The clinical presentation of drug-induced psychosis understands the presence of delusions and/or hallucinations [1]. Most frequent delusions are of the persecutory type, while grandiose, referential, erotomanic, nihilistic and somatic types have also been described [1]. On the other hand, an onset of vivid and clear hallucinations, either auditory (more common) or sensory, is also the main feature of psychosis [1]. The onset of symptoms significantly varies depending on the substance. For example, patients who inhale large amounts of cocaine can develop symptoms within minutes, whereas sedative-hypnotic drugs and alcohol can induce psychosis after a prolonged period of use [1] [2]. Methamphetamine and cocaine-induced psychosis typically presents with delusions of persecution and visual hallucinations that last for a short period of time, but relapses have shown to occur within one week or one month after the substance abuse [3]. A similar presentation is seen across other causes, but paranoia, distortion in the perception of time and feelings of depersonalization have been reported in patients who develop psychosis after use of hallucinogenic substances, such as cannabis or lysergic acid diethylamide (LSD) [1] [4]. Moreover, opioid intoxication is characterized by profound euphoria, while withdrawal can either lead to agitation, gastrointestinal irritation, and craving, or to depression and anhedonia [4]. Drug-induced psychosis can also occur in patients who are taking antiepileptic and antiparkinsonian drugs [5] [6], which can mislead the physician toward substance abuse.

• Malaise

  Symptoms of alcohol withdrawal include agitation, anxiety, tremor, malaise, hyperreflexia (exaggeration of reflexes), mild tachycardia (rapid heart beat), increasing blood pressure, sweating, insomnia, nausea or vomiting, and perceptual distortions. [ncbi.nlm.nih.gov]

• Constipation

  There were no anticholinergic effects, such as urinary retention, dry mouth, blurred vision, or constipation. [nejm.org]

• Hypertension

  She had a history of non-insulin dependent diabetes, which was controlled by diet, and hypertension, which was controlled with doxazosin (Cardura). [bmj.com]

  Many reports of severe hypertension after therapeutic and toxic doses of PPA have been published, some of which resulted in intracranial hemorrhage and death. 7 ,13 ,14 Reflex bradycardia may accompany the hypertension, which distinguishes toxicity from [pediatrics.aappublications.org]

  […] with cannabis and alcohol being the most commonly abused. [13] Some of the medical complications observed with alcohol-related psychosis and chronic alcoholism include liver disease, pulmonary tuberculosis, diabetes mellitus, musculoskeletal injury, hypertension [emedicine.medscape.com]

• Heart Disease

  […] significantly increases the risk of coronary heart disease. [doi.org]

• Formication

  It can also cause the grinding of teeth, scratching of skin (usually due to formication) or pulling out hair. [thecabinchiangmai.com]

  For instance, auditory hallucinations (specifically, hearing voices), visual hallucinations, and tactile hallucinations are most common in an alcohol-induced psychotic disorder, whereas persecutory delusions and tactile hallucinations (especially formication [minddisorders.com]

  The hallucination of bugs or vermin crawling in or under the skin (formication) can lead to scratching and extensive skin excoriations. [health.am]

• Muscle Spasm

  Bath salts have known dangerous side effects including hallucinations, panic attacks, violent behavior and muscle spasms. Those who abuse the drug recreationally have a substantial likelihood of becoming addicted. [addictions.com]

• Visual Impairment

  However, his visual impairment remained unchanged. [doi.org]

• Fear

  The court heard police believe Mr Higgins was suffering from a drug-induced psychosis and feared for his life. The 40-year-old has been remanded in custody until July 7. [perthnow.com.au]

  His mother feared he would begin abusing it and took him off the drug. Now, five years later, He snorts Ritalin with friends. [cchrflorida.org]

  Some of the more common symptoms of drug induced psychosis might be: Unable to be verbally understood A sense of fear or panic Violent or erratic behavior Changes in emotion Lack of motivation, lethargy or appearing very withdrawn A sense of incoherence [vantagepointrecovery.com]

  Paranoia is a self-reinforcing loop of beliefs that escalates in a fearful emotional state. Meth can distort reality, altering belief systems, and lessens the ability to control emotions, making fear and anxiety prevalent. [sobernation.com]

