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Cannabis-Induced Psychosis

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Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

Abstract

The association between mental illness and drug abuse is complex and has been investigated by a wide scientific literature. Such comorbidity has a negative impact on both persistence and severity of illness. Nonetheless, a causal relationship still needs to be univocally defined, and the sole chronological criterion is not sufficient to determine a cause-effect relationship.

Among different illicit drugs, cannabis is the most commonly used in Europe, with almost 26.3% of adults using it in their lifetime. Although cannabis is generally regarded as a substance with low acute toxicity, its THC content and relative potency have increased over time, leading to a more frequent onset of psychotic pictures and an increased number of hospital admissions and of anxiety symptoms. As many experimental studies on healthy humans report, THC cannot only induce transient, dose-dependent psychotic symptoms but also affective, behavioral, cognitive, neurovegetative, and psychophysiological effects.

This chapter will present a case of a young adult with a history of cannabis abuse and who was admitted to the psychiatric ward for an acute psychotic symptomatology. His clinical picture was characterized by psychomotor agitation, aggressiveness, logorrhea, and a florid psychotic dimension. A toxicology screen on his urine resulted positive for cannabinoids. He underwent EKG, blood tests, magnetic resonance imaging, and positron emission tomography, all resulted in normal range.

In clinical cases similar to the current one, it seems crucial to distinguish between a primary psychiatric syndrome and a substance-induced disorder in order to establish an adequate acute treatment and follow-up.

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Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Lucio Oldani & Benedetta Grancini

Authors
  1. Lucio Oldani
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  2. Benedetta Grancini
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Corresponding author

Correspondence to Lucio Oldani .

Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment Questionnaire

Self-Assessment Questionnaire

  1. 1.

    What percentage of the total adult European population has tried cannabis at least once in their life?

    • (A) 15%

    • (B) 26%

    • (C) 13%

  2. 2.

    Why might neuroimaging be so important in cannabis psychosis?

    • (A) To exclude medical conditions

    • (B) To help a differential diagnosis

    • (C) To choose the most suitable pharmacological treatment

  3. 3.

    Tetrahydrocannabinol in cannabis represents:

    • (A) The calming component

    • (B) The psychotropic component

    • (C) An inactive component

  4. 4.

    Collecting medical history, in a psychotic patient and substance abuse, is:

    • (A) Not strictly necessary, as further diagnostic tools are more relevant to formulate a final diagnosis

    • (B) Very valuable in discriminating between a primary psychiatric disorder and a substance-induced clinical picture

    • (C) A process that has to be performed accurately, as only poor tools exist for detecting data such as intensity of abuse, clinical symptomatology, etc.

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Oldani, L., Grancini, B. (2019). Cannabis-Induced Psychosis. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_7

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  • DOI: https://doi.org/10.1007/978-3-319-91557-9_7

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