Substance/Medication-Induced Psychotic Disorder

Signs and symptoms of substance/medication-induced psychotic disorders can vary based on individual susceptibility and specific substance or medication consumption. While the characteristics of a psychotic episode can also vary, some common signs of psychosis may include: 

• Hallucinations² involving the perception of non-existent sights, sounds, scents, sensations, or tastes 
• Delusions,³ which are strongly held false beliefs 
• Religious delusions, such as those of divine communication
• Challenges in distinguishing fantasy from reality, such as imagined communication from public figures or celebrities
• Struggling to practice self-care like nourishment and hygiene
• Paranoia involving unwarranted suspicions of harm from loved ones, institutions, or others
• Clear communication difficulties like disordered thinking and speech
• Heightened sensitivity to external stimuli such as lights, sounds, smells, etc.
• A flat affect or lack of emotional expressions

Substance/medication-specific symptoms may present in the form of: 

• Symptoms that emerge shortly after starting or stopping a particular substance or medication
• Increased severity of symptoms with higher doses or prolonged use
• Symptoms that improve with substance cessation or medication adjustment

Note that substance-induced psychotic disorder is a serious condition that often requires immediate medical intervention. If you or a loved one are experiencing symptoms of substance/medication-induced psychotic disorder, it is recommended to seek emergency care.

Substance/medication-induced psychotic disorder commonly emerges due to the misuse of substances, including alcohol, amphetamines, cannabis, cocaine, hallucinogens, opioids, phencyclidine (PCP), and sedatives/hypnotics. However, symptoms may occur as an unintended result of certain medications. 

Several additional risk factors can heighten the susceptibility to developing this condition, including:

• Traumatic brain injury or stroke
• Family or personal background of substance use disorders, schizophrenia,⁴ mood disorders, or psychotic disorders
• Adverse effects stemming from specific prescription medications
• Presence of dementia, such as Alzheimer's disease
• Existence of brain tumors, lesions, or cysts
• Genetic abnormalities

Educating yourself and your loved ones on the causes and risk factors of substance/medication-induced psychotic disorder can be highly beneficial in avoiding substances and knowing when to seek treatment.

While the primary goal of treating substance/medication-induced psychotic disorder is often to alleviate active symptoms of psychosis, it can be relevant to note that individuals with prodromal or early-stage schizophrenia may use substances that can induce psychosis. For this reason, it may be helpful to examine the possibility of prior mental health symptoms before concluding that psychosis is due solely to substance use.

Medication

In cases of substance or medication-induced psychosis (sometimes called drug-induced psychosis), a healthcare professional will often review, modify, or discontinue medications or substances that are implicated in causing the psychotic symptoms. 

In addition, medication is often used to treat psychosis and the anxiety/agitation associated with it, including but not limited to the following options: 

• Antipsychotics: For psychosis, an antipsychotic medication may be prescribed.
• Anxiolytics: For agitation and acute anxiety, anti-anxiety medications like benzodiazepines are sometimes used short-term. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatments

In cases of severe psychosis, medically supervised detoxification may be required to manage episodes safely. Detoxification might constitute emergency treatment or inpatient services. In some cases, individuals experiencing severe psychosis may benefit from short- or long-term care in an inpatient facility or group home. 

Self-care

It can be crucial to care for oneself at home in addition to treatment protocols. Below are a few self-care strategies to consider: 

• Lifestyle changes: Adopting a healthy lifestyle, including regular exercise, balanced nutrition, and sufficient sleep, may positively impact overall cognitive health.
• Mindfulness and meditation: Practicing mindfulness and meditation techniques can aid in managing stress and regulating emotions.
• Social support: Engaging with a network of family, friends, and specialized support groups can provide encouragement and understanding during challenging times.

By closely monitoring mental health and substance use, along with seeking emergency treatment when necessary, individuals experiencing substance/medication-induced psychotic disorder may achieve full recovery.

In cases of substance/medication-induced psychosis, therapy may play a crucial role in helping individuals understand the connections between substance use and symptoms. Several online therapy platforms, such as BetterHelp, offer comfortable and convenient therapy options, allowing clients to receive specialized treatment from the comfort of their homes.

Additional resources to review may include the following: 

• Substance Abuse and Mental Health Services Administration (SAMHSA)
• American Addiction Centers (AAC)
• Mental Health America (MHA)
• National Alliance on Mental Illness (NAMI)

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Due to a complex interplay between substance use and mental health symptoms, making the distinction between substance/medication-induced psychosis symptoms vs. symptoms of a separate mental illness can be difficult for medical professionals. For this reason, research focused on the link between episodes of substance/medication-induced psychosis and the development of a primary mental illness with psychosis symptoms is being actively explored.

A recent study suggests that individuals experiencing substance/medication-induced psychosis are more likely to develop disorders like schizophrenia or other primary psychotic illnesses. This study examined data collected over 20 years and found about 32% of people who had substance-induced psychosis later developed schizophrenia or bipolar disorder. While many of these individuals were previously diagnosed with schizophrenia, about 50% of those who were later diagnosed with schizophrenia or bipolar disorder were diagnosed within 3 to 4.5 years after the episode of substance-induced psychosis.

Below are several key statistics on psychosis, in general, as well as substance/medication-induced psychotic disorder: 

• About three in every 100 people will experience at least one psychotic episode in their lifetimes.
• Episodes of substance-induced psychosis are common in emergency departments and crisis centers.
• The prevalence of substance use disorders in individuals with schizophrenia is significantly higher than in the general population.
• In a study that analyzed recovery outcomes of individuals who’ve experienced first-episode psychosis, positive results were reported in approximately 42.2% of cases.