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.
