An International Perspective and Review of Cocaine-Induced Psychosis: A Call to Action

Abstract

ABSTRACT. Cocaine use can induce transient psychotic symptoms that include suspiciousness, paranoia, hallucinations, and other cocaine-related behaviors. In this commentary, the authors provide an international perspective while reviewing the recent advances in epidemiology, clinical features, and risk factors related to cocaine-induced psychosis exhibited by patients with cocaine use disorders. In some settings, the occurrence of cocaine-induced psychosis has been shown to be as high as 86.5%. Many risk factors have been linked with cocaine-induced psychosis, including the quantity of cocaine consumed, lifetime amount of cocaine use, onset of cocaine dependence, years of use, routes of administration, other substance use disorder comorbidity, weight, gender, comorbidity with other medical and mental health disorders, genetics, and pharmacological interactions. Research has shown that the evaluation of cocaine-induced psychosis in patients with cocaine use is clinically relevant, especially in those patients who consume high amounts of cocaine, have a cannabis dependence history, have antisocial personality disorder, use administration routes other than intranasal, or exhibit attention-deficit/hyperactivity disorder (ADHD) comorbidity. Currently, the literature lacks information regarding the evolution of cocaine dependence or cocaine-dependent patients’ risk for developing schizophrenia or other psychotic disorders. Furthermore, clinicians still do not have an evidence-based pharmacological approach to management of cocaine dependence available to them. Additional research is also needed regarding risk factors such as neurobiological markers and personality traits. Finally, we recommend the development of an integrative model including all of the risk factors and protective factors for cocaine-induced psychosis.

Keywords:

• Cocaine
• cocaine dependence
• cocaine-induced psychosis (CIP)
• psychosis
• psychotic symptoms
• risk factors

ACKNOWLEDGMENTS

We are grateful to our research team for their support, particularly Drs. Begoña Gonzalvo, Laia Miquel, and Ángel Egido. We also thank our psychology research team members Susana Gómez-Baeza, Laía Rodriguez-Cintas, and Yasmina Pallarés.

AUTHOR CONTRIBUTIONS

Dr. Roncero and Dr. Casas designed the objective of the study. Dr. Roncero and Dr. Daigre wrote the first and last manuscript drafts. The other authors contributed to the literature review and provided critical revisions to all of the versions of the manuscript.

Additional information

Funding

We are grateful for the grants from the Departament de Salut, Government of Catalonia, Spain, to support the study of cocaine dependence, from the Instituto Carlos III (Spain) FIS PI13/1911 and from the Delegación del Gobierno para el Plan Nacional sobre Drogas (Spain) 2013I044 for the study of the psychotic symptoms in cocaine-dependent patients.