SUBSTANCE-INDUCED PSYCHOTIC DISORDER

A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and other or unknown substances. Psychotic symptoms can also result from withdrawal from alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances. Some medications that may induce psychotic symptoms include anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, antidepressant medications, neurleptic medications, antipsychotics, and disulfiram . Toxins that may induce psychotic symptoms include anticholinesterase, organophosphate insecticides, nerve gases, heavy metals, carbon monoxide, carbon dioxide, and volatile substances (such as fuel or paint). Before assigning the diagnosis of Bipolar Disorder or Schizophrenia due diligence should be asserted in the clinical evaluation of psychotic and manic symptoms to address Psychosis Due to General Medical Conditions, and Substance Induced Psychosis (DSM-IV Codes 293.81 & 292.11). Improvements in the diagnostic accuracy and treatment of psychosis is cost-effective for both the mental health consumer and society. Advocacy for mental illness must include the consideration of underlying etiological factors of psychiatric symptoms. A large number of toxic or psychoactive substances can cause psychotic reactions. Such substance-induced psychosis can occur in multiple ways. First, people may inadvertently ingest toxic substances by accident, either because they don't know any better (as is the case when a child eats lead paint chips, or mercury in tuna fish), or by mistake (such as when someone eats a poison mushroom they thought was safe, or gets food poisoning from mishandled food). Alternatively, people may take too much of a legitimately prescribed medicine, medicines may interact in unforeseen ways, or doctors may miscalculate the effects of medicines they prescribe.

Finally, people may overdose on recreational drugs they commonly use (such as cocaine), or become dependent on drugs or alcohol and experience psychotic symptoms while in withdrawal from those substances. While the substance induced psychosis is triggered and then sustained by intoxication or withdrawal, its effects can continue long after intoxication or withdrawal has ended. Drugs of abuse that can cause psychosis include alcohol, amphetamines, marijuana, cocaine, hallucinogens, inhalants, opioids, and sedative-hypnotics, including medicines that are sometimes used to treat anxiety. A number of drugs have been associated with the development of schizophrenia, including cannabis, cocaine, and amphetamines. About half of those with schizophrenia use drugs and/or alcohol excessively. The role of cannabis could be causal, but other drugs may be used only as coping mechanisms to deal with depression, anxiety, boredom, and loneliness. Cannabis is associated with a dose-dependent increase in the risk of developing a psychotic disorder with frequent use being correlated with twice the risk of psychosis and schizophrenia. While cannabis use is accepted as a contributory cause of schizophrenia by many, it remains controversial. Amphetamine, cocaine, and to a lesser extent alcohol, can result in psychosis that presents very similarly to schizophrenia. Although not generally believed to be a cause of the illness, people with schizophrenia use nicotine at much greater rates than the general population. Common over-the-counter and doctor-prescribed medications that can cause psychosis include anesthetics (knock-out drugs), analgesics (pain-relievers), anticholinergic agents, anticonvulsants, antihistamines, cardiovascular (heart) medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids (steroids), gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications (NSAIDS like ibuprophin), and anti-depressants. Environmental toxins reported to induce psychotic symptoms include anticholinesterase, organophosphate insecticides, nerve gases, carbon monoxide (car exhaust), carbon dioxide, and volatile substances such as fuel or paint.

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