Substance-induced Psychosis
Disease Details
Family Health Simplified
- Description
- Substance-induced psychosis is a mental disorder characterized by temporary hallucinations, delusions, and confusion caused by the use or withdrawal of drugs or alcohol.
- Type
- Substance-induced psychosis is not classified as a genetic disorder and does not involve genetic transmission. It is a type of psychosis that is directly related to the use of substances such as drugs, alcohol, or other toxins.
- 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's demands. While there are many types of psychosis, the cause of substance-induced psychosis can be pinpointed to intake of specific chemicals.
- Prognosis
- Substance-induced psychosis can have a varied prognosis depending on several factors such as the type of substance used, the duration and quantity of use, any underlying mental health conditions, and the individual's overall health. In many cases, if the substance use is identified early and stopped, symptoms can resolve completely. However, prolonged or heavy use can lead to more enduring or even permanent psychiatric symptoms. Immediate treatment and long-term support can significantly improve outcomes.
- Onset
- Substance-induced psychosis typically occurs soon after the substance use, intoxication, or withdrawal. The onset can vary depending on the specific substance involved but generally happens within hours to a few days. This type of psychosis may include hallucinations, delusions, and disorganized thinking. The duration of symptoms can also vary, usually resolving within a few days to weeks once the substance is cleared from the body and the individual has received appropriate treatment.
- Prevalence
- The exact prevalence of substance-induced psychosis can be challenging to determine due to variations in substance use patterns and diagnostic criteria. However, studies suggest that it occurs in a significant minority of individuals who abuse substances. Common substances associated with psychosis include alcohol, stimulants (such as cocaine and methamphetamine), cannabis, and hallucinogens. The rates can vary widely depending on the specific substance and population studied.
- Epidemiology
- Substance-induced psychosis is a form of psychosis that is directly caused by the consumption of psychoactive substances, including alcohol, drugs, and toxins. The prevalence of substance-induced psychosis varies based on the substance used and the population studied. It is most commonly associated with the use of stimulants like amphetamines and cocaine, hallucinogens like LSD and PCP, as well as heavy alcohol use. The incidence is generally higher in populations with substance use disorders. It is challenging to provide an exact epidemiological figure due to the variations in substance use across different regions and demographics.
- Intractability
- Substance-induced psychosis is typically not considered intractable. It often resolves once the substance is eliminated from the body and the individual undergoes appropriate medical treatment and cessation of use. However, the outcome can vary depending on factors like the type and duration of substance use, the presence of any underlying mental health conditions, and the individual's overall health. In some cases, long-term psychiatric care may be necessary if the psychosis leads to residual psychological issues.
- Disease Severity
- Substance-induced psychosis is a severe mental health condition that can arise after the use of certain substances, including drugs and alcohol. It is characterized by symptoms such as hallucinations, delusions, and significant impairment in reality testing. The severity of the condition can vary based on the type of substance involved, the amount consumed, the duration of use, and individual susceptibility. Treatment typically involves stopping the use of the substance, managing symptoms through medications and therapy, and addressing any underlying mental health conditions. If not promptly and effectively treated, substance-induced psychosis can lead to long-term mental health issues and significantly impact one's quality of life.
- Healthcare Professionals
- Disease Ontology ID - DOID:8646
- Pathophysiology
- Substance-induced psychosis occurs when the abuse of drugs or alcohol leads to psychotic symptoms. The pathophysiology involves the acute effects of substances on the brain's neurotransmitter systems, including dopamine, serotonin, and glutamate pathways. These substances can alter normal neurotransmission, leading to disruptions in perception, thoughts, and emotions, manifesting as hallucinations, delusions, or disorganized thinking. Chronic use can damage neural circuits, further exacerbating psychotic symptoms. Individual susceptibility, genetic factors, and the specific substance used also play significant roles in the development of psychosis.
- Carrier Status
- Carrier status is not applicable to substance-induced psychosis, as it is not a genetic or inherited condition. Substance-induced psychosis is caused by the use of drugs or other substances that affect the brain.
- Mechanism
-
Substance-induced psychosis is a condition where the use of or withdrawal from certain substances triggers psychotic symptoms such as hallucinations or delusions.
**Mechanism:**
The primary mechanism involves the direct or indirect impact of substances on the brain's neurotransmitter systems. Key substances that can induce psychosis include alcohol, cannabis, stimulants (like cocaine and methamphetamine), hallucinogens (like LSD), and certain prescription medications.
**Molecular Mechanisms:**
1. **Dopamine Dysregulation:** Many substances, particularly stimulants, increase the release of dopamine or inhibit its reuptake, leading to elevated dopamine levels in the brain. This hyperactivity in dopaminergic pathways, especially in the mesolimbic system, is associated with psychotic symptoms.
2. **Serotonin Alterations:** Hallucinogens such as LSD work primarily by acting on serotonin receptors, particularly the 5-HT2A receptor. This overactivation can cause alterations in perception and cognition, leading to hallucinations and delusions.
3. **Glutamate System:** Substances such as PCP (phencyclidine) and ketamine block NMDA receptors in the glutamate system. This inhibition disrupts normal synaptic plasticity and transmission, contributing to psychotic symptoms.
4. **GABAergic System:** Alcohol and benzodiazepines enhance the activity of GABA, the main inhibitory neurotransmitter. Withdrawal from these substances can lead to a decrease in GABA function, resulting in hyperexcitability and potential psychosis.
