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Drug-induced psychosis — Clinical Guidelines

Overview

Drug-induced psychosis refers to the onset of psychotic symptoms, such as hallucinations or delusions, that are directly attributable to the use or misuse of certain medications or substances 2. These symptoms can occur with both prescription and over-the-counter (OTC) drugs 2.

Diagnosis

Management

Antipsychotic medications are used to treat psychosis 3.

Cariprazine has demonstrated efficacy in treating acute psychosis, regardless of the primary psychiatric diagnosis, and may be useful at the beginning of treatment for schizophrenia or bipolar disorder 3.

Long-acting injectable (LAI) antipsychotics may be considered for patients with schizophrenia, potentially addressing adherence issues 1.

Adjunctive pharmacological interventions may be necessary to manage antipsychotic-induced weight gain in patients with schizophrenia 4.

Misuse of OTC medications, including antihistamines, cough medicines, and decongestants, has been associated with the risk of developing psychotic symptoms 2.

Special Populations

Key Recommendations

Early treatment of psychotic illness with antipsychotic medications improves outcomes and reduces relapse rates 3. (Evidence: Strong)

Cariprazine is significantly superior to placebo for acute psychosis, independent of the primary psychiatric diagnosis 3. (Evidence: Strong)

Long-acting injectable antipsychotics are associated with a lower risk of all-cause mortality compared to oral antipsychotics in patients with schizophrenia 1. (Evidence: Strong)

References

1 Aymerich C, Salazar de Pablo G, Pacho M, Pérez-Rodríguez V, Bilbao A, Andrés L et al.. All-cause mortality risk in long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis. Molecular psychiatry 2025. link 2 Mosca A, Chiappini S, Mancusi G, Miuli A, Marrangone C, Allegretti R et al.. Over-the-counter Psychosis: A Systematic Review of the Misuse of Antihistamines, Cough Medicines, and Decongestants and the Risk of Developing Psychosis. Current neuropharmacology 2025. link 3 Generoso MB, Taiar I, Cordeiro Q, Shiozawa P, Kasper S. Cariprazine for treating psychosis: an updated meta-analysis. International journal of psychiatry in clinical practice 2023. link 4 Agarwal SM, Stogios N, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H et al.. Pharmacological interventions for prevention of weight gain in people with schizophrenia. The Cochrane database of systematic reviews 2022. link 5 Ayenew W, Asmamaw G, Bitew T. Antipsychotic Polypharmacy Among Patients With Schizophrenia in Africa: A Systematic Review and Meta-Analysis. The international journal of neuropsychopharmacology 2021. link 6 Oh H, Jang SK, Lee HS, Lee EB, Choi KH. Personality Traits in Individuals with the Dual Diagnosis of Psychosis and Substance Use Disorders: A Comprehensive Review and Meta-Analysis. Journal of dual diagnosis 2021. link

Drug-induced psychosis