Substance-induced psychosis: differential diagnosis

Abstract

Substance-induced psychosis (SIP) is a mental condition that develops as a result of alcohol or drug use. Can be defined by psychotic symptoms: visual hallucinations, memory problems, delusions, and disorganized behavior, that occur during or shortly after the use of a psychoactive substance. The literature review was performed using PubMed, Medline, analyzing articles and official sources, like DSM-V and ICD-11. Studies comparing SIP with schizophrenia (SZ) or bipolar disorder (BD) were included. SIP typically presents with acute onset, close temporal association with substance use (e.g., Cannabis sativa), and symptom resolution upon abstinence, which help differentiate it from primary psychoses. Large registry studies report 6-year cumulative transition rates of 27.6% for SZ spectrum disorders and 4.5% for BD, indicating that most SIP cases remain transient. Higher transition rates to SZ were observed in younger men and in cannabis- (36.0%) or polysubstance-induced (32.0%) cases, while alcohol-induced cases had the lowest risk (13.2%). Transition to BD was generally lower (4.5%) and higher among women (7.1%) than men (3.5%). Diagnostic indicators for SZ included formal thought disorder (OR = 3.55) and bizarre delusions (OR = 6.09), whereas features such as suicidal ideation, intravenous cocaine use, history of detoxification, and methadone maintenance were more characteristic of SIP. These results underscore that SIP is a heterogeneous condition, and assessment of symptom temporality, substance type, and specific psychotic features is crucial for accurate differential diagnosis from primary psychotic disorders.