5. **Endocannabinoid System:** Cannabis acts on the CB1 receptors in the brain, affecting the release of various neurotransmitters. High doses or chronic use can lead to changes in this system, potentially inducing psychotic symptoms, especially in individuals predisposed to psychosis. - Treatment
-
Substance-induced psychosis typically requires a comprehensive treatment approach, which includes:
1. **Immediate Medical Care**: Hospitalization may be necessary to ensure the safety of the individual and manage acute symptoms.
2. **Detoxification**: Supervised detox to remove the intoxicating substance from the body.
3. **Medications**: Antipsychotic medications may be prescribed to manage psychotic symptoms, and other medications may be used to treat co-occurring withdrawal symptoms or underlying conditions.
4. **Psychotherapy**: Behavioral therapies, such as cognitive-behavioral therapy (CBT), can help individuals understand and manage their substance use and psychotic symptoms.
5. **Support Systems**: Engaging with support groups and counseling can provide emotional support and help maintain sobriety.
6. **Long-term Care**: Continuous monitoring and regular follow-up appointments to prevent relapse and manage any ongoing mental health issues.
Treatment plans should be individualized to address the specific needs of the person affected. - Compassionate Use Treatment
-
Substance-induced psychosis, which is a form of psychosis triggered by substance use, typically requires prompt and appropriate treatment. Compassionate use treatments, off-label treatments, or experimental approaches may be considered in certain cases:
1. **Compassionate Use Treatment**:
- This involves using investigational drugs not yet approved by regulatory bodies for patients who have no other treatment options. Such cases are rare for substance-induced psychosis; it’s more common for terminal illnesses.
2. **Off-label Treatments**:
- **Antipsychotic Medications**: While many antipsychotic medications are primarily approved for schizophrenia and bipolar disorder, they may be used off-label to manage acute symptoms of psychosis resulting from substance use. Examples include quetiapine, olanzapine, and risperidone.
- **Benzodiazepines**: These may be used off-label to help manage severe agitation or distress during withdrawal phases, especially when psychosis is triggered by stimulant abuse or alcohol withdrawal.
3. **Experimental Treatments**:
- **Ketamine and Psychedelic-assisted Therapy**: Research is ongoing into the use of substances like ketamine or psilocybin for various psychiatric conditions. However, these are experimental and should only be administered under strict research protocols.
- **Transcranial Magnetic Stimulation (TMS)**: Though primarily used for depression, TMS is being studied for its efficacy in treating various forms of psychosis, including substance-induced psychosis.
Any use of these treatments should be under the guidance and supervision of a qualified healthcare professional, with careful consideration of the potential benefits and risks. - Lifestyle Recommendations
-
For substance-induced psychosis, the following lifestyle recommendations can be beneficial:
1. **Abstinence from Substances**: Avoid drugs and alcohol that can trigger or worsen psychosis. Seek professional help if needed to achieve and maintain sobriety.
2. **Medical Treatment**: Follow prescribed treatments, including antipsychotic medications, and always consult healthcare providers before making any changes.
3. **Healthy Diet**: Maintain a balanced diet rich in nutrients to support overall mental and physical health.
4. **Regular Exercise**: Engage in regular physical activity to improve mood and reduce stress.
5. **Adequate Sleep**: Aim for 7-9 hours of quality sleep per night to support brain function and mental health.
6. **Stress Management**: Practice stress-reducing techniques such as mindfulness, meditation, or yoga.
7. **Support Systems**: Build a strong support network of friends, family, or support groups to provide emotional and practical assistance.
8. **Mental Health Monitoring**: Regularly attend therapy sessions and keep track of mental health symptoms to adjust treatment as needed.
9. **Avoid Triggers**: Identify and avoid situations or environments that might increase the risk of relapse.
Implementing these lifestyle changes can help in managing and reducing the risk of substance-induced psychosis. - Medication
-
Fluoroquinolone drugs: Fluoroquinolone use has been linked to serious cases of toxic psychosis (see Quinolone antibiotic § Adverse effects). 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
antipsychotics, in an idiosyncratic or paradoxical reaction
antimalarials
mepacrine - Repurposable Drugs
- Research into repurposable drugs for substance-induced psychosis is ongoing, and there is limited information specifically targeting this condition. However, some antipsychotic medications, like haloperidol and olanzapine, are commonly used to manage symptoms. Other potential candidates include medications with regulatory approvals for other psychiatric or neurological conditions, which might show efficacy in managing psychotic symptoms. Continuous medical supervision is necessary to account for individual differences and potential drug interactions.
- Metabolites
- In substance-induced psychosis, metabolites are often crucial in both the diagnosis and understanding of the condition. Metabolites are the byproducts formed when the body processes substances such as drugs or alcohol. These substances can interfere with brain chemistry, leading to psychotic symptoms such as hallucinations, delusions, and impaired thinking. Monitoring and identifying these metabolites through blood, urine, or other tests can help in diagnosing the psychosis and determining the substance involved. Understanding the specific metabolites can also assist in developing appropriate treatment plans to mitigate the psychotic symptoms.
- Nutraceuticals
- There is limited evidence to support the use of nutraceuticals (dietary supplements) for the treatment of substance-induced psychosis. Standard treatment typically involves discontinuing the substance, providing supportive care, and using antipsychotic medications if necessary. Always consult a healthcare professional before beginning any supplement regimen for psychosis.
- Peptides
- Peptides are not specifically associated with the treatment or causation of substance-induced psychosis. Substance-induced psychosis results from drug or toxin exposure and often requires addressing the underlying substance use disorder. Treatment typically involves discontinuing the substance, providing medical and psychological support, and sometimes using antipsychotic medications.