Psychotic Cannabis Withdrawal: A Clinical Case

Abstract

Cannabis use has been associated with several psychiatric comorbidities and there appears to be a doseresponse relationship between the intensity and duration of its use and the risk of psychosis. More commonly, acute episodes of cannabis induced-psychosis manifest immediately following exposure, are precipitated after the use of large amounts of cannabis, resolve with abstinence, and are of shorter duration than those observed with primary psychotic disorders.Cannabis withdrawal symptoms usually manifest when heavy, prolonged consumption of this substance is interrupted or significantly reduced. The withdrawal syndrome may include sympathetic autonomic hyperactivity, irritability, anxiety, sleep disturbance, and reduced appetite. On the other hand, cases of psychosis induced by cannabis withdrawal are rare.In this case, we present a 32-year-old healthy woman without personal or family psychiatric history who showed a heavy and continued consumption of cannabis since she was 10 years old, without developing any psychiatric symptoms. However, recently she experienced two brief psychotic episodes with disorganized behavior and persecutory delusions, both episodes happening a week after discontinuing cannabis consumption.

Cannabis-induced psychotic disorder with onset during withdrawal: a brief report of emerging evidence

“…Accordingly, therapeutic approaches aimed at normalising low endocannabinoid levels following abstinence, when withdrawal symptoms emerge, may be essential not only to prevent relapse and treating cannabis use disorders but also perhaps to treat/avoid cannabis-induced psychotic symptoms during withdrawal in vulnerable individuals. Consistent with previous reports (Joseph et al, 2018;Marín et al, 2021;Shakya and Upadhaya, 2021;Kung et al, 2022;Ramos et al, 2022), the cases described in this article showed improvement after administration of dopamine D2 blockers. Nonetheless, alternative treatments other than targeting the dopaminergic system may be warranted.…”

“…Cannabis-induced psychotic episodes with onset during withdrawal are scarcely described in medical literature (Joseph et al, 2018;Marín et al, 2021;Shakya and Upadhaya, 2021;Kung et al, 2022;Ramos et al, 2022), and very little understood. Currently, the DSM does not consider psychotic symptoms as part of CWS (American Psychiatric Association, 2013).…”

“…To date, few individual cases of cannabis-induced psychotic disorder with onset during withdrawal have been reported (Joseph et al, 2018;Marín et al, 2021;Shakya and Upadhaya, 2021;Kung et al, 2022;Ramos et al, 2022). Overall, previous reports described the onset of a psychotic episode in the context of cannabis withdrawal in a group of five young subjects (mean age [SD] = 25.8 [4.8] years; gender [male/female] = 3/2).…”