Substance-Induced Psychoses: A Critical Review of the Literature

Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, IRCCS Foundation Ospedale Maggiore Policlinico, Milano MI, Italy.
Current Drug Abuse Reviews 12/2011; 4(4):228-40. DOI: 10.2174/1874473711104040228
Source: PubMed


Substances with psychotomimetic properties such as cocaine, amphetamines, hallucinogens and cannabis are widespread, and their use or abuse can provoke psychotic reactions resembling a primary psychotic disease. The recent escalating use of methamphetamine throughout the world and its association with psychotic symptoms in regular users has fuelled concerns. The use of cannabis and cocaine by young people has considerably increased over recent years, and age at first use has dramatically decreased. There is some evidence that cannabis is now on the market in a more potent form than in previous decades. Furthermore, a large number of studies have reported a link between adolescent cannabis use and the development of stable psychosis in early adulthood. The situation is further complicated by the high rates of concomitant substance use by subjects with a psychotic illness which, especially in young users with an early-phase psychotic disorder, can make diagnosis difficult. This paper reviews the literature concerning the properties of psychotogenic substances and the psychotic symptoms they can give rise to, and discusses the association between substance abuse and psychosis with particular emphasis on the differential diagnosis of a primary and substance-induced psychotic disorder. The findings of this review indicate that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and dependence. From a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.

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    • "In line with earlier studies that have found links between survival sex and stimulant use (Chettiar, Shannon, Wood, Zhang, & Kerr, 2010; Semple, Strathdee, Zians, & Patterson, 2011), we observed that stimulant users were twice as likely to be engaging in survival sex, than cannabis users. We also observed cannabis use to be strongly associated with the existence of psychotic disorders (Fiorentini et al., 2011; Moore et al., 2007) as is commonly known. Interestingly, stimulant users were more likely to be dealing with drugs—both buying and selling—than cannabis users. "
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    • "Acute and chronic exposure to cocaine is associated with significant psychiatric co-morbidities of which psychotic symptoms are one of the most typical (Roncero et al., 2001). The symptoms seen most frequently are paranoid ideation and the auditory and visual hallucinations (Fiorentini et al., 2011). The cocaine-induced psychotic symptoms (CIPS) are aggressive serious adverse effects and may lead to psychomotor agitation and behaviours potentially lifethreatening (Vorspan et al., 2001). "
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    • "Too, what complicates the situation further, are data which show that about 50% of the patients who suffer from schizophrenia are also substance abusers at some time during their illness [45,46]. It is now known that substances with psychomimetic properties such as cocaine are used and abused worldwide and consumption of such substances can and will induce psychotic reactions including primary psychotic disease [47,48,49,50,51,52,53,54,55,56,57,58]. "
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