  Plus, the constant fear of finally getting pregnant under the use of AEDs constituted an additional limitation to her treatment compliance. [doi.org]

• Visual Hallucination

  RESULTS: A total of 157 of 160 patients had hallucinations, with visual hallucinations being the most common (97% of subjects), followed by auditory (48%), tactile (23%), and olfactory (16%). [ncbi.nlm.nih.gov]

  Methamphetamine and cocaine-induced psychosis typically presents with delusions of persecution and visual hallucinations that last for a short period of time, but relapses have shown to occur within one week or one month after the substance abuse. [symptoma.com]

  hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy, and hypomania. [doi.org]

  This same patient described vivid visual hallucinations, the ability to “see in all four quadrants,” delusions of telepathy, and paranoid thoughts that others wanted to kill him. [primarypsychiatry.com]

  Symptoms of an antihistamine psychosis often include both auditory and visual hallucinations. [mentalhealthdaily.com]

• Aggressive Behavior

  Blunted affect was milder in users than in non-users, whereas hostility and aggressive behavior was significantly more severe in users than in non-users. [doi.org]

  Keywords: Ecstasy use, psychotic acute episode, aggressive behavior 1. [ncbi.nlm.nih.gov]

  Tranquillizers Causing Aggression. BMJ 1975; 1: 113-114. Zisook S, DeVaul RA. Adverse Behavioral Effects of Benzodiazepines. Journal of Family Practice 1977; 6: 963-966. French AP. Dangerously Aggressive Behavior as a Side Effect of Alprazolam. [benzo.org.uk]

  Hinsberger and colleagues 10 described toxic effects such as slurred speech, nausea, ataxia, nystagmus, mood changes, perceptual distortions, and aggressive behavior. [primarypsychiatry.com]

• Urinary Retention

  Physical symptoms of dextromethorphan overdose may include dilated pupils, urinary retention, elevated temperature, tachycardia, dizziness, vomiting, rash, and headache. 9 Cases have been reported with severe overdoses in which there was lethargy, somnolence [primarypsychiatry.com]

  There were no anticholinergic effects, such as urinary retention, dry mouth, blurred vision, or constipation. [nejm.org]

• Agitation

  These symptoms, plus agitation and hostility, may ultimately be the best measure of DIP in patients with PD. [ncbi.nlm.nih.gov]

  Upon presentation, he demonstrated echolalia, paranoia, flight of ideas, and psychomotor agitation. The patient remained agitated for the first 2 days of hospitalization. He attempted to barricade himself in his room. [doi.org]

  Moreover, opioid intoxication is characterized by profound euphoria, while withdrawal can either lead to agitation, gastrointestinal irritation, and craving, or to depression and anhedonia. [symptoma.com]

• Confusion

  Confused thoughts result in confused speech that may not make any sense. [sovteens.com]

  Six did not (five on clozapine, one on olanzapine) because of confusion, erratic behavior, and increased hallucinations. No crossover failure had worsened PD except for increased tremor in one. [ncbi.nlm.nih.gov]

  This psychosis can last up to a few days, and is often characterized by hallucinations, delusions, memory loss and confusion. This usually results from prolonged or heavy street-drug use; and it responds well to treatment. [earlypsychosis.ca]

  Confused thinking : Everyday thoughts can become confused, making sentences unclear or hard to understand. A person might find it hard to concentrate, follow a conversation or remember things. Thoughts can seem to speed up or slow down. [headspace.org.au]

  Normally this kind of psychotic symptoms (Transient) can last for a few days until detoxing off the drug and is often characterized by delusions, memory loss, confusion and sometimes hallucinations. [thewellnessseeker.com]

• Irritability

  Moreover, opioid intoxication is characterized by profound euphoria, while withdrawal can either lead to agitation, gastrointestinal irritation, and craving, or to depression and anhedonia. [symptoma.com]

  Symptoms of delirium tremens include: Agitation/excitement Irritability Confusion/disorientation Delirium Sudden mood changes Fatigue or stupor Restlessness Body tremors Changes in mental functions Decreased attention span Sensitivity to light, sound, [americanaddictioncenters.org]

