Demographic and clinical profiles of drug-induced psychosis: age, gender, and social context in a German cohort

Drug-induced psychosis (DIP) represents a complex clinical challenge, particularly among younger substance-using populations. Recent epidemiological data indicate increasing DIP prevalence and decreasing age at first presentation, underscoring its growing clinical and public health relevance. While DIP arises in the context of substance use, distinguishing transient episodes from emerging primary psychotic disorders remains difficult, and data on demographic and clinical variations are limited. We conducted a descriptive cohort study of 340 patients diagnosed with DIP (ICD-10: F1X.5) between 2010 and 2020 at two university hospitals in Germany. We collected data from all eligible cases (n = 170) from a toxicology department (Technical University of Munich, TUM), and from the same number of cases from a psychiatry department (Ludwig-Maximilians-Universität in Munich, LMU). Variables assessed included sociodemographic data, psychiatric symptoms, substance use (self-report and toxicology), comorbidities, and family history. Analyses included descriptive statistics, chi-square or Fisher’s exact tests, and Mann–Whitney U tests to examine group differences, and Cohen’s Kappa coefficients to quantify agreement between self-reported and toxicologically confirmed substance use. The cohort was predominantly male (77.4%) with a median age of 27 years. Migration background was present in 27.6%, with admissions peaking in 2015–2018. Psychotic symptoms were dominated by perceptual disturbances (62.3%) and thought disorder (76.3%). Women exhibited higher rates of tactile hallucinations, suicidal ideation, and depression (all p < 0.05) and tended to have higher serum ethanol levels. Daily substance use was common (69.0%), with polysubstance use exceeding 75%. Cannabis and stimulants predominated in younger patients, while opiates, sedatives, and ethanol were more frequent in older groups. Self-reported substance use showed fair to good agreement with toxicological findings, with the highest concordance for opiates and lower agreement for sedatives and ethanol. DIP showed clear gender- and age-related differences in psychotic symptom profiles and clinical presentation, alongside high rates of daily and polysubstance use, young male predominance, and migration-related patterns. These findings underscore the need for early, individualized, and demographically informed interventions.