Substance-Induced Psychoses: An Updated Literature Review

Background: On the current psychopharmacological panorama, the variety of substances able to provoke an episode of acute psychosis is rapidly increasing. Such psychotic episodes are classified according to the major category of symptoms: positive, negative, or cognitive psychotic episodes. On one hand, the abuse of methamphetamines, cannabis, and cocaine plays a big role in increasing the incidence of episodes resembling a psychotic disorder. On the other hand, the progress in terms of pharmacodynamics knowledge has led to the synthesis of new drugs, such as cannabinoids and cathinone's, which have rapidly entered into the common pool of abusers' habits. Regarding these newly synthesized substances of abuse, further clinical studies are needed to understand their psychogenic properties. The topic of this review is complicated due to the frequent abuse of psychotomimetic drugs by patients affected by psychotic disorders, a fact that makes it extremely difficult to distinguish between an induced psychosis and a re-exacerbation of a previously diagnosed disorder.Methods: The present narrative review summarizes results from clinical studies, thus investigating the psychotogenic properties of abused substances and the psychotic symptoms they can give rise to. It also discusses the association between substance abuse and psychosis, especially with regards to the differential diagnosis between a primary vs. a substance-induced psychotic disorder.Findings: Our findings support the theory that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and addiction. Of note, from a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.

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Pharmacological approaches to treatment

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0054 ◽

2020 ◽

pp. 487-495

Author(s):

Stefan Leucht ◽

Andrea Cipriani ◽

Toshi A. Furukawa

Keyword(s):

Psychotic Disorder ◽

Mechanism Of Action ◽

Pharmacological Treatment ◽

Antipsychotic Drugs ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Dopamine Antagonists ◽

Partial Agonists ◽

The Common

Antipsychotic drugs should be efficacious for all psychotic symptoms, whether they occur in schizophrenia, depression, mania, or any other psychotic disorder. All currently marketed antipsychotic drugs are dopamine antagonists or partial agonists, making the role of dopamine blockade in this context the most likely mechanism of action. Antipsychotics show efficacy in treatment and in maintenance across the common psychosis diagnoses, especially when looking across large metanalyses. Yet, there is an important imbalance as to how well the pharmacological treatment of the different psychotic disorders have been addressed in the literature, with schizophrenia being predominant.

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Frontal Lobe Epilepsy Presenting as a Psychotic Disorder With Delusions and Hallucinations: A Case Study

CNS Spectrums ◽

10.1017/s1092852900012207 ◽

1999 ◽

Vol 4 (9) ◽

pp. 64-66,82 ◽

Cited By ~ 4

Author(s):

Bonnie J. Ramsey

Keyword(s):

Temporal Lobe Epilepsy ◽

Frontal Lobe ◽

Psychotic Disorder ◽

Temporal Lobe ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Frontal Lobe Epilepsy ◽

Unique Case ◽

Frontal Lobe Seizures

AbstractAlthough psychotic symptoms are a recognized manifestation of epilepsy, these are more often associated with seizures of the temporal lobe type. While 10% of children with temporal lobe epilepsy develop a psychotic disorder by adulthood, the literature does not report any cases of psychotic disorders associated with frontal lobe seizures in children. This article presents a unique case of a girl whose frontal lobe seizures were associated with delusional psychotic symptoms. Once her seizure disorder was identified through electroencephalography (EEG) and appropriate anticonvulsant therapy was initiated, her associated psychotic symptoms resolved.

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Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

Psychological Medicine ◽

10.1017/s0033291720004444 ◽

2021 ◽

pp. 1-11

Author(s):

Andrea A. Jones ◽

Kristina M. Gicas ◽

Sara Mostafavi ◽

Melissa L. Woodward ◽

Olga Leonova ◽

...

Keyword(s):

Risk Factors ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Community Sample ◽

Dynamic Networks ◽

Premature Mortality ◽

Psychotic Symptoms ◽

Network Measures ◽

History Of ◽

Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

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Pathological laughing and psychotic disorder: the medical evaluation of the Joker

Acta Neurologica Belgica ◽

10.1007/s13760-020-01332-3 ◽

2020 ◽

Vol 120 (6) ◽

pp. 1379-1382

Author(s):

