The Table of Evidence is literally that- A Table
– consisting of the 10 articles you have committed to while formulating your argument.
The TOE is you getting organized, committing to at least 10 peer reviewed articles, and summarizing those 10
based on the same criteria of relevance across all ten.
The TOE highlights the critical aspects of the 10 articles.
The TOE is a summary figure that highlights the following:
Authors and Dates; Questions, variables, objectives, hypothesis; Design, sample, setting; Findings; Level of Evidence / Quality Indicator; and Notes / Comments.
These are the required TOE Headers.
APA ranks highly in the construction, presentation, and organization of this table and should not be overlooked (Publication Manual of the American Psychological Association- the Official Guide to APA Style, 7
th
ed; ©2020).
Avoid decorative flourishes or anything distracting from the importance of the elements and the ultimate learning goals. When constructing your Analysis and Synthesis manuscript, be sure to review your reference to this TOE (Chapter 7.5), and the proper citation and use of
any specific note below the TOE
that supplements or clarifies any information in the table itself (See Table 7.1 example on table notes, page 200).
ARTICLES ATTACHED
Substance-Induced Psychoses: An Updated Literature Review - PMC 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 1 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Front Psychiatry. 2021; 12: 694863. Published online 2021 Dec 23. doi: 10.3389/fpsyt.2021.694863 PMCID: PMC8732862 PMID: 35002789 Substance-Induced Psychoses: An Updated Literature Review Alessio Fiorentini, Filippo Cantù, Camilla Crisanti, Guido Cereda, Lucio Oldani, and Paolo Brambilla Abstract Background: On the current psychopharmacological panorama, the variety of substances able to provoke an episode of acute psychosis is rapidly increasing. Such psychotic episodes are classified according to the major category of symptoms: positive, negative, or cognitive psychotic episodes. On one hand, the abuse of methamphetamines, cannabis, and cocaine plays a big role in increasing the incidence of episodes resembling a psychotic disorder. On the other hand, the progress in terms of pharmacodynamics knowledge has led to the synthesis of new drugs, such as cannabinoids and cathinone's, which have rapidly entered into the common pool of abusers' habits. Regarding these newly synthesized substances of abuse, further clinical studies are needed to understand their psychogenic properties. The topic of this review is complicated due to the frequent abuse of psychotomimetic drugs by patients affected by psychotic disorders, a fact that makes it extremely difficult to distinguish between an induced psychosis and a re-exacerbation of a previously diagnosed disorder. Methods: The present narrative review summarizes results from clinical studies, thus investigating the psychotogenic properties of abused substances and the psychotic symptoms they can give rise to. It also discusses the association between substance abuse and psychosis, especially with regards to the differential diagnosis between a primary vs. a substance-induced psychotic disorder. 1 2 2 2 1 1 , 2 , * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/# https://doi.org/10.3389%2Ffpsyt.2021.694863 https://pubmed.ncbi.nlm.nih.gov/35002789 https://www.ncbi.nlm.nih.gov/pmc/about/disclaimer/ https://www.ncbi.nlm.nih.gov/pmc/about/copyright/ https://pubmed.ncbi.nlm.nih.gov/?term=Fiorentini%20A%5BAuthor%5D https://pubmed.ncbi.nlm.nih.gov/?term=Cant%C3%B9%20F%5BAuthor%5D https://pubmed.ncbi.nlm.nih.gov/?term=Crisanti%20C%5BAuthor%5D https://pubmed.ncbi.nlm.nih.gov/?term=Cereda%20G%5BAuthor%5D https://pubmed.ncbi.nlm.nih.gov/?term=Oldani%20L%5BAuthor%5D https://pubmed.ncbi.nlm.nih.gov/?term=Brambilla%20P%5BAuthor%5D 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 2 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ Findings: Our findings support the theory that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and addiction. Of note, from a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes. Keywords: drugs, substance, substance (ab)use, induced psychosis, review Background According to the state of the art of literature, a relationship between drug abuse and the onset of psychotic symptoms is strongly supported (1, 2). In fact, plenty of findings prove that illicit substances (i.e., cannabinoids, cocaine, amphetamines, and hallucinogens) have psychotomimetic properties (3, 4). That is, their use can induce transient psychotic symptoms due to acute intoxication, but also possibly leading to a syndrome directly resembling a primary psychotic disorder (5). Furthermore, over the last decades, a vast range of new psychoactive substances has emerged: synthetic cannabinoids, cathinone derivatives, psychedelic phenethylamines, novel stimulants, synthetic opioids, tryptamine derivates, phencyclidine-like dissociatives, piperazines, and GABA A/B receptors agonists are steeply becoming more rampant among the drug abuse panorama (6). A struggling clinical dilemma is how to clearly identify a substance-induced psychosis from a primary psychotic illness or a psychotic illness with comorbid substance use. This could possibly be a subtle conundrum and a chance for elucubration, yet it becomes greatly important when treating and choosing the best therapeutic strategy for patients. The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (7) defines the substance- induced psychotic disorder as a psychiatric disease featured by delusions and/or hallucination during or soon after substance intoxication or withdrawal (please see Table 1). Furthermore, the symptoms of a psychotic disorder that is not substance-induced is yet to be properly understood. