MHM: Substance-Induced Psychosis (Part I) - The Emergency Medical Minute

MHM: Substance-Induced Psychosis (Part I)


Substance-Induced Psychosis (Part I)

In this first episode of a two-part mini-series, we feature Dr. Nadia Haddad, a Colorado psychiatrist, and Dr. Ricky Dhaliwal, an emergency medicine physician, as they discuss the different substances that cause psychosis and their unique presentations in the ED and in the psychiatric world. First, Dr. Haddad establishes a medical definition of psychosis. Then, Dr. Haddad and Dr. Dhaliwal partake in a fruitful discussion, each providing their unique perspective on the drugs that affect our patient populations today.

 

Key Points:

 

  • Psychosis is a cognitive processing disorder, which leads to auditory hallucinations, visual hallucinations, and delusions.
  • Axis one psychosis like that from schizophrenia or mania typically produces auditory hallucinations, not visual hallucinations. Delusions are also common in underlying psychiatric psychosis. 
  • One of the most common substances that cause psychosis today is methamphetamine. Meth-induced psychosis can mimic schizophrenia symptoms, though tactile hallucinations are very common with methamphetamine use. 
  • Methamphetamine is active for up to about 8 hours but can vary depending on underlying mental health predispositions, which can be exacerbated for several days or a week before neurotransmitters right themselves after meth use. 
  • Cannabis can lead to psychosis and paranoia for people – especially young people – with a predisposition to schizophrenia or bipolar.
  • Alcohol-related psychosis comes primarily from withdrawal, though acute alcohol intoxication may cause mild alcoholic hallucinosis. 
  • The hallmark of delirium tremens is a fluctuating, waxing-and-waning consciousness, which can occur 72 hours after the last drink. DTs can occur after treatment of the physical withdrawal symptoms.
  • Alcohol withdrawal can occur even at high BALs relative to a patient’s baseline.
  • Cocaine psychosis is similar to methamphetamine-induced psychosis.

Recorded, Summarized, and Edited By: Jorge Chalit

 

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