The document discusses psychosis, characterized by hallucinations and delusions, often linked with mental illness or substance use. Various drugs, including recreational and prescription medications, can induce or exacerbate psychotic symptoms, with treatments involving cessation of drug use and potential psychiatric intervention. The DSM-V criteria for drug-induced psychotic disorder is outlined, emphasizing the importance of proper diagnosis and management of symptoms.

1. PRESENTED BY,
VISHWANATH GOUDA
1ST M.PHARM
PHARMACY PRACTICE

2. PSYCHOSIS
Psychosis is a condition characterized by delusions and
hallucinations, and is commonly associated with mental
illness.
 Delusions occur when a person believes something outside of
what is really going on despite any external argument or
contradiction to such beliefs.
 Hallucinations are perceptions (primarily visual and
auditory, but sometimes tactile and scents) of things that
aren't actually present.

3. Examples of Psychotic Symptoms
Hallucinations
 Auditory: Hearing internal or external voices. Sometimes the
voices may be arguing with each other or may tell the person what
to do.
 Visual: Seeing things that aren't really there. For example:
shadows, people, or other perceptual abnormalities.
 Tactile: Feeling sensations that aren't really occurring. For
example: feeling bugs crawling on the skin.
 Olfactory: Smelling an odour around you that cannot be confirmed
by others.

4. Delusions
 Erotomanic: A person will believe someone (usually a famous
person) is in love with him/her. Stalking is not uncommon in
these cases.
 Grandiose: A person with delusions of grandeur will have an
over-inflated sense of self-worth and power. He may believe he
has some special type of talent or has made a grand discovery.
 Jealousy: These delusions usually involve believing that a
spouse or significant other has cheated even if there is no
evidence this is the case.

5.  Persecution: A person with persecution delusions may
believe someone (often an authority figure) is spying on
them and planning to do harm.
 Somatic: A somatic delusion occurs when a person believes
he has a health problem, or some other bodily complaint,
when no real symptoms are present.

6. Other symptoms of psychosis may include:
 Disorganized speech.
 Incoherent thoughts.
 Lethargy.
 Emotional changes (lack of emotion, difficulty expressing
emotion, etc.).
 Antisocial behaviour.
 Erratic behaviour (sometimes violent and/or dangerous).

7. Drugs That Can Cause Psychosis
 Many recreational and prescription drugs can induce psychotic
symptoms that can mimic serious psychiatric disorders.
 Drug induced psychosis is also known as substance induced
psychotic disorder, is simply any psychotic episode that is
related to the abuse of an intoxicant
 It associated with suicidal thoughts, dangerous and violent
behaviour, hospitalization, and arrests.

8.  This can occur from taking too much of a certain drug
having an adverse reaction, during withdrawal from a
drug, or if the individual has underlying mental health
issues.

9. SYMPTOMS OF DRUG INDUCED PSYCHOSIS
 Changes in emotion, no emotional response, difficulty in
expressing feeling, flat effect (appearance or no emotional
expression)
 Lethargy, lack of motivation
 Socially withdrawn
 Incoherence in thought and actions, disorganised speech
 Violent behaviour, erratic, sometimes dangerous actions

10. ALCOHOL
 Alcohol is one of the most commonly abused substances
among individuals with schizophrenia
 Alcohol can cause delusions, mental confusion,
disorganized speech, and disorientation.

11.  Alcohol abuse can cause psychosis but typically only after
days or weeks of intense use.
People who have a chronic alcohol abuse problem that has
lasted for several years are also vulnerable to intense
paranoia and hallucinations.
This occurs due to the damaging effects of alcohol on the
brain over time and due to a lack of thiamine (a vitamin B
complex) in the body that can lead to Wernicke-Korsakoff
syndrome.

12. BENZODIAZEPINES
 Both benzodiazepines and barbiturates - causing
psychotic symptoms in the event of overdoses as well
as during withdrawal.
 Benzodiazepines are preferred for patients with severe
anxiety.

13.  The onset of withdrawal symptoms in patients physically
dependent on the long-acting benzodiazepines can be delayed
up to 7 days after discontinuation of the drug.
 A common approach in detoxification of such patients is to
initiate treatment at usual dosages (chlordiazepoxide orally
50 mg three times a day; lorazepam orally 2 mg three times a
day) and to maintain the initial dosage for 5 days, with
gradual tapering over an additional 5 days.

