Cannabis-induced psychotic disorder
Psychotic disorder caused by cannabis
From Wikipedia, the free encyclopedia
Cannabis-induced psychotic disorder (CIPD), also known as cannabis-induced psychosis, cannabis-associated psychotic symptoms, or cannabis psychosis, is a mental disorder characterized by psychotic symptoms such as hallucinations, delusions, severe paranoia, disorganized thinking, disorganized behavior, and insomnia that occurs following the use of or withdrawal from cannabis.[3] Cannabis-induced psychotic disorder is more likely to occur in individuals with a personal or family history of mental illness.[1][4] The incidence rate of CIPD is estimated to be 1 in 200 people who use cannabis.[1][2] More than 50% of patients recover within 24 hours, but the disorder may last for weeks or months if left untreated.[1][5] The treatment is atypical antipsychotic medication.[1][6]
| Cannabis-induced psychotic disorder | |
|---|---|
| Other names | CIPD, cannabis-induced psychosis, CIP, cannabis-associated psychotic symptoms, CAPS, cannabis psychosis |
| Specialty | Psychiatry, addiction psychiatry |
| Symptoms | Hallucinations, delusions, paranoia, insomnia |
| Complications | Self-harm, suicide |
| Causes | cannabis, cannabinoids |
| Risk factors | History of depression, anxiety, or bipolar disorder[1] |
| Treatment | Atypical antipsychotics |
| Frequency | 0.47%[1][2] |
Signs and symptoms
The symptoms of cannabis-induced psychotic disorder involve the symptoms of psychosis such as severe paranoia, confusion, agitation, hallucinations, delusions, disorganized thinking, and disorganized behavior. Memory problems and insomnia may also occur.[4] The symptoms typically begin shortly after using cannabis or during cannabis withdrawal and continue until they are treated with an antipsychotic medication.[7]
Diagnosis
Cannabis-induced psychotic disorder has the code 6C41.6 in the ICD-11.[3]
The risk of cannabis-induced psychotic disorder is higher for those who use high-potency THC (greater than 10% THC) and for those who use cannabis often.[1] The risk is also higher for younger and male individuals.[1] A history of mental illness, such as depression, anxiety, or bipolar disorder, also increases the risk of psychosis.[1][4] In addition to cannabis, synthetic cannabinoids can also induce psychosis.[8][9]
Treatment
Treatment consists of atypical antipsychotics such as risperidone, olanzapine, aripiprazole, or quetiapine.[1][6] Haloperidol, a typical antipsychotic may be given in the emergency room to stabilize a patient before they are switched to an atypical antipsychotic for maintenance therapy.[6][10] Aripiprazole, brexpiprazole, cariprazine, and lurasidone are third-generation antipsychotics used to treat substance-induced psychosis.[11] Compared to second and first-generation antipsychotics, third-generation antipsychotics have a better side effect profile and improved tolerability for long-term use.[12] Individuals are also recommended to practice abstinence from cannabis and can be given counseling designed to assist with preventing a relapse of substance use.[13][14]
Prognosis
Individuals with symptoms lasting longer than 1 week or a history of psychosis have hospitalization rates ranging between 54% to 76%.[1][4]
Cannabis-induced psychotic disorder is later diagnosed as schizophrenia in approximately 34% of individuals.[15] This was found to be comparatively higher than hallucinogens (26%) and amphetamines (22%).[15] Researchers maintain there exists "a strong association" between schizophrenia and cannabis use.[16]
Left untreated, cannabis-induced psychotic disorder has led to suicide.[17][18][19]
Epidemiology
Cannabis-induced psychotic disorder has been reported to occur at a rate of 1 in 200 people who use cannabis, or 0.47%.[1][2]
At an epidemiological level, a dose–response relationship exists between cannabis use and increased risk of psychosis and earlier onset of psychosis.[20][21][22][23] Researchers found an increase in schizophrenia and psychosis cases in Canada linked to cannabis use disorder following the drug's legalization.[24] According to the National Academies of Sciences, Engineering and Medicine, there is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other chronic psychoses, with the highest risk potentially among the most frequent users.[25]
In 2016 a meta-analysis was published on associations studies covering a range of dosing habits, again showing that cannabis use is associated with a significantly increased risk of psychosis, and alleged that a dose–response relationship exists between the level of cannabis use and risk of psychosis. The risk was increased 4-fold with daily use.[26]
A 2016 study regarded the epidemiologic evidence on cannabis use and psychosis strong enough "to warrant a public health message that cannabis use can increase the risk of psychotic disorders."[27] A public health message was subsequently issued in August 2019 by the Surgeon General of the United States.[28] The review also stated "If the association between cannabis and schizophrenia is causal and of the magnitude estimated across studies to date, this would equate to a schizophrenia lifetime risk of approximately 2% in regular cannabis users (though risk for broader psychotic outcomes will be greater). This implies that about 98% of regular cannabis users will not develop schizophrenia...[and that] risk could be much greater in those at a higher genetic risk, or in those who use particularly potent strains of cannabis."[27]