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Epidemilogy and Diagnosis of Substance Induced Psychosis

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Epidemilogy and Diagnosis of Substance Induced Psychosis EPIDEMILOGY AND DIAGNOSIS OF SUBSTANCE INDUCED PSYCHOSIS Jassin M. Jouria, MD Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e- module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT When patients present with signs of psychosis, it is critical that health clinicians are able to properly assess and determine root cause. A diagnosis of substance-induced psychosis is an opportunity to work with the patient to determine and resolve underlying mental illnesses and to discourage a reliance on drugs or alcohol. Because individuals with a history of psychosis have a higher than average suicide rate, early recognition and intervention by a qualified health clinician is extremely important. Policy Statement 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content 0.5 hours (30 minutes). Statement of Learning Need Currently, the prevalence of psychosis is higher than reported cases of treatment. This raises questions about how effectively a psychotic disorder is identified and the appropriate treatment started. Understanding psychosis related to substance use requires clinical knowledge of the types of substances used and influencing factors, such as age, gender, and socio- economics, that influence symptom outcomes. Epidemiology, risk factors, and comorbid conditions are relevant to a comprehensive medical work-up during a case of suspected substance use occurring with acute psychosis. Course Purpose 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com To provide clinicians with knowledge of substance-induced psychosis for early recognition and ongoing management of an underlying mental health disorder or comorbid substance use disorder and mental illness. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA Susan DePasquale, MSN, FPMHNP-BC - all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Substance-induced psychosis is commonly known as __________, which is a condition that can be attributed to psychosis as a result of substance use. a. pseudo psychosis b. delirium tremors c. toxic psychosis d. artificial psychosis 2. Psychosis in an individual is manifested as a. lack of empathy and socially manipulative behavior. b. delirium and violent behavior. c. disorientation accompanied by clinical insanity. d. disorientation and visual hallucinations. 3. Which of the following can lead to psychosis? a. Drug use b. Addiction c. Withdrawal d. All of the above 4. True or False: Psychosis is defined as a mental state where a person’s mental capacity to recognize reality, communicate, and relate to others is impaired. a. True b. False 5. A substance-induced psychotic state is often temporary and reversible but it can be irreversible in ____________________ psychosis. a. cannabis-induced b. estrogen-induced c. fluoroquinolone-induced d. benzylpenicillin-induced 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Issues related to substance-induced psychosis are important for health clinicians to understand so that they can properly assess and determine root cause when patients manifest signs of mental illness. Factors related to substance-induced psychosis vary depending on the patient’s age, type and frequency of drug used. Early intervention by a qualified and knowledgeable health clinician is critical to help patients obtain the needed treatment and to avoid patient risk of harm to self and harm to others. A high risk factor that clinicians should always keep at the forefront of medical management in cases of substance-induced psychosis is that individuals with a history of psychosis can have a higher than average suicide rate. Substance-Induced Psychosis: Epidemiology Psychosis is a mental state where a person’s mental capacity to recognize reality, communicate, and relate to others is impaired. This interferes with life demands. It manifests as disorientation, disorganized thought processes and often can include varied forms of hallucinations. An estimated 13 to 23 percent of people experience psychotic symptoms at some point in their lifetime, and 1 to 4 percent of people will meet the criteria for a psychotic disorder.2 Substance-induced psychosis is commonly known as toxic psychosis, which is a condition that can be attributed to psychosis as a result of substance use. The psychosis results from the poisonous effects of drugs or chemicals. This includes those chemicals produced by the body itself. Some psychoactive substances could be implicated in causing or worsening an existing mental illness involving psychosis. 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Clinicians can pinpoint substance-induced psychosis to specific chemicals affecting the brain as well as to the type of drug activity. Drug use, addiction, and withdrawal can all lead to psychosis. Additionally, a psychotic state can occur after a person uses a variety of legal or illegal substances, or a combination thereof. Such a state can often be temporary and reversible. A fluoroquinolone-induced psychosis is an exception and can be irreversible.2,7 Clinicians should keep in mind that substance-induced psychosis can include many substances. These include alcohol, illegal and street drugs, and medications. Substance-related causes of psychosis may also include using too much of a substance or having an adverse reaction to mixing substances. Symptoms of a substance-induced psychosis can include delirium tremors, paranoia, persecutory delusions, and hallucinations. The hallucinations can be visual, auditory, and tactile. The epidemiology of psychosis is determined by studying and analyzing the patterns, causes, and effects of psychosis in a defined population. This allows clinicians to identify risk factors for the disease and to create preventive health approaches for patients at risk. Understanding psychosis related to substance use requires knowledge of the types of substances used and factors that play a role, such as age or socioeconomic factors. Typically, illicit drug use is seen in younger individuals whereas medication-related psychosis may occur in the elderly. When considering the epidemiology, types, and age-specific considerations of substance-induced psychosis, it is important to be aware of the common types of illicit drug use with the young and drug and/or medication-induced symptoms known to occur in the elderly. A relevant part of the patient work- 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com up during acute psychosis is determination of a pre-existing mental health disorder that commonly becomes exacerbated by the use of substances. Correlating Factors in Acute Psychosis Substance-induced psychosis may be complicated in the setting of correlating or contributing factors. For example, epidemiologic studies show that the prevalence of substance use disorder is higher in persons with schizophrenia, as compared to the general population. One study on substance use had evaluated 9,142 people with severe psychotic disorders, of which 5,586 subjects had schizophrenia and 2,037 had a schizoaffective disorder. In this group, the odds of drug use appeared higher in patients with psychosis compared to the control
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