14. Symptoms are:
 Restlessness
 Akathisia
Anxiety
 Blurred vision
 Chest pain

15. CNS STIMULANTS
METHAMPHETAMINE
 The use of methamphetamine can lead to paranoia, persecution
delusions, and auditory and visual hallucinations.
 One common hallucination is the feeling of bugs crawling on one's
skin.
 These symptoms might subside after stopping use, but they can
also persist for weeks or longer, and may increase one's
susceptibility for developing future psychosis.
 Even after long periods of abstinence, psychotic symptoms may
return in periods of stress

16. COCAINE
 Up to 50% of cocaine users will show some symptoms of
psychosis after use. The risk increases with needle or
freebased use.
 Persecution, delusions and tactile hallucinations are
common. Psychotic symptoms can persist days, months,
and sometimes years after use has stopped.

17.  Cocaine psychosis can occur in the powdered cocaine user
and the crack cocaine smoker. It may be more common
among crack users but when a person gets his hands on a
large quantity of powdered cocaine and binges non-stop for
days, psychosis becomes a common symptom.
 Paranoia is a common symptom that accompanies heavy
cocaine abuse.

18. AMPHETAMINE
 Amphetamine can cause psychotic symptoms similar to
methamphetamine and cocaine after repeated use.
 Symptoms includes: lack of concentration, delusions of
persecution, increased motor activity, disorganization of
thoughts, lack of insight, anxiety, suspicion and auditory
hallucinations.

19.  Amphetamines are highly addictive drugs.
 Both amphetamine and methamphetamine act directly on the
mesolimbic dopaminergic “reward system” by inducing
release of dopamine, and to some extent norepinephrine, in
the synaptic clefts of the Nucleus Accumbens (NAc) and other
terminal areas provoking a euphoric state, but also addiction.

20. CLUB/RECREATIONAL DRUGS (E.g., ECSTASY)
 Ecstasy can cause psychotic symptoms, antisocial behaviour,
and panic attacks. Persistent psychosis has been reported after
a single use in some people.
HALLUCINOGENS
KETAMINE
 Ketamine users typically exhibit a variety of symptoms that
mimic psychosis including delusions, cognitive impairments,
disordered thinking, and incoherent.

21. Already have schizophrenia or a mental illness tend to
experience more severe psychotic episodes after ingesting
even subanesthetic doses of ketamine.
It is believed that ketamine impacts both glutamatergic
and dopaminergic function to provoke psychosis.

22. LSD ((Lysergic acid diethylamide)
 Episodes of LSD-induced psychosis are subject to significant
individual variation.
 It is characterized by delirium, while others are more similar to
schizophrenia.
 Deficient levels of CNS serotonin (i.e. low serotonin) may be a
causative factor.
 A serotonin precursor (L-5-hydroxytrptophan) was administered
and successfully treated symptoms of a LSD-psychosis.

23. PCP (Phencyclidine)
High doses and/or use PCP over a long-term may be more
likely to become psychotic.
PCP psychosis was characterized more by: delusions of
physical power, sensory alterations, time distortion, and
bizarre experiences (e.g. out-of-body experiences – as
opposed to suspiciousness and paranoia.

24. INHALANTS
Butane
 It can cause severe psychotic episodes even among
individuals with no previous psychiatric illness.
It is more common among those that abuse butane,
especially those that use it regularly over an extended time
span.
Butane-induced psychosis could produce symptoms such as:
violence, persecutory delusions, and visual hallucinations

25. OPIOIDS
 opioid psychosis is associated with opioid abuse and/or
opioid withdrawal. It alter dopaminergic processing,
which contributes to psychotic episodes.
 Nalbuphine shows psychotic symptoms, it is treated with
administration of Naloxone.
 It is characterized by delirium

26. OVER-THE-COUNTER DRUGS (OTC)
 Various over-the-counter (OTC) medications have been
associated with psychotic symptoms when taken at
supratherapeutic doses.
ANTIHISTAMINES
individuals either taking the antihistamines as supratherapeutic
levels (e.g. way too much) or taking antihistamines in
conjunction with another substance. Abusing antihistamines
for a “high” or taking them at extremely high doses may
provoke psychotic symptoms.

27.  Diphenhydramine
 Pheniramine
 Promethazine
 Symptoms of an antihistamine psychosis often include both
auditory and visual hallucinations.
 It can be mitigated with administration of physostigmine
salicylate.
 This drug rapidly crosses the blood-brain barrier and functions
as a reversible acetylcholinesterase inhibitor, thus increasing
levels of acetylcholine to decrease psychotic symptoms.

28.  Dextromethorphan (DXM)
Abusing cough syrup (with DXM) may experience
psychotic episodes.
Symptoms associated with DXM-induced psychosis
include: bizarre feelings, dissociation, and paranoia.
DXM-psychosis occurs as a result of its serotonergic and
opioidergic effects.

