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Many recreational and prescription drugs can induce psychotic symptoms that can mimic serious psychiatric disorders.
Drug-induced psychosis has been associated with suicidal thoughts, dangerous and violent behavior, hospitalization, and arrests.
Because treatment modalities can vary, it is important to distinguish whether psychotic symptoms are substance-induced or caused by other factors .
What is Psychosis?
Psychosis is a condition characterized by delusions and hallucinations, and is commonly associated with mental illness.
Delusions occur when a person believes something outside of what is really going on despite any external argument or contradiction to such beliefs.
Hallucinations are perceptions (primarily visual and auditory, but sometimes tactile and scents) of things that aren't actually present.
After long periods of use, some drugs can cause psychotic symptoms which mimic those experienced by individuals with schizophrenia, bipolar disorder, or other mental illnesses involving psychosis [1,2,3].
Examples of Psychotic Symptoms
Auditory: Hearing internal or external voices. Sometimes the voices may be arguing with each other or may tell the person what to do.
Visual: Seeing things that aren't really there. For example: shadows, people, or other perceptual abnormalities.
Tactile: Feeling sensations that aren't really occurring. For example: feeling bugs crawling on the skin.
Olfactory: Smelling an odor around you that cannot be confirmed by others .
Erotomanic: A person with this type of delusion will believe someone (usually a famous person) is in love with him/her. Stalking is not uncommon in these cases.
Grandiose: A person with delusions of grandeur will have an over-inflated sense of self-worth and power. He may believe he has some special type of talent or has made a grand discovery. Jealousy: These delusions usually involve believing that a spouse or significant other has cheated even if there is no evidence this is the case.
Persecution: A person with persecution delusions may believe someone (often an authority figure) is spying on them and planning to do harm.
Somatic: A somatic delusion occurs when a person believes he has a health problem, or some other bodily complaint, when no real symptoms are present .
Other symptoms of psychosismay include:
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Heavy, long-term use of many substances can result in psychotic symptoms. However, certain drugs are more likely to cause psychotic symptoms than others. These include:
The use of methamphetamine can lead to paranoia, persecution delusions, and auditory and visual hallucinations.
One common hallucination is the feeling of bugs crawling on one's skin. These symptoms might subside after stopping use, but they can also persist for weeks or longer, and may increase one's susceptibility for developing future psychosis. Even after long periods of abstinence, psychotic symptoms may return in periods of stress [1,4,5].
Cannabis use has long been associated with psychotic symptoms. The first evidence came from the Swedish Conscripts Study of 45,570 military inductees who were followed-up for 15 years.
The results showed that those who had used cannabis by the age of 17 were 2.4 times more likely to develop schizophrenia than non-users. The risk of schizophrenia rose to 6 times that of non-users for heavy cannabis users (more than 50 times at initial interview) [1,6].
Up to 50% of cocaine users will show some symptoms of psychosis after use. The risk increases with needle or freebased use.
Persecution delusions and tactile hallucinations are common. Psychotic symptoms can persist days, months, and sometimes years after use has stopped .
Amphetamine (Speed) can cause psychotic symptoms similar to methamphetamine and cocaine after repeated use .
Alcohol can cause delusions, mental confusion, disorganized speech, and disorientation. Typically, these symptoms subside upon sobriety.
Alcohol is one of the most commonly abused substances among individuals with schizophrenia, although diagnosis usually precedes use .
Psychedelic drugs (e.g., LSD, PCP, etc)
Psychedelic drugs can induce temporary effects that mimic psychosis. However, these symptoms typically cease when the drug wears off.
For most people, psychotic symptoms will not be present after first use. It is only after repeated use that psychotic symptoms become more prevalent and long-lasting .
Club/recreational drugs (e.g., ecstasy)
Ecstasy can cause psychotic symptoms, antisocial behavior, and panic attacks. Persistent psychosis has been reported after a single use in some people .
Prescription meds (e.g., ketamine)
Ketamine users typically exhibit a variety of symptoms that mimic psychosis including delusions, cognitive impairments, disordered thinking, and incoherent speech .
DSM-V Criteria for Drug/Medication-Induced Psychotic Disorder
Substance-induced psychotic disorder is diagnosed by the presence of delusions and/or hallucinations that are determined to be caused by the use of a psychoactive substance. Most psychotic symptoms unrelated to drugs continue even after complete abstinence from a particular substance.
Symptoms of drug-induced psychosis will typically wear off when use is stopped. However, frequent and prolonged use can result in years of psychotic symptoms, making it difficult to differentiate from other psychiatric disorders such as schizophrenia.
A diagnosis of drug-induced psychosis is only made when psychotic symptoms are severe and go beyond the normal psychological symptoms of drug withdrawal.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), meeting the following criteria is necessary for diagnosis :
The symptoms are not better explained by a psychotic disorder (schizophrenia, bipolar, etc.) that is not medication induced.
Evidence from medical examination, lab results, and patient history that psychotic symptoms developed during substance use, or within one month of withdrawal from a substance known to cause psychotic symptoms.
Presence of delusions and/or hallucination
Psychotic symptoms do not occur only during an episode of delirium.
Symptoms are causing significant distress and/or impairment in one's daily life and ability to function.
Treatment for Drug-Related Psychosis
It is important to determine whether psychotic symptoms are drug-induced or caused by an organic biological factor, trauma, a separate medical condition, or any other variables in order to initiate the proper course of treatment .
First, the patient must stop using the drug.
If symptoms continue, and the patient feels he is a threat to himself or those around him, he should call 911.
Medically assisted detox may be needed for some patients.
Psychiatric hospitalization in an inpatient facility is a common treatment regimen for severe psychotic symptoms.
Antipsychotic medication is often prescribed.
Outpatient treatment may include medication, and individual and group therapy.
Caton, C., Samet, S., & Hasin, D. (September 2000). When Acute-Stage Psychosis and Substance Use Co-Occur: Differentiating Substance-Induced and Primary Psychotic Disorders. Journal of Psychiatric Practice. Retrieved from: http://www.columbia.edu/~dsh2/prism/files/caton.pdf
Teeple, R. The Primary Care Companion to the Journal of Clinical Psychiatry, 2009.
Golberg, J. (May 23, 2014). Mental Health and Delusional Disorder. WedMd.
Grant, K. M., LeVan, T. D., Wells, S. M., Li, M., Stoltenberg, S. F., Gendelman, H. E., ... & Bevins, R. A. (2012). Methamphetamine-associated psychosis. Journal of Neuroimmune Pharmacology, 7(1), 113-139.
Sato, M., Chen, C. C., Akiyama, K., & Otsuki, S. (1983). Acute exacerbation of paranoid psychotic state after long-term abstinence in patients with previous methamphetamine psychosis. Biological psychiatry.
Andreasson S, Allenbeck P, Engstrom A, Rydberg U. Cannabis and schizophrenia: A longitudinal study of Swedish conscripts. Lancet 1987;2:1483-6
American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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