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   Encyclopedia of Mental Disorders   
   Mental Disorders  Py-Z  Substance-induced psychotic disorder   
   Substance-induced psychotic disorder   
       
       
   Substance Induced Psychotic Disorder 816   
   Photo by: Mark Winder   
   Definition   
   Prominent psychotic symptoms (i.e., hallucinations and/or delusions )   
   determined to be caused by the effects of a psychoactive substance is the   
   primary feature of a substance-induced psychotic disorder. A substance may   
   induce psychotic symptoms during    
   intoxication (while the individual is under the influence of the drug) or   
   during withdrawal (after an individual stops using the drug).   
      
   Description   
      
       
   A substance-induced psychotic disorder is subtyped or categorized based on   
   whether the prominent feature is delusions or hallucinations. Delusions are   
   fixed, false beliefs. Hallucinations are seeing, hearing, feeling, tasting, or   
   smelling things that are    
   not there. In addition, the disorder is subtyped based on whether it began   
   during intoxication on a substance or during withdrawal from a substance. A   
   substance-induced psychotic disorder that begins during substance use can last   
   as long as the drug is    
   used. A substance-induced psychotic disorder that begins during withdrawal may   
   first manifest up to four weeks after an individual stops using the substance.   
      
   Causes and symptoms   
   Causes   
      
   A substance-induced psychotic disorder, by definition, is directly caused by   
   the effects of drugs including alcohol, medications, and toxins. Psychotic   
   symptoms can result from intoxication on alcohol, amphetamines (and related   
   substances), cannabis (   
   marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP)   
   and related substances, sedatives, hypnotics, anxiolytics, and other or   
   unknown substances. Psychotic symptoms can also result from withdrawal from   
   alcohol, sedatives, hypnotics,    
   anxiolytics, and other or unknown substances.   
      
   Some medications that may induce psychotic symptoms include anesthetics and   
   analgesics, anticholinergic agents, anticonvulsants, antihistamines,   
   antihypertensive and cardiovascular medications, antimicrobial medications,   
   antiparkinsonian medications,    
   chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle   
   relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter   
   medications, antidepressant medications, and disulfiram . Toxins that may   
   induce psychotic    
   symptoms include anticholinesterase, organophosphate insecticides, nerve   
   gases, carbon monoxide, carbon dioxide, and volatile substances (such as fuel   
   or paint).   
      
   The speed of onset of psychotic symptoms varies depending on the type of   
   substance. For example, using a lot of cocaine can produce psychotic symptoms   
   within minutes. On the other hand, psychotic symptoms may result from alcohol   
   use only after days or    
   weeks of intensive use.   
      
   The type of psychotic symptoms also tends to vary according to the type of   
   substance. For instance, auditory hallucinations (specifically, hearing   
   voices), visual hallucinations, and tactile hallucinations are most common in   
   an alcohol-induced psychotic    
   disorder, whereas persecutory delusions and tactile hallucinations (especially   
   formication) are commonly seen in a cocaine- or amphetamine-induced psychotic   
   disorder.   
      
   Symptoms   
      
   The Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR ) notes   
   that a diagnosis is made only when the psychotic symptoms are above and beyond   
   what would be expected during intoxication or withdrawal and when the   
   psychotic symptoms are    
   severe. Following are criteria necessary for diagnosis of a substance-induced   
   psychotic disorder as listed in the DSMIV-TR :   
      
   Presence of prominent hallucinations or delusions.   
   Hallucinations and/or delusions develop during, or within one month of,   
   intoxication or withdrawal from a substance or medication known to cause   
   psychotic symptoms.   
   Psychotic symptoms are not actually part of another psychotic disorder (such   
   as schizophrenia , schizophreniform disorder , schizoaffective disorder ) that   
   is not substance induced. For instance, if the psychotic symptoms began prior   
   to substance or    
   medication use, then another psychotic disorder is likely.   
   Psychotic symptoms do not only occur during delirium .   
   Demographics   
   Little is known regarding the demographics of substance-induced psychosis .   
   However, it is clear that substance-induced psychotic disorders occur more   
   commonly in individuals who abuse alcohol or other drugs.   
      
   Diagnosis   
   Diagnosis of a substance-induced psychotic disorder must be differentiated   
   from a psychotic disorder due to a general medical condition. Some medical   
   conditions (such as temporal lobe epilepsy or Huntington's chorea) can produce   
   psychotic symptoms, and,    
   since individuals are likely to be taking medications for these conditions, it   
   can be difficult to determine the cause of the psychotic symptoms. If the   
   symptoms are determined to be due to the medical condition, then a diagnosis   
   of a psychotic disorder    
   due to a general medical condition is warranted.   
      
   Substance-induced psychotic disorder also needs to be distinguished from   
   delirium, dementia , primary psychotic disorders, and substance intoxication   
   and withdrawal. While there are no absolute means of determining substance use   
   as a cause, a good    
   patient history that includes careful assessment of onset and course of   
   symptoms, along with that of substance use, is imperative. Often, the   
   patient's testimony is unreliable, necessitating the gathering of information   
   from family, friends, coworkers,    
   employment records, medical records, and the like. Differentiating between   
   substance-induced disorder and a psychiatric disorder may be aided by the   
   following:   
      
   Time of onset: If symptoms began prior to substance use, it is most likely a   
   psychiatric disorder.   
   Substance use patterns: If symptoms persist for three months or longer after   
   substance is discontinued, a psychiatric disorder is probable.   
   Consistency of symptoms: Symptoms more exaggerated than one would expect with   
   a particular substance type and dose most likely amounts to a psychiatric   
   disorder.   
   Family history: A family history of mental illness may indicate a psychiatric   
   disorder.   
   Response to substance abuse treatment: Clients with both psychiatric and   
   substance use disorders often have serious difficulty with traditional   
   substance abuse treatment programs and relapse during or shortly after   
   treatment cessation.   
      
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