29. Prescription Drugs
Anticholinergics
 Anticholinergic agents have a tendency to cause psychotic
episodes, when ingested at high dosages.
 Two common anticholinergic drugs linked to psychosis include:
Atropine and Scopolamine.
 It successfully treat by administering Physostigmine, which acts as
an acetylcholinesterase inhibitor.
 By administering an acetylcholinesterase inhibitor, acetylcholine
levels increase, which counteracts the effect of the anticholinergic
drugs.

30. Symptoms include:
restlessness, excitement, hallucinations, elevated mood, disorientation,
stupor, and possibly coma.
ANTIEPILEPTICS
 It elicit psychotropic effects via alterations in GABAergic
neurotransmission.
 phenytoin (PHT) or zonisamide (ZNS) were more likely to experience
psychosis than other drugs.
 Additionally those that experienced complex partial seizures and had a
low level of intelligence were more likely to develop psychosis.

31.  Corticosteroids
Those utilizing corticosteroids like Prednisone may
experience psychotic episodes.
low levels of complement proteins, and low creatinine may
also be influential factors.
symptoms subsided upon discontinuation, followed by re-
administration of prednisone at smaller increments of
dosing (2.5 mg/day).

32. Decarboxylase Inhibitors
 Those that have Parkinson’s disease are commonly prescribed L-
Dopa to increase low dopamine levels.
 most people tolerate L-Dopa well, some individuals end up
experiencing psychosis as a result of the dopaminergic increase.
 Those that experience psychosis from L-Dopa (levodopa),
Lodosyn (carbidopa), or dopamine agonists may experience a
variety of symptoms including: paranoia, agitation,
hallucinations (particularly visual), as well as delusions.

33.  Seroquel have been administered at low doses with success for
treating levodopa-induced psychosis.
FLUOROQUINOLONES
It is antibiotics that are associated with causing damage to the
CNS and in some cases, irreversible psychotic episodes.
 Most people treated with fluoroquinolones do not experience
psychosis, but it is important to be aware of adverse reactions
and the potential for permanent neurological changes as a result
of treatment.

34.  Ciprofloxacin
 Enoxacin
 Gatifloxacin
 Levofloxacin
 Moxifloxacin
 Pefloxacin
 Sparfloxacin

35.  The drug most commonly linked to psychotic episodes is
that of Ciprofloxacin.
It is inhibit binding of GABA to the GABA receptors,
leaving the nervous system in an excitatory state.
It can be mitigated via medication discontinuation or
taking the minimal effective dose.
 Symptoms are: Dizziness, restlessness, Hallucinations,
Anxiety.

36. MARIJUANA
 Psychosis induced purely by cannabis is rare.
 However, anyone can have a psychosis on marijuana if
they ingest a large enough amount.
 Two ingredients in marijuana have opposite effects on
certain regions of the brain.
 One chemical, tetrahydrocannabinol (THC), increases
the brain processes that can lead to symptoms of
psychosis.

37.  While another compound, cannabidiol, may negate such
symptoms.
 Symptoms of psychosis includes:
- Hallucinations: auditory, visual, olfactory, tactile and taste
- Delusions: fixed false belief (grandiose, paranoid)
- Bizarre behaviours and thoughts

38. DSM-V Criteria for Drug/Medication-Induced Psychotic Disorder
 The symptoms are not better explained by a psychotic disorder
(schizophrenia, bipolar, etc.) that is not medication induced.
 Evidence from medical examination, lab results, and patient history
that psychotic symptoms developed during substance use, or within
one month of withdrawal from a substance known to cause
psychotic symptoms.
 Presence of delusions and/or hallucination

39. • Psychotic symptoms do not occur only during an episode of
delirium.
 Symptoms are causing significant distress and/or impairment in
one's daily life and ability to function.

40. Treatment for Drug-Related Psychosis
First, the patient must stop using the drug.
If symptoms continue, and the patient feels
he is a threat to himself or those around him
Medically assisted detox may be needed for some
patients.

41. Psychiatric hospitalization in an inpatient facility is a common
treatment regimen for severe psychotic symptoms.
Antipsychotic medication is often prescribed.
Outpatient treatment may include medication, and
individual and group therapy.

42. REFERENCES
 Tackett B. DRUG INDUCED PSYCHOTIC SYMPTOMS. Mar.
14,2016.
 How Marijuana may drive the brain into psychosis.
LIVESCIENCE. Jan.3, 2012.

43. THANK YOU