Psychotic symptoms, particularly delusions and hallucinations, can result from a wide variety of substances, including alcohol, amphetamines, marijuana, cocaine, hallucinogens, inhalants, opioids, phencyclidine, and certain sedatives and anxiolytics.

Diagnosis

The diagnosis is made when symptoms begin during or < 1 mo after intoxication with or withdrawal from the implicated substance and after other psychotic disorders are ruled out. Because symptoms may overlap with brief psychotic disorder, schizophreniform disorder, and acute episodes of psychotic mania or schizophrenia, differentiating these conditions may be difficult. Diagnosis may require several days of observation.

Treatment

• Symptomatic

Treatment may vary depending on the drug involved. Hallucinogen and phencyclidine psychosis may not respond well to antipsychotics. A supportive approach is preferred, with reassuring, structured, and protective surroundings. Agitation may be best treated with short-acting benzodiazepines, such as lorazepam given po or IM.

Last full review/revision June 2008 by Juan R. Bustillo, MD