Abstract
Background: On the current psychopharmacological panorama, the variety of substances able to provoke an episode of acute psychosis is rapidly increasing. Such psychotic episodes are classified according to the major category of symptoms: positive, negative, or cognitive psychotic episodes. On one hand, the abuse of methamphetamines, cannabis, and cocaine plays a big role in increasing the incidence of episodes resembling a psychotic disorder. On the other hand, the progress in terms of pharmacodynamics knowledge has led to the synthesis of new drugs, such as cannabinoids and cathinone's, which have rapidly entered into the common pool of abusers' habits. Regarding these newly synthesized substances of abuse, further clinical studies are needed to understand their psychogenic properties. The topic of this review is complicated due to the frequent abuse of psychotomimetic drugs by patients affected by psychotic disorders, a fact that makes it extremely difficult to distinguish between an induced psychosis and a re-exacerbation of a previously diagnosed disorder.Methods: The present narrative review summarizes results from clinical studies, thus investigating the psychotogenic properties of abused substances and the psychotic symptoms they can give rise to. It also discusses the association between substance abuse and psychosis, especially with regards to the differential diagnosis between a primary vs. a substance-induced psychotic disorder.Findings: Our findings support the theory that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and addiction. Of note, from a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.
Highlights
In recent years, there has been a significant increase in interest in the relationship between cannabis use and psychosis, partly because of concerns related to the growing availability of cannabis and its potential risks to health and human functioning.Epidemiology Cannabis is the most widely used illicit substance in the world, with 6–7% of the population in Europe and 15.3% of the population in the USA using it each year [30]
Despite the effort in defining clear-cut criteria of substanceinduced psychosis, the results of the present review shows a picture of the complex relationship between psychotic symptoms and the use and abuse of illicit drugs
It is to note that Vallersnes et al [102], in the attempt of estimating the frequency of psychosis for different recreational drugs, found a prevalence of psychosis of 14.7% for amphetamine and 11.3% for methamphetamine, while collecting data of cases with acute toxicity induced by recreational drugs accessing the Emergency Departments (EDs)
Summary
There has been a significant increase in interest in the relationship between cannabis use and psychosis, partly because of concerns related to the growing availability of cannabis and its potential risks to health and human functioning.Epidemiology Cannabis is the most widely used illicit substance in the world, with 6–7% of the population in Europe and 15.3% of the population in the USA using it each year [30]. Indigenous people of South America have chewed the leaves of a plant (i.e., Erythroxylon coca) which is packed with plenty of alkaloids, including cocaine, isolated only in 1855 by Friedrich Gaedcke, who called such compound “erythroxyline” [80] Epidemiology It is well-known that cocaine use is associated with various mental disorders [81, 82] and that its consumption may lead to both transient psychotic symptoms [23, 24, 83, 84] and a complete induced psychosis [85]. Plenty of findings prove that illicit substances (i.e., cannabinoids, cocaine, amphetamines, and hallucinogens) have psychotomimetic properties [3, 4] That is, their use can induce transient psychotic symptoms due to acute. This could possibly be a subtle conundrum and a chance for elucubration, yet it becomes greatly important when treating and choosing the best therapeutic strategy for patients
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