Substance-Induced
Psychotic Disorder (SIPD) displays psychotic symptoms (hallucinations
not recognized by the individual as substance-induced, or delusions).
In order to justify this diagnosis if they, the psychotic symptoms,
must occur within a month after substance intoxication or withdrawal,
or as a result of medication that caused the symptoms. However, the
diagnosis is not made if the symptoms occurred before the substance
or medication was ingested, or are more severe than could be reasonably
caused by the amount of substance involved. If the disorder persists
for more than a month after the withdrawal of the substance, the diagnosis
becomes increasingly questionable, and a diagnosis of Schizophrenia,
or the existence of a medical condition, becomes more plausible. Many
medications and drugs of abuse, including alcohol, can cause psychotic
symptoms upon intoxication and/or withdrawal. Characteristic symptoms
included:
Two (or more) Criterion A ( active phase ) symptoms of the following,
each present for a significant portion of time during a 1-month period:
Delusions.
Hallucinations.
Disorganized Speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Negative symptoms, i.e., affective flattening, alogia, or avolition.
Note: Only one
Criterion A symptom is required if delusions are bizarre or hallucinations
consist of a voice keeping up a running commentary on the person's
behavior or thoughts, or two or more voices conversing with each other.
For a significant portion of the time since the onset of the disturbance,
one or more major areas of functioning such as work, interpersonal
relations, or self-care are markedly below the level achieved prior
to the onset.
Continuous signs of the disturbance persist for at least 6 months.
This 6-month period must include at least 1 month of symptoms that
meet Criterion A.
If mood episodes have occurred during Criterion A symptoms, their
total duration has been brief relative to the duration of the active
and residual periods.
The disturbance is not due to the direct physiological effects of
a substance (e.g., a drug of abuse, a medication) or a general medical
condition.
If there is a history of Autistic Disorder or another Pervasive Developmental
Disorder, the additional diagnosis of Schizophrenia is made only if
prominent delusions or hallucinations are also present for at least
a month.
Associated
Features:
May have a previous
history of drug abuse..
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Schizoaffective
Disorder.
Mood Disorder With Psychotic Features.
Major Depressive, Manic, or Mixed
Episodes.
Schizophrenia.
Cause:
Substance induced.
Treatment:
Treatment involves relieving
the intoxicated condition under careful medical observation to control
withdrawal symptoms, or medical management of a continuing withdrawal
process or, if the condition was produced by the effects of a medication,
withdrawal of the medication or reduction of the dose under close
medical supervision. If these treatments are not successful, the diagnosis
likely changes to primary psychosis.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Drug counseling
and supportive therapy may be beneficial. Cognitive-Behavioural therapy,
for treating delusions that is based on persistent gentle discussions
about evidence for the belief, might help overcome the problem the
person has with believing this substitution al delusion against the
available evidence.
