CANNABIS PSYCHOSIS

Home Journals Search Rules for Submit a Sponsor

Authors Paper Us
Printer friendly version
Default text | Increase text size
Online Journals
VET ON-LINE Vet On-Line
Browse
Through Our PHARMACY ON-LINE Pharmacy On-
Medical Line
ANAESTHESIA ON-LINE Anaesthesia
Journals...
GENERAL PRACTICE ON-LINE On-Line
General
PSYCHIATRY ON-LINE HISTORY OF MEDICINE ON-LINE Practice On-
Line
MEDICINE ON-LINE
History Of
FAMILY MEDICINE ON- Medicine On-
LINE Line
CHEST MEDICINE ON- Psychiatry On-
LINE Line
Medicine On-
DENTISTRY ON-LINE Line
Family
Medicine On-
CANNABIS PSYCHOSIS Line
Chest Medicine
Dr Brian Boettcher Consultant Psychiatrist Shelton Hospital, On-Line
Shropshire’s Community & Mental Health Services NHS Trust, Bicton Dentistry On-
Line
Heath, Shrewsbury, SY3 8DN
Surgery On-
Introduction Line

The drug induced psychosis seen when Cannabis is the main

substance being abused is distinct phenomenologically from other
psychosis.
It is unusual for such a psychosis to occur without other drugs being
involved to some extent and so it is difficult to tease out the differences
between the effects of Cannabis and other drugs.
However it is misleading and dangerous, to our youth in particular, to
label Cannabis as “soft”. In fact the serious adverse effects of Cannabis
have been known for some time now and Hall and Solowij in the British
Journal of Psychiatry sounded warnings in 1997 about such issues as
dependence on Cannabis, adolescent developmental problems,
permanent cognitive impairment as well as involvement in and the
development of psychosis.[1]
There are suggestions that in a small number of cases Cannabis is
capable of precipitating psychosis, going on to the chronic picture
described below, in people who have had no family and personal
history of psychiatric illness.There have been suggestions that such
people may be the ones who have started Cannabis in their teens and
caused disturbance to neural connectivity. However, it seems Cannabis
can precipitate or exacerbate a schizophrenic tendency in a
characteristic manner.[2]
ACUTE SYMPTOMS OF CANNABIS PSYCHOSIS

International Classification of Diseases (ICD-10)

Often the combination of symptoms makes one suspicious that

schizophrenia is present but at the same time there is an affective
component. There may be the suspicion that the condition, either in
part of whole, is feigned for reasons that are unclear because the
pattern of symptoms do not fall easily into the usual criteria for
psychosis. Drug taking is often denied, or the amount that is admitted
by the patient is so little that one cannot say that this accounts for the
current symptoms. Worse still, patients may not even consider
Cannabis as an illicit or dangerous drug and so do not mention using it.
Hallucinations are vague and delusions may be transitory with little in
the way of thought disorder. There is often a lack of volition and a
history of gradually deteriorating social ability and contact with others,
including significant others. This history will often be verified by
relatives and close friends who may be either completely ignorant of
the drug taking, or confirm that there has been some in the past but
believe that there has been little drug taking recently. There is often a
depressive component with suicide attempts in the past but nothing
recent or, if there is, then they are only ineffectual pleas for help. The
person has usually lost his or her job some months or weeks before
due to their poor performance at work. There is often very poor memory
and concentration, which may be marked at the time of presentation.
Paranoid delusions may be present and quite severe which can be the
most alarming psychotic feature and result in hospital admission. If
confronted with aggressive and authoritarian staff, who indicate verbally
or non-verbally, that they do not believe the patient, the patient may
become violent or simply leave against medical advice. There is a slow
and gradual effect of cannabis and the symptoms continue to worsen
for some time after the person stops using it. Thus by the time of
presentation the person may be so disorganised and confused that
they can’t even arrange their next “cone” or “joint”. Over the following
few days the symptoms ease quickly. The improvement is easily
credited to the neuroleptics and/or the antidepressants, which may in
fact have contributed to the improvement. Symptoms such as the
paranoia, hallucinations and depression fade until the patient is allowed
to go on leave from the hospital and, a worsening of the symptoms may
follow this. More often than not the nursing staff are the first to become
suspicious that drugs have been taken when the patient is on leave
from the hospital.
It could even be that the drug screen only indicated small dose drug
taking or even absent. The International Classification of Disease
indicates the following symptoms due to Cannabis.
“There must be dysfunctional behaviour, as evidenced by at least one
at of the following:
(1) Apathy and sedation
(2) Disinhibition
(3) Psychomotor retardation
(4) Impaired attention
(5) Impaired judgement
(6) Interference with personal functioning.
C. At least one of the following signs must be present:
(1) Drowsiness
(2) Slurred speech
(3) Pupillary constriction (except in anoxia from severe overdose, when
pupillary dilatation occurs)
(4) Decreased level of consciousness (e.g. Stupor, coma)

F12.0 Acute intoxication due to use of cannabinoids F12.0 DCR-10

A. The general criteria for acute intoxication (F1x.0) must be met.

B. There must be dysfunctional behaviour or perceptual disturbances
including at least one at least one of the following:

(1) Euphoria and disinhibition

(2) Anxiety or agitation
(3) Suspiciousness or paranoid ideation
(4) Temporal slowing (a sense that time is passing very slowly, and/or
the person is experiencing a rapid flow of ideas)
(5) Impaired judgement
(6) Impaired attention
(7) Impaired reaction time
(8) Auditory, visual or tactile illusions
(9) Hallucinations, with preserved orientation
(l0) depersonalization
(11) derealization
(12) Interference with personal functioning
 increased appetite
dry mouth
conjunctival injection
tachycardia.”

