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Block 4 Unit 4 Substance Induced Psychotic Disorder

1. Describe in detail the various psychotic disorders.

• Schizophrenia is a severe psychotic disorder where people may experience hallucinations, delusions and believe that others are controlling their minds.
• Delusional disorder involves persistent delusions without other psychotic symptoms.
• Schizoaffective disorder is characterised by the presence of both a mood episode and the active phase symptoms of schizophrenia.
• Brief Psychotic disorder must last for more than one day and goes away by one month.
• Shared psychotic disorder is where an individual has delusions that have been influenced by someone else who has similar delusions.
• Substance induced psychotic disorders are caused by substance use.

2. Define substance-induced psychotic disorders.

• Substance-induced psychotic disorders are characterised by prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance, such as a drug of abuse, a medication, or toxin exposure.
• These symptoms arise in association with intoxication or withdrawal states.
• Hallucinations that the individual recognises as substance-induced are not classified as part of this disorder but are instead diagnosed as substance intoxication or withdrawal with accompanying specifiers.

3. What are the criteria to diagnose substance-induced psychotic disorders?

• Substance-induced psychotic disorders arise only in association with intoxication or withdrawal states.
• The psychotic symptoms must be judged to be in excess of those usually associated with the intoxication or withdrawal syndrome.
• The symptoms should be sufficiently severe to warrant independent clinical attention.
• The symptoms may persist for weeks.

4. Describe the essential features of substance-induced psychotic disorders.

• Essential features include prominent hallucinations or delusions that are judged to be due to the direct physiological effects of a substance (a drug of abuse, a medication, or toxin exposure).
• The symptoms are a direct result of the physiological effects of the substance.
• If an individual recognises that their perceptual disturbances are substance-induced, and they have not lost their reality testing, it is not considered a substance-induced psychotic disorder.

5. Differentiate between substance-induced psychotic disorder and other psychotic disorders.

• Onset: Substance-induced disorders begin following the ingestion of a substance, whereas other psychotic disorders have an insidious onset or develop over time and are not related to substance use.
• Course: Substance-induced disorders are associated with drug intake and may disappear after the withdrawal period. Other psychotic disorders are not linked to drug use.
• Relationship to substance use: Substance-induced disorders are directly related to the use of substances. Other psychotic disorders do not have any association with drug or intoxication or withdrawal.
• Persistence: The psychotic symptoms in a substance induced disorder can persist as long as substance use continues.

6. What are the methods used in diagnosing substance-induced psychotic disorders?

• Diagnosis involves assessing the consistency of symptoms. If the symptoms are more exaggerated than expected for a particular substance, it may indicate a psychiatric disorder.
• A family history of mental illness may suggest a psychiatric disorder.
• The patient's stated reason for substance use is important. Those with a primary psychiatric diagnosis may indicate they "medicate symptoms," for example, using stimulants to combat depression.
• Neuropsychological tests can be used to assess cognitive abilities such as speed of information processing, attention, memory, and language.
• The diagnosis should be made after ruling out other causes of the symptoms, including substance intoxication and withdrawal and other medical conditions.

7. Differentiate between substance-induced and medicine-induced psychotic disorders.

• The distinction is made based on whether the psychotic symptoms are due to a drug of abuse, a medication, or toxin exposure.
• A diagnosis of Substance-Induced Psychotic Disorder should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the psychotic symptoms are more severe than usually associated with the intoxication or withdrawal syndrome and when the symptoms are severe enough to require independent clinical attention.
• If a person experiences altered perceptions from a drug, but recognises these as drug-induced, and their reality testing remains intact, then it is not diagnosed as Substance-Induced Psychotic Disorder, but as Substance Intoxication or Withdrawal, With Perceptual Disturbances.
• Flashback hallucinations from hallucinogen use are diagnosed as Hallucinogen Persisting Perception Disorder.

8. Discuss the various treatment approaches to substance-induced psychotic disorder.

• Treatment is determined by the underlying cause and severity of the symptoms.
• Treatment includes hospitalisation and antipsychotic medication, similar to the treatment for primary psychotic disorders such as schizophrenia.
• A multidisciplinary approach is considered most effective, with detoxification, physical rehabilitation, control over drug-abuse behaviour, and development of individual coping mechanisms for living without drugs.
• Psychotherapy, including both group and individual therapy, has also proven effective. Group therapy can help patients connect with others with similar problems, share experiences, and learn from one another. Therapies include 12-step programs, rational-emotive therapy, cognitive behaviour therapy, and family therapy.
• Medications, such as antipsychotics like risperidone or haloperidol, and anticonvulsants like carbamazepine, may be used. Benzodiazepines should be avoided as they can worsen respiratory depression.
• Patients should be evaluated for other psychiatric illnesses using DSM-IV-TR once detoxified. Depression independent of substance abuse should be treated with an antidepressant.

