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Old 01-05-2012, 06:26 PM
coop
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Default cannabis psychosis

Cannabis psychosis

CANNABIS PSYCHOSIS

Dr Brian Boettcher Consultant Psychiatrist Shelton Hospital, Shropshire’s Community & Mental Health Services NHS Trust, Bicton Heath, Shrewsbury, SY3 8DN
Introduction

The drug induced psychosis seen when Cannabis is the main substance being abused is distinct phenomenologically from other psychosis.

It is unusual for such a psychosis to occur without other drugs being involved to some extent and so it is difficult to tease out the differences between the effects of Cannabis and other drugs.

However it is misleading and dangerous, to our youth in particular, to label Cannabis as “soft”. In fact the serious adverse effects of Cannabis have been known for some time now and Hall and Solowij in the British Journal of Psychiatry sounded warnings in 1997 about such issues as dependence on Cannabis, adolescent developmental problems, permanent cognitive impairment as well as involvement in and the development of psychosis.[1]

There are suggestions that in a small number of cases Cannabis is capable of precipitating psychosis, going on to the chronic picture described below, in people who have had no family and personal history of psychiatric illness.There have been suggestions that such people may be the ones who have started Cannabis in their teens and caused disturbance to neural connectivity. However, it seems Cannabis can precipitate or exacerbate a schizophrenic tendency in a characteristic manner.[2]
ACUTE SYMPTOMS OF CANNABIS PSYCHOSIS
International Classification of Diseases (ICD-10)

Often the combination of symptoms makes one suspicious that schizophrenia is present but at the same time there is an affective component. There may be the suspicion that the condition, either in part of whole, is feigned for reasons that are unclear because the pattern of symptoms do not fall easily into the usual criteria for psychosis. Drug taking is often denied, or the amount that is admitted by the patient is so little that one cannot say that this accounts for the current symptoms. Worse still, patients may not even consider Cannabis as an illicit or dangerous drug and so do not mention using it. Hallucinations are vague and delusions may be transitory with little in the way of thought disorder. There is often a lack of volition and a history of gradually deteriorating social ability and contact with others, including significant others. This history will often be verified by relatives and close friends who may be either completely ignorant of the drug taking, or confirm that there has been some in the past but believe that there has been little drug taking recently. There is often a depressive component with suicide attempts in the past but nothing recent or, if there is, then they are only ineffectual pleas for help. The person has usually lost his or her job some months or weeks before due to their poor performance at work. There is often very poor memory and concentration, which may be marked at the time of presentation. Paranoid delusions may be present and quite severe which can be the most alarming psychotic feature and result in hospital admission. If confronted with aggressive and authoritarian staff, who indicate verbally or non-verbally, that they do not believe the patient, the patient may become violent or simply leave against medical advice. There is a slow and gradual effect of cannabis and the symptoms continue to worsen for some time after the person stops using it. Thus by the time of presentation the person may be so disorganised and confused that they can’t even arrange their next “cone” or “joint”. Over the following few days the symptoms ease quickly. The improvement is easily credited to the neuroleptics and/or the antidepressants, which may in fact have contributed to the improvement. Symptoms such as the paranoia, hallucinations and depression fade until the patient is allowed to go on leave from the hospital and, a worsening of the symptoms may follow this. More often than not the nursing staff are the first to become suspicious that drugs have been taken when the patient is on leave from the hospital.

It could even be that the drug screen only indicated small dose drug taking or even absent. The International Classification of Disease indicates the following symptoms due to Cannabis.

“There must be dysfunctional behaviour, as evidenced by at least one at of the following:



(1) Apathy and sedation

(2) Disinhibition

(3) Psychomotor retardation

(4) Impaired attention

(5) Impaired judgement

(6) Interference with personal functioning.

C. At least one of the following signs must be present:

(1) Drowsiness

(2) Slurred speech

(3) Pupillary constriction (except in anoxia from severe overdose, when pupillary dilatation occurs)

(4) Decreased level of consciousness (e.g. Stupor, coma)
F12.0 Acute intoxication due to use of cannabinoids F12.0 DCR-10

A. The general criteria for acute intoxication (F1x.0) must be met.

B. There must be dysfunctional behaviour or perceptual disturbances including at least one at least one of the following:



(1) Euphoria and disinhibition

(2) Anxiety or agitation

(3) Suspiciousness or paranoid ideation

(4) Temporal slowing (a sense that time is passing very slowly, and/or the person is experiencing a rapid flow of ideas)

(5) Impaired judgement

(6) Impaired attention

(7) Impaired reaction time

(8) Auditory, visual or tactile illusions

(9) Hallucinations, with preserved orientation

(l0) depersonalization

(11) derealization

(12) Interference with personal functioning



* increased appetite
* dry mouth
* conjunctival injection
* tachycardia.”

