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Hallucinogen-induced psychotic disorder

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Hallucinogen-induced psychotic disorder
Other namesHIPD, hallucinogen-induced psychosis, psychedelic-induced psychosis
SpecialtyPsychiatry, addiction psychiatry
SymptomsHallucinations, delusions, paranoia, insomnia
ComplicationsSelf-harm, suicide
CausesHallucinogens including dissociatives, cannabinoids, psychedelics, and others
Risk factorsPre-existing psychosis or schizophrenia, personal or family history of mental illness
TreatmentAtypical antipsychotics
Frequency0.002–0.6% in different studies[1]

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 dissociatives like phencyclidine (PCP),[1][3] cannabinoids like cannabis, and psychedelics like LSD.[4][5][6]

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][7]

The treatment is atypical antipsychotic medication.[4] Hallucinogen-induced psychotic disorder may last for weeks or months if left untreated.[4][8][9]

Signs and symptoms

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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.[4] Memory problems and insomnia may also occur.[10] The symptoms typically begin shortly after using a hallucinogen and continue until they are treated with an antipsychotic medication.[4][11] The symptoms of hallucinogen-induced psychotic disorder are similar to those of schizophrenia and it may have a similar underlying genetic vulnerability.[11] The typical duration of psychedelic-induced psychosis, including with pharmacological treatment, is 1.8 weeks (~13 days).[4] Rarely, psychedelic-related psychosis has been associated with homicide.[12]

Causes

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Dissociatives

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Dissociatives like phencyclidine (PCP) and ketamine are said to be strongly linked to hallucinogen-induced psychotic disorder.[1][3][13]

Cannabinoids

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Cannabinoids such as cannabis and especially synthetic cannabinoids can induce psychosis.[14][15]

Psychedelics

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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.[4]

Psilocybin can cause hallucinogen-induced psychotic disorder after brief or intermittent use. There are several case studies of psilocybin-induced psychosis.[5] A 25-year-old woman was treated with olanzapine for hallucinogen-induced psychotic disorder caused by psilocybin.[5] A 30-year-old man was also successfully treated with olanzapine for hallucinogen-induced psychotic disorder caused by psilocybin.[5] In emergency departments, psilocybin is responsible for 18.8% of all cases of psychedelic-induced psychosis.[4]

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.[16]

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.[17] In another case, a 25-year-old male was successfully treated with paliperidone for hallucinogen-induced psychotic disorder caused by DMT.[18] In emergency departments, DMT is responsible for 3.2% of all cases of hallucinogen-induced psychotic disorder.[4]

Psychedelics are not thought to cause de novo psychosis but instead to exacerbate or unmask it in people with pre-existing psychotic susceptibility.[19]

Diagnosis

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Hallucinogen-induced psychotic disorder has the code 6C49.5 in the ICD-11.[2]

Differential diagnosis

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Hallucinogen persisting perception disorder (HPPD) involves lasting visual changes after use of a hallucinogenic drug.[20] Hallucinogen persisting perception disorder is not a psychotic disorder. It is a long-term visual condition most often found among frequent hallucinogenic drug users.[21]

Treatment

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Aripiprazole 15 mg is used to treat hallucinogen-induced psychotic disorder.

Treatment consists of atypical antipsychotics such as risperidone, olanzapine, aripiprazole, or quetiapine.[4] 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.[22] If the hallucinogen is still active in an individual's system, risperidone is recommended directly as a first-line hallucinogen antidote, or trip killer.[23] Aripiprazole, brexpiprazole, cariprazine, and lurasidone are third-generation antipsychotics used to treat substance-induced psychosis.[24] Compared to second and first-generation antipsychotics, third-generation antipsychotics have a better side effect profile and improved tolerability for long-term use.[25] Individuals are also recommended to practice abstinence from hallucinogens and can be given counseling designed to assist with preventing a relapse of substance use.[22][26]

Prognosis

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Hallucinogen-induced psychotic disorder is later diagnosed as schizophrenia in approximately 13 to 26% of individuals.[1][27][28] 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.[29][30][31][32] Patients usually have an individual or family psychiatric history.[32]

Epidemiology

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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 much lower than with dissociatives like phencyclidine (PCP).[1][3] 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.[33]