9. How do we prevent this substance induced psychotic disorder from manifesting?

• Abstaining from drugs and alcohol or using these substances only in moderation would clearly reduce the risk.
• Taking medication under the supervision of a trained physician reduces the likelihood of medication-induced disorders.
• Reducing one's exposure to toxins would also reduce the risk of toxin-induced psychotic disorders.

10. Define and describe substance-induced psychotic disorders.

• Substance-induced psychotic disorders are characterised by hallucinations or delusions directly caused by a substance (drug of abuse, medication, or toxin).
• The symptoms arise during intoxication or withdrawal and the symptoms are more severe than would be expected from the substance alone.
• If the individual recognizes the symptoms are caused by the substance, then it is not a substance-induced psychotic disorder, but rather substance intoxication or withdrawal with perceptual disturbance.

11. Discuss how substance-induced disorder can be caused?

• Substances like amphetamines, phencyclidine, and cocaine can cause psychotic reactions.
• Psychoactive substances can induce or exacerbate psychotic states.
• Drugs of abuse, such as alcohol, marijuana, hallucinogens, inhalants, and opioids can cause substance-induced psychotic disorders.
• Prescription medications and over-the-counter medications including anesthetics, analgesics, anticonvulsants and antidepressants can cause psychotic symptoms.

12. What are the causes of these disorders?

• Substance-induced psychotic disorders are caused by the direct physiological effects of substances.
• These substances can include drugs of abuse, medications, or toxins.
• The symptoms must occur during intoxication or withdrawal from the substance.

13. Discuss critically the various treatments available for this disorder.

• Treatments include hospitalisation, medication, and psychosocial support.
• A multidisciplinary approach is preferred that also includes detoxification, physical rehabilitation and substance abuse control.
• Medications such as antipsychotics and anticonvulsants may be used.
• Psychotherapies such as cognitive behaviour therapy, family therapy and group therapy are used.

14. What are the subtypes and specifiers? Discuss.

Subtypes and Specifiers of Substance-Induced Psychotic Disorder

Specifiers are used to provide more context for the psychotic symptoms, such as:

• With Hallucinations: This specifier is used if hallucinations are the predominant symptom.
• With Onset During Intoxication: This specifier is used if the symptoms develop during the intoxication phase, meaning that the criteria for intoxication with the substance are met.
• With Onset During Withdrawal: This specifier is used if the symptoms develop during or shortly after a withdrawal syndrome, meaning that the criteria for withdrawal from the substance are met.

15. Discuss hospitalisation and medical care as important methods of treatment of this disorder.

Hospitalisation and Medical Care for Substance-Induced Psychotic Disorder

• Hospitalisation:

  • Hospitalisation is a restrictive form of treatment, and patients may be admitted on a voluntary or involuntary basis.
  • It is considered when patients are delirious, suicidal, homicidal, or gravely disabled.
  • The aim of hospitalisation is to prevent harm to the patient or others, and to provide a safe environment for medication administration and stabilisation.
  • Hospitalisation is ideally part of a comprehensive range of services and is used after other less restrictive treatments have failed.

• Medical Care:

  • Medical care involves a team of professionals who work together to ensure all aspects of the treatment plan are fulfilled.
  • This care often includes evaluating patients for psychiatric comorbidity.
  • Medical care also includes interventions like motivating patients to seek detoxification, educating patients about psychiatric and addictive illnesses, and providing support for recovery.
  • It also involves referring patients for other services (medical, social, vocational and economic).
  • Additionally, medical care helps patients increase self-awareness, identify problems, improve problem-solving abilities, develop recovery coping skills, and facilitate pharmacotherapy.

• Specifics

  • In the case of hallucinogen or phencyclidine-induced psychosis, antipsychotics may not be effective, and supportive care is preferred, using short-acting benzodiazepines for agitation.

• Once a patient is detoxified, they should be evaluated for other psychiatric illnesses using the DSM-IV-TR.

16. What is the prognosis of this disorder?

Prognosis of Substance-Induced Psychotic Disorder

• Symptom Resolution: Depressive or manic symptoms induced by substance intoxication usually subside once the substance responsible is eliminated from the body.
• Duration of Symptoms: The duration that symptoms persist depends on the half-life of the substance, meaning that symptoms can last for hours, days, or weeks after the substance is last used.
• Persistent Symptoms: In some cases, symptoms induced by substances may not disappear, even after the substance is eliminated. In these situations, more intensive treatment including a combination of medication and behavioural therapy will be necessary.
• Variability: Substance-induced psychotic disorders can vary, with some resolving quickly after the substance is removed, while others may persist for longer.

17. Define subtypes of substance-induced psychotic disorder?

Definition of Subtypes of Substance-Induced Psychotic Disorder