“Immediate Medical Evaluation is Warranted if Someone is Experiencing Possible Drug Induced Psychosis.”

Substance-Induced Psychosis (SIP) is a mental health condition in which a person may experience a loss of contact with reality due to the effects of alcohol, drugs, medications, or toxins. Unlike primary psychotic disorders such as schizophrenia, the psychotic symptoms are directly caused by the substance itself or by withdrawal from the substance.

The condition maybe frightening for both the individual and those around them, but with Prompt Medical Attention, many people recover completely once the substance is removed and appropriate treatment is provided.

What Is Psychosis?

Psychosis is a syndrome characterized by significant impairment in reality testing. During psychosis, a person may have difficulty distinguishing what is real from what is not.

Common symptoms may include:

• Hallucinations: Seeing, hearing, smelling, tasting, or feeling things that are not actually present.
  • Auditory hallucinations (hearing voices) could be common.
• Delusions: Strongly held false beliefs despite clear evidence to the contrary.
  • Persecutory (“People are following me.”)
  • Grandiose (“I have supernatural powers.”)
  • Referential (“The television is sending me secret messages.”)
• Disorganized thinking
  • Jumping from topic to topic
  • Illogical speech
  • Difficulty organizing thoughts
• Disorganized or bizarre behavior
• Agitation or aggression
• Poor insight
• Confusion and impaired judgment

How Substance Induced Psychosis Develops

Psychoactive substances affect the brain’s communication systems (neurotransmitters), particularly:

(Consult with a Medical Doctor/Psychiatrist/Neurologist)

• Dopamine
• Glutamate
• Serotonin
• GABA
• Norepinephrine

When these systems become excessively stimulated, or disrupted during withdrawal, the mind may temporarily lose its ability to accurately interpret reality.

Think of it as the mind’s “reality filter” becoming overwhelmed.

Causes

Substance Induced Psychosis may occur from:

1. Intoxication

While actively using a substance.

Examples:

• Methamphetamine
• Cocaine
• PCP
• Ketamine
• LSD
• Psilocybin
• High-potency cannabis
• MDMA (ecstasy)

2. Withdrawal

Psychosis may also occur after abruptly stopping certain substances.

Examples include:

• Alcohol withdrawal (especially delirium tremens)
• Benzodiazepine withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)
• Severe sedative withdrawal: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Withdrawal psychosis is considered a medical emergency.

3. Medication Induced

Certain prescribed medications may rarely cause psychosis, especially at high doses or in susceptible individuals.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Examples: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

• Some Priscribed stimulants (usually at high doses or if misused)
• Certain Priscription Medications

Common Substances that Maybe Associated with Psychosis

Stimulants

• Methamphetamine
• Cocaine
• Amphetamine

Symptoms often include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

• Extreme paranoia
• Feeling watched
• Auditory hallucinations
• Delusions
• Violent agitation
• Sleep deprivation

Methamphetamine induced psychosis is among the most well studied forms.

Cannabis

High potency cannabis (especially products with high THC content) may trigger psychosis in vulnerable individuals.

Risk factors include:

• Daily use
• High THC concentrations
• Early age of first use
• Family history of psychosis

Not everyone who uses cannabis develops psychosis.

Hallucinogens

Examples:

• LSD
• Psilocybin
• PCP
• Ketamine

These substances may cause:

• Visual hallucinations
• Distorted perceptions
• Altered sense of time
• Delusions

Symptoms usually resolve as the drug wears off, although complications can occur.

Alcohol

Heavy alcohol use may produce psychosis during:

• Severe intoxication (less common)
• Withdrawal (more common)

Alcohol withdrawal delirium (delirium tremens) often includes:

• Confusion
• Hallucinations
• Tremors
• Fever
• Autonomic instability

This requires emergency treatment: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Risk Factors

Certain individuals are more vulnerable.

Risk factors include:(Consult with a Medical Doctor/Psychiatrist/Neurologist)

• Family history of schizophrenia
• Previous psychotic episode
• Heavy substance use
• Sleep deprivation
• Chronic stress
• Trauma
• Young adulthood
• Multiple substance use (polysubstance use)

Symptoms

Symptoms may or may not appear suddenly.

