What Is Substance/Medication-Induced Psychotic Disorder?

What Is Substance/Medication-Induced Psychotic Disorder?

Substance/medication-induced psychotic disorder, also known as toxic psychosis, alcohol-induced psychosis, and drug-induced psychosis, is the diagnostic name for a specific mental health condition where an individual experiences hallucinations, delusions, or both within a month of using or withdrawing from prescription drugs, illegal drugs, and/or alcohol.

According to the Diagnostic and Statistical Manual (DSM-5), 7% to 25% of patients treated for their first psychotic episode are reported to have substance/medication-induced psychotic disorder.

If you or a loved one are experiencing symptoms of substance/medication-induced psychotic disorder, know that there are many treatment options and resources available to support you.

Symptoms 

Symptoms of substance/medication-induced psychotic disorder include experiencing delusions, hallucinations, or both. Individuals experiencing these symptoms may or may not have insight into whether their delusions and/or hallucinations are real.

Delusions

Delusions are thoughts and beliefs that are not based in reality.

Types of delusions include:

• Persecutory: Thoughts that others, including organizations, are out to get you or are surveilling you
• Grandiose: Belief that you are exceptional, special, gifted, and better than others
• Referential: Belief that individuals and environmental signals have hidden meanings meant to communicate with you
• Erotomanic: Belief that someone or multiple people are in love with you despite contrary evidence
• Nihilistic: Thoughts that a disaster will take place
• Somatic: Belief that something is wrong with your body

For example, a persecutory delusion may be "my former company is monitoring my every move and is out to get me." An example of an erotomanic delusion may be "Tom Hanks is madly in love with me."

Hallucinations

If you have a hallucination, you are experiencing something with one or multiple senses that isn't based in reality.

If an individual has substance/medication-induced psychosis and their hallucinations are due to drugs and/or alcohol, this symptom does not count toward their diagnostic criteria.

Types of hallucinations include:

• Auditory: Hearing voices or sounds that aren't really present
• Visual: Seeing things that aren't really there
• Olfactory: Smelling scents that no one else can
• Tactile: Feeling like you're being touched when no one or nothing is on you
• Gustatory: Tasting something when there's nothing in your mouth

For example, with an auditory hallucination, an individual may hear a voice telling them to run away or that they are being followed. With a visual hallucination, an individual may see someone following them who isn't really there.

How Long Does It Last?

An individual's medical history, when a particular substance was ingested, and how much was ingested can all impact how long symptoms of substance/medication-induced psychosis may persist.

While symptoms may decrease and stop shortly after a substance has been eliminated from the body, other substances may cause symptoms that last for weeks.

• Individuals taking certain pain medications may experience substance/medication-induced psychosis symptoms that may take up to a week to resolve.
• Individuals taking amphetamines, such as methamphetamine, may experience symptoms that persist for weeks. It's important to note that amphetamine use in some patients is also linked to schizophrenia (more persistent symptoms of psychosis).
• In a study of individuals with cannabis or stimulant use disorder, 46% of individuals who were diagnosed with substance-induced psychosis later developed schizophrenia. Those with cannabis-use disorder were more vulnerable to developing long-term symptoms. About half of the other individuals in the study only experienced symptoms for a brief period.

Diagnosis

For the diagnosis of substance/medication-induced psychotic disorder to be made, symptoms must have a significant impact on your quality of life.

While it can be difficult to differentiate substance/medication-induced psychotic disorder from schizophrenia spectrum and other psychotic disorders, there are some key factors to note.

With substance/medication-induced psychosis:

• Symptoms begin within a month of using or withdrawing from drugs, alcohol, or both.
• There are no psychosis-related symptoms noted prior to the substance use or withdrawal.
• Symptoms typically last for under a month.
• Symptoms usually diminish after withdrawal.
• Individuals typically don't experience disorganized speech or behavior, or reduced emotional expression, which are common symptoms in schizophrenia spectrum and other psychotic disorders.

Onset During Intoxication

Symptoms of substance/medication-induced psychotic disorder can begin almost immediately after ingesting certain substances.

When diagnosing an individual, the treating physician or mental health professional will determine if the symptoms began while the substance was still present in the individual's system. Such a case is known as an onset during intoxication.

Onset During Withdrawal

Symptoms of substance/medication-induced psychotic disorder can also occur during withdrawal.

Your treating clinician will monitor how long your symptoms persist to ensure that other mental health disorders don't need to be ruled out.

If symptoms last longer than a month and the substance has cleared your body, they may collect more information to see if another mental health disorder, such as substance-induced mood disorder, better fits your symptom experience.

Causes

There is a high incidence of having a co-occurring mental health disorder alongside a diagnosis of substance use disorder. While substances alone do not directly cause substance/medication-induced psychotic disorder, someone who is at a greater risk for psychosis can be triggered by certain substances.

In a longitudinal study of individuals who presented with substance-induced psychotic disorder due to cannabis, opiates, stimulants, or multiple drugs, risk factors included:

• Being male
• Being 30 years old or younger
• Having an underlying mental health condition

These individuals weren't only at risk for substance-induced psychotic disorder, but were also more prone to developing schizophrenia within the next few years.

Psychoactive Substances

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

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

Medications

Medications that may trigger substance/medication-induced psychotic disorder include:

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

Treatment

Treatment for substance/medication-induced psychotic disorder will vary depending on the specific patient and their unique needs. In many cases, stopping the triggering substance and closely monitoring the patient in a safe environment may be enough. However, different substances, such as alcohol, may require more intensive treatment.

Medication

Medications may be used to help reduce symptoms of substance/medication-induced psychosis and stabilize the individual's mood. Medications that may be used include:

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

Psychotherapy

Long-term, it's important to treat any underlying mental health conditions to reduce the chances of experiencing substance/medication-induced psychosis again.

Treatment options may include:

• Cognitive behavioral therapy (CBT)
• Inpatient rehabilitation for drug and/or alcohol use
• Outpatient rehabilitation for drug and/or alcohol use
• Eye movement desensitization and reprocessing (EMDR)
• Dialectical behavior therapy (DBT)
• Group therapy

Alcohol-Induced Psychotic Disorder Considerations

Withdrawing from alcohol may require more monitoring compared to other substances and medications. In serious cases, which can be fatal, the individual may experience delirium tremens (DTs), symptoms of alcohol-induced psychosis, and bodily function failure.

Treatment options and care may include:

• Tests and monitoring as you withdraw at the hospital
• Stabilizing vitals, replenishing electrolytes and vitamins, and testing for liver disease
• Sedation using antipsychotics or benzodiazepines, if needed
• Suicide evaluation and monitoring

Once withdrawal is complete and the patient is stabilized, beginning inpatient or outpatient treatment can be incredibly helpful. Support groups may also be beneficial in addition to psychotherapy.

Coping

If you or a loved one are experiencing symptoms of substance/medication-induced psychosis, it's important to prioritize self-care.

In addition to seeking professional care, you may also:

• Begin practicing mindfulness to help reduce stress
• Engage in breathing exercises to ground yourself
• Look for signs of caregiver fatigue and take time for yourself to decompress
• Connect with trusted loved ones about what you are experiencing
• Read helpful literature about substance/medication-induced psychosis

A Word From Verywell

Although it can feel incredibly frightening to experience symptoms of psychosis, keep in mind that they may be directly related to a substance or medication, which can be addressed. Be sure to contact a medical professional if you or a loved one are experiencing any symptoms of psychosis so you can receive appropriate care.