of those who were diagnosed with substance-induced psychosis later developed schizophrenia, which was reported to affect 46% of those with cannabis or stimulant use disorder. Patients who suffer from the cannabis-use disorder have an increased risk of developing long-term symptoms. About half of the other individuals in the study only experienced symptoms for a brief period.

Diagnosis

An individual must experience symptoms that significantly impact their quality of life in order to be diagnosed with substance or medication-induced psychotic disorder.

Even though it is sometimes difficult to distinguish substance/medication-induced psychosis from schizophrenia spectrum disorder and other psychotic disorders, there are some key factors to remember.

With substance/medication-induced psychosis:

  • Symptoms usually appear after one month of addiction or withdrawal from drugs, alcohol, or both.
  • No psychotic symptoms are noted before using or withdrawing from drugs.
  • Symptoms usually last less than a month.
  • Withdrawal usually reduces symptoms.
  • Most individuals who suffer from schizophrenia spectrum or other psychotic disorders do not experience disorganized speech or behavior, or diminished emotion.

Onset during intoxication

When certain substances are ingested, symptoms of substance/medication-induced psychotic disorder can appear almost immediately.

An individual’s symptoms are diagnosed by determining if they began while the substance was still in the individual’s body. When the onset occurs during intoxication, it is called a case of onset during intoxication.

Onset During Withdrawal

The withdrawal symptoms of substance/medication-induced psychosis can also occur.

It is important to ensure that additional mental health disorders have not been ruled out by monitoring how long your symptoms persist.

You may be asked for more information if symptoms last longer than a month and you have cleared your body of the substance. Substance-induced mood disorders, such as chemical dependency, may be more appropriate based on your symptoms.

Causes

In many cases, substance use disorder is a co-occurrence with mental health disorders. While substances do not directly cause substance- or medication-induced psychosis, certain substances can trigger psychosis in people who are at a greater risk for it.

One longitudinal study found that people with substance-induced psychotic disorders from marijuana, opiates, stimulants, or multiple drugs presented with the following risk factors:

  • Being male
  • 30 years of age or younger
  • Being mentally ill

Consistently having substance-induced psychoses, these individuals were at an increased risk of schizophrenia in the future.

Psychoactive Substances

There are a wide variety of psychoactive substances that can trigger substance-induced psychosis, including:

  • Alcohol
  • Cannabis
  • Phencyclidine (PCP)
  • Hallucinogens
  • Inhalants
  • Sedatives
  • Hypnotics
  • Amphetamines
  • Stimulants

Medications

Several medications can trigger substance/medication-induced psychosis:

  • Analgesics
  • Anticholinergics
  • Antiepileptics
  • Antidepressants
  • Antiparkinsonian medication
  • Steroids
  • Muscle relaxants
  • Disulfiram

Treatment

The type and severity of treatment for substance/medication-induced psychosis will vary based on the specific patient. Most patients can be treated by stopping the trigger substance and closely monitoring them in a safe environment. Treatment may be more intensive for different substances, such as alcohol.

Taking the substance out of the patient’s system (acutely) is important, but it’s equally significant to address any mental health conditions underlying the substance use (long-term). Individuals can be prevented from experiencing a future substance/medication-induced psychosis by combining long-term and acute care.

Medication

It is possible to use medications to reduce the symptoms of substance/medication-induced psychosis and stabilize the individual’s mood. Some possible medications are:

  • Benzodiazepines
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Antipsychotics

Psychotherapy

The longer you wait until you receive treatment for any underlying mental health conditions, the greater the possibility of experiencing another drug/medication-induced psychosis.

The following treatments may be considered:

  • Cognitive-behavioral therapy (CBT)
  • Drug and alcohol rehab inpatient programs
  • Outpatient treatment for drug and/or alcohol abuse
  • Eye movement desensitization and reprocessing (EMDR)
  • Dialectical behavior therapy (DBT)
  • Group therapy

Alcohol-Induced Psychotic Disorder Considerations

It may be necessary to monitor alcohol withdrawal more closely than other substances and medications. A person with delirium tremens (DTs), symptoms of alcohol-induced psychosis, and bodily function failure may suffer a serious case of alcohol-induced psychosis, which can be fatal.

You may be able to receive treatment from:

  • Testing and monitoring while you are in the hospital
  • Testing for liver disease, replenishing electrolytes and stabilizing vitals
  • If necessary, antipsychotics or benzodiazepines can be used to calm the patient
  • Monitoring and evaluation of suicide

Inpatient or outpatient treatment can be extremely helpful after withdrawal is complete and the patient has been stabilized. Psychotherapy may be ineffective without a support group.

Coping

Ideally, prioritize self-care if you or someone you love is experiencing symptoms of psychosis that have been brought on by drugs or medication.

You can also seek professional help:

  • Reduce stress by practicing mindfulness
  • Ground yourself through breathing exercises
  • Take time to decompress and watch out for caregiver fatigue
  • Share your feelings with trusted family and friends
  • Research substances or medications that can cause psychosis

Conclusion

Psychosis symptoms can feel terrifying, but if they are related to a substance or medication, they can be addressed. If you or a loved one are feeling any of these symptoms, you must seek medical attention immediately.

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