Positive Symptoms

• Hallucinations
• Delusions
• Suspiciousness
• Paranoia
• Agitation
• Racing thoughts

Cognitive Symptoms

• Confusion
• Poor concentration
• Memory impairment
• Disorganized thinking

Behavioral Symptoms

• Aggression
• Social withdrawal
• Fearfulness
• Odd behaviors
• Emotional instability

How Is It Different From Schizophrenia?

Substance Induced Psychosis	Schizophrenia
Triggered by substances	Not caused by substances
May begins suddenly	Usually develops gradually
May improve after stopping the substance	Might persists without treatment
Symptoms maybe closely tied to intoxication or withdrawal	Symptoms occur independently of substance use
Recovery maybe complete	It requires long term treatment

Sometimes the distinction is not immediately clear. If psychotic symptoms continue well beyond the expected effects of intoxication or withdrawal, clinicians evaluate for a primary psychotic disorder or a substance induced episode that has uncovered an underlying vulnerability.(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis: (Consult with a Medical Doctor/Psychiatrist/Neurologist)

Diagnosis involves determining whether the symptoms are primarily due to substance use/abuse rather than another medical or psychiatric condition. Clinicians may consider:

• Detailed history of substance use
• Timing of symptom onset
• Physical and neurological examination
• Mental status examination
• Laboratory testing (including toxicology when appropriate)
• Review of medications
• Assessment for other medical causes of psychosis
• Psychiatric evaluation

Treatment(Consult with a Medical Doctor/Psychiatrist/Neurologist)

Treatment may depend on the severity of symptoms and the substance involved.

Immediate Priorities

• Ensure the person’s safety and the safety of others.
• Treat any medical emergencies.
• Manage intoxication or withdrawal.

Medications: (Consult with a Medical Doctor/Psychiatrist)

Depending on the situation, treatment may include:

• Certain priscribed pain medications
• Certain priscribed medications (commonly used for severe alcohol or substance withdrawal, and sometimes for stimulant-related agitation under medical supervision)
• Intravenous fluids
• Supportive medical care

Long-Term Care: (Consult with a Medical Doctor/Psychiatrist)

After stabilization, treatment may focuses on preventing recurrence:

• Substance use treatment
• Individual psychotherapy
• Motivational Interviewing
• Cognitive Behavioral Therapy (CBT)
• Relapse prevention planning
• Family education and support
• Peer support groups when appropriate
• Ongoing psychiatric follow-up if symptoms persist

Prognosis: (Consult with a Medical Doctor/Psychiatrist)

Some people may fully recover, particularly when:

• The substance is discontinued.
• Treatment begins early.
• There is no underlying psychotic disorder.
• They remain abstinent from the substance that triggered the episode.

However, recurrent episodes increase the risk of lasting difficulties. In some individuals especially those with a genetic or biological vulnerability, a substance induced psychotic episode may precede the development of a primary psychotic disorder, though most people who experience substance induced psychosis do not go on to develop schizophrenia.(Consult with a Medical Doctor/Psychiatrist)

When to Seek Emergency Help

(Call 911, and also Consult with a Medical Doctor/Psychiatrist)

Immediate medical evaluation is warranted if someone experiencing possible substance induced psychosis:

• Is unable to distinguish reality from hallucinations or delusions.
• Becomes violent or threatens harm to themselves or others.
• Is extremely confused or difficult to awaken.
• Has seizures, a high fever, severe tremors, chest pain, or trouble breathing.
• Is experiencing severe alcohol or sedative withdrawal symptoms.

Psychosis related to substance use is a medical emergency because it may lead to accidental injury, self-harm, violence, dehydration, or life threatening complications depending on the underlying cause.

Key Takeaways: (Consult with a Medical Doctor/Psychiatrist)

• Substance Induced Psychosis:  Could be a temporary or sometimes prolonged psychotic state caused by intoxication with, or withdrawal from, alcohol, drugs, medications, or toxins.
• Common symptoms include hallucinations, delusions, paranoia, confusion, and disorganized thinking.
• Stimulants (especially methamphetamine and cocaine), high potency cannabis, hallucinogens, and alcohol withdrawal are among the most common causes.
• Prompt medical assessment is important to identify the cause, ensure safety, and begin appropriate treatment.
• Most individuals improve significantly with abstinence and appropriate medical and psychological care, although some may require ongoing psychiatric follow ups if symptoms persist or reveal an underlying vulnerability to psychotic disorders.

Shervan K Shahhian