Substance-Induced Psychosis: A Diagnostic Conundrum
J Clin Psychiatry 2008;69(3):358-367
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To critically examine the DSM-IV-TR criteria for
substance-induced psychotic disorder (SIPD).
Data Sources: Leading electronic databases (such as MEDLINE,
PubMed) were searched for the years 1992 through 2007, using combinations of
the following key search terms: substance abuse/dependence, alcohol,
marijuana, cannabis, methamphetamine, crack,
cocaine, amphetamine, ecstasy, ketamine,
phencyclidine, LSD, mental health, drug-induced psychosis,
substance-induced psychosis, psychosis, and schizophrenia.
References identified from bibliographies of pertinent articles
and books in the field were also collected and reviewed.
Data Extraction: Only research studies or case reports/series
that presented data on populations diagnosed with SIPD by using clinical or
structured diagnostic interviews and that were published in English were used
to assess the validity of the current SIPD criteria.
Data Synthesis: We identified 49 articles that presented
clinical data on SIPD. Almost half of these publications were case reports,
with 18 articles specifically focusing on delineating the clinical
characteristics or outcomes of individuals diagnosed with SIPD. While several
large studies have recently been conducted to assess the stability of SIPD,
there is a dearth of research that rigorously examines the validity of DSM-IV
diagnostic criteria across substances.
Conclusions: There remains a striking paucity of information
on the outcome, treatment, and best practice for substance-associated psychotic
episodes. Further work is clearly required before the advent of DSM-V. We
propose an alternative, broader classification that better reflects the current
evidence base, inferring association rather than causation.