Substance/Medication-Induced Psychotic Disorder 113
or substance withdrawal with the accompanyi ng specifier “with perceptual disturbances”
(applies to alcohol withdrawal; cannabis into xication; sedative, hypnotic, or anxiolytic
withdrawal; and stimulant intoxication).
A substance/medication-induced psychotic di sorder is distinguished from a primary
psychotic disorder by considering the onset, course, and other factors. For drugs of abuse,
there must be evidence from the history, physical examination, or laboratory findings of
substance use, intoxication, or withdrawal . Substance/medication-induced psychotic
disorders arise during or soon after exposure to a medication or after substance intoxica-
tion or withdrawal but can persist for week s, whereas primary psychotic disorders may
precede the onset of substance/ medication use or may occur during times of sustained ab-
stinence. Once initiated, the psychotic symp toms may continue as long as the substance/
medication use continues. Anothe r consideration is the presence  of features that are atyp-
ical of a primary psychotic disord er (e.g., atypical age at onse t or course). For example, the
appearance of delusions de novo in a person older than 35 years without a known history
of a primary psychotic disorder should sugge st the possibility of a substance/medication-
induced psychotic disorder. Even  a prior history of a primary psychotic disorder does not
rule out the possibility of a substance/medicati on-induced psychotic disorder. In contrast,
factors that suggest that the psychotic symp toms are better accounted for by a primary
psychotic disorder include persistence of ps ychotic symptoms for a substantial period of
time (i.e., a month or more) after the end of substance intoxication or acute substance with-