Thursday, April 8, 2010

Marijuana Psychosis

I want to take a break from health care reform today to talk about the increasing evidence that there is a complex interplay between marijuana use and psychosis, particularly schizophrenic like psychosis. I have noted that we have seen this at Cottonwood. We do not usually treat schizophrenia here at Cottonwood but we have seen a number of individuals (all males) that were admitted for primarily marijuana dependence and then found upon evaluation that they had a schizophrenic like psychosis with thought and behavior disorganization, auditory hallucinations , and paranoid thinking or delusions. The nature of the interplay between marijuana use is not fully clear but the association seems to go in both directions with schizophrenia increasing the risk for marijuana dependence and marijuana dependence increasing the risk of developing schizophrenic like symptoms.

We have known for a long time that the most common drug of abuse in schizophrenic patients is marijuana. In many cases the the initiation of marijuana use precedes the psychosis by several years. Several studies have shown that marijuana may be a triggering cause of onset of psychotic symptoms. It probably is that the marijuana precipitates or triggers psychosis in a population that is genetically predisposed to schizophrenia that may or may not have developed the disorder if not abusing marijuana.

The active ingredient in marijuana is 9- tetrahydrocannbinol (THC). The concentrations of TCH in the 1960's was about 2%-5% but current marijuana has up to 10%-20% THC content. THC interacts with specific cannabanoid receptors that are distributed in brain regions implicated in schizophrenia. Secondly there is an increased cannabanoid receptor density in the brain regions of the dorsolateral prefrontal cortex and the anterior cingulate cortex in patients with schizophrenia. Thirdly there are increased levels of endogenous cannabanoids in the blood and cerebrospinal fluid of patients with schizophrenia and acute controlled administration of THC causes both patients and controls to experience transient increases in schizophrenic like symptoms.

Most marijuana users will not develop psychosis but there does appear to be a population of at risk individuals who will develop schizophrenia partially directly due to the effects of marijuana. This is an interesting area for further research.

Thought for the day

There is no " safe" drug.

1 comment:

  1. Our son experienced this same problem this past weekend (April 10) -- he should have read this posting before lighting up last Friday! We retrieved him from college on Saturday morning, as he was incoherent on Friday afternoon. We got him home Saturday night and figured we'd get him admitted to a local hospital on Sunday morning. Life had other plans when we was running through the house at 3 AM Sunday. Had to call 911.

    What followed was a parents' nightmare. It ended very badly with a violent outburst in the Psych ER and he had to be taken down by 5 (FIVE!) security guards, restrained and sedated.

    He is now in the psych ward and has improved much since administration of anti-psychotic medication -- but was basically "out of it" for 5 full days! The question is whether this is a one-time psychotic episode or a permanent psychosis. We won't know for some time.

    Needless to say, "do not pass go, do not collect $200" - direct to a 28 day in patient.

    The local ER Psychiatrist has seen 30 cases of this in the past 10 weeks. It was his feeling the weed is laced with a PCP-like derivative which they do not have tests for (his toxicology only showed weed). The weed was purchased at his school in Ontario, Canada and probably came from BC.

    It is evil and will no doubt kill people.

    His semester is ruined and will get a bunch of "incompletes". Thank god we got him home, otherwise he might have really hurt himself well beyond what happened. Not sure how his "party mates" fared, but we took the liberty of informing them via texts.


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