Sandbox/JRH

Substance/Medication-Induced Psychotic Disorder

Synonyms and keywords: Medication induced psychotic disorder; substance induced psychotic disorder; substance-medication induced psychotic disorder;

Differential Diagnosis

• Alcohol withdrawal
• Brief psychotic disorder
• Cannabis intoxication
• Delusional disorder
• Flashback hallucinations
• Intoxication with stimulants
• Phencyclidine
• Schizophrenia
• Schizoaffective disorder
• Schizophrenia spectrum
• Delusional disorder
• Opioid meperidine

Epidemiology and Demographics

Prevalence

The prevalence of paranoid personality disorder is unknown of the overall population.

Risk Factors

• Cocaine usage
• Heavy and constant ingestion of alcohol
• History of psychopathic disorder

Natural History, Complications and Prognosis

Poor prognosis factors include:

• Depersonalization
• Flashbacks
• Hallucinations
• Marked anxiety
• Persecutory delusions

Diagnostic Criteria

• A. Presence of one or both of the following symptoms:

1. Delusions

2. Hallucinations

AND

• B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.

2. The involved substance/medication is capable of producing the symptoms in Criterion A.

AND

• C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:

The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).

AND

• D. The disturbance does not occur exclusively during the course of a delirium.

AND

• E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

Psychotic Disorder Due to Another Medical Condition

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Diagnostic Criteria

• A. The clinical picture is dominated by three (or more) of the following symptoms:

1. Stupor (i.e., no psychomotor activity; not actively relating to environment).
2. Catalepsy (i.e., passive induction of a posture held against gravity).
3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
5. Negativism(i.e., opposition or no response to instructions or external stimuli).
6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
9. Agitation, not influenced by external stimuli.
10. Grimacing.
11. Echolalia (i.e., mimicking another’s speech).
12. Echopraxia (i.e., mimicking another’s movements).

• B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

• C. The disturbance is not better explained by another mental disorder(e.g.,amanicepisode).

• D. The disturbance does not occur exclusively during the course of a delirium.

• E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

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Catatonic Disorder Due to Another Medical Condition

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Sleep-Related Hypoventilation

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Circadian Rhythm Sleep-Wake Disorders

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Non-Rapid Eye Movement Sleep Arousal Disorders

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Other Hallucinogen Use Disorder

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Hallucinogen Persisting Perception Disorder

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Other Hallucinogen-Induced Disorders

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Unspecified Phencyclidine-Related Disorder

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Stimulant Use Disorder

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Stimulant Intoxication

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Stimulant Withdrawal

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Other (or Unknown) Substance Use Disorder

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Other (or Unknown) Substance Intoxication

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Other (or Unknown) Substance Withdrawal

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Other (or Unknown) Substance-Induced Disorders

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Personality Change Due to Another Medical Condition

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Exhibitionistic Disorder

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Frotteuristic Disorder

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Other Specified Mental Disorder Due to Another Medical Condition

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