Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
7.8 Major clinical issues with psychosis and inhalent/ solvent use
- Chronic inhalant use can produce persistent psychotic symptoms in susceptible individuals.
- Clozapine has been linked to cardiomyopathy and fatal myocarditis.
- As with most other substances, inhalant users should be encouraged to reduce or cease use to observe whether psychotic symptoms resolve.
7.8.1 Effects of inhalants/ solvents on psychotic disorders
- Chronic inhalant use can produce persistent psychotic symptoms in susceptible individuals(60, 62).
- Chronic inhalant use also has the potential to induce psychotic symptoms in those who are not susceptible to psychosis(61, 62).
- Inhalant use can induce a brief psychotic disorder that can last from a few hours up to a few weeks beyond the time of intoxication(61).
7.8.2 Interactions between inhalants/ solvents and therapeutic agents for psychotic disorders
- The sedative effects of antipsychotics may be exacerbated by inhalants and may possibly result in severe sedation and overdosex.
- Clozapine has been linked to cardiomyopathy and fatal myocarditisxx(311). Therefore, risks should be appraised prior to commencement.
- Inhalants will enhance the sedative effects of tricyclic antidepressants and benzodiazepines used to treat breakthrough depression(2) and anxiety with schizophrenia, which increases the risk of overdosex.
7.8.3 Management approaches to comorbid psychotic disorders and inhalant/ solvent use
- As with most other substances, inhalant users should be encouraged to try and reduce or cease use to observe whether psychotic symptomatology resolves.
- A case study reports the effectiveness of clozapine in reducing psychotic symptoms as well as glue sniffing(62).
- In general, with respect to inhalant/solvent use(65):
- Outline the harms associated with inhalant/solvent use.
- Investigate polysubstance use as this is common.
- Standard CBT approaches to both sets of issues should be used, with particular attention to the development of:
- Assertiveness skills (refusal skills).
- Coping skills for controlling and managing emotions such as anger and sadness.
- Offer alternatives to inhalant use, for example, recreational activities.
- Community reinforcement approaches should be developed by mobilising the local health and welfare service system in individual care plans.
- Family interventions need to be considered, for example, increasing communication between the person and the family.
- Assertive outreach and follow-up may be required.