  DISCUSSION OTC cough and cold preparations are nearly ubiquitous, and are marketed for the relief of those most irritating symptoms of the common cold: rhinorrhea and cough. [pediatrics.aappublications.org]

  The person can seem excited, depressed or irritable for little or no reason obvious to others. Symptoms of psychosis are different for everyone. They might not be present all the time, have different causes and can change over time. [headspace.org.au]

• Excitement

  Hoops had 1 case of mental excitement among 1,207 cases; Briercliffe 15 cases of delirium among some hundred persons taking mepacrine. Field estimated the incidence of mepacrine psychosis to be less than 01 per cent. of cases treated. [doi.org]

  Symptoms of delirium tremens include: Agitation/excitement Irritability Confusion/disorientation Delirium Sudden mood changes Fatigue or stupor Restlessness Body tremors Changes in mental functions Decreased attention span Sensitivity to light, sound, [americanaddictioncenters.org]

  The person can seem excited, depressed or irritable for little or no reason obvious to others. Symptoms of psychosis are different for everyone. They might not be present all the time, have different causes and can change over time. [headspace.org.au]

• Tremor

  No crossover failure had worsened PD except for increased tremor in one. Quetiapine is useful and well-tolerated as a first drug to treat DIP in PD but must be used cautiously to replace other atypical antipsychotic drugs. [ncbi.nlm.nih.gov]

  Clozapine in the treatment of tremor. Acta Neurol Scand 1986 ;73: 295 - 297 55. Friedman JH, Lannon MC. Clozapine-responsive tremor in Parkinson's disease. Mov Disord 1990 ;5: 225 - 229 56. Fischer PA, Baas H, Hefner R. [nejm.org]

  Yuk‐Fai Cheung, Winnie Wing‐Yin Wong, Kwok‐Wing Tang, John Hiu‐Ming Chan and Patrick Chung‐Ki Li, Ciprofloxacin‐induced palatal tremor, Movement Disorders, 22, 7, (1038-1043), (2007). Bart Post, Johannes H.T.M. Koelman and Marina A.J. [doi.org]

  During withdrawal from alcohol, the loss of GABA-A receptor stimulation causes a reduction in chloride flux and is associated with tremors, diaphoresis, tachycardia, anxiety, and seizures. [emedicine.medscape.com]

Current diagnostic criteria of drug-induced psychosis involve the following findings [1]:

• The onset of symptoms during or soon after an introduction of a harmful substance, or exposure to a medication that can provoke such symptoms.
• An absence of other signs and symptoms that may point to another cause, including the onset of symptoms before the use of suspected drugs, a prolonged duration of complaints (about 1 month) after cessation of use, or their presence in the setting of acute withdrawal.
• Appearance of symptoms in time not related to delirium
• Significant distress and impaired daily functioning caused by symptoms.

Once a presumptive diagnosis is made, it is necessary to determine the substance that is responsible for the development of symptoms. For this reason, an adequate and thorough patient history is considered to be the most important part of the diagnostic workup, which can reveal recent use of particular medications or substances [1] [7]. Preferably, hetero-anamnestic data should be obtained, involving both the family and friends, as the patient may often refrain from admitting substance abuse. If the cause remains undetermined, routine toxicology screening of urine for recreational drugs, alcohol testing, thyroid function tests, a basic metabolic panel and a thorough workup of the central nervous system (lumbar puncture, computed tomography of the endocranium) may be performed [2] [8].

However, patients who do not respond to clozapine monotherapy can be given adjunctive treatment with ECT. [ncbi.nlm.nih.gov]

Treatment for Drug Induced Psychosis There are a number of psychoactive substances or toxins that can cause psychotic reactions. [clinical-partners.co.uk]

[…] m; 15 min per treatment. [doi.org]

The prognosis for alcohol-induced psychosis is less favorable than earlier studies had speculated. However, if the patient can abstain from alcohol, the prognosis is good. [ncbi.nlm.nih.gov]

These papers cover the problems with long-term use, the supersensitivity psychosis, the fact the prognosis of schizophrenia is much better than has been claimed, that many people do fine going off meds, that prognosis is poorer for those on long term [forums.studentdoctor.net]