Alexis Demas ◽

David Tillot

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Social Withdrawal ◽

Neuropsychiatric Symptoms ◽

Public Health Problem ◽

Psychotic Symptoms ◽

Left Frontal Lobe ◽

Physically Abused ◽

Medical Evaluation ◽

Origin Story

Abstract In the psychological thriller film Joker, released in 2019 and starring Joaquin Phoenix in the first role, another possible origin story for this iconic character is reported. Above all, it brings us medical elements for the understanding of the development of this complex character. Contrary to other interpretations, we discover a lonely, timid and uncharismatic man (Arthur Fleck). He seems to be suffering from psychobehavioral disorders and seems depressed. There is a strangeness in his behavior along with social withdrawal. He suffers from fits of laughter that occur at socially inappropriate times. He also suffers from psychotic symptoms with visual delusions. We learn through the film that he was a beaten child, psychologically and physically abused with severe traumatic brain injury (TBI). The uncontrollable outbursts of laughter, behavioral and psychotic disorders followed these elements. As a neurologist, I was intrigued by these symptoms. I have explored the neuropsychiatric symptoms complicating TBI from which he seems to suffer and which have been reported in the literature. We can assume that the Joker is suffering from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe. The movie Joker has medical significance and covers social aspects of medicine and health care. First, it allows us to discuss whether psychotic disorder due to TBI should be considered a neurobiological syndrome. More broadly, albeit fictitious, it asks us about the management of patients with neuropsychiatric illness, which is a public health problem. It also reminds us that semiological descriptions of patients with neuropsychiatric disorders have served as inspiration for many authors.

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Clinical analysis of the case of the psychotic disorder due to the combined abuse of psychoactive substances

Ukrains'kyi Visnyk Psykhonevrolohii ◽

10.36927/2079-0325-v27-is4-2019-19 ◽

2019 ◽

Author(s):

Lyudmyla Yuryeva ◽

Viktor Kokashynskyi ◽

Tetiana Rachynska

Keyword(s):

Substance Abuse ◽

Psychotic Disorder ◽

Clinical Picture ◽

Psychotic Disorders ◽

Bipolar Affective Disorder ◽

Synthetic Cannabinoids ◽

Clinical Analysis ◽

Psychoactive Substances ◽

Second Generation Antipsychotic ◽

Mental And Behavioral Disorders

The clinical and social pathomorphism of mental and behavioral disorders due to the use of psychostimulants and cannabinoids actualized the problem of diff erential diagnosis and therapy of these patients. The most popular among young people are cannabinoids (including synthetic cannabinoids), psychostimulants and hallucinogens. In clinical practice, intoxication psychoses are more and more common due to the use of psychoactive substances, often occurring as schizophrenic-like disorders, which entails the diffi culties of diff erential diagnosis with endogenous disorders. The relevance of the "problem of psychotic potential" of psychostimulants is also due to the discussion about the advisability of medical use of cannabinoids in a number of serious diseases. The article describes the clinical picture and dynamics of the development of psychotic disorder due to the combined (cannabinoids, psychostimulants, hallucinogens) substance abuse. The presented clinical analysis and diff erential diagnosis between psychotic disorders due to substance abuse with schizophreniform symptoms and psychoses of endogenous origin (schizophrenia, bipolar affective disorder. The relevance of this case is the similarity of the clinical picture with endogenous disorders and the resulting diagnosis difficulties, differential and treatment of these disorders. The article discusses aspects of the use of second-generation antipsychotic drug olanzapin (Egolanza) in the treatment of psychotic disorders of exogenous etiology. Key words: cannabinoids, psychostimulants, hallucinogens, diff erential diagnosis of intoxication and endogenous psychoses, psychotic disorder, dependence on psychoactive substances, therapeutic tactics, olanzapine

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M92. THE OVERLAP BETWEEN PSYCHOTIC SYMPTOMS, SUBSTANCE USE, AND ADVERSITY HISTORY: A SYSTEMATIC REVIEW

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.404 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S169-S170

Author(s):

Victoria Patterson ◽

Alissa Pencer ◽

Philip Tibbo

Keyword(s):