[3] DSM IV also has similar but less complete information under the heading of Cannabis Induced Psychotic Disorder and refers the reader to a general description of “ Sunstance*Induced Psychotic Disorder”. That is the difference in the phenomenology of Cannabis Psychosis and other substance induced psychosis is not made, however this is now rather dated being 1994 when published.[4]

It can be seen from this that the range of symptoms is quite extensive and not confined to the core symptoms mentioned at the beginning.
CHRONIC SYMPTOMS OF CANNABIS PSYCHOSIS

Patients are left with the well-recognised and permanent symptoms of memory loss, apathy, loss of motivation and, paranoid ideation. These symptoms known as “ the Amotivational Syndrome” in the past are usually permanent.[5] If Cannabis using resumes then the acute symptoms redevelop. The chronic state can also be arrived at without a preceding psychotic episode. After Cannabis started to be widely used about 20 years ago, for permanent damage to occur it was felt by some that Cannabis had to be heavily used over at least three years [6]. However, there is accumulating evidence that smaller amount will do damage also and in animals “ deficits on tasks dependent on frontal lobe function have been reported in cannabis users” [7]. It is very difficult to conduct research in this area, as it is not acceptable to harm humans by doing trials with damaging substances such as Cannabis. However there is accumulating evidence of the psychological consequences of using Cannabis [8]. It is logical that to get the permanent “ Amotivational Syndrome” small amounts to damage have to accumulate incrementally. All this is in addition to the recognised danger of a recurrence of a pre-existing illness, such as Schizophrenia or Manic-depressive disorder. There are suggestions that Cannabis “ caused schizophrenia in young people and (or) enhanced the symptoms, especially in young people poorly able to cope with stress or in whom the antipsychotic therapy was unsuccessful”. [9] Caspari found “patients with previous cannabis abuse had significantly more rehospitalizations, tended to worse psychosocial functioning, and scored significantly higher on the psychopathological syndromes "thought disturbance" (BPRS) and "hostility" (AMDP). These results confirm the major impact of cannabis abuse on the long-term outcome of schizophrenic patients”.[10]P


References

[1] Hall W, Solowij N, “ Long-term Cannabis use and Mental Health “ 1997 British Journal of Psychiatry, August, 171:107-8

[2] Hall A, Degenhardt, “Cannabis and Psychosis” Australian National Drug and Alcohol Research Centre, Presented at The Inaugural International Cannabis and Psychosis Conference 1999 , Melbourne 16-17 February 1999

[3] World Health Organisation, Geneva, (1992) “ The ICD-10 Classification of Mental and Behavioural Disorders”

[4] Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, American Psychiatric Association,1994

[5] Schwartz RH “Marijuana: an overview”. Pediatr Clin North Am 1987 Apr;34(2):305-17 .

[6] Boettcher B, Medical Journal of Australia 11/25 December 1982 “Marijuana and Apathy”

[7] Jentsch J D, Verrico C D, Le D, Roth RH, “ Repeated exposure to dleta9-tetragydrocannabinol reduces prefrontal cortal dopamine metabolism in the rat “ ,Neurosci Lett (1998) May 1;246(3):169-72

[8] Hall W, Solowji N, Lemon J, The health and psychological consequences of Cannabis use. National Drug Strategy Monograph Series no 25. Canberra: Australia Government Publishing Service, 1994

[9] van Amsterdam JG, van der Laan JW, Slangen JL, “Cognitive and psychotic effects after cessation of chronic cannabis use “ Ned Tijdschr Geneeskd 1998 Mar 7;142(10):504-8

[10] Caspari D, “Cannabis and Schizophrenia: Results of a follow-up Study” Eur Arch Psychiatry Clin Neurosci 1999;249(1):45-9


Dr Brian Boettcher Consultant Psychiatrist Shelton Hospital, Shropshire’s Community & Mental Health Services NHS Trust, Bicton Heath, Shrewsbury, SY3 8DN
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  #2  
Old 01-05-2012, 06:31 PM
coop
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Long-time cannabis use associated with psychosis

Long-Time Cannabis Use Associated With Psychosis



Previous studies have identified an association between cannabis use and psychosis, according to background information in the article. However, concerns remain that this research has not adequately accounted for confounding variables.

