Substance-related exogenous psychosis: a postmodern syndrome

Abstract

There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). Within this diagnostic category, we refer to both transientand persistent psychoses associated with substance use. SREP is conceived as a distinct psychoticdisorder with psychopathological specificities that clearly differentiate it from schizophrenia. We address differences in terms of clinical presentation, epidemiology, etiological models and treatment response. SREP is characterized by altered states of consciousness, persecutory delusions, visual and cenesthetic hallucinations, impulsivity and psychomotor agitation, affectiveand negative symptoms, a pervasive feeling of unreality and intact insight. Delusions are typically secondary to abnormal perception resulting from a characteristic “sensorialization” of the world. Longitudinal studies are warranted to substantiate our hypothesis of a novel diagnostic categoryand support the clinical validity of SREP. This may have important implications in terms of early differential diagnosis and staging (i.e., between comorbid conditions, persistent and transientsubstance-related psychotic states) as well as choice of treatment interventions.

Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others–A Perspective of German Addiction Medicine Experts

“…Therapeutically used drugs such as non-opioid analgesics, methylphenidate, and opioids were estimated to be on the whole to be the least harmful at present. Such relative safety perception however is certainly subject to change should misuse and abuse patterns change over time (45).…”

Prescription Drug Misuse in “Clubbers” and Disco Goers in Ibiza

“…(46%) declared to have used a substance without knowing what it was at least once in their life. These results will be described in a separate manuscript (31). In our sample, 37 patients (40%) disclosed a lifetime misuse of prescription drugs.…”

“…Their effects and related risks are often unknown to both users and health professionals, due to the scarcity of evidence-based information regarding their toxicological profiles and to the ever-changing nature of this market (7,(26)(27)(28). Nevertheless, growing evidence reported potential acute and chronic psychiatric risks associated to NPS consumption, including confusion; paranoid thoughts; auditory and visual hallucinations; dissociation; delusions of reference, persecution, grandeur, and jealousy; cognitive impairment; hypomanic states; aggressiveness and irritability; violence; and suicidal thoughts (8,(29)(30)(31).…”

Club Drugs: Psychotropic Effects and Psychopathological Characteristics of a Sample of Inpatients

“…The delusions reported are similar to paraphrenic delusions, with a feeling of unreality, while the ability to analyze the feeling is preserved. In this regard, the model of the Lysergic Psychoma could be an interesting proposal (14). As already highlighted by previous studies (47), relevant symptoms were also inherent to the sphere of affectivity, both in the direction of positive and negative polarity.…”

“…Nevertheless, growing evidence supports the possibility of significant psychiatric and physical consequences related to NPS consumption ( 13 , 14 ). Recently, researchers have reported that NPS consumption may be associated with the onset of a variety of psychiatric symptoms and conditions, including confusion, paranoid thoughts, auditory and visual hallucinations, dissociation (e.g., derealization and somatopsychic depersonalization), insomnia, chronic cognitive impairment and delusions of reference, persecution, grandeur and jealousy, as well as hypomanic states, aggressiveness and irritability, violence, and suicidal thoughts ( 15 – 17 ).…”