Systematic Review ◽

Substance Use ◽

Adverse Event ◽

Adverse Events ◽

Psychotic Disorder ◽

Substance Misuse ◽

Psychotic Disorders ◽

Treatment Options ◽

Psychotic Symptoms ◽

History Of

Abstract Background Research has found that adversity and substance use individually influence the onset of psychosis and its clinical outcomes, though there has been little examination of a potential three-way interaction. An estimated 30–75% of individuals with psychosis have experienced at least one adverse event that predates their psychotic symptoms, and substance misuse is estimated to exceed 55% in individuals with psychosis. The current systematic review is the first attempt to review the temporal ordering of adversity, psychosis, and substance misuse, as well as examining the effect of type (e.g., type of adversity, type of substance) on the association between these variables. Methods Following PRISMA guidelines, a comprehensive search strategy and review of studies against strict inclusion and exclusion criteria was completed. Studies published between 2000 and 2020 were included from PsycINFO, PubMed, CINAHL, EMBASE, Scopus, Web of Science, and the grey literature. Inclusion criteria, all of which must be met within a single study, included a diagnosed psychotic disorder, experiencing at least one adverse event, and current or past problematic substance use (i.e., substance misuse). High-risk and prodromal studies were excluded. We used search term combinations such as (schizophrenia OR schizoaffective) AND (adversity or trauma OR abuse) AND (“substance abuse” OR cannabis OR cocaine). Results Our initial search found 7,183 papers examining psychotic disorders, substance misuse, and adversity. Preliminary results for included studies indicate that 13 studies met criteria for inclusion. Across studies, the prevalence of experiencing at least one adverse event ranged from 24.8 to 100%, with significant variation in rates among studies due to variance in definitions of adversity, instruments used, and types of adverse events assessed. It is noteworthy that people with a psychotic disorder and a substance use disorder experienced more adverse events compared to people with a psychotic disorder and no substance use disorder. Moreover, individuals with a psychotic disorder, substance misuse, and a history of adversity are more likely to experience reduced functional outcomes, lower rates of remission of psychotic symptoms, and increased post-traumatic stress symptoms and diagnoses. Across studies, adversity appeared to precede substance misuse, which preceded psychotic disorder onset. Discussion Our results suggest that individuals affected by psychotic disorders, substance misuse, and a history of adversity fare worse than those without a history of adversity, even once enrolled in a treatment program for psychosis. Moreover, adversity appeared to precede both substance misuse and psychotic disorders, however, the role of additional adverse events within this relationship was not well-studied and should be examined in the future. Findings suggest that assessing for substance use and a history of adversity within psychosis treatment programs is a critical first step in the recovery for people affected by these psychiatric comorbidities and specific treatment options addressing these factors would be critical for recovery. Moreover, treatment options should be capable of targeting maintenance mechanisms (e.g., avoidance, hopelessness) shared by all three constructs to provide an integrated treatment approach.

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From Speech Illusions to Onset of Psychotic Disorder: Applying Network Analysis to an Experimental Measure of Aberrant Experiences

Schizophrenia Bulletin Open ◽

10.1093/schizbullopen/sgaa025 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Lindy-Lou Boyette ◽

Adela-Maria Isvoranu ◽

Frederike Schirmbeck ◽

Eva Velthorst ◽

Claudia J P Simons ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Clinical High Risk ◽

Cross Sectional ◽

Affective Symptoms ◽

The Eu

Abstract Aberrant perceptional experiences are a potential early marker of psychosis development. Earlier studies have found experimentally assessed speech illusions to be associated with positive symptoms in patients with psychotic disorders, but findings for attenuated symptoms in individuals without psychotic disorders have been inconsistent. Also, the role of affect is unclear. The aim of this study was to use the network approach to investigate how speech illusions relate to individual symptoms and onset of a psychotic disorder. We estimated a network model based on data from 289 Clinical High-Risk (CHR) subjects, participating in the EU-GEI project. The network structure depicts statistical associations between (affective and all) speech illusions, cross-sectional individual attenuated positive and affective symptoms, and transition to psychotic disorder after conditioning on all other variables in the network. Speech illusions were assessed with the White Noise Task, symptoms with the BPRS and transition during 24-month follow-up with the CAARMS. Affective, not all, speech illusions were found to be directly, albeit weakly, associated with hallucinatory experiences. Hallucinatory experiences, in turn, were associated with delusional ideation. Bizarre behavior was the only symptom in the network steadily predictive of transition. Affective symptoms were highly interrelated, with depression showing the highest overall strength of connections to and predictability by other symptoms. Both speech illusions and transition showed low overall predictability by symptoms. Our findings suggest that experimentally assessed speech illusions are not a mere consequence of psychotic symptoms or disorder, but that their single assessment is likely not useful for assessing transition risk.

