# Substance Use Disorders and the Psychosis Spectrum: Assessment, Clinical Challenges and Management

**Authors:** Thomas Paparrigopoulos, Eleftherios Mellos, Charidimos Tzagarakis

PMC · DOI: 10.3390/jcm15041562 · 2026-02-16

## TL;DR

This paper reviews the challenges of diagnosing and managing patients with both substance use disorders and psychosis, emphasizing the need for careful evaluation and coordinated treatment.

## Contribution

The paper provides a comprehensive review of clinical challenges and management strategies for patients with co-occurring substance-induced psychosis and primary psychotic disorders.

## Key findings

- Dual diagnosis of substance use disorders and psychosis complicates treatment and requires coordinated care.
- Accurate assessment of patient history and symptomatology is essential for effective management.
- Management strategies must address the complex interplay between substance use and psychotic symptoms.

## Abstract

The intricate relationship between substance-induced psychotic disorders and primary disorders of the psychosis spectrum requires practitioners to meticulously evaluate patient history, substance use patterns, and clinical symptomatology. Also, the dual diagnosis of SUDs and psychotic disorders exacerbates treatment challenges, often leading to the need to coordinate differing treatment modalities and fragmented care. A nuanced understanding of the interplay between SUDs and the psychosis spectrum is crucial for effective assessment and comprehensive management strategies. In this review, the unique challenges presented by this complex clinical population are examined, and management strategies are explored.

## Full-text entities

- **Genes:** HTR2A (5-hydroxytryptamine receptor 2A) [NCBI Gene 3356] {aka 5-HT2A, HTR2}, CNR1 (cannabinoid receptor 1) [NCBI Gene 1268] {aka CANN6, CB-R, CB1, CB1A, CB1K5, CB1R}
- **Diseases:** alcohol abuse (MESH:D000437), hypertension (MESH:D006973), psychotic and/or mood (MESH:D000341), both auditory and visual (MESH:D014786), delusions (MESH:D063726), impaired thought processes (MESH:D001308), auditory and tactile hallucinations (MESH:D006212), withdrawal syndromes (MESH:D013375), cravings (MESH:C564883), injury to (MESH:D014947), Comorbidity (MESH:D004194), mydriasis (MESH:D015878), Co-Occurring Disorders (MESH:D060085), dissociation (MESH:D004213), psychotic episode (MESH:C580065), hepatic, cardiovascular, and infectious diseases (MESH:D006506), Schizophrenia (MESH:D012559), Cocaine bugs (MESH:D019970), anxiety (MESH:D001007), social deterioration (MESH:D000067404), visual distortions (MESH:D006311), Induced (MESH:D000092582), dehydration (MESH:D003681), cytotoxicity (MESH:D064420), primary (MESH:D010538), ADHD (MESH:D001289), primary psychosis (MESH:D011618), paranoia (MESH:D010259), agitated psychosis (MESH:D011595), Substance (MESH:D019966), Behavioral disturbances (MESH:D001523), amphetamine psychosis (MESH:D019969), aggression (MESH:D010554), Disorientation (MESH:D003221), SIP (MESH:D011605), delirium (MESH:D003693), formication (MESH:D010292), bipolar disorder (MESH:D001714), depression (MESH:D003866), paranoid ideation (MESH:D001072), Sleep deprivation (MESH:D012892), Mood symptoms (MESH:D019964), drug (MESH:D000081015), AIPD (MESH:D020751), neurostructural damage (MESH:D020263), Cognitive deficits (MESH:D003072), overdose (MESH:D062787), thought disorder (MESH:D009358), opioid use disorder (MESH:D009293), hyperthermia (MESH:D005334), post-traumatic stress disorder (MESH:D013313), neurological symptoms (MESH:D009461), delusional (MESH:D012563), flattened affect (MESH:C000721289)
- **Chemicals:** olanzapine (MESH:D000077152), opiates (MESH:D053610), benzodiazepines (MESH:D001569), Mephedrone (MESH:C548233), Methamphetamine (MESH:D008694), DMT (MESH:D004130), Bath Salts (-), haloperidol (MESH:D006220), paliperidone (MESH:D000068882), clozapine (MESH:D003024), 3,4-methylenedioxymethamphetamine (MESH:D018817), Substance (MESH:C012600), aripiprazole (MESH:D000068180), PCP (MESH:D010622), Cocaine (MESH:D003042), Delta9-tetrahydrocannabinol (MESH:D013759), DA (MESH:C025953), endocannabinoid (MESH:D063388), LSD (MESH:D008238), mescaline (MESH:D008635), Gln (MESH:D005973), Ketamine (MESH:D007649), risperidone (MESH:D018967), cannabinoid (MESH:D002186), JWH-018 (MESH:C552597), Cathinone (MESH:C023665), 5HT (MESH:D012701), CBD (MESH:D002185), Psilocybin (MESH:D011562), Alcohol (MESH:D000438), Amphetamine (MESH:D000661), Amphetamines (MESH:D000662), ziprasidone (MESH:C092292), GLU (MESH:D018698), NE (MESH:D009356), GABA (MESH:D005680), norepinephrine (MESH:D009638), Dopaminergic (MESH:D004298), N-methyl-D-aspartate (MESH:D016202)
- **Species:** Homo sapiens (human, species) [taxon 9606], Catha edulis (Abyssinian tea, species) [taxon 123405]

## Figures

1 figure with captions in the complete paper: https://tomesphere.com/paper/PMC12942059/full.md

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Source: https://tomesphere.com/paper/PMC12942059