Psychotic Cannabis Withdrawal: A Clinical Case - Cureus

Cannabis usage has been associated with respective psychiatric comorbidities, including mood, anxiety, and psychotic disorders, peculiarly successful the lawsuit of depletion astatine an aboriginal property [1]. While these associations are good established, the mechanisms progressive are not afloat understood, with inconsistent and adjacent contradictory findings [2].

Cannabis withdrawal syndrome occurs erstwhile dense and prolonged depletion of this substance is interrupted oregon importantly reduced. Its symptoms usually look wrong 24 to 72 hours and past for astir 1 to 2 weeks [3]. It tin mimic withdrawal syndromes from different substances, specified arsenic intoxicant oregon opioids, with sympathetic autonomic hyperactivity, stomach pain, tremors, sweating, fever, headaches, irritability, anxiety, slumber disturbance, and, much rarely, psychosis [4-6].

In summation to the cannabis withdrawal syndrome, the Eleventh Revision of the International Classification of Diseases (ICD-11) includes cannabis-induced psychotic disorder, which is characterized by “psychotic symptoms that make during oregon soon aft intoxication with oregon withdrawal from cannabis” and that “are not amended explained by a superior disorder” [7]. While intoxication-induced psychotic cases are commonly described connected literature, psychotic cases aft cannabis cessation are seldom reported.

We contiguous the lawsuit of a 32-year-old woman, with an acute psychotic occurrence admitted to the psychiatry exigency department, wherever she was brought by the constabulary for disorganized behavior. The lone psychiatric grounds she presented was a sojourn to the exigency work with a akin occurrence to the existent one, which happened four years before. However, astatine that clip she did not travel the recommendations fixed aft discharge, specified arsenic attending a follow-up consultation and taking the prescribed antipsychotic medication.

In the exigency department, she was agitated, restless, and assertive and she stated that she was being threatened by idiosyncratic she did not know, who was pursuing her and wanted to termination her and her family. She besides believed she had a weaponry wrong her body, which she tried to region by scratching herself successful the cervix region, and that her ovaries had been disturbed by an exterior force. In this archetypal evaluation, the diligent could not tell when she started to consciousness similar this.

She was disheveled, with mediocre hygiene, barefoot, and wearing bedewed clothes. She was unpleasant and uncooperative successful the psychiatric interview, but attentive and alert of the time, existent location, and situation. Mood and impact were highly irritable. She displayed disorganized code and persecutory delusions, though she did not amusement immoderate motion of hallucinations. The penetration and judgement were poor, and she did not privation aesculapian assistance oregon medication. She had nary past of immoderate aesculapian condition, seizure activity, oregon caput trauma. There were nary symptoms accordant with mania oregon hypomania.

The neuroimaging (head computerized tomography) and analytic survey (including hemogram, leucogram, ionogram, thyroid, renal and hepatic relation analysis, syphilis, borrelia, HIV, HCV, and HBV serologies, inflammatory markers, intoxicant seric levels) were normal. The urine toxicology surface taken was positive for cannabis and antagonistic for cocaine, opiates, and psychostimulant drugs.

During hospitalization, it was imaginable to recognize that she presented altered behaviour and archetypal and slumber attraction insomnia for 2 weeks. These symptoms started 2 days aft she stopped utilizing cannabis (she was consuming 2 g per time successful the past 15 years). A week erstwhile coming to the exigency department, she was much agitated, with disorganized behavior, and with full insomnia. Because of that, she was nary longer capable to signifier her occupation arsenic a hairdresser and prosecute successful activities with her societal web arsenic she utilized to.

Four years back, she presented a psychotic occurrence akin to the existent one, besides aft the suspension of cannabis use. After being evaluated successful the exigency department, she was discharged location and diagnosed with unspecified inorganic psychosis. At that time, she was medicated with an oral antipsychotic and oriented to a psychiatry consultation, which she missed. After that, she maintained the medicine for 1 week, was abstinent for 3 months, and returned to her regular routines and functionality. After resuming cannabis use, she denied having caller symptoms. A household past of psychosis oregon different terrible intelligence unwellness was not present.

Regarding cannabis use, she began utilizing cannabis astatine the property of 10, fractional a associated a day. At 12 years old, she was smoking 10 joints a day, having reduced to 2 joints a time erstwhile she started moving astatine the property of 17. Shortly after, she accrued the cause usage to six joints a day, astir 2 grams of cannabis, which she has maintained until the present. She stated that depletion helped her to unbend and interact with others. Moreover, she was an progressive smoker (10 cigarettes a day) and did not contiguous immoderate different substance use. On the psychiatric ward, she was treated with aripiprazole 15 mg (once a day) and diazepam 5 mg (twice a day). After the due pharmacological intervention, she showed gradual betterment implicit 1 week of hospitalization.

On the time of discharge, she did not contiguous psychotic symptoms, namely delusions oregon hallucinations. She was prescribed the aforesaid medicine connected discharge and referred to psychiatric consultation for follow-up. She was evaluated successful ambulatory consultation, wherever she admitted resuming smoking cannabis again, astatine a little dose (about 0.5 g per day), portion taking the medicine prescribed. She presented psychopathological stability, without psychotic symptomatology. She was doing a hairdressing people and has resumed her societal life, seemingly regaining her erstwhile functionality.

This objective lawsuit describes a psychotic occurrence that appears to person occurred owed to the abrupt cessation of cannabis use. The diligent was utilizing cannabis regular for the past 24 years and with regular usage of 2 g for the past 15 years.

Cannabis usage is simply a well-recognized hazard origin for psychotic symptoms and determination appears to beryllium a dose-response narration betwixt the strength and duration of its usage and the hazard of psychosis [8,9]. According to European Drug Report 2020, astir 1% of adults successful the European Union countries are regular oregon astir regular (20 days oregon much successful a month) cannabis users and the bulk of these are nether 35 years aged [10].

Usually, the usage of cannabis is associated with acute episodes of psychosis that manifest instantly pursuing exposure, which is typically precipitated aft the usage of ample amounts of cannabis, resoluteness with abstinence, and are of shorter duration than those observed with superior psychotic disorders [11,12], though the idiosyncratic has besides been associated with episodes of psychosis persisting beyond the play of intoxication [13].

Cannabis withdrawal is babelike connected the magnitude of depletion pre-cessation, gender, familial and biology factors. Besides the carnal signs, the psychiatric symptoms that person been described successful the lit see irritability, choler oregon aggression; nervousness oregon anxiety; slumber difficulty; decreased appetite; restlessness; depressed mood, and rarely, psychosis. However, psychiatric manifestations are inactive an infrequent and misunderstood phenomenon [4-6].

Both withdrawal symptoms (particularly slumber deprivation) and a little psychotic occurrence were observed successful this young big patient, who presented to the exigency psychiatry section with persecutory delusions. The timeline of this patient’s episodes powerfully suggests psychosis induced by cannabis withdrawal, whose symptoms are accordant with erstwhile reports disposable successful the lit [13]. We besides considered that sleep deprivation, effect of cannabis withdrawal, contributed to the onset and improvement of psychotic symptomatology successful this case.