Drug abuse psychosis

Question 1

What suggests that psychosis is drug induced

Answer 1

• Non-auditory hallucinations (seeing things) (90% = drug induced)
• Hx
• Severity of symptoms
• Drug-seeking behaviour
• Physical examination
• Blood + urine tests
• Imaging

Question 2

What components of the Hx and severity of symptoms suggests drug induced psychosis

Answer 2

• Hx = Be precise about timing. If more >4wks have elapsed between abuse and psychosis unlikely to be drug induced
• Severity of symptoms = If symptoms are severe and only a small amount of drug was taken, unlikely to be drug induced

Question 3

What components of the physical examination suggest drug induced psychosis

Answer 3

• Track marks
• Cellulitis
• Spider naevi, Dupuytren’s contracture (alcohol misuse)

Question 4

What components of the blood/urine test and imaging suggests drug induced psychosis

Answer 4

• Blood/urine = Raised MCV + Raised GGT (alcohol abuse)

- Imaging = Esp. if elderly + no Hx of drug abuse brain tumour

Question 5

What age is drug induced psychosis most likely to present

Answer 5

Middle age (CNS condition is also more likely)

Question 6

What must the patient do for a diagnosis of drug induced psychosis to be made

Answer 6

Interact with the hallucinations as if they were real

Question 7

If a patient is not interacting with hallucinations as though they were real what could the diagnosis be

Answer 7

• Flashbacks (past but no current exposure to hallucinogens)

- Substance intoxication or withdrawal

Question 8

Trigger for non-auditory hallucinations

Answer 8

-Darkness
-Fatigue
-Stress
All with previous drug misuse