From substance-induced psychosis to schizophrenia: Predictors of treatment response and transition to chronic psychotic illness-A systematic review.

Treatment response in substance-induced psychotic disorders is predicted by several factors with varying levels of evidence. Acute symptom onset within 24-48 hours of substance use predicts favorable treatment response, while prominent negative symptoms predict slower remission and higher transition to chronic psychotic disorders. Poor premorbid functioning and bimodal response patterns (rapid remission within 30 days versus poor outcomes thereafter) distinguish responders from non-responders. Early age of substance use onset, family history of psychotic disorders, abstinence achievement, and premorbid cognitive capacity may influence outcomes. Cannabis-induced and methamphetamine-induced psychosis warrant particular caution given higher persistence rates and psychiatric comorbidity.

Study at a glance

Abstract

Substance-induced psychotic disorders (SIPDs) present significant clinical challenges with variable outcomes. While some patients achieve complete remission following substance cessation, others develop persistent symptoms requiring extended intervention. Understanding treatment response predictors is critical for optimizing clinical management and prognostic accuracy. Following PRISMA guidelines, we systematically searched PubMed, Scopus, Web of Science, PsycINFO, and Embase (inception to October 2024) for studies examining treatment response predictors in SIPDs. We assessed certainty of evidence using modified GRADE criteria for prognostic factor research. Twenty-seven studies representing approximately 33,500 SIPD patients with follow-up ranging from 1 month to 15.5 years met inclusion criteria. Moderate-certainty evidence indicates that acute symptom onset within 24-48 h of substance use predicts favorable treatment response, while prominent negative symptoms predict slower remission and higher transition to chronic psychotic disorders. Moderate-certainty evidence supports that poor premorbid functioning and bimodal response patterns (rapid remission within 30 days vs poor outcomes thereafter) distinguish treatment responders from non-responders. Low-certainty evidence suggests early age of substance use onset, family history of psychotic disorders, abstinence achievement, and premorbid cognitive capacity influence outcomes. Very low-certainty evidence from small neuroimaging studies suggests preserved brain structure and normal dopaminergic function may predict sustained remission. Cannabis-induced and methamphetamine-induced psychosis warrant particular caution given higher persistence rates and psychiatric comorbidity. Treatment response in SIPDs is determined by multiple interacting factors. Moderate-certainty predictors (temporal onset, negative symptoms, premorbid functioning) provide the strongest basis for clinical decision-making, while lower-certainty findings require validation before widespread implementation.