Prescription Drug-Induced Psychosis

Prescription drug-induced psychosis, also known as medication-induced psychosis, involves psychotic symptoms that occur directly from the use of a prescription drug.

It could happen from legal use of prescription drugs but is more likely to occur from drug misuse and abuse.

Psychosis is marked by delusions, hallucinations, or other forms of separating from reality. Prescription drug intoxication or withdrawal may cause these effects, yet a diagnosis of prescription drug-induced psychosis would be made only if the effects exceed those levels.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a tool used by professionals to diagnose mental health disorders, lists drug/medication-induced psychotic disorder as an official diagnosis.

Drug-induced psychosis is generally short-lived, yet its effects sometimes continue for an extended period of time. Even cases that quickly resolve benefit from treatment, while persistent cases may require more extensive treatment.

Substance-induced psychosis can happen with the use of over-the-counter drugs as well as illegal drugs, such as cocaine, but prescription drug-induced psychosis specifically refers to the use of prescription medications. It could accompany the use of:

• Amphetamines, stimulants prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy
• Methamphetamine, a stimulant prescribed for ADHD and limited weight loss cases
• Methylphenidate, a stimulant prescribed for ADHD and narcolepsy
• Opioids, narcotics prescribed for pain relief
• Barbiturates, sedative-hypnotics prescribed for insomnia, headaches, and seizures
• Benzodiazepines, sedative-hypnotics prescribed for anxiety, epilepsy, insomnia, and alcohol dependence
• Fluoroquinolones, antibiotics prescribed for respiratory infections, urinary tract infections, and other illnesses

The previous list is more commonly associated with psychosis, yet it may also happen from prescription:

• Corticosteroids
• Antidepressants
• Antiepileptic drugs
• Anticholinergic drugs
• Antipsychotics
• Isotretinoin
• L-dopa

Prescription drug use is not necessarily safe. Especially when prescription drugs are misused or abused, they can result in side effects, addiction, and other harmful consequences such as psychotic symptoms.

• In the U.S., 48.9 percent of people had used one or more prescription drugs in the last month, and 23.1 percent had used at least three. According to the 2016 National Survey on Drug Use and Health, 6.2 million Americans aged 12 and older (2.3 percent) misused a prescription drug in the last month.

• Using more than one type of drug can increase the risk of psychotic syndromes from substance use.
• A study compared 302 emergency department (ED) psychosis diagnoses with best-estimate longitudinal diagnoses (BELD) standards. It found that 25 percent of ED primary psychotic disorder diagnoses were classified as a substance-induced psychotic disorder or no psychotic disorder by BELD standards, and 21 percent of ED substance-induced psychotic disorder diagnoses had a primary psychotic disorder according to BELD.

Psychosis is not considered its own condition but is associated with the cause, which in this case is the use of a prescription drug. While psychosis itself is considered a symptom, certain symptoms are connected with psychosis and used to identify it.

Overall, psychosis is marked by experiences set apart from reality and could exhibit itself in these main symptoms:

• Delusions: The person has false beliefs, which can come from suspicions or fears. These could be paranoid delusions or delusions of grandeur.
• Hallucinations: The person may see, hear, feel, or otherwise experience things that are not real.
• Disordered thoughts: The person’s thinking may switch from topic to topic in a disordered, abnormal way that may not make sense.
• Disorganization: The person’s way of thinking, speaking, and behaving could be disorganized.
• Concentration problems: The person could have trouble focusing and concentrating.
• Catatonia: The person may be unresponsive.
• Changes in behavior or emotions: The person could become violent, have trouble expressing emotion, or show other emotional or behavioral changes.

It’s also possible to experience milder symptoms of psychosis. The person could have depression or anxiety, be obsessive or suspicious, have difficulty sleeping, and experience distorted perceptions.

Psychosis can present itself differently depending on the cause, so psychosis from schizophrenia may look different than that from substance use. The typical symptoms of substance-induced psychosis include visual hallucinations, disorientation, and memory problems. Nonetheless, the symptoms could vary based on the type of medication.

