Drug and Alcohol Dependence 80 (2005) 23–33 Rating the severity and character of transient cocaine-induced delusions and hallucinations with a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP) Joseph F. Cubells a,∗ , Richard Feinn b , Deborah Pearson b , Jeffrey Burda a , Yilang Tang a,1 , Lindsay A. Farrer c , Joel Gelernter a , Henry R. Kranzler b a Department of Psychiatry, Yale University School of Medicine and VA Connecticut Health Care System, West Haven, CT 06516, USA b Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030, USA c Departments of Medicine, Neurology, Genetics and Genomics, Epidemiology, and Biostatistics, Boston University, Boston, MA 02118, USA Received 26 March 2004; received in revised form 11 March 2005; accepted 14 March 2005 Abstract Background: Cocaine can induce transient psychotic symptoms. We examined the phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the Scale for Assessment of Positive Symptoms (SAPS), a well-validated instrument for the assessment of schizophrenic psychosis. Methods: We developed a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP), based on the well-validated SAPS. We interviewed 243 unrelated cocaine-dependent adults using both the SAPS-CIP and an instrument for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ). Results: One hundred and eighty-one (75%) of the subjects endorsed CIP using the CEQ. With the SAPS-CIP, hallucination (HAL) and delusion (DEL) scores correlated strongly, and the DEL domain showed excellent concurrent validity with the CEQ. We observed significant positive correlations, respectively, between severity of HAL and DEL, and lifetime number of episodes of cocaine use, and negative correlations with age at onset of cocaine use. Conclusions: The results suggest that CIP consists of transient delusional and hallucinatory symptoms, which tend to occur together and co-vary in severity. It appears that rating cocaine-induced paranoia alone (e.g., with the CEQ) can identify most subjects experiencing CIP. However, the SAPS-CIP is useful for quantifying the severity of CIP according to operational criteria. Our data provide additional evidence that CIP is a sensitizing response. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Psychostimulant; Psychosis; Paranoia; Severity rating; Quantitative trait; Sensitization 1. Introduction Cocaine can induce transient psychotic symptoms, such as paranoia that typically resolve with abstinence (Brady ∗ Corresponding author. Present address: Department of Human Genetics, Emory University School of Medicine, 615 Michael St., Suite 301, Atlanta, GA 30322, USA. Tel.: +1 404 7272005; fax: +1 404 727 3949. E-mail address: jcubells@genetics.emory.edu (J.F. Cubells). 1 Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA. et al., 1991; Satel et al., 1991b). The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. A second, distinct condition associated with chronic cocaine use is cocaine-induced excited delirium, which is typified by hyperthermia, clouded sensorium, muscular rigidity and, in some cases, severe complications including rhabdomyoly- sis and death (Wetli and Fishbain, 1985). Finally, prolonged exacerbation of psychotic symptoms in cocaine users with pre-existing schizophrenia or other psychotic illness has also been reported (Satel et al., 1991a). In the present report, we use the term CIP to refer to transient psychosis induced by co- 0376-8716/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2005.03.019