What is Drug-Induced Psychosis?
Drug-induced psychosis (DIP) is an episode or episodes in which a person experiences symptoms of disconnection from reality directly caused by using a drug or substance. These symptoms may occur either while the person is under the influence of the drug or going through withdrawal after discontinuing the use of a drug.
DIP symptoms may be similar to those of other psychotic disorders such as schizophrenia, but DIP symptoms typically differ. For example, they may come on more suddenly and intensely than disorder-related symptoms, and they usually resolve when the person stops using the drug.
Symptoms of DIP may include:
- Hallucinations (sensing something that does not really exist)
- Delusions (intensely believing something that is untrue)
- Extreme fear
- Disorganized, irrational thought processes
- Impulsive, dangerous behavior
Drugs That May Cause DIP
Many different types of drugs have the potential to cause psychotic symptoms. They include many illegal drugs, legal intoxicants, and some prescription drugs. In addition, in rare cases, certain over-the-counter medications may cause psychotic episodes.
Some drugs that may cause DIP include:
- Dissociative drugs (PCP, ketamine, etc.)
- Hallucinogens (LSD, psilocybin, etc.)
Prescription drugs that have been associated with psychotic side effects include:
- Muscle relaxants
- Blood pressure medications
- Parkinson’s disease medications
- Anti-seizure medications
What Causes Drug-Induced Psychosis?
Scientists don’t know precisely why some people experience psychotic symptoms in reaction to certain drugs. Psychotic episodes likely arise as part of a complex brain chemical reaction to the drug, and the precise mechanism of the chemical process probably varies depending on the drug being used.
For example, methamphetamine changes how the brain responds to dopamine, a chemical that enables the communication between nerve cells in the brain. Some studies have suggested that the use of the drug may change how different parts of the brain communicate with one another. Some scientists believe that excessive dopamine levels and another neurotransmitter, glutamate, in certain parts of the brain may be responsible for DIP symptoms in methamphetamine users.
Is Drug-Induced Psychosis Hereditary?
There is no clear evidence that susceptibility to DIP is inherited. However, there is a complex association between drug-related psychosis and some other disorders, such as schizophrenia, which may have an inherited component.
How Is Drug-Induced Psychosis Detected?
DIP can be challenging to identify because its symptoms are similar to those of some mental disorders. Various drugs may also have similar effects, such as causing hallucinations, that are not in themselves evidence of psychosis. Because DIP symptoms are often intense, have a rapid onset, and can have life-threatening consequences, it is important to seek medical attention immediately when someone experiences psychotic symptoms in conjunction with drug use.
How Is Drug-Induced Psychosis Diagnosed?
A doctor with experience in diagnosing mental illnesses may diagnose DIP. The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes diagnostic criteria that providers can use to assess Substance/Medication-Induced Psychotic Disorder. The criteria include:
- The person has experienced hallucinations or delusions. Other psychotic symptoms may be present as well.
- The symptoms occur during or soon after substance use or during withdrawal.
- The substance is capable of producing the symptoms.
- The symptoms aren’t better explained by a mental disorder not caused by substance use.
- The symptoms cause significant distress or impairment.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Drug-Induced Psychosis Treated?
DIP symptoms usually improve after the use of the triggering drug stops. Therefore, the first step in treatment is making sure substance abuse is discontinued in a safe environment where medical professionals can monitor the person.
In some cases, anti-anxiety or antipsychotic drugs may be administered to counteract the psychotic effects of the substance that caused the psychosis.
In rare cases, symptoms may continue after substance use ceases, and further treatment may be required. Ongoing treatment options may include:
- Psychotherapy such as cognitive-behavioral therapy
- Counseling or rehabilitation for underlying addiction or substance use disorders
- Treatment for underlying mental health-related issues
- Changes in medical treatment if the psychosis is caused by a prescription drug used to treat an underlying medical condition
How Does Drug-Induced Psychosis Progress?
DIP usually resolves on its own when substance use stops. However, in rare cases, symptoms may continue. There is evidence indicating long-term drug use that triggers psychotic symptoms may sometimes evolve into other disorders such as bipolar disorder or schizophrenia.
Even when DIP symptoms are temporary, they can produce potentially serious consequences. People experiencing DIP symptoms may be a danger to themselves or others, and prompt medical attention is vital to avoid potentially harmful situations.
How Is Drug-Induced Psychosis Prevented?
Because there is no clear way to judge who may be susceptible to DIP, the only reliable way to prevent it is to avoid using substances that can cause it. Long-term substance use and abuse can increase DIP risk, and heavier substance use may produce more severe DIP symptoms. Therefore, treatment of underlying substance use disorders is essential in preventing DIP episodes.
Drug-Induced Psychosis Caregiver Tips
Some people with DIP also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with DIP:
- Alcoholism and other substance use disorders are commonly co-morbid with DIP.
- Many people with DIP also experience symptoms of depression.
- Disorders such as bipolar disorder and schizophrenia are sometimes associated with DIP, although the relationship between the disorders is not yet well understood.
Drug-Induced Psychosis Brain Science
Drugs such as methamphetamine create feelings of euphoria by increasing dopamine levels in the user’s brain. Dopamine is a chemical called a neurotransmitter, a kind of compound that helps the brain’s nerve cells communicate with each other. Dopamine is released when we do something pleasurable–like eat our favorite foods or have sex–so the artificially high level of the dopamine produced by methamphetamine results in an intense good feeling.
