Managing drug-induced psychosis

Int Rev Psychiatry. 2023 Aug-Sep;35(5-6):496-502. doi: 10.1080/09540261.2023.2261544. Epub 2024 Feb 1.


Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with cannabis users and those with early-onset substance abuse at the highest risk.

Keywords: Drug-induced psychosis; bipolar disorder; psychotic disorders; risk; schizophrenia.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents* / adverse effects
  • Bipolar Disorder* / diagnosis
  • Humans
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / drug therapy
  • Psychotic Disorders* / etiology
  • Schizophrenia* / drug therapy
  • Schizophrenia* / etiology
  • Substance-Related Disorders* / complications
  • Substance-Related Disorders* / drug therapy


  • Antipsychotic Agents