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/table/T1/ 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 3 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ Table 1 Diagnostic criteria of substance-induced psychosis according to the DSM-5 (7). Disorder Criteria Substance-induced psychosis A. Presence of one or both of the following symptoms: •Delusions •Hallucinations B. There is evidence from the history, physical examination, or laboratory findings that either (1) or (2): •The symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal •Medication used is etiologically related to the disturbance C. The disturbance is not more accounted for by a psychotic disorder that is not substance-induced. D. The disturbance does not occur exclusively during delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Primary psychotic diseases This group includes: •Schizophrenia •Other psychotic diseases •Schizotypal personality disorder All the previous conditions must have one or more symptoms of the following: •Delusions •Hallucinations •Disorganized speech •Disorganized behavior •Negative symptoms Psychotic illness with comorbid substance use At least, one of the criteria defining a psychotic disease and all the criteria of a substance use disorder must be present: •A pattern of use that results in marked distress and/or impairment, with two or more of the following symptoms for 12 months. •Using the substance in larger amounts or over a longer period of time than intended •Unsuccessful attempts or persistent desire to reduce its use •Excessive time spent on obtaining, using, and/or recovering from the 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 4 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ The occurrence of drug-induced psychosis seems to be related to several pathogenetic mechanisms: (a) higher levels of central dopamine, especially for hallucinogens or psychedelic substances, stimulants and cathinone derivates, (b) a cannabinoid CB1-receptor agonist, in particular for cannabis-related substances (c) 5HT2A-receptor agonist for hallucinogenic plants, latest phenethylamines and tryptamine derivates, (d) antagonist activity at NMDA receptors (n-methyl-D-aspartate receptors) in ketamine and methoxetamine and, lastly, (e) k-opioid receptor activation in Salvia divinorum and Mitragyna speciosa (8). A previous review of our group showed that psychosis due to substance abuse is a common issue in clinical practice and that the propensity to develop psychosis seems to be associated with the severity of use and dependence (2). However, this topic is continuously changing, with new substances coming out every day. Thus, an update of the previous review is highly required to create a better understanding of substance induced psychosis. In this review, the presence of associated psychotic symptoms and the differences in clinical presentation will be analyzed for each substance. The second aim of our review is, in this complex framework, to perform an update of our previous work (2), in order to better define what is new and outstanding with regards to recently abused drugs, hopefully leading to a better comprehension of this topic. Methods For this review, a PubMed, Medline and PsychINFO search for articles regarding drug abuse as causal or trigger factor for psychosis was performed; relevant studies were by two authors (FC and CC), and controversies were resolved by confrontation with a third author (GC). In our article search, we only considered articles published from 01/01/2000, in order to exclude excessively outdated works. Specifically, articles of potential interest were identified by using the following terms: (substance OR drug OR inhalant cannab OR THC OR cathinone OR stimulant OR cocaine OR amphetamine OR methamphetamine OR hallucinogen OR LSD OR lysergic OR entactogen [All Fields]) AND (psycho OR hallucin OR delusion OR parano [All Fields]). The selected papers were included in the reference list only if meeting all the inclusion criteria, which consist of being (I) published in a peer-reviewed journal, (II) conducted in humans; (III) written in English and (IV) being an original study or a case-report. The exclusion criteria consisted of: (I) studies focusing on psychoses due to other causes than substances; (II) reviews, commentaries and book chapters; (III) abstracts from conferences; (IV) studies in animal-models and in vitro studies. The pertinent results were then selected on the basis of their relevance to the topic areas covered by the authors, and then synthesized for reporting and discussion. Titles of articles focused only on a small geographical area (e.g., Martinique, France or small Chinese populations), with patients who assumed * * * * * * * * * * * 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 5 