(See Prognosis, Clinical Presentation, Differentials, Workup, and Treatment .) Chronic intake of alcohol affects several neurotransmitter systems in the brain. [emedicine.medscape.com]

It is characterized by hallucinations, paranoia, and fear. [1] [2] [3] Etiology There are a variety of hypotheses to describe the etiology of alcohol-induced psychosis, but none of them can fully explain the development of acute or chronic hallucinations [ncbi.nlm.nih.gov]

Advocacy for mental illness must include the consideration of underlying etiological factors of psychiatric symptoms. [psychoticdisorders.wordpress.com]

Images: Related links to external sites (from Bing) Ontology: Substance-induced psychotic disorder (C2987469) Definition (NCI) A psychotic disorder characterized by prominent hallucinations or delusions that have been determined to be etiologically linked [fpnotebook.com]

There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): (1) the symptoms in Criterion A developed during, or within a month of Substance Intoxication or Withdrawal (2) medication use is etiologically related [behavenet.com]

(See Etiology .) During withdrawal from alcohol, the loss of GABA-A receptor stimulation causes a reduction in chloride flux and is associated with tremors, diaphoresis, tachycardia, anxiety, and seizures. [emedicine.medscape.com]

473-480, AUG 1990 PMID: 2380692 Issn Print: 0022-3018 Publication Date: 1990/08/01 Checking for direct PDF access through Ovid Abstract Clinical and laboratory studies link alcohol and other drug use to the occurrence of psychotic experiences, but epidemiologic [doi.org]

Schizophr Res 29: 22 Google Scholar | Crossref Hall W, Degenhardt L ( 2000 ) Cannabis use and psychosis: a review of clinical and epidemiological evidence. [jop.sagepub.com]

Laboratory of Pathophysiology of Pain, Institute of General Pathology and Pathophysiology Russian Academy of Medical Sciences Moscow [doi.org]

Patients with alcohol-induced psychosis have a 5 % to 30% risk of developing a chronic schizophrenia-like syndrome. [4] Pathophysiology The pathophysiology of alcohol-induced psychosis is unclear. Several hypotheses exist. [ncbi.nlm.nih.gov]

"Altered prefrontal-striatal interactions are thought to be critical in the pathophysiologic characteristics of psychosis," the authors wrote in their conclusion. [livescience.com]

Behavioural sensitization can also occur, and neuroleptics may prevent the recurrence of further psychosis triggered by ongoing low-dose methamphetamine use. [ncbi.nlm.nih.gov]

Behavioural sensitization can also occur, and neuroleptics may prevent the recurrence of further psychosis triggered by ongoing low-dose methamphetamine use [homelesshub.ca]

Lee de Paauw, 18 is accused of trying to steal a car and assaulting two police officers, including an off-duty officer who prevented him leaving in the stolen vehicle on Sunday. [cairnspost.com.au]

An experienced clinician is required to help supervise recovery as it is important to know when a psychosis has become so serious, that an in-patient stay may be necessary, or is skilful in preventing this outcome. [clinical-partners.co.uk]

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255. [healthline.com]

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2. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J;2011.
3. Chen Z, Lusicic A, O'Brien TJ, et al. Psychotic disorders induced by antiepileptic drugs in people with epilepsy. Brain. 2016;139(10):2668-2678
4. Paparelli A, Di Forti M, Morrison PD, Murray RM. Drug-Induced Psychosis: How to Avoid Star Gazing in Schizophrenia Research by Looking at More Obvious Sources of Light. Front Behav Neurosci. 2011;5:1.
5. Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US);2005.
6. Kuzuhara S. Drug-induced psychotic symptoms in Parkinson's disease. Problems, management and dilemma. J Neurol. 2001;248(3):III28-31.
7. Grant KM, LeVan TD, Wells SM, et al. Methamphetamine-Associated Psychosis. Journal of Neuroimmune Pharmacology. 2012;7(1):113-139.
8. Algon S, Yi J, Calkins ME, Kohler C, Borgmann-Winter KE. Evaluation and Treatment of Children and Adolescents with Psychotic Symptoms. Curr Psychiatry Rep. 2012;14(2):101-110.