Substance-Induced Psychosis

F10.0-F19.9 + (R45.0-8/Z65.0-5/Z65.8-9/Z81.0-4/Z81.8)

DESCRIPTION

Psychosis secondary to a substance use or withdrawal such as abuse of alcohol, drugs e.g. cannabis.

GENERAL MEASURES

  • Most patients with substance-induced psychosis can be managed without medication.
  • Ensure the safety of the patient and those caring for them.
  • Minimise stress and stimulation (do not argue with psychotic thinking).
  • Avoid confrontation or criticism, unless it is necessary to prevent harmful or disruptive behaviour.

MEDICINE TREATMENT

See: Aggressive disruptive behaviour in adults.

Always use non-pharmacological de-escalation techniques first.

  • Calm the patient.
  • Manage in a safe environment.
  • Ensure the safety of all staff members.

Offer oral treatment:

LoEIII [21]

  • Benzodiazepines, e.g.:
  • Diazepam, oral, 5–15 mg, immediately

LoEIII [22]

OR

  • Midazolam, buccal, 7.5–15 mg, immediately.

LoEIII [23]

If oral treatment fails after 30–60 minutes,

OR

The patient is placing themselves and others at significant risk:

LoEIII [24]

Consider IM treatment:

  • Benzodiazepines, e.g.:
  • Midazolam, IM, 7.5–15 mg, immediately.
    • Repeat after 30–60 minutes if needed.

OR

  • Haloperidol, IM, 5 mg, immediately.
    • Repeat after 30–60 minutes if needed.
  • AND
  • Promethazine, IM, 25–50 mg.
    • In the elderly 25 mg.

LoEIII [25]

Always monitor vital signs of sedated patient:

  • Vital signs: pulse, respiratory rate, blood pressure, temperature.
  • Monitor every 5–10 minutes for the 1st hour, and then every 30 minutes until the patient is ambulatory.

REFERRAL

All patients.