Galen Hope, like many mental health providers, has seen an increase in drug-induced psychosis among clients. For psychiatrists, it can be challenging to determine whether symptoms are caused by recent substance use or are part of a primary psychotic illness. In this guide, I review the difference between drug-induced psychosis vs. psychotic illness and how you can tell the difference.
Symptoms may include agitation, hallucinations, delusions, or paranoia, though the presentation can vary depending on the substance used. As cannabis-based products and other drugs have become more widely available and more potent over the years, the incidence of drug-induced psychosis has increased. Cannabis appears to be most associated with the development of a long-term psychiatric condition, specifically bipolar disorder or schizophrenia.
So how do you differentiate drug-induced psychosis from a psychiatric disorder? It’s not always clear, but there are several important factors to consider.
Key Takeaways
- Drug-induced psychosis can look similar to schizophrenia or bipolar disorder, making diagnosis challenging.
- Clues include functioning before symptoms, family history, and whether symptoms improve after stopping substances.
- Cannabis-induced psychosis carries a meaningful risk of progressing to a persistent psychotic disorder.
- Early, intensive intervention improves prognosis.
How to Differentiate Drug-Induced Psychosis From a Psychiatric Disorder
Clinicians often look at a few key contextual factors that help clarify whether psychotic symptoms are more likely substance-induced or part of an underlying psychiatric disorder.
1) What was the person’s level of functioning before symptoms began?
In drug-induced psychosis, the individual typically has not shown a noticeable change in:
Behavior, self-care, and interest in others. The symptoms may appear more “out of the blue.” In contrast, people who are developing schizophrenia, for example, often show changes before psychotic symptoms begin, such as: increased social isolation, negative changes in personal hygiene, confusion, and mood changes. Similarly, individuals who later receive a bipolar diagnosis may show: sleep changes, mood swings (including mania or depression), and behavior changes such as increased spending, hypersexuality, or being very talkative before the onset of psychotic symptoms.
2) Is there a family history of serious mental health conditions?
Does the individual have family members with serious mental health diagnoses, including conditions where psychosis can be a symptom? In general, research has found that people with drug-induced psychosis have little family history of schizophrenia and bipolar disorder.
3) Do symptoms improve after stopping substances?
One key question is whether symptoms are improving upon cessation of the drugs. Usually, drug-induced psychosis improves quickly, within hours to days. While it may take several weeks for someone to fully recover, there should be meaningful improvement relatively soon. In cases of schizophrenia or bipolar disorder, symptoms may persist for months.
Will Drug-Induced Psychosis Become Permanent?
It is common for clients and families to worry that symptoms will persist and become a more permanent condition. This concern is well founded. Approximately 25–50% of individuals with cannabis-induced psychosis (including traditional and synthetic cannabis) will transition to a diagnosis of schizophrenia or a persistent psychotic disorder. Factors that may influence this include:
- a person’s biology
- the length of substance abuse
- the potency of the drugs used
Research has also clarified that the substances themselves are related to the development of the psychotic disorder, suggesting these drugs may cause structural changes in the brain that can lead to psychosis.
When to Seek Help
If you or a loved one has recently experienced a psychotic episode, it is essential to reach out to a mental health professional immediately. Prognosis improves with early and intensive intervention.
At Galen Hope, we accept clients who are discharging or have recently discharged from an emergency psychiatric hospitalization for continuing care and stabilization from drug-induced psychosis.
About the Author
Amy Boyers, PhD is a licensed clinical psychologist and Co-Founder and President of Galen Hope, a behavioral health treatment center specializing in eating disorders and complex mental health conditions. With more than 20 years of experience, Dr. Boyers is a nationally recognized expert in eating disorder treatment, family involvement in care, and trauma-informed approaches to recovery.
Galen Hope has locations in South Florida and provides in-person programming for adolescents and adults of all genders.
For more information about Galen Hope, please call 866-304-2955 or visit www.galenhope.com.
Key Statistics:
- 4%: Reported conversion rate (in one large cohort) from cannabis-induced psychosis to schizophrenia or bipolar disorder.
- 34%: Pooled estimate (meta-analysis) for transition from cannabis-induced psychosis to schizophrenia.
- About 25%: Pooled transition rate from substance-induced psychosis to schizophrenia across substances (meta-analysis).
References:
- Starzer MSK, Nordentoft M, Hjorthøj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry.
- Murrie B, Lappin J, Large M, Sara G, et al. Transition of substance-induced, brief, and atypical psychoses to schizophrenia: A systematic review and meta-analysis. Schizophrenia Bulletin.
- Arendt M, Rosenberg R, Foldager L, Perto G, Munk-Jørgensen P. Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: Follow-up study of incident cases. Br J Psychiatry.
- 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). Lancet Psychiatry.
- Vassos E, et al. Substance-induced psychotic disorders and persistence beyond intoxication/withdrawal. Am J Psychiatry.