See also

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References

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  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Sabé, Michel; Sulstarova, Adi; Glangetas, Alban; De Pieri, Marco; Mallet, Luc; Curtis, Logos; Richard-Lepouriel, Héléne; Penzenstadler, Louise; Seragnoli, Federico; Thorens, Gabriel; Zullino, Daniele; Preller, Katrin; Böge, Kerem; Leucht, Stefan; Correll, Christoph U. (2025-03-01). "Reconsidering evidence for psychedelic-induced psychosis: an overview of reviews, a systematic review, and meta-analysis of human studies". Molecular Psychiatry. 30 (3): 1223–1255. doi:10.1038/s41380-024-02800-5. PMC 11835720. PMID 39592825.
  2. 1 2 "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Archived from the original on 2026-07-31. Retrieved 2026-08-02.
  3. 1 2 3 Armanino-Irigaray M, Catalán A, Aymerich C, Pedruzo B, Argüelles I, Ramírez A, Armyra E, González-Torres MÁ, Salazar de Pablo G (March 2026). "Unusual experiences and early-onset psychosis associated to hallucinogen use in adolescents: a systematic review and meta-analysis". Child Adolesc Psychiatry Ment Health. 20 (1) 56. doi:10.1186/s13034-026-01060-1. PMC 13081284. PMID 41796365.
  4. 1 2 3 4 5 6 7 8 9 10 Sulstarova, Adi; Scheuerlein, Luise; Monari, Silvia; Seragnoli, Federico; Gabriel, Thorens; Preller, Katrin; Böge, Kerem; Sentissi, Othman; Kaiser, Stefan; Solmi, Marco; Kirschner, Matthias; Sabé, Michel (August 2025). "Treatment approaches and efficacy in psychedelic-induced psychosis: A systematic review". Asian Journal of Psychiatry. 110 104604. doi:10.1016/j.ajp.2025.104604. PMID 40614615.
  5. 1 2 3 4 Kim, Yumin; Bigley, Rachel; DeVinney, Aubrey; Nestadt, Paul S. (June 2025). "The many faces of psilocybin-related psychosis: A case series". Psychiatry Research Case Reports. 4 (1) 100243. doi:10.1016/j.psycr.2024.100243.
  6. ↑ Paterson, Neil E.; Darby, W. Connor; Sandhu, Preetpal S. (July 2015). "N,N-Dimethyltryptamine–Induced Psychosis". Clinical Neuropharmacology. 38 (4): 141–143. doi:10.1097/WNF.0000000000000078. PMID 26166234.
  7. ↑ Vardy, Michael M. (August 1983). "LSD Psychosis or LSD-Induced Schizophrenia?: A Multimethod Inquiry". Archives of General Psychiatry. 40 (8): 877–883. doi:10.1001/archpsyc.1983.01790070067008. PMID 6870484.
  8. ↑ Fiorentini, Alessio; Sara Volonteri, Lucia; Dragogna, Filippo; Rovera, Chiara; Maffini, Michele; Carlo Mauri, Massimo; A. Altamura, Carlo (December 2011). "Substance-Induced Psychoses: A Critical Review of the Literature". Current Drug Abuse Reviewse. 4 (4): 228–240. doi:10.2174/1874473711104040228. PMID 21999698.
  9. ↑ Deng, Xianhua; Huang, Zhibiao; Li, Xuewu; Li, Yi; Wang, Yi; Wu, Dongling; Gao, Beiling; Yang, Xi (2012-10-01). "Long-term follow-up of patients treated for psychotic symptoms that persist after stopping illicit drug use". Shanghai Archives of Psychiatry. 24 (5): 271–278. doi:10.3969/j.issn.1002-0829.2012.05.004. ISSN 1002-0829. PMC 4198875. PMID 25328350.
  10. ↑ Mauri, Massimo Carlo; Paletta, Silvia; Di Pace, Chiara (2018). "Hallucinations in the Substance-Induced Psychosis". Hallucinations in Psychoses and Affective Disorders. pp. 57–83. doi:10.1007/978-3-319-75124-5_5. ISBN 978-3-319-75123-8.
  11. 1 2 Garson, Emily; Castle, David J.; George, Tony P. (6 April 2023). "Substance-Induced Psychosis: a Narrative Review". Current Addiction Reports. 10 (2): 335–340. doi:10.1007/s40429-023-00475-6.
