Psychotic symptoms associated with synthetic cathinone use in chemsex: clinical features and temporal patterns in a retrospective surveillance-based case series

29/10/2026

AI Summary

22% of 99 chemsex-related cathinone reports described psychotic spectrum symptoms.
Clinical features were mainly persecutory delusions, hallucinations and marked suspiciousness, typically during use, shortly after use, or during comedown and withdrawal.
Most presentations were acute or subacute; three cases persisted beyond the acute phase, required specialised psychiatric care and suggest need for longitudinal research.

TL;DR (AI Generated)

Reports describing clinical features compatible with psychotic-spectrum symptoms were specifically analyzed, focusing on the nature of the reported symptoms and on their distribution according to an operational categorization consistent with DSM-5-TR categories.

Three cases, with no reported prior history of psychotic disorder, had clinical presentations compatible with stimulant-induced psychotic disorder and required specialized psychiatric care.

DISCUSSION - CONCLUSION: Psychotic-spectrum symptoms associated with cathinone use in a chemsex context were most often acute or subacute, but a small number of more prolonged presentations were observed.

Basic summary

Addict Behav. 2026 Oct 17;185:108874. doi: 10.1016/j.addbeh.2026.108874. Online ahead of print.

ABSTRACT

INTRODUCTION: Although psychotic symptoms are a well-known complication of classical psychostimulants, synthetic cathinones have heterogeneous pharmacological profiles, with variable effects on dopamine, norepinephrine and serotonin systems. Distinguishing transient substance-related psychotic symptoms from persistent psychotic disorders remains clinically challenging. This study aimed to characterize the clinical features and temporal patterns of psychotic manifestations associated with cathinone use in a chemsex context.

MATERIALS AND METHODS: We performed a retrospective descriptive analysis of cases involving cathinone use in a chemsex context that were reported to a French regional substance use surveillance center between January 01, 2020 and December 31, 2025. Reports describing clinical features compatible with psychotic-spectrum symptoms were specifically analyzed, focusing on the nature of the reported symptoms and on their distribution according to an operational categorization consistent with DSM-5-TR categories.

RESULTS: Among the 99 cases, 22 (22%) reported psychotic-spectrum symptoms. Clinical presentations mainly included persecutory delusions, hallucinations, and marked suspiciousness, most often occurring during substance use, shortly after use, or during the comedown/withdrawal phase. Three cases, with no reported prior history of psychotic disorder, had clinical presentations compatible with stimulant-induced psychotic disorder and required specialized psychiatric care. In these cases, symptoms persisted beyond the acute phase.

DISCUSSION – CONCLUSION: Psychotic-spectrum symptoms associated with cathinone use in a chemsex context were most often acute or subacute, but a small number of more prolonged presentations were observed. These findings support careful assessment of symptoms temporality and persistence, and highlight the need for longitudinal studies to clarify the risk of stimulant-induced psychotic disorders.

PMID:42950701 | DOI:10.1016/j.addbeh.2026.108874

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