The problem is that long-term use of meth changes how the brain’s nerve cells respond to dopamine, making it more difficult for the user to experience good feelings. Eventually, the drug promotes a rewiring of the brain’s nerve circuitry that prevents parts of the brain from communicating with each other effectively.
It’s this rewiring that causes long-term neurological effects in methamphetamine users, including depression, anxiety, and problems with decision-making, memory, and motor skills. In some cases, psychotic symptoms may persist as well. It may take years for the damage to improve even after the user entirely abstains from drug use, and in some cases, the impairments may be permanent.
Drug-Induced Psychosis Research
Title: Meth-OD: A Study of IXT-m200 in Patients With Toxicity From Methamphetamine Overdose (Meth-OD)
Principal investigator: Michael Wilson, MD
University of Arkansas for Medical Sciences
Little Rock, AR
This multisite Phase 2a study hypothesizes that IXT-m200 will be well-tolerated in patients with acute mild to moderate METH toxicity. A randomized, open-label design will be used in which one dose of IXT-m200 will be compared to treatment-as-usual (TAU). Approximately 40 participants will be enrolled in 4 cohorts. A dose-escalation approach will be used to evaluate progressively higher IXT-m200 doses in each cohort. In conjunction with safety monitoring, this design assures the opportunity to observe early safety findings before any participants are exposed to the next higher dose. The randomization ratio for IXT-m200 versus TAU is defined as 4:1 for each cohort so that the number of participants receiving TAU equals the number receiving each dose of IXT-m200 at the end of the study.
Agitation scales and vital signs will be recorded to track the effectiveness of the antibody treatment versus TAU over time on agitation associated with METH use. While in the emergency department (ED), detailed and pertinent medical and psychiatric histories and physical exams will be obtained, along with laboratory assessments and ECGs. In the ED, participants will give blood samples for analysis of METH and IXT-m200 concentrations and followed for the development of adverse events. Participants will be evaluated at two days and four weeks after discharge from the ED for adverse events and drug use history. Cohort escalation reviews will be performed by the Sponsor, Medical Monitor, and Data and Safety Monitoring Board (DSMB) between cohorts, and the next group will not start until after the completion of this review.
Title: Clinical and Genetic Factors Associated With Psychotic Symptoms Among Cocaine Abusers (PSYCHOCOKE)
Principal investigator: Florence Vorspan, MD, MSC
Hôpitaux de Paris
This study aims to determine the clinical, genetic, and environmental factors associated with the phenotype “severe psychotic symptoms” caused by cocaine.
The second purpose is to include gene x environment interaction and analyze the factors associated with the presence or the absence of severe psychotic symptoms induced by cocaine.
Title: A Cannabis Harm Reduction e-Intervention for Young Cannabis Users With Early Psychosis (CHAMPS)
Stage: Enrolling by invitation
Principal investigator: Didier Jutras-Aswad, MD, MSc
Centre hospitalier de l’Université de Montréal
Cannabis users who experience psychosis are particularly vulnerable to cannabis-related harms, including worse psychotic symptoms and more hospitalizations. Unfortunately, few psychosocial interventions exist that aim to decrease these harms. Instead, most focus on ceasing cannabis use which is rarely appealing to cannabis users. Furthermore, face-to-face psychotherapy often remains inaccessible to people with psychosis primarily due to a lack of trained clinicians. Alternatives such as e-interventions have the potential to increase access to treatment and decrease clinicians’ workload. Among cannabis harm reduction approaches are the protective behavioral strategies. These strategies do not encourage nor discourage cannabis use. Instead, they recommend behaviors for safer cannabis use. For example, these strategies include: 1) avoid driving a car under the influence of cannabis, 2) avoid mixing cannabis with other drugs, and 3) purchase cannabis only from a trusted source. In the present pan-Canadian study, we will test the first e-intervention called CHAMPS (Cannabis Harm-reducing App for Managing Practices Safely) for cannabis harm reduction adapted for young adult cannabis users who experienced a psychosis. CHAMPS is a smartphone application that includes 17 strategies for safer cannabis use, a personalized consumption goal, and a consumption journal. The goals of this study are 1) to confirm whether CHAMPS is acceptable to participants and 2) to test whether it works, notably by positively impacting participants’ health and cannabis consumption habits.
This multicentric, two-arm, open-labeled, pilot randomized controlled trial involves 100 young cannabis users who experienced psychosis and are followed in an early intervention service (EIS) in Canada. Participants will be randomized in a 1:1 ratio to one of two interventions:
The smartphone application CHAMPS contains six modules (each lasting 15-20 min, weeks 1 to 6) and a booster session (20 min, week 10) based on motivational interviewing and harm reduction approaches. EIS consists of standard of care and psychoeducation material on cannabis use offered in first-episode psychosis clinics and administered through in-person visits and/or phone or video calls.
All participants will be assessed for a follow-up at weeks 6, 12, and 18. Data on mental health, substance use, cannabis dependence severity, cannabis-related problems, quality of life, and health care service utilization will be obtained through questionnaires and medical charts.