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.
