Psych · General adult psychiatry — substance/medication-induced psychosis
Substance/medication-induced psychotic disorder
Also known as Substance-induced psychosis · SIP · Drug-induced psychosis · Medication-induced psychotic disorder · Cannabis-induced psychosis · Methamphetamine-associated psychosis · MAP · Stimulant psychosis · Steroid-induced psychosis · Corticosteroid psychosis · Toxic psychosis
Exam-exhaustive fellowship reference on substance/medication-induced psychotic disorder — DSM-5-TR and ICD-11 criteria, temporal rules versus primary psychosis, cannabis and stimulant and corticosteroid pathways, conversion risk (Starzer, Niemi-Pynttäri, Murrie), acute and definitive management with named doses, dual-diagnosis integrated care, and exam discriminators. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- New psychosis with fever, fluctuating attention, seizure, dysautonomia or rapid cognitive decline — exclude delirium and encephalitis before locking a substance-only label
- Chest pain, severe hypertension, hyperthermia or rhabdomyolysis with stimulant intoxication — medical emergency first
- Persistent psychosis days to weeks after confirmed last use, especially cannabis or amphetamines — do not discharge as trivial SIP without dual-aware follow-up
- Active suicidal intent, command hallucinations to harm, or high violence risk — same-day senior review and documented safety plan
- Corticosteroid on the drug chart with new mania or psychosis — co-manage taper with the treating medical team
- Do not withhold antipsychotics solely because the urine drug screen is positive
Meet the patient
A 19-year-old is brought in by his older sister at 2am. For three months he has been smoking high-potency cannabis daily. For the last five days he has believed that his housemates are filming him through the smoke alarm, and tonight he unscrewed it with a bread knife.[8][9]
He is anxious, hyper-vigilant and partly insightful — he can accept the camera "might not be real" for about a minute at a time. Urine screen: positive for THC, nothing else. Observations normal. Sister says he was a completely ordinary kid.[4][6]
The night registrar writes drug-induced psychosis, for discharge when settled. The examiner's question is the whole topic: "What is the chance he has schizophrenia in five years, and what did you do about it tonight?"[1][3]
References18ShowHide
- [1]Starzer MSK, Nordentoft M, Hjorthøj C Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis Am J Psychiatry, 2018.PMID 29179576
- [2]Niemi-Pynttäri JA, Sund R, Putkonen H, et al. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases J Clin Psychiatry, 2013.PMID 23419236
- [3]Murrie B, Lappin J, Large M, et al. Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis Schizophr Bull, 2020.PMID 31618428
- [4]Caton CL, Drake RE, Hasin DS, et al. Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses Arch Gen Psychiatry, 2005.PMID 15699290
- [5]Caton CL, Hasin DS, Shrout PE, et al. Stability of early-phase primary psychotic disorders with concurrent substance use and substance-induced psychosis Br J Psychiatry, 2007.PMID 17267925
- [6]Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review Lancet, 2007.PMID 17662880
- [7]Marconi A, Di Forti M, Lewis CM, et al. Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis Schizophr Bull, 2016.PMID 26884547
- [8]Di Forti M, Marconi A, Carra E, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study Lancet Psychiatry, 2015.PMID 26359901
- [9]Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study Lancet Psychiatry, 2019.PMID 30902669
- [10]Schoeler T, Petros N, Di Forti M, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study Lancet Psychiatry, 2016.PMID 27567467
- [11]McKetin R, Lubman DI, Baker AL, et al. Dose-related psychotic symptoms in chronic methamphetamine users: evidence from a prospective longitudinal study JAMA Psychiatry, 2013.PMID 23303471
- [12]McKetin R, Lubman DI, Najman JM, et al. Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study Addiction, 2014.PMID 24400972
- [13]Howes OD, Kapur S The dopamine hypothesis of schizophrenia: version III--the final common pathway Schizophr Bull, 2009.PMID 19325164
- [14]Gardner DM, Murphy AL, O'Donnell H, et al. International consensus study of antipsychotic dosing Am J Psychiatry, 2010.PMID 20360319
- [15]Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders Aust N Z J Psychiatry, 2016.PMID 27106681
- [16]Drake RE, Mercer-McFadden C, Mueser KT, et al. Review of integrated mental health and substance abuse treatment for patients with dual disorders Schizophr Bull, 1998.PMID 9853791
- [17]Hunt GE, Siegfried N, Morley K, et al. Psychosocial interventions for people with both severe mental illness and substance misuse Cochrane Database Syst Rev, 2019.PMID 31829430
- [18]Brown ES, Chandler PA Mood and cognitive changes during systemic corticosteroid therapy Prim Care Companion J Clin Psychiatry, 2001.PMID 15014624