A Systematic Review of Clinical Phenomenology, Differential Diagnosis and Prognostic Outcomes of Substance-Induced Psychotic Disorders.
Valerio Ricci, Giovanni Martinotti, Giuseppe Maina
International Journal of Social Psychiatry April 26, 2026 DOI: 10.1177/00207640261439774 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Longitudinal Cross-sectional Peer reviewed |
|---|---|
| Sample size | 80,000 |
| Population | Individuals with substance-induced psychotic disorders |
| Topics | Cannabis Philosophy of mind |
| Keywords | Methamphetamine Psychotic disorders Schizophrenia Substance-induced psychosis |
| Key findings | Cannabis- and methamphetamine-induced psychoses show distinctive phenomenological signatures, but substantial overlap with primary psychotic disorders and poor diagnostic stability (25% to 39% conversion) necessitate longitudinal monitoring. |
Abstract
Distinguishing substance-induced psychotic disorders (SIPD) from primary psychotic disorders with concurrent substance use remains a critical diagnostic challenge for treatment planning and prognostic counseling. To systematically review the clinical phenomenology of SIPD, identify distinguishing symptom patterns, and examine relationships between phenomenology and outcomes. A systematic search of PubMed, PsycINFO, and Web of Science (1990-2025) was conducted for studies examining clinical characteristics of SIPD using standardized diagnostic criteria and validated instruments. Study quality was assessed using the Newcastle-Ottawa Scale. The review was registered on PROSPERO (CRD42025123563; 19/11/2025). Thirty-six studies encompassing over 80,000 individuals were included. Cannabis-induced psychosis was consistently characterized by prominent positive symptoms, preserved negative domains, and elevated affective and anxiety features, with transition rates to schizophrenia spectrum disorders ranging from 36% to 46%. Methamphetamine-induced psychosis presented along a phenomenological gradient, from simple persecutory delusions and tactile hallucinations in transient cases-accompanied by markedly elevated violence rates (75.6%)-to complex multimodal sensory disturbances in persistent presentations. Despite these substance-specific signatures, substantial phenomenological overlap with primary psychotic disorders and poor diagnostic stability, with 25% to 39% of initial SIPD diagnoses converting to primary disorders over follow-up, limit the utility of cross-sectional assessment alone. Superior antipsychotic response at lower doses emerged as a potential marker favoring substance-induced over primary etiology. SIPD exhibit distinctive phenomenological signatures varying by substance class, yet considerable overlap with primary psychotic disorders and poor diagnostic stability underscore the necessity of longitudinal monitoring and integrated psychiatric-addiction care.
Comparable studies
Other systematic reviews and meta-analyses on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The brain in flow: A systematic review on the neural basis of the flow state. Participants in studies measuring or manipulating flow state with brain activity recording | 2022 | Systematic review | n = 471 |
| Synergistic, multi-level understanding of psychedelics: three systematic reviews and meta-analyses of their pharmacology, neuroimaging and phenomenology. | 2024 | Systematic review and meta-analysis | |
| Evidence synthesis indicates contentless experiences in meditation are neither truly contentless nor identical Expert texts from Shamatha, Transcendental, and Stillness Meditation traditions | 2022 | Systematic review | n = 135 |
| Novel psychoactive substances (NPS) use in severe mental illness (SMI) patients: Potential changes in the phenomenology of psychiatric diseases Patients with severe mental illness (SMI), such as psychotic patients | 2017 | Systematic review | |
| Scoping review on shamanistic trances practices. | 2024 | Systematic review |
Citations in the library
Cites 16
- Dose-Response Study of N,N-Dimethyltryptamine in Humans Archives of General Psychiatry February 1, 1994
- Neuropharmacology of N,N-dimethyltryptamine Brain Research Bulletin April 30, 2016
- Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases The British Journal of Psychiatry November 30, 2005
- Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis The Lancet Psychiatry July 10, 2017
- Association Between Continued Cannabis Use and Risk of Relapse in First-Episode Psychosis JAMA Psychiatry September 28, 2016
and 11 more in the library