Demographic and Clinical Profiles of Drug-Induced Psychosis: Age, Gender, and Social Context in a German Cohort

Background: Drug-induced psychosis (DIP) represents a complex clinical challenge, particularly among younger substance-using populations. 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. Methods: 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. Equal numbers of cases (n=170) were included from the toxicology and psychiatry departments; all eligible cases at TUM were included, and the same number were randomly selected from the LMU cohort. 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. Results: 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. Conclusion: 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.