With substances for which relevant blood levels are available (e.g., blood alcohol level, other quantifiable blood levels such as digoxin), the presence of a level consistent with toxicity may increase diagnostic certainty..

Michigan State University

Substance/medication-induced psychotic disorder occurs when a specific substance (e.g., cocaine, dexamethasone) causes the delusions and/or hallucinations, or other schizophrenic-like symptoms. It is not to be confused with Substance/Medication-Induced Sleep Disorder.

Substance/Medication-Induced Psychotic Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

Psychotic disorders can occur in association with intoxication with the following classes of substances: alcohol; cannabis; hallucinogens, including phencyclidine and related substances; inhalants; sedatives, hypnotics, and anxiolytics; stimulants (including cocaine); and other (or
unknown) substances. Psychotic disorders can occur in association with withdrawal from the following classes of substances: alcohol; sedatives, hypnotics, and anxiolytics; and other (or unknown) substances.

Associated Features of Substance/Medication-Induced Psychotic Disorder

Prevalence of substance/medication-induced psychotic disorder in the general population is unknown. Between 7% and 25% of individuals presenting with a first episode of psychosis in different settings are reported to have substance/medication-induced psychotic disorder.

Prevalence of Substance/Medication-Induced Psychotic Disorder

Diagnostic Markers of Substance/Medication-Induced Psychotic Disorder

Substance/medication-induced psychotic disorder is typically severely disabling and consequently is observed most frequently in emergency departments, as individuals are often brought to the acute-care setting when it occurs. However, the disability is typically self-limited and resolves upon removal of the offending agent.

Functional Consequences of Substance/Medication-Induced Psychotic Disorder

The following list consists of possible diagnoses that may share the same symptoms with Substance/Medication-Induced Psychotic Disorder. 

- Substance Intoxication or Substance Withdrawal
- Independent Psychotic Disorder
- Psychotic Disorder due to Another Medical Condition
- Other Specified or Unspecified Schizophrenia Spectrum and Other Psychotic Disorder


Differential Diagnoses to Substance/Medication-Induced Psychotic Disorder

This includes the intersection of connections and/or research related to substance / medication-induced psychotic disorder as a in other fields of study and research. Such fields include:

- Behavioral Neuroscience
- Clinical Psychology
- Health Psychology


Interdisciplinary Connections & Research Related to Substance/Medication-Induced Psychotic Disorder

The initiation of the psychotic symptoms may vary considerably with the substance. Such variations in symptoms can be divided by the type of drug as described in the following categories:

- Alcohol 
- Amphetamine-type substances and Cocaine
- Cannabis
- Polypharmacy

Development and Course of Substance/Medication-Induced Psychotic Disorder


A. Presence of Delusions and/or Hallucinations.

B. There is evidence from the history, physical examination, or laboratory findings of both:

1. The symptoms in Criterion A developed during or soon after substance
intoxication or withdrawal or after exposure to or withdrawal from a
medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. 

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of  substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

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