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ more than one drug and on population with psychiatric comorbidities were excluded. Furthermore, we decided to exclude studies on the development of psychosis in patient at high risk or at ultra-high risk of developing psychosis. In conclusion, we also excluded not pertinent articles (e.g., forensic articles, psychosocial and not psychiatric articles). In the choice of articles of interest for out paper, we initially identified, after the removal of duplicates, a number of 157 articles. We then removed not pertinent works (i.e., n = 55), and discrepancies were resolved by authors confrontation; a further number of 12 papers by other sources was found, and a total number of 72 papers was collected. Due to the extent of the topic studied, it was not possible to adopt a systematic approach to analyse the data collected and to conduct a statistical analysis to compare them. Indeed, the substances described present evident heterogeneous features, and, for this reason, a descriptive approach has been adopted to provide a broad yet thorough overview of this topic. Results Clinical Differences in Psychoses Despite the effort in defining clear-cut criteria of substance-induced psychosis, the results of the present review shows a picture of the complex relationship between psychotic symptoms and the use and abuse of illicit drugs. Furthermore, in most cases, chronological criteria are not sufficient to prove a direct causal effect between the substance and psychosis. In fact, in patients who use drugs and develop a psychotic episode for the first time, the evidence that such psychotic symptoms are primary and independent from drugs requires their persistence during a period of sustained abstinence from psychoactive substances. Indeed, drug-induced psychoses are expected to be resolved during a period of abstinence (9). On the other hand, subjects affected by drug-induced psychosis were more likely to abuse more than one drug and seemed to also show long-term hallucination after drug interruption (9). In their longitudinal study, Mauri and colleagues examined the diagnostic and clinical courses of patients who used drugs while experiencing early-phase psychoses, with the aim to focus on the initial distinction between primary psychosis with drug abuse and substance-induced psychosis. The results obtained showed that the patients with primary psychosis had an earlier age of onset compared to the ones with drug-induced psychosis, it also showed baseline higher scores in the item called “unusual content of thought” according to the Brief Psychiatric Rating Scale (BPRS). In their systematic review, Wilson et al. (10) summarized results from six studies, assessing the differences, particularly concerning psychopathology between subjects with a diagnosis of substance- induced psychosis and subjects affected by primary psychosis. The findings did not reveal several 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 6 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ consistent differences. However, they found that, compared to primary psychosis, subjects affected by drug-induced psychosis showed a weaker family history of psychotic disorders, a greater degree of insight, fewer positive and negative symptoms, more depressive symptoms, and more anxiety. The other important issue is that subjects who presented psychotic symptoms after substance abuse seemed to have a higher risk of the development of a primary psychotic illness (11). In fact, recent studies provide evidences that the abovementioned group of subjects is more likely to develop a schizophrenia-spectrum disorder or a primary psychotic disorder (11, 12). In this regard, Starzer et al. (13) carried out a longitudinal study in a cohort of 6,788 subjects who received a diagnosis of substance-induced psychosis, investigating the rate of conversion to schizophrenia and bipolar disorder as well as risk factors for conversion. The results obtained showed a strong association between substance-induced psychosis and the development of either bipolar or schizophrenia-spectrum disorder. Moreover, young age was associated with a higher risk of converting to schizophrenia. Finally, self-harm episodes after substance-induced psychosis seemed to be significantly linked to a higher risk of converting to either schizophrenia or bipolar disorder. In the following paragraphs we will discuss each single drug and its evidence on psychotic episodes. A useful summary on main data is reported in Table 2. Table 2 Summary of major mechanism of action, nature of evidence and prevalence of psychotic symptoms for each substance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/table/T2/ 4/23/24, 9:17 AMSubstance-Induced Psychoses: An Updated Literature Review - PMC Page 7 of 35https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732862/ Substance Major mechanism of action Nature of evidence Prevalence of psychotic symptoms Cannabinoids Partial agonist activity on CB1 Partial agonist activity on CB1 0.8–10% (14) Synthetic cannabinoids Agonist activity on CB1 Case reports NA Synthetic catinones Increase of dopamine release and inhibition of the reuptake of monoamines (15–19). Cross-sectional studies NA Cocaine SERT, DAT, and NET block (20), antagonism of the 5-HT3