Primary psychosis with comorbid drug abuse and drug-induced psychosis: Diagnostic and clinical evolution at follow up

Drugs and violence are often observed as bedfellows; both have been associated with psychosis but the nature and timing of their relationships remains unclear. As part of the UK Prisoner Cohort Study, Keers et al prospectively followed up 967 prisoners convicted of sexual or violent offences (about a quarter of whom had a psychotic illness) in the community after release. Schizophrenia was associated with greater rates of violence, but the risk was mediated by untreated psychosis or when presenting with persecutory delusions – and no other definable psychopathology. Interestingly, drug-induced psychosis did not increase the risk of violence per se, once the substance misuse itself was accounted for. Does treatment have an impact on risk of violence in a population-based sample of patients with psychosis? Fazel et al demonstrated reductions in violent crime in patients during the time they were prescribed antipsychotics. Interestingly, the rates of violent crime were also reduced in patients with bipolar disorder who received mood stabilisers. Therefore, in addition to the effects of antipsychotics and mood stabilisers on relapse rates, their potential effects on violence and crime could be used to make decisions about management for these groups of patients. There is a clearer need for the appropriate treatment of prisoners with psychotic illnesses if their risk of violence is to be moderated. Cannabis is one of the most commonly used social drugs worldwide; it increases risk of psychosis, but there has been little to offer pharmacologically to those dependent upon this most prevalent illicit drug, and various trials of mood stabilisers, antidepressants and α2 adrenergic agonists have generally been disappointing. Allsop et al evaluated the novel cannabis extract nabiximols, containing cannabidiol – which has been shown to attenuate paranoia and euphoria – and tetrahydrocannabinol, delivered as a buccal spray. The active drug group showed statistically significant benefits in reduced withdrawal irritability, depression and cravings and remained longer in treatment. However, both placebo and drug groups showed reduced cannabis use at follow-up, with placebo being as effective as nabiximols in promoting longer-term cessation.

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the Effect of Drug Abuse on the Duration of Acute Hospitalization in Schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(09)71383-5 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M.D. Ortega ◽

N. Jimeno ◽

M.L. Vargas

Keyword(s):

Drug Abuse ◽

Length Of Stay ◽

Regression Model ◽

Drug Users ◽

Clinical Status ◽

Significant Risk ◽

Drug Induced ◽

Acute Hospitalization ◽

Drug Induced Psychosis ◽

The Moment

Aims:Drug-induced psychosis and drug abuse/dependence in schizophrenia are new clinical problems due to the increasing prevalence of drug consumption in this population. the objective is to know if the abuse/dependence of illegal drugs may influence the duration of acute hospitalization in schizophrenia.Method:It was conducted a retrospective cohort study on a sample of 256 acute hospitalizations of patients with schizophrenia and related disorders in Valladolid (Spain) between 2004 and 2006. at the moment of admission 82 patients had active drug abuse/dependence and 174 did not. A Cox proportional-hazards regression model was constructed considering drug abuse/dependence as predicting factor and length of stay as result variable.Results:The mean length of stay was 12.2 days (SD= 7.5) in the group without drug abuse/dependence and 7.7 days (SD= 29.0) in the drug group (means difference p=0.05). When abuse/dependence of drugs is present, the risk of discharge at any moment during the hospitalization increases in 34% (p=0.04). When Global Assessment of Functioning at the moment of admission is included in the regression model, the results remain significant (risk 35%, p=0.047). Clinical status at discharge was significantly better for the drug users group. Drug users were more frequently at his/her first hospitalization (58.2% versus 35.2%; p=0.001).Conclusion:In schizophrenia, abuse/dependence of drugs is associated with a 34% lower duration of acute hospitalization. This fact might be due to a relevant proportion of drug-induced psychosis who recovers earlier than idiopathic schizophrenia episodes.

