Substance-induced psychotic disorder
Substance-induced psychotic disorder is basically psychosis brought on by the abuse of drugs and alcohol. It usually features hallucinations or delusions that are judged to be due to the direct effects of a substance.
Substance-induced psychotic disorder: Causes
Many drugs of abuse can cause substance-induced psychotic disorder. These include alcohol, amphetamines, marijuana, cocaine, hallucinogens, inhalants, opioids and sedative hypnotics like benzodiazepines and barbiturates. Many prescription medications and over the counter medications can cause it too. These include anesthetics, analgesics, anticholinergic agents, anticonvulsants, antihistamines, cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, and anti-depressants.
Not all cases of substance-induced psychotic disorder occur as a result of substance abuse. Sometimes people (especially small children) ingest toxic substances by accident. Other times, people are exposed to toxins and don’t even know it (such as when someone gets food poisoning at a restaurant). Alternatively, people may take too much of a legitimately prescribed medication, medicines may interact in unforeseen ways, or doctors may miscalculate the effects of medicines they prescribed.
Substance-induced psychotic disorder: Criteria
For a person to be diagnosed with substance-induced psychotic disorder, they have to exhibit certain criteria. The first criterion is that the psychotic disorder features prominent hallucinations, delusions, disorganized speech or behavior, or catatonia. Secondly, the psychotic symptoms must be due to the direct effect of a substance. This can be a drug of abuse or a toxin. Hallucinations that the person realizes are brought on by the substance are not included, because these are diagnosed as substance intoxication or withdrawal. The third criterion is that the disturbance is not better accounted for by a different psychotic disorder. The fourth criterion is that the symptoms do not only occur during the course of a delirium. Only when the symptoms exceed normal intoxication or withdrawal is the individual deemed to have substance-abuse psychotic disorder.
Substance-induced psychotic disorder: Difficulty
Sometimes it is very difficult to diagnose substance-induced psychotic disorder. If a person has a psychotic episode while under the influence of drugs or alcohol, it can be difficult to determine if the symptoms go above and beyond the normal signs of intoxication. Similarly, when a person is withdrawal, they may suffer psychotic symptoms that are due to the withdrawal process and aren’t substance-induced psychotic disorder.
Further complicating the matter is that many drugs exacerbate or trigger an underlying mental condition. It can be difficult to determine whether the symptoms of psychosis are due to substance-induced psychotic disorder or whether the drugs and alcohol just set off a mental disorder that was already present.
The strongest predictors of substance-induced psychotic disorder are a family history of psychosis, trauma history and current cannabis dependence. These traits can sometimes help doctors differentiate between primary psychosis and substance-induced psychotic disorder.
Substance-induced psychotic disorder: Treatment
Treatment involves relieving the intoxicated condition under medical observation to control withdrawal symptoms. Sometimes treatment means medical management of a continuing withdrawal process. If these treatments are not successful, then usually the diagnoses changes to primary psychosis.