Drug-induced psychosis is transient psychotic behavior induced by using (or withdrawing from) certain substances. It is characterized by disturbed behaviors including hallucinations, delusions, paranoia, delirium, or other mental status changes. Implicated substances include stimulants, hallucinogens, amphetamines, cannabis, anxiolytics, antibiotics, anticonvulsants, antihypertensives, antifungals, antivirals, and analgesics. Drug-induced psychosis can manifest in children, adolescents, and adults when exposed to hallucinogens, illicit drugs, and steroids (glucocorticoids). Psychotic events and altered mental status should be considered emergency situations.

Sympathomimetic psychosis can be accompanied by hypertension, mydriasis, tachycardia, and diaphoresis. Anticholinergic psychosis can be accompanied by hypertension, mydriasis, tachycardia, hyperthermia, urinary retention, dry mucous membranes, and lack of sweating. Isoniazid has been reported to induce psychosis in association with antituberculous therapy.

Steroid-induced psychosis is a type of drug-induced psychosis that can result from prescribed steroid medication (eg, glucocorticoids) or illicit steroid use (eg, anabolic androgenic steroids for bodybuilding), the latter of which the provider may not be aware. It is more commonly seen in adults but can occur in children, eg, those treated with prednisone for asthma or an autoimmune condition. In addition to psychosis, adverse psychological effects such as mania, depression, anxiety, delirium, hallucinations, and cognitive impairment can occur as well as less severe mood symptoms.

Management of drug-induced psychosis involves modification of medication regimen and dosage and titration adjustments. Patients exhibiting psychotic behavior during drug withdrawal syndromes require special management utilizing a number of therapeutic options.