One of my most hated diagnoses is “drug-induced psychosis”. It’s not a diagnosis that I can particularly recall ever having made – despite seeing many many patients with drug use – and psychosis. This is a category which should hold people who do not have a psychiatric illness (like a schizophrenia or bipolar disorder for instance), but who are presenting with psychotic symptoms that have been caused by some drug or other.
I believe this diagnostic entity demonstrates that psychiatrists are as vulnerable to mistaking correlation for causation as is anyone else. In other words, someone presents psychotic, they have recently used a drug, ergo drug-induced psychosis. Seems neat and tidy – but the world isn’t that neat and tidy.
To me it betrays an almost charming naivete on the part of the psychiatrists making such diagnoses. It suggests they have absolutely no idea how much drug use there is out there. The number of people who we see, who are psychotic after using drugs, is tiny in comparison.That suggests to me that there is at least a vulnerability, if not an underlying illness in these people – that yes, could have been brought forward, or made more severe by the drugs, but if you take a mentally completely well person and give them a drug, I’d be pretty sure it’s unlikely to really demonstrate anything strongly enough to support the notion of causation.
The real foolishness comes when you have someone who has a pre-existing diagnosis of a major mental illness, and someone diagnoses a drug-induced psychosis. I’ve recently seen someone with a bipolar disorder, including past presentations with psychosis, who also uses various drugs. Last time this person was admitted to hospital the diagnosis made was .. drug-induced psychosis, with hardly a mention of the bipolar affective disorder at all.
That, to my mind, is idiotic. This person has a serious bipolar disorder. Yes, abuse of alcohol and other drugs, which complicates the presentation, and probably makes it worse, but srsly: a “drug-induced psychosis”?
You know what it actually is? The function it serves in reality? … A bullshit way of excluding people from care, based on an antiquated moral compass: that someone whose own (supposedly “immoral”) actions have led to illness, is somehow less deserving than someone whose illness has struck unprovoked.
In my not so humble opinion, the “drug-induced whatever” diagnostic categories do more harm than good, and they need to go. If it looks like a schizophrenia, and hallucinates like a schizophrenia, then call it a schizophrenia … complicated by alcohol/other drug abuse if that’s the case.
Heh – I really am a lumper, not a splitter 
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