Drug-induced psychotic disorders
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Substance-induced psychosis (commonly known as toxic psychosis or drug-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 Orientation is a function of the mind involving awareness of three dimensions: time, Location (geography), place and person. Problems with orientation lead to ''dis''orientation, and can be due to various conditions, from delirium to Substance int ...
, 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.


Substance use and schizophrenia

Rates of drug use amongst people with schizophrenia are higher than the general population; 50% of those diagnosed with schizophrenia use substances over their life. There is a model that this arises because those with schizophrenia
self-medicate Self-medication is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions: for example headaches or fatigue. The substances most widely used in s ...
with psychoactive drugs.


Transition to schizophrenia

A 2019 systematic review and meta-analysis found that the of people diagnosed with substance-induced psychosis went on to be diagnosed with schizophrenia, compared with for brief, atypical and not otherwise specified psychoses. The substance present was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (), hallucinogen () 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. Substances whose use or withdrawal are implicated in psychosis include the following:


International Classification of Diseases

Psychoactive substance-induced psychotic disorders outlined within the
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
codes F10.5—F19.5: * F10.5
alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...
: 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 excessive alcohol use 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. * F13.5 sedatives/hypnotics (
barbiturate Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as we ...
s;
benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...
s): It is also important to this topic to understand the
paradoxical effects A paradoxical reaction (or paradoxical effect) is an effect of a chemical substance, such as a medical drug, that is opposite to what would usually be expected. An example of a paradoxical reaction is pain caused by a pain relief medication. Parado ...
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:
amphetamine Amphetamine (contracted from alpha- methylphenethylamine) is a strong central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. It is also commonly used ...
s;Diaz, Jaime. How Drugs Influence Behavior. Englewood Cliffs: Prentice Hall, 1996.
methamphetamine Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder and obesity. Methamph ...
; methylphenidate. See also
stimulant psychosis Stimulant psychosis is a mental disorder characterized by psychotic symptoms (such as hallucinations, paranoid ideation, delusions, disorganized thinking, grossly disorganized behaviour) which involves and typically occurs following an overdose or ...
. * F16.5 hallucinogens ( LSD and others) * F18.5 volatile solvents ( volatile inhalants); ** Toluene, found in glue, paint, thinner, etc. See also
toluene toxicity Toluene toxicity refers to the harmful effects caused by toluene on the body. Metabolism in humans While a significant amount of toluene, 25%–40%, is exhaled unchanged via the lungs, a greater proportion is metabolised and excreted via other pat ...
. **
Butane Butane () or ''n''-butane is an alkane with the formula C4H10. Butane is a gas at room temperature and atmospheric pressure. Butane is a highly flammable, colorless, easily liquefied gas that quickly vaporizes at room temperature. The name but ...
** Gasoline (petrol) 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 taken in excess for long periods of time, may induce psychosis.


Medication

* Fluoroquinolone drugs, fluoroquinolone use has been linked to serious cases of toxic psychosis, see adverse effects of fluoroquinolones The related quinoline derivative
mefloquine Mefloquine, sold under the brand name Lariam among others, is a medication used to prevent or treat malaria. When used for prevention it is typically started before potential exposure and continued for several weeks after potential exposure. It ...
(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 Phenylpropanolamine (PPA) is a sympathomimetic agent which is used as a decongestant and appetite suppressant. It was commonly used in prescription and over-the-counter cough and cold preparations. In veterinary medicine, it is used to contro ...
, or PPA) *prescription drugs: ** Prednisone and other corticosteroids ** Isotretinoin **Anticholinergic drugs ***
atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given i ...
***
scopolamine Scopolamine, also known as hyoscine, or Devil's Breath, is a natural or synthetically produced tropane alkaloid and anticholinergic drug that is formally used as a medication for treating motion sickness and postoperative nausea and vomiting ...
** antidepressants ** L-dopa ** antiepileptics * antipsychotics, in an idiosyncratic or paradoxical reaction * antimalarials ** mepacrine


Other drugs illicit in America

Other drugs illegal in America (not listed above), including: * MDMA (ecstasy) * Phencyclidine (PCP) * Ketamine *Synthetic research chemicals used recreationally, including: * JWH-018 and some other
synthetic cannabinoids Synthetic cannabinoids are a class of designer drug molecules that bind to the same receptors to which cannabinoids (THC, CBD and many others) in cannabis plants attach. These novel psychoactive substances should not be confused with synthetic ...
, 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 and have been found to cause psychosis in some people. *
Mephedrone Mephedrone, also known as , , and , is a synthetic stimulant drug of the amphetamine and cathinone classes. Slang names include drone, , White Magic, meow meow, bubble, ''txomin'' and yurrpt. It is chemically similar to the cathinone compounds ...
and related amphetamine-like drugs sold as " bath salts" or "plant food".Bath Salt Addiction
''www.addictions.com'', Accessed 06-25-2011


Plants

Plants: * Hawaiian baby woodrose (contains ergine) * Morning glory seeds (contains ergine) *
Jimson weed ''Datura stramonium'', known by the common names thorn apple, jimsonweed (jimson weed), devil's snare, or devil's trumpet, is a poisonous flowering plant of the nightshade family Solanaceae. It is a species belonging to the '' Datura'' genus ...
(Datura, angel's trumpet, thorn apple) * Belladonna (deadly nightshade) *
Salvia divinorum ''Salvia divinorum'' (Latin: "sage of the diviners"; also called ska maría pastora, seer's sage, yerba de la pastora, magic mint or simply salvia) is a plant species with transient psychoactive properties when its leaves are consumed by che ...


Nonmedicinal substances

Substances chiefly nonmedicinal as to source: * Carbon monoxide (), carbon dioxide (†), carbon disulfide (†); *
heavy metals upright=1.2, Crystals of osmium, a heavy metal nearly twice as dense as lead">lead.html" ;"title="osmium, a heavy metal nearly twice as dense as lead">osmium, a heavy metal nearly twice as dense as lead Heavy metals are generally defined as ...
; *
organophosphate In organic chemistry, organophosphates (also known as phosphate esters, or OPEs) are a class of organophosphorus compounds with the general structure , a central phosphate molecule with alkyl or aromatic substituents. They can be considered a ...
insecticide Insecticides are substances used to kill insects. They include ovicides and larvicides used against insect eggs and larvae, respectively. Insecticides are used in agriculture, medicine, industry and by consumers. Insecticides are claimed to b ...
s (†); *
sarin Sarin (NATO designation GB G-series, "B"">Nerve_agent#G-series.html" ;"title="hort for Nerve agent#G-series">G-series, "B" is an extremely toxic synthetic organophosphorus compound.nerve gases Nerve agents, sometimes also called nerve gases, are a class of organic chemistry, organic chemicals that disrupt the mechanisms by which nerves transfer messages to organs. The disruption is caused by the blocking of acetylcholinesterase (ACh ...
; * tetraethyllead (†); * aniline (†); * acetone and other
ketone In organic chemistry, a ketone is a functional group with the structure R–C(=O)–R', where R and R' can be a variety of carbon-containing substituents. Ketones contain a carbonyl group –C(=O)– (which contains a carbon-oxygen double bo ...
s (†); * antifreeze – a mixture of ethylene glycol and other glycols (†); * arsenic and its compounds (†).


References


External links

{{Psychoactive substance use Psychosis Substance-related disorders