  12. ↑ Norris, Jesse J.; Holoyda, Brian (15 September 2026). "Homicides associated with psychedelic use: Psychiatric features, risk factors and sentencing outcomes". Psychiatry, Psychology and Law: 1–27. doi:10.1080/13218719.2026.2718113. ISSN 1321-8719. Retrieved 19 September 2026.
  13. ↑ Xu K, Lipsky RH (February 2015). "Repeated ketamine administration alters N-methyl-D-aspartic acid receptor subunit gene expression: implication of genetic vulnerability for ketamine abuse and ketamine psychosis in humans". Exp Biol Med (Maywood). 240 (2): 145–155. doi:10.1177/1535370214549531. PMC 4469194. PMID 25245072.
  14. ↑ Hasan A, von Keller R, Friemel CM, Hall W, Schneider M, Koethe D, Leweke FM, Strube W, Hoch E (June 2020). "Cannabis use and psychosis: a review of reviews". Eur Arch Psychiatry Clin Neurosci. 270 (4): 403–412. doi:10.1007/s00406-019-01068-z. PMID 31563981.
  15. ↑ Deng H, Verrico CD, Kosten TR, Nielsen DA (October 2018). "Psychosis and synthetic cannabinoids". Psychiatry Res. 268: 400–412. doi:10.1016/j.psychres.2018.08.012. PMID 30125871.
  16. ↑ Duraković, Din; Silić, Ante; Peitl, Vjekoslav; Vlahović, Darko; Vojnović, Daniela; Karlović, Dalibor (25 October 2022). "Acute Mescaline Intoxication Followed by Catatonia". Archives of Psychiatry Research. 58 (2): 287–292. doi:10.20471/dec.2022.58.02.12.
  17. ↑ Barbic, David; Fernandes, Justin; Eberdt, Caroline; Chakraborty, Apu (September 2020). "N,N-Dimethyltryptamine: DMT-induced psychosis". The American Journal of Emergency Medicine. 38 (9): 1961.e1–1961.e2. doi:10.1016/j.ajem.2020.04.090. PMID 32389398.
  18. ↑ Barbic, David; Fernandes, Justin; Eberdt, Caroline; Chakraborty, Apu (September 2020). "N,N-Dimethyltryptamine: DMT-induced psychosis". The American Journal of Emergency Medicine. 38 (9): 1961.e1–1961.e2. doi:10.1016/j.ajem.2020.04.090. PMID 32389398.
  19. ↑ Brar PS, Price RB, Ross S, Tofighi B, Sarpal DK (July 2026). "The intersection between psychedelics and schizophrenia spectrum disorders: Reevaluating risk and therapeutic potential". J Psychopharmacol. 40 (7): 1037–1053. doi:10.1177/02698811261456191. PMC 13376330. PMID 42345450. Psychedelics likely trigger in the setting of risk, but do not cause SSDs (Paparelli et al., 2011; Sabé et al., 2024). It is critical to distinguish risk in individuals with preexisting SSDs from the potential for psychedelics to induce de novo chronic psychotic illness. Substantial evidence for the latter is lacking.
  20. ↑ Martinotti, Giovanni; Santacroce, Rita; Pettorruso, Mauro; Montemitro, Chiara; Spano, Maria Chiara; Lorusso, Marco; di Giannantonio, Massimo; Lerner, Arturo G. (2018-03-16). "Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives". Brain Sciences. 8 (3): 47. doi:10.3390/brainsci8030047. PMC 5870365. PMID 29547576.
  21. ↑ Halpern, J (March 2003). "Hallucinogen persisting perception disorder: what do we know after 50 years?". Drug and Alcohol Dependence. 69 (2): 109–119. doi:10.1016/S0376-8716(02)00306-X. PMID 12609692.
  22. 1 2 DiSclafani, Antonio; Hall, Richard C.W.; Gardner, Earl R. (October 1981). "Drug-induced psychosis: Emergency diagnosis and management". Psychosomatics. 22 (10): 845–855. doi:10.1016/S0033-3182(81)73092-5. PMID 7313045.
