Hallucinogen-induced psychotic disorder
Psychotic disorder caused by hallucinogenic drug use
From Wikipedia, the free encyclopedia
Hallucinogen-induced psychotic disorder (HIPD), also known as hallucinogen-induced psychosis or psychedelic-induced psychosis, is a mental disorder characterized by psychotic symptoms such as hallucinations, delusions, severe paranoia, disorganized thinking and behavior, and insomnia.[2] Hallucinogen-induced psychotic disorder occurs following the use of hallucinogens, for instance psychedelics like LSD, psilocybin, or dimethyltryptamine (DMT).[3][4][5]
| Hallucinogen-induced psychotic disorder | |
|---|---|
| Other names | HIPD, hallucinogen-induced psychosis, psychedelic-induced psychosis |
| Specialty | Psychiatry, addiction psychiatry |
| Symptoms | Hallucinations, delusions, paranoia, insomnia |
| Complications | Self-harm, suicide |
| Causes | Hallucinogens, including psychedelics |
| Risk factors | Pre-existing psychosis or schizophrenia, personal or family history of mental illness |
| Treatment | Atypical antipsychotics |
| Frequency | 0.002–0.6% in different studies[1] |
The incidence rate of HIPD with psychedelics is 0.002% to 0.6% in different types of studies and is considered to be low and rare.[1] HIPD with psychedelics is more likely to occur in individuals with a personal or family history of mental illness and is far more likely to occur in people with schizophrenia.[1][6]
The treatment is atypical antipsychotic medication.[3] Hallucinogen-induced psychotic disorder may last for weeks or months if left untreated.[3][7][8]
Signs and symptoms
The symptoms of hallucinogen-induced psychotic disorder involve the symptoms of psychosis such as severe paranoia, confusion, agitation, hallucinations, delusions, disorganized thinking, and disorganized behavior.[3] Memory problems and insomnia may also occur.[9] The symptoms typically begin shortly after using a hallucinogen and continue until they are treated with an antipsychotic medication.[3][10] The symptoms of hallucinogen-induced psychotic disorder are similar to those of schizophrenia and it may have a similar underlying genetic vulnerability.[10] The typical duration of psychedelic-induced psychosis, including with pharmacological treatment, is 1.8 weeks (~13 days).[3] Rarely, psychedelic-related psychosis has been associated with homicide.[11]
Causes
Psychedelics
LSD is a known cause of hallucinogen-induced psychotic disorder. It is the most common psychedelic in emergency department visits, being responsible for 47.3% of all cases of psychedelic-induced psychosis.[3]
Psilocybin can cause hallucinogen-induced psychotic disorder after brief or intermittent use. There are several case studies of psilocybin-induced psychosis.[4] A 25-year-old woman was treated with olanzapine for hallucinogen-induced psychotic disorder caused by psilocybin.[4] A 30-year-old man was also successfully treated with olanzapine for hallucinogen-induced psychotic disorder caused by psilocybin.[4] In emergency departments, psilocybin is responsible for 18.8% of all cases of psychedelic-induced psychosis.[3]
There are case reports of mescaline causing hallucinogen-induced psychotic disorder. In one case, a 41-year-old man was successfully treated with first risperidone, then aripiprazole for HIPD caused by mescaline.[12]
Dimethyltryptamine (DMT) is known to cause hallucinogen-induced psychotic disorder. There are case reports of DMT-induced psychosis. In one case, a 42-year-old man was successfully treated with quetiapine for hallucinogen-induced psychotic disorder caused by DMT.[13] In another case, a 25-year-old male was successfully treated with paliperidone for hallucinogen-induced psychotic disorder caused by DMT.[14] In emergency departments, DMT is responsible for 3.2% of all cases of hallucinogen-induced psychotic disorder.[3]
Psychedelics are not thought to cause de novo psychosis but instead to exacerbate or unmask it in people with pre-existing psychotic susceptibility.[15]
Diagnosis
Hallucinogen-induced psychotic disorder has the code 6C49.5 in the ICD-11.[2]
Differential diagnosis
Hallucinogen persisting perception disorder (HPPD) involves lasting visual changes after use of a hallucinogenic drug.[16] Hallucinogen persisting perception disorder is not a psychotic disorder. It is a long-term visual condition most often found among frequent hallucinogenic drug users.[17]
Treatment
Treatment consists of atypical antipsychotics such as risperidone, olanzapine, aripiprazole, or quetiapine.[3] Haloperidol, a typical antipsychotic may be given in the emergency room to stabilize a patient before they are switched to an atypical antipsychotic for maintenance therapy.[18] If the hallucinogen is still active in an individual's system, risperidone is recommended directly as a first-line hallucinogen antidote, or trip killer.[19] Aripiprazole, brexpiprazole, cariprazine, and lurasidone are third-generation antipsychotics used to treat substance-induced psychosis.[20] Compared to second and first-generation antipsychotics, third-generation antipsychotics have a better side effect profile and improved tolerability for long-term use.[21] Individuals are also recommended to practice abstinence from hallucinogens and can be given counseling designed to assist with preventing a relapse of substance use.[18][22]
Prognosis
Hallucinogen-induced psychotic disorder is later diagnosed as schizophrenia in approximately 13 to 26% of individuals.[1][23][24] A rate of transition to schizophrenia of 13% has been found with psychedelics in a 2025 study and a rate of 26% with hallucinogens including psychedelics and phencyclidine (PCP) in an 2020 study.[1] The rate of transition to schizophrenia with psychedelics is lower than with amphetamines (22%) and cannabis (34%).[1]
Left untreated, hallucinogen-induced psychotic disorder has sometimes led to suicide.[25][26][27][28] Patients usually have an individual or family psychiatric history.[28]
Epidemiology
Psychedelic-induced psychosis has been reported to occur at rates of 0.002% of individuals in population studies, 0.2% in uncontrolled trials, and 0.6% in randomized controlled trials, with an overall rate of 0.4%.[1] Excluding people with psychiatric disorders caused the overall rate to drop to 0.2%.[1] In uncontrolled trials of people with schizophrenia, the rate was 3.8%, albeit based on low-quality data from the 1950s and 1960s.[1] The risk of psychedelic-induced psychosis is considered to be low and rare for the general population when people with pre-existing schizophrenia or psychosis are excluded.[1] In addition, it is far lower than with cannabis and psychostimulants, which have reported rates of 30 to 55%.[1] It is also thought to be lower than with dissociatives like phencyclidine (PCP).[1][29] The quality of existing findings on incidence of psychedelic-induced psychosis is low as of 2025.[1] Little to no data exist for some types of hallucinogens such as Salvia divinorum.[30]