Schizophrenia spectrum and other psychotic disorders
Substance/Medication-Induced Psychotic Disorder
Substance/medication-induced psychotic disorder involves clinically significant delusions or hallucinations developing during or soon after intoxication, withdrawal or exposure to a medicine known to cause psychosis.
Timing and causation need careful assessment
Substance use alone does not prove causation. Clinicians examine timing, dose, duration, course after the effect ends and whether psychotic episodes occurred without exposure.
Possible contributors include stimulants, cannabis, hallucinogens, alcohol or sedative withdrawal and some prescribed medicines. Confusion, fluctuating attention, seizures, overdose and severe withdrawal suggest a medical emergency rather than psychosis alone.
Assessment
- Delusions and/or hallucinations arise during or soon after intoxication, withdrawal or medication exposure capable of producing them.
- Symptoms occurring before exposure, in substance-free periods or persisting well beyond expected effects prompt assessment for an independent psychotic disorder.
- Psychosis does not occur exclusively during delirium, and physical observations, toxicology and a complete medication history may be needed.
Treatment
Immediate care checks overdose, withdrawal, delirium, seizures, dehydration and cardiovascular complications. Stopping or changing a medicine is medically supervised because abrupt withdrawal from some substances is dangerous.
Short-term symptom medication may be used according to the cause. Substance-use and psychiatric services should coordinate care, followed by relapse prevention, harm reduction and monitoring for persistent psychosis.
When urgent help is needed
New delusions or hallucinations after substance use, withdrawal or a medication change needs same-day assessment. Suspected overdose, seizures, unconsciousness, slow breathing, chest pain, high fever, severe confusion, extreme agitation or immediate danger is an emergency.