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.

Criterion A

Presence of 1 or both of the following symptoms:

  1. Delusions
  2. Hallucinations
Criterion B

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
Criterion C

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)
Criterion D

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

Criterion E

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]