Substance-induced psychosis

Substance-induced psychosis
Specialty	Psychiatry, narcology, addiction psychiatry

Substance-induced psychosis is a form of substance-related disorder where psychosis can be attributed to substance use.

Various psychoactive substances (both legal and illegal) have been implicated in causing, exacerbating, and/or precipitating psychotic states and/or disorders in users. This is also true of several medications that are not traditionally considered psychoactive drugs.

Substances

Psychotic states may occur after ingesting a variety of substances both legal and illegal and both prescription and non-prescription. Usually such states are temporary and not irreversible, with fluoroquinolone-induced psychosis being a notable exception. Drugs whose use, abuse or withdrawal are implicated include the following:

ICD-10

• F10.5 alcohol: Alcohol is a common risk of causing 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.

• F12.5 cannabinoid: Some studies indicate that cannabis, especially certain strains containing large proportions of THC and low proportions of CBD, may lower the threshold for psychosis, and thus help to trigger full-blown psychosis in some people. Early studies have been criticized for failing to consider other drugs (such as LSD) that the participants may have used before or during the study, as well as other factors such as pre-existing ("comorbid") mental illness. However, more recent studies with better controls have still found an increase in risk for psychosis in cannabis users, albeit a more modest one. It is still not clear whether this is a causal link, and it is possible that cannabis use only increases the chance of psychosis in people already predisposed to it; or that people with developing psychosis use cannabis to provide temporary relief of their mental discomfort. Cannabis use has increased dramatically over past few decades but declined in the last decade, whereas the rate of psychosis has not increased. This suggests that a direct causal link is unlikely for all users.

• F13.5 sedatives/hypnotics (barbiturates; benzodiazepines): It is also important to this topic to understand the paradoxical effects of some sedative drugs. Serious complications can occur in conjunction with the use of sedatives creating the opposite effect as to that intended. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis. However, psychosis is more commonly related to the benzodiazepine withdrawal syndrome.

• F14.5 cocaine

• F15.5 other stimulants: amphetamines; methamphetamine; methylphenidate. See also stimulant psychosis.

• F16.5 hallucinogens (LSD and others)

The code F11.5 is reserved for opioid-induced psychosis, and F17.5 is reserved for tobacco-induced psychosis, but neither substance is traditionally 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.

Other

• Fluoroquinolone drugs, fluoroquinolone use has been linked to serious cases of toxic psychosis that have been reported to be irreversible and permanent, see Fluoroquinolone toxicity The related quinoline derivative mefloquine (Lariam) has also been associated with psychosis.
• some over-the-counter drugs, including:
  • Dextromethorphan (DXM) at high doses.
  • Certain antihistamines at high doses.
  • Cold Medications (i.e. containing Phenylpropanolamine, or PPA)

• prescription drugs:
  • Prednisone and other corticosteroids
  • Isotretinoin
  • Anticholinergic drugs
    • atropine
    • scopolamine
  • antidepressants
  • L-dopa
  • antiepileptics

• Other illegal drugs (not listed above), including:
  • MDMA (ecstasy)
  • Phencyclidine (PCP)
  • Ketamine

• Synthetic research chemicals used recreationally, including:
  • JWH-018 and some other synthetic cannabinoids, or mixtures containing them (e.g. "Spice", "Kronic", "MNG" or "Mr. Nice Guy", "Relaxinol", etc.). Various "JWH-XXX" compounds in "Spice" or "Incense" have also been found.
  • Mephedrone and related amphetamine-like drugs sold as "bath salts" or "plant food".

• Plants
  • Hawaiian baby woodrose (contains ergine)
  • Morning glory seeds (contains ergine)
  • Jimson weed (Datura, angel's trumpet, thorn apple)
  • Belladonna (deadly nightshade)
  • Salvia divinorum

• Volatile solvents and gases (inhalants)
  • Toluene, found in glue, paint, thinner, etc. See also toluene toxicity.
  • Butane
  • Gasoline (petrol),