New substances, new psychoses

Abstract

Consensual clinical experience indicates that in recent years the spread of an increasingly large and heterogeneous number of psychoactive substances is leading to substantial changes in the phenomenology and course of mental disorders, particularly psychotic disorders. NPS play a central role in this change and contribute, in a powerful yet highly variable manner, to the presence of previously undescribed clinical entities. The clinical constructs of Substance Use Disorder and Dual Diagnosis now appear insufficient to describe the breadth and complexity of the phenomenon. Some new clinical categories have been described, not yet included in official nosographic systems, such as spiceophrenia, synthetic psychosis, lysergic psychoma, hallucinogen persistent perceptual disorder, and others, in an attempt to recognize clinical forms of highly variable psychopathological conditions. In fact, the traditional diagnostic categories of psychiatry, particularly those of psychotic disorders and mood disorders, no longer appear capable of realistically describing the clinical variability of the psychopathological pictures of psychotic patients. Furthermore, it is necessary to consider the marked clinical and outcome changes that the widespread use of psychoactive substances induces in the clinical presentations of patients already suffering from mental disorders, so that the clinical presentations of, for example, schizophrenia or bipolar disorder very often appear significantly altered in their symptomatology and course. On a strictly clinical level, certain psychopathological features appear more consistently associated with the use of psychoactive substances, such as greater severity of paranoid symptoms, high frequency of exacerbations, mood instability, dysregulation of emotions and behavior, early cognitive decline, and resistance to traditional pharmacological treatments. This is a clinical landscape of enormous significance, which shows how the clinical presentations and diagnostic categories of traditional psychiatry have progressively and severely changed.