To be officially diagnosed with drug/medication-induced psychotic disorder, a person must meet the following criteria from the DSM-V:

• Delusions and/or hallucinations are more severe than drug intoxication or withdrawal symptoms.
• Schizophrenia and other mental health disorders with psychosis as a symptom have been ruled out as the cause.
• Evidence shows that the psychosis developed during use or within one month of stopping use of a substance associated with psychotic symptoms.
• Symptoms exist beyond a delirium episode.
• Symptoms cause a level of difficulty that interferes with the person’s ability to function.

It can be difficult to identify drug use as the definitive cause of psychosis, particularly in the emergency department or clinics where the medical professional is not given enough time to make a proper diagnosis. A person could have an early-phase psychotic disorder with a co-occurring substance use disorder rather than having substance-induced psychosis. A distinguishing sign of substance-induced psychosis is that the symptoms generally end after the cessation of substance use. However, it complicates matters that some drug-induced psychosis will continue for weeks, years, or even become permanent.

Causes and Risk Factors

Prescription drug-induced psychosis is caused by the use of prescription drugs. The cause would be intake of one or more prescription medications that are capable of producing psychotic symptoms. Also, it would be ruled out that the psychosis was coming from a different source, such as schizophrenia.

Certain risk factors may contribute to the development of medication-induced psychosis. These predictors include:

• Frequent, heavy, or ongoing use of prescription drugs
• Dependence on any type of drug
• Using drugs with a higher incidence of producing psychotic symptoms, such as methamphetamine and amphetamines
• Polydrug use, which is the use of more than one type of drug
• Previous psychiatric hospitalization
• Non-drug related hallucinations
• Substance abuse in parents

It is possible for someone with drug/medication-induced psychotic disorder to have one or more co-occurring disorders from a broad range of physical and mental conditions. If the person has a prescription for medication due to a medical condition, the psychotic disorder would co-occur with the medical condition.

Also, it is likely that the person has a co-occurring substance use disorder. The likelihood of both psychotic episodes and addiction increase with frequent, heavy, and ongoing drug use, so the two problems could develop and co-occur. A substance use disorder could be diagnosed for the drug causing the psychosis and/or for any other psychoactive substance the person uses.

Someone with medication-induced psychosis could also have a co-occurring mental health disorder, such as anxiety or depression. It is very common for people to have co-occurring substance use disorders and other mental disorders, and people often try to use substances as an unhealthy coping strategy for mental health symptoms.

However, if it is suspected that a person has schizophrenia or another mental disorder with psychosis as a symptom, medical professionals should assess whether this disorder is the true cause of the psychosis.

Prescription drug-induced psychosis will often resolve itself quickly after use of the drug is stopped. Initial treatment is generally focused on stabilizing the patient from the psychotic episode, which could take place through hospitalization or a detox program. In some cases, the person only requires a non-stimulating environment with observation to safely recover from the psychotic state. In other cases, antipsychotics or anxiolytic (anti-anxiety) drugs such as benzodiazepines may be used to facilitate recovery. Treatment plans tend to vary based on the type of prescription drug used and the symptoms the person exhibits.

However, recovering from medication-induced psychosis is not always fast or simple. For instance, psychosis from amphetamine use can last for weeks after cessation of the drug. Also, using a medication frequently or for an extended period of time can cause psychosis to continue for years. Even if the psychosis stops quickly, many people need additional treatment for substance abuse and mental health disorders.

Residential treatment could be beneficial to properly identify the cause of the psychosis and to screen for co-occurring disorders. Also, inpatient treatment can provide comprehensive and long-term programs that support a person in the difficult and ongoing process of learning to live without substance abuse. Treatment may include therapy, medication, relapse prevention, and other forms of support.

Prescription drug-induced psychosis will generally clear up so the person can return to normal. However, the prognosis improves for those who get treatment for associated substance use disorder and/or mental health disorders. Treating these problems reduces the risk of experiencing additional episodes of psychosis from continued substance use, helping the person have a healthier and more fulfilling life.

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