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

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..

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.

[DSM-5-TR] Diagnostic Criteria of Substance/Medication-Induced Psychotic Disorder

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.

Michigan State University

The DSM-5-TR separates Schizophrenia and Other Psychotic Disorders into the following specific disorders and groups:

- Schizotypal (Personality Disorder)
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Schizoaffective Disorder
- Substance/Medication-Induced Psychotic Disorder
- Psychotic Disorder Due to Another Medical Condition
- Catatonia*
- Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
- Unspecified Schizophrenia Spectrum and Other Psychotic Disorder


[DSM-5-TR] List of Schizophrenia Spectrum and Other Psychotic Disorders

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

A personality disorder characterized by: 
- Various oddities of thought, perception, speech, and behavior that are not severe enough to warrant a diagnosis of schizophrenia

Symptoms may include:
- Perceptual distortions
- Magical thinking
- Social isolation 
- Vague speech without incoherence
- Inadequate rapport with others due to aloofness or lack of feeling
- Symptoms not because of schizophrenia, other psychotic disorder, or ASD

Schizotypal Personality Disorder

Previously referred to as paranoid disorder, delusional disorder is characterized by an inability to recognize reality from false beliefs called delusions. It occurs more often in middle age or later in life. This disorder is diagnosed when someone holds one or more non-bizarre delusions as truth for a month or more. These delusions cannot be sourced from culture or other causes. Symptoms include irritability and hallucinations.  

Delusional Disorder

A sudden and temporary display of psychotic behavior, and can be triggered by extreme stress and trauma. This episode lasts less than a month, and is followed by complete remission, though future relapses are possible. 

Brief psychotic disorder

Schizophreniform disorder is a psychotic disorder that affects action, thought, relationship with others, emotional expression, and reality perceived within one to six months lasting duration.

Schizophreniform Disorder

Schizophrenia is a severe psychological disorder that leads to a profound breakdown in an individual's ability to function, often necessitating hospitalization. It is characterized by significant disruptions in thought, perception, emotion, and behavior, including symptoms like hallucinations, delusions, incoherent thinking, bizarre actions, flat emotions, and a lack of motivation for basic activities. It is important to distinguish schizophrenia from dissociative identity disorder ('split personality'), as the term 'schizophrenia' refers to a 'splitting of psychic functions,' not a divided personality.

Schizophrenia

An uninterrupted illness featuring at some time a major depressive episode, manic episode, or mixed episode concurrently with characteristic symptoms of schizophrenia (e.g., delusions, hallucinations, disorganized speech, catatonic behavior) and, in the same period, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. DSM–5 identifies the mood episodes only as either major depressive or manic and emphasizes that mood disturbances must be present for a majority of the time.

Schizoaffective Disorder

Substance/Medication-Induced Psychotic Disorder

This condition is when hallucinations and delusions occur are physiologically caused by a separate medical condition. Psychosis appears outside states of delirium as well. The disorder significantly interferes with major areas of life.

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