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Drug Abuse and Psychosis: New Insights into Drug-induced Psychosis

Experimental Neurobiology ◽

10.5607/en.2017.26.1.11 ◽

2017 ◽

Vol 26 (1) ◽

pp. 11-24 ◽

Cited By ~ 13

Author(s):

Suji Ham ◽

Tae Kyoo Kim ◽

Sooyoung Chung ◽

Heh-In Im

Keyword(s):

Drug Abuse ◽

Drug Induced ◽

Drug Induced Psychosis

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Neuropsychology in the Differential Diagnosis of Dual Pathology: Schizophrenia and Drugs Abuse/Dependence

European Psychiatry ◽

10.1016/s0924-9338(09)70701-1 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

M.L. Vargas ◽

S. Lopez ◽

A.M. del Brio ◽

M.L. Fernandez ◽

M.A. Franco

Keyword(s):

Differential Diagnosis ◽

Drug Abuse ◽

Drug Users ◽

Verbal Learning ◽

Diagnostic Tools ◽

Control Group ◽

Drug Induced ◽

Dual Pathology ◽

Visual Spatial ◽

Drug Induced Psychosis

Aims:Dual diagnosis of schizophrenic disorders and drug abuse/dependence are increasing due to more frequent use of cannabis and cocaine. It is important to differentiate between primary schizophrenia with associate drug abuse/dependence and drug-induced psychosis. The objective is to detect neuropsychological differences between drug users and non-users in schizophrenia patients, which could be used as diagnostic tools.Method:We conduct one case-control study on 12 schizophrenia out-patients (10 male) with vital history of drug abuse/dependence (mainly cannabis and cocaine) and one control group of 18 schizophrenia out-patients (12 male) who never used illegal drugs (global age mean: 32.8 years; SD:7.2). It was applied one neuropsychological battery sensitive to the neuropsychological deficit frequent in schizophrenia: WAIS-III, BADS, WCST, Colour Trails, Trail Making A and B, BVRT, California Verbal Learning Test (spanish version: TAVEC). Variables was summarized determining Z values and principal components. It was constructed one Logistic Regression Model to determinate the better predicting model of drug use state.Results:The resultant model included two predictors: WAIS Perceptive Organization Index and Trails Component. The prediction formula for Ln Odd Ratio of drug abuse/dependence group is: -13.83 + 1.09 (Trails Z score) + 0.16 (WAIS Perceptive Organization Index). It explains for 63% of the variance (p = 0.001). The ROC curve for using in diagnose was constructed.Conclusion:Neuropsychological diagnosis can contribute to the differential diagnosis of schizophrenia in dual pathology. The better functioning in visual-spatial tasks increases the probability of psychosis related with drugs use.

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Stability of the diagnosis of first-episode drug-induced psychosis

The Psychiatrist ◽

10.1192/pb.bp.110.032524 ◽

2011 ◽

Vol 35 (6) ◽

pp. 224-227 ◽

Cited By ~ 4

Author(s):

Aravind Komuravelli ◽

Rob Poole ◽

Robert Higgo

Keyword(s):

Mental Health ◽

First Episode ◽

Clinical Implications ◽

Psychiatric History ◽

Schizophreniform Disorder ◽

Drug Induced ◽

Functional Psychosis ◽

Drug Induced Psychosis ◽

The Stability

Aims and methodTo assess the stability of the diagnosis of first-episode drug-induced psychosis over a follow-up period of at least 2 years. Patients with no psychiatric history who had been discharged from in-patient care between January 2002 and April 2006 with a firm diagnosis of drug-induced psychosis were identified. Follow-up information for at least the next 2 years or until discharge from mental health services was collected retrospectively from psychiatric records.ResultsNearly all of the patients who remained under psychiatric follow-up had a change in diagnosis, most commonly to a schizophreniform disorder. Those who were retained in follow-up had significantly longer index admissions than those discharged to primary care (P = 0.05).Clinical implicationsThis study suggests that many individuals diagnosed with drug-induced psychosis are further diagnosed as having a functional psychosis, usually schizophreniform in nature. This is compatible with the suggestion that individuals diagnosed with drug-induced psychosis are experiencing either the effects of drug intoxication or an ordinary functional psychosis complicated by incidental drug use.