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Acute psychosis in an adolescent with cerebral palsy

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1229 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S348-S348

Author(s):

C.A. Moreira ◽

A.R. Soares ◽

G. Maia

Keyword(s):

Cerebral Palsy ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Inflammatory Diseases ◽

Clinical Investigation ◽

Female Adolescent ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Brief Psychotic Disorder ◽

Pubmed Search

IntroductionCerebral Palsy is a movement, posture or muscle toning disorder caused by an insult to the immature, developing brain, most often before birth. It is a leading cause for serious disabilities in childhood and a risk factor for the development of psychiatric disorders, particularly in adolescents. Moreover, according to DSM-5, a Brief psychotic disorder is a short-term illness with psychotic symptoms, which arise suddenly, but last for less than one month, after which the person recovers completely.Objectives/AimsThe authors aim to present a case of an adolescent with cerebral palsy who has developed secondary psychotic symptoms, a rare and sparsely understood phenomenon.MethodsA non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “Cerebral Palsy” and “Brief Psychotic Disorder”.ResultsA 16-year-old female adolescent with history of Cerebral Palsy (due to neonatal anoxia) was admitted in the paediatric ward due to behaviour disorder characterized by incoherent speech, full insomnia, agitation and auto/alo-aggression. A complete clinical investigation was performed, in which trauma, organic brain injury, degenerative and inflammatory diseases, infection or toxic ingestion were all excluded. The hypothesis of an acute psychotic disorder was considered and after antipsychotic treatment, a total remission of the symptoms was obtained.ConclusionsAlthough rare, the association between cerebral palsy and psychotic disorders should be considered in the diagnostic investigation of behavioural changes. Early identification allows a proper therapeutic intervention and a better quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Early intervention program for psychosis: Experience and results in a mental health center

European Psychiatry ◽

10.1016/s0924-9338(11)72868-1 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1163-1163

Author(s):

M.C. Campos Mangas ◽

M.A. Ruiz Feliu

Keyword(s):

Early Intervention ◽

Young People ◽

Psychotic Disorder ◽

Intervention Program ◽

Psychotic Disorders ◽

Mental Health Center ◽

Community Treatment ◽

Initial Assessment ◽

Psychotic Symptoms ◽

List Type

IntroductionThis program aims to assist young people aged 16 to 35 years at risk for or who have a severe mental disorder, a psychosis both affected and unaffected, according to the principles of early intervention and assertive community treatment.ObjectivesAssisting young people with psychosis in order to achieve symptomatic and functional recovery, return to provide standardized environment and prevent deterioration.MethodsInitial assessment is made and individualized plan of work.Inclusion criteria1.Diagnosis: substance-induced psychotic disorder, schizophrenia and other psychotic disorders, bipolar disorder and mood disorders with psychotic symptoms2.age: 16–35 years3.Informed consentEvaluation ToolsPANSS, SCIP, CDS, CGI-S, PAS, CAN, EU, SFS, GAF, WHOQUOL-BREF, IEQ-EU, UKU, HoNOS, CGI-IP, CGI-ICResultsThe sample consisted of 22 patients. 45.5% men and 54.5% women. Mean age 24 (SD = 4.74). Diagnosis: schizophrenia 54.5%, 27.3% acute psychotic disorder, 4.5% and 13.6% schizoaffective disorder manic episode with psychotic symptoms. Clinical stage at the beginning of the program: 45.5% stage 2, 4.5% stage 3a; 22.7% stage 3b, 3c stage 22.7% and 4.5% stage 4.ConclusionsIt is necessary to implement such programs to establish the treatment as soon as possible to the onset of the disease and improve prognosis.

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Resurrection of the Follow-Back Method to Study the Transdiagnostic Origins of Psychosis

Schizophrenia Bulletin ◽

10.1093/schbul/sbab008 ◽

2021 ◽

Author(s):

Jim van Os ◽

Annette Schaub ◽

William T Carpenter

Keyword(s):

High Risk ◽

General Population ◽

Psychotic Disorder ◽

Help Seeking ◽

Psychotic Disorders ◽

Common Mental Disorders ◽

Psychotic Symptoms ◽

Clinical High Risk ◽

Representative Cohort ◽

Representative Samples

Abstract There has been a major drive in research trying to understand the onset of psychosis. Clinical-high risk (CHR) studies focus on opportunistic help-seeking samples with non-psychotic disorders and a degree of psychosis admixture of variable outcome, but it is unlikely that these represent the population incidence of psychotic disorders. Longitudinal cohort studies of representative samples in the general population have focused on development and outcome of attenuated psychotic symptoms, but typically have low power to detect transition to clinical psychotic disorder. In this issue of Schizophrenia Bulletin, Cupo and colleagues resurrect a time-honored method to examine psychosis onset: the epidemiological follow-back study, modernizing it to fit the research framework of the early intervention era. The authors set out to investigate the hypothesis that psychotic disorder represents the poorest outcome fraction of initially non-psychotic, common mental disorders and present compelling findings, unifying previous opportunistic CHR and representative cohort-based work.

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