Substance-induced psychosis is a form of psychosis that is attributed to substance use. It is a psychosis that results from the effects of chemicals or drugs, including those produced by the body itself. Various psychoactive substances have been implicated in causing or worsening psychosis in users.
Signs and symptoms
Psychosis manifests as disorientation, visual hallucinations and/or haptic hallucinations. It is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the capacity to deal with life demands. While there are many types of psychosis, substance-induced psychosis can be pinpointed to specific chemicals.
A 2019 systematic review and meta-analysis by Murrie et al found that the pooled proportion of transition from substance-induced psychosis to schizophrenia was 25%, compared with 36% for brief, atypical and not otherwise specified psychoses. Type of substance was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis, hallucinogens and amphetamines. Lower rates were reported for opioid, alcohol and sedative induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up.
Substances
Psychotic states may occur after using a variety of legal and illegal substances. Usually such states are temporary and reversible, with fluoroquinolone-induced psychosis being a notable exception. Drugs whose use, abuse, or withdrawal are implicated in psychosis include the following:
F10.5 alcohol: Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions. Research has shown that alcohol abuse causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women. While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent. Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia.
F11.5 opioid: Studies show stronger opioids such as Fentanyl are more likely to cause psychosis and hallucinations
F12.5 cannabinoid: Some studies indicate that cannabis may trigger full-blown psychosis. Recent studies have found an increase in risk for psychosis in cannabis users.
*Toluene, found in glue, paint, thinner, etc. See also toluene toxicity.
*Butane
*Gasoline
F17.5 is reserved for tobacco-induced psychosis, but is traditionally not associated with the induction of psychosis. The code F15.5 also includes caffeine-induced psychosis, despite not being specifically listed in the DSM-IV. However, there is evidence that caffeine, in extreme acute doses or when severely abused for long periods of time, may induce psychosis.
Medication
Fluoroquinolone drugs, fluoroquinolone use has been linked to serious cases of toxic psychosis that have been reported to be irreversible and permanent, see adverse effects of fluoroquinolones The related quinoline derivative mefloquine has also been associated with psychosis.
JWH-018 and some other synthetic cannabinoids, or mixtures containing them. Various "JWH-XXX" compounds in "Spice" or "Incense" have also been found and have been found to cause psychosis in some people.
Mephedrone and related amphetamine-like drugs sold as "bath salts" or "plant food".
