Psychosis Among Substance Users

Jagadisha Thirthalli; Vivek Benegal


Curr Opin Psychiatry. 2006;19(3):239-245. 

In This Article


Studies on cocaine abusers in clinical settings report that more than half of such individuals experience paranoia and hallucinations.[43,44,45] Even in community samples, the rates of psychotic experience are comparable.[46*] Among patients who attend psychiatric emergency services, nonschizophrenic cocaine abusers are reported to have as severe hallucinations as schizophrenic patients who do not abuse cocaine.[47] Believing that their drug-using behaviour is being watched and they are being followed, hallucinations, in keeping with these delusions, are typical of cocaine-induced psychosis. This is so typical that it may be used as an important tool to differentiate it from schizophrenia. Presence or absence of Schneiderian first-rank symptoms can be another differentiating point between the two.[48]

Those who develop psychosis with cocaine are likely to be men, have a greater duration and amount of use,[49] have greater psychosis proneness[50] and have a lower body mass index.[51] Intravenous abusers have more paranoia and hallucinations than nonintravenous abusers.[46*,49] This may, however, just be a reflection of greater levels of cocaine use rather than the effect of the route of administration.[46*] Cocaine-induced psychosis shows sensitization - psychosis becomes more severe and occurs more rapidly with continued cocaine use.[43,45] Interestingly, sensitization occurs only with psychosis and not with other effects of cocaine.[44] Cocaine abusers who experience sensitization to psychotogenic properties of cocaine seem to have less naturally occurring craving and are likely to reduce their cocaine and other substance use.[52*] Unlike with cannabis and amphetamines, reports of cocaine being aetiologically linked to chronic psychosis are very rare.[53,54]


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