A call for action: Closing the evidence gap in management of stimulant-induced psychosis.

backgroundStimulant-induced psychosis (StIP) is emerging as one of most pressing health challenges. Over the past two decades, stimulant-related harms and psychiatric care demands have risen sharply. Individuals with StIP often present with severe agitation and high suicide risk, and up to half progress to chronic psychotic illness within two years. Despite this burden, clinical recommendations remain sparse and largely based on consensus rather than evidence. This article aims to critically appraise current conceptual and therapeutic approaches to StIP, highlight evidence gaps, and outline priorities for research and clinical practice. ARGUMENT: We propose a re-evaluation of StIP nosology, shifting away from DSM-5 distinctions that require symptom presence beyond abstinence and often fail in real-world settings. Management might require stage-specific approaches- acute (safety and short-term antipsychotics), subacute (stabilization and relapse prevention), and long-term (management of recurrent or persistent psychosis)- yet no validated staging models exist. Antipsychotic prescribing remains guided by expert opinion, with unresolved questions around choice of agent, treatment duration, and relapse prevention strategies. Evidence for psychosocial and behavioral interventions is very limited. Individualized care, supported by predictive tools, biomarkers, and longitudinal risk stratification, is essential to identify individuals at highest risk of progression and chronicity while minimizing unnecessary long-term pharmacotherapy.

conclusionsStimulant-induced psychosis (StIP) exemplifies a widening evidence-practice gap. Addressing this requires a coordinated research agenda to address nosology and phenomenology, validate diagnostic algorithms, develop stage-specific management models, and test integrated pharmacological and behavioral strategies. Without such efforts, outcomes will remain poor, and StIP will continue to represent one of psychiatry's most consequential yet neglected syndromes.