Family and Caregiver Schizophrenia Discussion Forum

Psychosis from Schizophrenia Versus Drug Use

My daughter has been hospitalized at least 3 times a year for the past 5 years. “Sometimes” she shows drugs in her system…sometimes she doesn’t. Her diagnosis in the past was PTSD and bi-polar. However, earlier this year when she was hospitalized, they switched her diagnosis to Schizoaffective with bipolar. She did not have any drugs in her system when admitted that time.

She is in the hospital again as I write this…and she tested positive for Meth. So…how do you know if the psychosis is from SCZ or from the drug use? I have heard that people with bi polar or SCZ tend to use illegal drugs just to cope with their condition.

@Sweetpea while you can never be 100% sure, there are some rules of thumb.

In my experience people take drugs for two reasons, either to distract from or escape from reality or affect their mood. So depressant and stimulant use tracks more with mood disorders like Bipolar Disorder, whereas cannabis use and the like track with Psychotic disorders like Schizophrenia.

Both PTSD and SZA (the more common abbreviation for Schizoaffective Disorder) present with a mix both psychotic and mood symptoms, so the drug used may relate to the predominant symptom. PTSD is more transitory and trigger-based than SZA. Drug induced psychosis tends to fade as the drugs leave the system, but there’s evidence that prolonged drug use or even short term drug use by susceptible individuals can lead to more lasting issues or permanent damage.

What they generally look for is whether symptoms fade on their own, whether drugs are found in the patients’ system and how they respond to medication. The bottom line is she shouldn’t be taking illegal drugs regardless. While there may be some consolation in thinking that her issue is drug induced and possibly temporary, versus of seemingly permanent organic origin, I’m not sure it matters. She needs to stop using and keeping sober will be a life-long vigil. I don’t see much of a distinction between that and taking medication and getting psychiatric help instead or in addition.

One thing I’ll mention that I’ve had both psychiatrists and psychologists say to me. People should not get so hung up with chasing their tails with diagnoses. I went to a psychologist for a year and never once did she give me a DX. I ended up telling her what I thought I was, but she never said I was ‘right’.

My present Psychiatrist says that no one fits a DX perfectly that they might be PTSD-ish or SZ or SZA -ish or any mix or match. Insurance companies force doctors to put down a code and that can dictate what they pay, so the DX may change based on what insurance company the patient is filing a claim with and so on. I pay my psychiatric bills out of my HSA, because my psychiatrist like many nowadays refuses to deal with insurance company paperwork. I could file on my own, but isn’t much worth it. Because of this, he uses some medical code that I looked up that translates to Unknown Psychotic Disorder.



I agree that it is not most important to have “the” diagnosis…however having a clearer picture helps in knowing what to do. For example, there is much on this forum about LEAP. I have read the book and there is obviously a lot of good information there. However, I don’t see anything about drug use (or maybe I have not seen that yet :blush:). So while LEAP seems to be about building a relationship and being careful about what you say…I would think that her drug use should be addressed very directly.

Interesting enough she was the one that brought to my attention that they had accused her of drug use. While she did test positive for Meth…and even told the nurse initially that she used on her birthday…she believes it is a false accusation. It is the not the first time she has said something like this.

I would love to believe that all of her issues are temporary and caused by drug abuse…it would seem easier to treat. But from what I have seen over the years, and the fact that we have a family history of SZA…it just feels like things have gotten more complicated.

Thank you so much for your invaluable insight!