[3] DSM IV also has similar but less complete information under the
heading of Cannabis Induced Psychotic Disorder and refers the reader
to a general description of “ SunstanceInduced Psychotic Disorder”.
That is the difference in the phenomenology of Cannabis Psychosis
and other substance induced psychosis is not made, however this is
now rather dated being 1994 when published.[4]
It can be seen from this that the range of symptoms is quite extensive
and not confined to the core symptoms mentioned at the beginning.
CHRONIC SYMPTOMS OF CANNABIS PSYCHOSIS
Patients are left with the well-recognised and permanent symptoms of
memory loss, apathy, loss of motivation and, paranoid ideation. These
symptoms known as “ the Amotivational Syndrome” in the past are
usually permanent.[5] If Cannabis using resumes then the acute
symptoms redevelop. The chronic state can also be arrived at without a
preceding psychotic episode. After Cannabis started to be widely used
about 20 years ago, for permanent damage to occur it was felt by some
that Cannabis had to be heavily used over at least three years [6].
However, there is accumulating evidence that smaller amount will do
damage also and in animals “ deficits on tasks dependent on frontal
lobe function have been reported in cannabis users” [7]. It is very
difficult to conduct research in this area, as it is not acceptable to harm
humans by doing trials with damaging substances such as Cannabis.
However there is accumulating evidence of the psychological
consequences of using Cannabis [8]. It is logical that to get the
permanent “ Amotivational Syndrome” small amounts to damage have
to accumulate incrementally. All this is in addition to the recognised
danger of a recurrence of a pre-existing illness, such as Schizophrenia
or Manic-depressive disorder. There are suggestions that Cannabis “
caused schizophrenia in young people and (or) enhanced the
symptoms, especially in young people poorly able to cope with stress
or in whom the antipsychotic therapy was unsuccessful”. [9] Caspari
found “patients with previous cannabis abuse had significantly more
rehospitalizations, tended to worse psychosocial functioning, and
scored significantly higher on the psychopathological syndromes
"thought disturbance" (BPRS) and "hostility" (AMDP). These results
confirm the major impact of cannabis abuse on the long-term outcome
of schizophrenic patients”.[10]P

References
[1] Hall W, Solowij N, “ Long-term Cannabis use and Mental Health “
1997 British Journal of Psychiatry, August, 171:107-8
[2] Hall A, Degenhardt, “Cannabis and Psychosis” Australian National
Drug and Alcohol Research Centre, Presented at The Inaugural
International Cannabis and Psychosis Conference 1999 , Melbourne
16-17 February 1999
[3] World Health Organisation, Geneva, (1992) “ The ICD-10
Classification of Mental and Behavioural Disorders”
[4] Diagnostic and Statistical Manual of Mental Disorders , Fourth
Edition, American Psychiatric Association,1994
[5] Schwartz RH “Marijuana: an overview”. Pediatr Clin North Am 1987
Apr;34(2):305-17 .
[6] Boettcher B, Medical Journal of Australia 11/25 December 1982
“Marijuana and Apathy”
[7] Jentsch J D, Verrico C D, Le D, Roth RH, “ Repeated exposure to
dleta9-tetragydrocannabinol reduces prefrontal cortal dopamine
metabolism in the rat “ ,Neurosci Lett (1998) May 1;246(3):169-72
[8] Hall W, Solowji N, Lemon J, The health and psychological
consequences of Cannabis use. National Drug Strategy Monograph
Series no 25. Canberra: Australia Government Publishing Service,
1994
 [9] van Amsterdam JG, van der Laan JW, Slangen JL, “Cognitive and
psychotic effects after cessation of chronic cannabis use “ Ned Tijdschr
Geneeskd 1998 Mar 7;142(10):504-8
[10] Caspari D, “Cannabis and Schizophrenia: Results of a follow-up
Study” Eur Arch Psychiatry Clin Neurosci 1999;249(1):45-9

Dr Brian Boettcher Consultant Psychiatrist Shelton Hospital,

Shropshire’s Community & Mental Health Services NHS Trust, Bicton
Heath, Shrewsbury, SY3 8DN

All pages copyright ©Priory Lodge Education Ltd 1994-1999.

Click on these links to visit our Journals:

Psychiatry On-Line
Dentistry On-Line | Vet On-Line | Chest Medicine On-Line
GP On-Line | Pharmacy On-Line | Anaesthesia On-Line | Medicine On-
Line
Family Medical Practice On-Line

Home • Journals • Search • Rules for Authors • Submit a Paper • Sponsor us

All pages in this site copyright ©Priory Lodge Education Ltd 1994-2020