Neuroimaging Patterns in Substance-Induced Psychotic Disorders

Substance-induced psychotic disorder (SIPD) is a clinically significant condition characterized by the emergence of psychotic symptoms following the use, intoxication, or withdrawal of psychoactive substances. The increasing prevalence of substance use worldwide, coupled with the growing recognition of psychosis as a severe neuropsychiatric consequence of substance exposure, has intensified interest in understanding the underlying neurobiological mechanisms of the disorder. Neuroimaging has become a valuable tool for investigating structural, functional, and neurochemical abnormalities that may contribute to symptom development. Evidence from magnetic resonance imaging (MRI), functional MRI, diffusion tensor imaging, positron emission tomography, and single-photon emission computed tomography has identified abnormalities in several brain regions involved in cognition, emotional regulation, salience attribution, and reward processing. Frequently implicated areas include the prefrontal cortex, hippocampus, amygdala, thalamus, and striatum. Structural imaging studies have demonstrated alterations in gray matter volume and white matter integrity, while functional imaging has revealed disruptions in neural connectivity and network organization. Molecular imaging findings have highlighted disturbances in dopaminergic and other neurotransmitter systems that parallel mechanisms observed in primary psychotic disorders. Neuroimaging data also suggest the presence of substance-specific patterns of brain dysfunction. Psychosis associated with methamphetamine use is commonly linked to frontostriatal abnormalities and dopaminergic dysregulation, whereas cannabis-related psychosis has been associated with hippocampal and cortical alterations. Despite considerable overlap with schizophrenia-spectrum disorders, distinct imaging profiles may exist that reflect the neurobiological effects of different substances. The identification of reliable neuroimaging biomarkers remains challenging due to methodological heterogeneity, variations in substance exposure, and the complex interaction between substance-related effects and underlying vulnerability to psychosis. Nevertheless, advances in multimodal imaging and computational analysis continue to improve our understanding of SIPD and may facilitate more accurate diagnosis, risk stratification, and treatment planning.