The use of psychostimulants, such as amphetamines and cocaine in psychotic patients is 4 times more frequent than non-psychotic ones. It is believed that people with psychosis may use substances as a self-treatment for negative symptoms. However, early onset of substance use disorder can develop psychotic and/or negative symptoms, leading to confusion between primary or secondary psychosis.

Systematic review of the literature in English (PubMed) and patient's clinical record. Keywords: “Substance use disorder”; “psychosis”.

to highlight the importance of an adequate characterization of psychotic symptoms in patients with substance use disorder.

A 29-year-old man, with psychostimulants and cannabis abuse since adolescence and very short abstinence episodes. Later on, he developed paranoia symptoms that slightly improved once he decreased drugs dosage, but they were still present even on complete abstinence. Over the last year he has showed negative and psychotic symptoms that have been worsening with aggressive behavior during the last months, so he had to be hospitalized. During this period, he has been treated successfully with aripiprazol depot once monthly. His evolution has been positive, it has disappeared psychotic symptoms and paranoia, and after discharge he has managed to remain abstinent to psychostimulants.

Adequate characterization of patients with psychotic symptoms and substance abuse is essential to determine whether the psychotic disorder is associated with primary or induced TUS. Therefore, it is essential a thorough clinical evaluation to make an accurate diagnosis and to draw an individualized treatment plan.

The authors have not supplied their declaration of competing interest.