  23. ↑ O’Mahony, Brian; Harrington, Colm; Harkin, Andrew; Lally, Níall (May 2026). "Trip killers: Addressing a critical knowledge gap in psychedelic research". Journal of Psychopharmacology. 40 (5): 687–702. doi:10.1177/02698811261431056. PMC 13310301. PMID 41869862.
  24. ↑ Ricci, Valerio; De Berardis, Domenico; Maina, Giuseppe (29 January 2024). "Third-Generation Antipsychotics and Lurasidone in the Treatment of Substance-Induced Psychoses: A Narrative Review". Healthcare. 12 (3): 339. doi:10.3390/healthcare12030339. PMC 10855531. PMID 38338224.
  25. ↑ Mucci, Federico; Arone, Alessandro; Gurrieri, Riccardo; Weiss, Francesco; Russomanno, Gerardo; Marazziti, Donatella (March 2025). "Third-Generation Antipsychotics: The Quest for the Key to Neurotrophism". Life. 15 (3): 391. Bibcode:2025Life...15..391M. doi:10.3390/life15030391. PMC 11944073. PMID 40141736.
  26. ↑ Mathias, Steve; Lubman, Dan I.; Hides, Leanne (15 March 2008). "Substance-Induced Psychosis: A Diagnostic Conundrum". The Journal of Clinical Psychiatry. 69 (3): 358–367. doi:10.4088/jcp.v69n0304. PMID 18278990.
  27. ↑ Murrie, Benjamin; Lappin, Julia; Large, Matthew; Sara, Grant (10 April 2020). "Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis". Schizophrenia Bulletin. 46 (3): 505–516. doi:10.1093/schbul/sbz102. PMC 7147575. PMID 31618428.
  28. ↑ Myran, Daniel T.; Pugliese, Michael; Xiao, Jennifer; Kaster, Tyler S.; Husain, M. Ishrat; Anderson, Kelly K.; Fabiano, Nicholas; Wong, Stanley; Fiedorowicz, Jess G.; Webber, Colleen; Tanuseputro, Peter; Solmi, Marco (February 2025). "Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder". JAMA Psychiatry. 82 (2): 142–150. doi:10.1001/jamapsychiatry.2024.3532. PMC 11561722. PMID 39535804.
  29. ↑ Armanino-Irigaray, Maite; Catalán, Ana; Aymerich, Claudia; Pedruzo, Borja; Argüelles, Ignacio; Ramírez, Alazne; Armyra, Eleonora; González-Torres, Miguel Ángel; Salazar de Pablo, Gonzalo (8 March 2026). "Unusual experiences and early-onset psychosis associated to hallucinogen use in adolescents: a systematic review and meta-analysis". Child and Adolescent Psychiatry and Mental Health. 20 (1) 56. doi:10.1186/s13034-026-01060-1. PMC 13081284. PMID 41796365.
  30. ↑ Myran, Daniel T.; Xiao, Jennifer; Fabiano, Nicholas; Pugliese, Michael; Kaster, Tyler S.; Rosenblat, Joshua D.; Husain, M. Ishrat; Fiedorowicz, Jess G.; Wong, Stanley; Tanuseputro, Peter; Solmi, Marco (3 March 2025). "Mortality risk among people receiving acute hospital care for hallucinogen use compared with the general population". Canadian Medical Association Journal. 197 (8): E204–E213. doi:10.1503/cmaj.241191. PMC 11879370. PMID 40032291.
  31. ↑ Darke, Shane; Duflou, Johan; Peacock, Amy; Farrell, Michael; Hall, Wayne; Lappin, Julia (September 2024). "A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia". Addiction. 119 (9): 1564–1571. doi:10.1111/add.16518. PMID 38771189.
  32. 1 2 Morris, Sorsha Lee (30 November 2024). "A Case Report of Psilocybin-induced Psychosis in a Predisposed Patient". Clinical Psychopharmacology and Neuroscience. 22 (4): 684–687. doi:10.9758/cpn.24.1180. PMC 11494431. PMID 39420616.
  33. ↑ Tomašić, Lea; Peček, Mirta; Petrović, Zrnka Kovačić (22 December 2023). "Substance-Induced Psychosis: a Narrative Review". Current Addiction Reports. 11 (1): 55–67. doi:10.1007/s40429-023-00528-w. ISSN 2196-2952. Retrieved 9 August 2026.
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