Psychiatric Side Effects of Medications and Substances

Primer

Medications and recreational substances can sometimes induce psychiatric syndromes, including depression, anxiety, mania/hypomania, sleep, and cognitive impairment. Thus, it is important to ensure that these iatrogenic effects are not mistaken for a “primary” psychiatric disorder.

Offending Agents

  • Individuals may experience changes in mood, cognition, memory, or behaviour during glucocorticoid treatment or withdrawal.[1]
    • Severe neuropsychiatric sequelae including suicide, suicide attempts, psychosis, mania, depression, panic disorder, delirium, confusion, and disorientation have also been reported.[2]

Cognition

The diagnosis for a Substance/Medication-Induced Major or Mild Neurocognitive Disorder is as follows:

Criterion A

The criteria are met for major or mild neurocognitive disorder.

Criterion B

The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal.

Criterion C

The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment.

Criterion D

The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).

Criterion E

The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder

Specifiers

Substance Specifier

  • Alcohol (major neurocognitive disorder), nonamnestic-confabulatory type
  • Alcohol (major neurocognitive disorder), amnestic-confabulatory type
  • Alcohol (mild neurocognitive disorder)
  • Inhalant (major neurocognitive disorder)
  • Inhalant (mild neurocognitive disorder)
  • Sedative, hypnotic, or anxiolytic (major neurocognitive disorder)
  • Sedative, hypnotic, or anxiolytic (mild neurocognitive disorder)
  • Other (or unknown) substance (major neurocognitive disorder)
  • Other (or unknown) substance (mild neurocognitive disorder)

Other Specifier

Specify if:

  • Persistent: neurocognitive impairment continues to be significant after an extended period of abstinence.

Depression

Mania/Hypomania

Anxiety

Sleep

Sexual Dysfunction

References

1) Judd, L. L., Schettler, P. J., Brown, E. S., Wolkowitz, O. M., Sternberg, E. M., Bender, B. G., ... & Joëls, M. (2014). Adverse consequences of glucocorticoid medication: psychological, cognitive, and behavioral effects. American Journal of Psychiatry, 171(10), 1045-1051.
2) Judd, L. L., Schettler, P. J., Brown, E. S., Wolkowitz, O. M., Sternberg, E. M., Bender, B. G., ... & Joëls, M. (2014). Adverse consequences of glucocorticoid medication: psychological, cognitive, and behavioral effects. American Journal of Psychiatry, 171(10), 1045-1051.