Sources of Diagnostic Uncertainty for Chronically Psychotic Cocaine Abusers

Abstract

It was frequently difficult to distinguish schizophrenia from chronic substance-induced psychoses. Rather than concluding prematurely that psychotic symptoms are, or are not, substance induced, clinicians should initiate treatment of both psychosis and the substance use disorder in uncertain cases. The persistence or resolution of psychosis during abstinence and additional history from the stabilized patient or collateral sources may clarify the diagnosis.

The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements

“…We also reasoned that the validity of diagnoses is somewhat questionable in the setting of active substance abuse. [171][172][173][174][175] To overcome this problem, we have limited the review to RCTs and studies with similarly rigorous methodology but have included (in separate sections) studies with samples of less than 50% schizophrenia-spectrum diagnoses. With respect to specific treatments for SUD, 6 RCT's were available that included more than 50% of individuals with schizophrenia.…”

Methamphetamine Psychosis: Epidemiology and Management

“…Among the most common reasons for diagnostic uncertainty when evaluating the differential diagnosis between a primary psychotic disorder and a stimulant-induced psychosis are: an insufficient period of abstinence from which to evaluate the role of stimulant use in the symptom presentation, inconsistencies in patient reports, and poor recall [65]. As such, diagnostic accuracy can be bolstered by the use of multiple sources of clinical data, including interviews with collateral sources of information (e.g., family or other individuals with whom the patient is close) concerning patterns of stimulant use and psychosis onset, review of medical records, collection of objective indicators of stimulant use (i.e., urine tests), clinical observations, and structured interview assessments with the patient (in which information is gathered concerning lifetime history as well as current substance use, detailed description of presenting symptoms, and temporal relationship between current substance use and psychotic symptoms).…”

Psykisk syke mangler rettssikkerhet

“…Vurderingen av dette kan vaere vanskelig på grunn av manglende perioder med avholdenhet fra det aktuelle rusmiddelet, inkonsistent rapportering og en dårlig gjenkalling fra pasientens side (503). Ved bedring kan det også vaere vanskelig å fastslå om bedringen skyldes avholdenhet eller behandling (503).…”

“…Ved bedring kan det også vaere vanskelig å fastslå om bedringen skyldes avholdenhet eller behandling (503). For noen vil en innleggelse kunne vaere nyttig for å oppnå rusfrihet over tid, slik at diagnostiseringen kan bli mest mulig korrekt.…”