Substance-induced psychosis

Substance-induced psychosis (commonly known as toxic psychosis) is a form of substance use disorder where psychosis can be attributed to substance use. It is a psychosis that results from the poisonous effects of chemicals or drugs, including those produced by the body itself. Various psychoactive substances have been implicated in causing or worsening psychosis in users.

Effects of Psychosis

Psychosis manifests as disorientation and visual (and/or haptic) hallucinations.^[1] It is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the capacity to deal with life demands. While there are many types of psychosis, substance-induced psychosis can be pinpointed to specific chemicals.^[2]

Substances

Psychotic states may occur after using a variety of legal and illegal substances. Usually such states are temporary and reversible, with fluoroquinolone-induced psychosis being a notable exception. Drugs whose use, abuse, or withdrawal are implicated in psychosis include the following:

ICD-10

• F10.5 alcohol:^[3][4][5] Alcohol is a common cause of psychotic disorders or episodes, which may occur through acute intoxication, chronic alcoholism, withdrawal, exacerbation of existing disorders, or acute idiosyncratic reactions.^[3] Research has shown that alcohol abuse causes an 8-fold increased risk of psychotic disorders in men and a 3 fold increased risk of psychotic disorders in women.^[6][7] While the vast majority of cases are acute and resolve fairly quickly upon treatment and/or abstinence, they can occasionally become chronic and persistent.^[3] Alcoholic psychosis is sometimes misdiagnosed as another mental illness such as schizophrenia.^[8]
• F12.5 cannabinoid: Some studies indicate that cannabis may trigger full-blown psychosis.^[9] Recent studies have found an increase in risk for psychosis in cannabis users.^[10]
• F13.5 sedatives/hypnotics (barbiturates;^[11][12] benzodiazepines^[13][14][15]): It is also important to this topic to understand the paradoxical effects of some sedative drugs.^[16] Serious complications can occur in conjunction with the use of sedatives creating the opposite effect as to that intended. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs.^[17] The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.^[18][19] However, psychosis is more commonly related to the benzodiazepine withdrawal syndrome.^[20]
• F14.5 cocaine^[21]
• F15.5 other stimulants: amphetamines;^[22] methamphetamine;^[22] methylphenidate.^[22] See also stimulant psychosis.
• F16.5 hallucinogens (LSD and others)

The code F11.5 is reserved for opioid-induced psychosis, and F17.5 is reserved for tobacco-induced psychosis, but neither substance is traditionally associated with the induction of psychosis.

The code F15.5 also includes caffeine-induced psychosis, despite not being specifically listed in the DSM-IV. However, there is evidence that caffeine, in extreme acute doses or when severely abused for long periods of time, may induce psychosis.^[23][24]

Other

• Fluoroquinolone drugs, fluoroquinolone use has been linked to serious cases of toxic psychosis that have been reported to be irreversible and permanent, see adverse effects of fluoroquinolones^{[25][26][27][28][29][30][31][32]} The related quinoline derivative mefloquine (Lariam) has also been associated with psychosis.^[33][34]
• some over-the-counter drugs, including:
  • Dextromethorphan (DXM) at high doses.^[35][36]
  • Certain antihistamines at high doses.^{[37][38][39][40]}
  • Cold Medications^[41] (i.e. containing Phenylpropanolamine, or PPA)
• prescription drugs:
  • Prednisone and other corticosteroids^[42]
  • Isotretinoin^[43]
  • Anticholinergic drugs
    • atropine^[44][45]
    • scopolamine^[46]
  • antidepressants^[47]
  • L-dopa^[48]
  • antiepileptics^[49]
• antipsychotics, in an idiosyncratic reaction
• Other illegal drugs (not listed above), including:
  • MDMA (ecstasy)^[50]
  • Phencyclidine (PCP)^[51]
  • Ketamine
• Synthetic research chemicals used recreationally, including:
  • JWH-018 and some other synthetic cannabinoids, or mixtures containing them (e.g. "Spice", "Kronic", "MNG" or "Mr. Nice Guy", "Relaxinol", etc.).^[52] Various "JWH-XXX" compounds in "Spice" or "Incense" have also been found and have been found to cause psychosis in some people.^[53][54][55]
  • Mephedrone and related amphetamine-like drugs sold as "bath salts" or "plant food".^[56]

• Plants
  • Hawaiian baby woodrose (contains ergine)
  • Morning glory seeds (contains ergine)
  • Jimson weed^[57] (Datura, angel's trumpet, thorn apple)
  • Belladonna (deadly nightshade)
  • Salvia divinorum^[58]
• Volatile solvents and gases (inhalants)
  • Toluene,^[59][60] found in glue, paint, thinner, etc. See also toluene toxicity.
  • Butane^[61]
  • Gasoline (petrol),^[62]

References