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Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis

Schizophrenia Bulletin ◽

10.1093/schbul/sbz102 ◽

2019 ◽

Vol 46 (3) ◽

pp. 505-516 ◽

Cited By ~ 5

Author(s):

Benjamin Murrie ◽

Julia Lappin ◽

Matthew Large ◽

Grant Sara

Keyword(s):

Meta Analysis ◽

Diagnostic Methods ◽

Rural Setting ◽

Drug Induced ◽

Not Otherwise Specified ◽

Substantial Risk ◽

Psychiatric Intervention ◽

Drug Induced Psychosis ◽

Primary Predictor

Abstract Some people who experience substance-induced psychosis later develop an enduring psychotic disorder such as schizophrenia. This study examines the proportion of people with substance-induced psychoses who transition to schizophrenia, compares this to other brief and atypical psychoses, and examines moderators of this risk. A search of MEDLINE, PsychINFO, and Embase identified 50 eligible studies, providing 79 estimates of transition to schizophrenia among 40 783 people, including 25 studies providing 43 substance-specific estimates in 34 244 people. The pooled proportion of transition from substance-induced psychosis to schizophrenia was 25% (95% CI 18%–35%), compared with 36% (95% CI 30%–43%) for brief, atypical and not otherwise specified psychoses. Type of substance was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (6 studies, 34%, CI 25%–46%), hallucinogens (3 studies, 26%, CI 14%–43%) and amphetamines (5 studies, 22%, CI 14%–34%). Lower rates were reported for opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up. Substance-induced psychoses associated with cannabis, hallucinogens, and amphetamines have a substantial risk of transition to schizophrenia and should be a focus for assertive psychiatric intervention.

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First-episode drug-induced psychosis: a medium term follow up study reveals a high-risk group

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-008-0490-2 ◽

2009 ◽

Vol 44 (9) ◽

pp. 710-715 ◽

Cited By ~ 27

Author(s):

Kathleen Crebbin ◽

Emma Mitford ◽

Roger Paxton ◽

Douglas Turkington

Keyword(s):

High Risk ◽

Risk Group ◽

High Risk Group ◽

First Episode ◽

Medium Term ◽

Drug Induced ◽

Follow Up Study ◽

Drug Induced Psychosis

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Treatment of Drug-Induced Psychosis with Diphenylhydantoin†

Canadian Psychiatric Association Journal ◽

10.1177/070674377602100811 ◽

1976 ◽

Vol 21 (8) ◽

pp. 565-569

Author(s):

O. I. Ifabumuyi ◽

J. J. Jeffries

Keyword(s):

Drug Abuse ◽

Antiepileptic Drugs ◽

Epileptiform Activity ◽

Multiple Drug ◽

Drug Induced ◽

Hallucinogenic Drugs ◽

Eeg Recordings ◽

Drug Induced Psychosis

Summary This paper introduces an alternative to the major tranquilizers in the treatment of acute psychotic breakdown following multiple drug abuse. All the patients described had been taking hallucinogenic drugs for over five years. Only three of several successfully treated cases are described. Two of these cases were followed by EEG recordings, which did not show any localized epileptiform activity. The response to diphenylhydantoin is described both clinically and as recorded by EEG. An initial two-week period is necessary in order that the effects of the drugs can be demonstrated clinically or on EEG tracing. It cannot be concluded from this that the antiepileptic drugs are the drugs of choice in drug-induced psychosis; but, diphenylhydantoin has shown dramatic effectiveness in these previously refractory cases. In view of the response, some abnormal cerebral discharge from an as yet undiscovered locus may be involved in the pathogenesis of drug-induced hallucinations.

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