Substance/Medication-Induced Psychotic Disorder

Substance/medication-induced psychotic disorder is a psychotic disorder diagnosed after an individual uses a substance (e.g. - a drug of abuse, a medication, or a toxin exposure) that leads to prominent symptoms of psychosis.

Presence of 1 or both of the following symptoms:

1. Delusions
2. Hallucinations

There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
2. The involved substance/medication is capable of producing the symptoms in Criterion A

The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:

• The symptoms preceded the onset of the substance/medication use; or
• The symptoms persist for a substantial period of time (e.g. - about 1 month) after the cessation of acute withdrawal or severe intoxication; or
• There is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g. - a history of recurrent non-substance/medication-related episodes)

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• A variety of medications can cause medication-induced psychosis, including:
  • Steroids
  • Interferon therapy
  • Mefloquine^[1]
  • Diphenhydramine^[2]

Common substances include alcohol, amphetamines, cannabis, cocaine, hallucinogens, opioids, phencyclidine (PCP), and sedative/hypnotics.

In individuals diagnosed with a substance-induced psychosis (SIP), predictors of conversion to schizophrenia include male sex, early age at first diagnosis, additional SIP diagnoses, initial hospitalization, longer hospitalizations, and most importantly, a family history of non-affective psychosis. This suggests that familial vulnerability for psychosis greatly increases the risk for later schizophrenia.^[3]

• Paparelli, A., Di Forti, M., Morrison, P. D., & Murray, R. M. (2011). Drug-induced psychosis: how to avoid star gazing in schizophrenia research by looking at more obvious sources of light. Frontiers in Behavioral Neuroscience, 5, 1.