Substance-induced psychotic disorder

Boutros NN and Bowers MB (1996). Chronic substance-induced psychotic disorders State of the literature. Journal of Neuropsychiatry and Clinical Neurosciences, 8, 262-269. 

Substance-induced Psychotic Disorder. Nearly every psychiatrist has had the... 

Various other psychotic disorders, such as brief psychotic disorder, delusional disorder, shared psychotic disorder, substance-induced psychotic disorder, and psychotic disorder not otherwise specified (94)... 

Substance-induced delirium Substance-induced psychotic disorder Substance-induced mood disorder Substance-induced persisting amnestic disorder Substance-induced anxiety disorder... 

Most inhalants or volatile substances are solvents, but the DSM-IV-TR text attributes only five of the eight disorders associated with inhalants to solvents substance-induced psychotic disorder, anxiety disorder, delirium, persisting amnestic disorder, and symptoms of dementia. The association of solvents with dementia is more controversial than their association with mood disorders, but DSM-IV-TR does not recognize mood disorder resulting from solvent exposure. These inconsistencies probably reflect incomplete fidelity between the literature and the psychiatric nosology rather than current opinion. 

Substance-induced (i.e., drug-induced) psychotic disorders... 

Those disorders that require the presence of psychosis (Table 10—1) as a defining feature of the diagnosis include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, and psychotic disorder due to a general medical condition. Disorders that may or may not have psychotic symptoms (Table 10—2) as an associated feature include mania and depression as well as several cognitive disorders such as Alzheimer s dementia. 

The antipsychotic medications tend to be effective in the treatment of psychotic symptoms, regardless of the disorder. They can be effective in substance-induced delusional disorders, delirium, schizophrenia, mania, delusional disorder, and so on. Standard antipsychotics tend to be much more effective for positive symptoms but do little to improve negative symptoms. The newer, atypical antipsychotics are more effective for negative symptoms although clearly not a panacea since they are successful in only about 30 percent of cases. 

DSM-IV-TR (American Psychiatric Association 2000) recognizes four disorders resulting from lead poisoning (Table 8-6). The lack of consistency between DSM-IV-TR disorders and the literature probably reflects a developing psychiatric nosology, not an absence of association. The literature supports inclusion of substance-induced psychotic and mood disorders and delirium in addition to the four already listed in DSM-IV-TR. 

DSM-IV-TR (American Psychiatric Association 2000) recognizes inhalant-, anesthetic-, and solvent-related disorders (Table 13-8). Anesthetics are associated with substance-induced anxiety disorder. Inhalant-related disorders include intoxication, delirium, persisting dementia, psychotic disorders with delusions or hallucinations, mood or anxiety disorders, and disorders not otherwise specified. Diagnosis depends on history or laboratory studies described earlier in this chapter. Physical signs such as deposits from inhalants around the mouth or nose or on hands and clothing may indicate recent use (Westermeyer 1987). Nasal membranes may be inflamed (Wester-meyer 1987). 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Psychotic Disorders Due to a Nonpsychiatric Medicai Condition or Substance-induced... 

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