John McGrath, M.D., Ph.D., F.R.A.N.Z.C.P., of the Queensland Brain Institute, University of Queensland, Australia, and colleagues studied 3,801 young adults born between 1981 and 1984. At a 21-year follow-up, when participants were an average age of 20.1, they were asked about cannabis use in recent years and assessed using several measures of psychotic outcomes (including a diagnostic interview, an inventory of delusions and items identifying the presence of hallucinations).

At the 21-year follow-up, 17.7 percent reported using cannabis for three or fewer years, 16.2 percent for four to five years and 14.3 percent for six or more years. Overall, 65 study participants received a diagnosis of "non-affective psychosis," such as schizophrenia, and 233 had at least one positive item for hallucination on the diagnostic interview.

Among all the participants, a longer duration since the first time they used cannabis was associated with multiple psychosis-related outcomes. "Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a non-affective psychosis and were four times as likely to have high scores on the Peters et al Delusions Inventory [a measure of delusion]," the authors write. "There was a 'dose-response' relationship between the variables of interest: the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes."

In addition, the researchers assessed the association between cannabis use and psychotic symptoms among a subgroup of 228 sibling pairs. The association persisted in this subgroup, "thus reducing the likelihood that the association was due to unmeasured shared genetic and/or environmental influences," the authors continue.

"The nature of the relationship between psychosis and cannabis use is by no means simple," they write. Individuals who had experienced hallucinations early in life were more likely to have used cannabis longer and to use it more frequently. "This demonstrates the complexity of the relationship: those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a non-affective psychotic disorder."

The findings should encourage further research to elucidate the mechanisms underlying the relationship between psychosis and cannabis use, the authors conclude.

This work was funded by the National Health and Medical Research Council of Australia. Co-author Dr. Alati is funded by a National Health and Medical Research Council Career Development Award in Population Health.



Journal Reference:

1. John McGrath; Joy Welham; James Scott; Daniel Varghese; Louisa Degenhardt; Mohammad Reza Hayatbakhsh; Rosa Alati; Gail M. Williams; William Bor; Jake M. Najman. Association Between Cannabis Use and Psychosis-Related Outcomes Using Sibling Pair Analysis in a Cohort of Young Adults. Arch Gen Psychiatry, 2010; 0 (2010): 2010. 6 [link]
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Old 01-05-2012, 06:35 PM
coop
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http://ukcia.org/research/CannabisUseAndPsychosis.pdf

Cannabis use and psychosis: a review of
clinical and epidemiological evidence*
Wayne Hall, Louisa Degenhardt
Objective: This paper evaluates evidence for two hypotheses about the relationship
between cannabis use and psychosis: (i) that heavy cannabis use causes a
‘cannabis psychosis’, i.e. a psychotic disorder that would not have occurred in the
absence of cannabis use and which can be recognised by its pattern of symptoms
and their relationship to cannabis use; and (ii) that cannabis use may precipitate
schizophrenia, or exacerbate its symptoms.
Method: Literature relevant to drug use and schizophrenia is reviewed.
Results: There is limited clinical evidence for the first hypothesis. If ‘cannabis
psychoses’ exist, they seem to be rare, because they require very high doses of
tetrahydrocannabinol, the prolonged use of highly potent forms of cannabis, or a preexisting
(but as yet unspecified) vulnerability, or both. There is more support for the
second hypothesis in that a large prospective study has shown a linear relationship
between the frequency with which cannabis had been used by age 18 and the risk
over the subsequent 15 years of receiving a diagnosis of schizophrenia.
Conclusions: It is still unclear whether this means that cannabis use precipitates
schizophrenia, whether cannabis use is a form of ‘self-medication’, or whether the
association is due to the use of other drugs, such as amphetamines, which heavy
cannabis users are more likely to use. There is better clinical and epidemiological
evidence that cannabis use can exacerbate the symptoms of schizophrenia.
Key words: cannabis, psychosis, schizophrenia.
Australian and New Zealand Journal of Psychiatry 2000; 34:26–34
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Old 01-05-2012, 11:14 PM
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Quote:
Originally Posted by coop View Post
Long-time cannabis use associated with psychosis

Long-Time Cannabis Use Associated With Psychosis



Previous studies have identified an association between cannabis use and psychosis, according to background information in the article. However, concerns remain that this research has not adequately accounted for confounding variables.

John McGrath, M.D., Ph.D., F.R.A.N.Z.C.P., of the Queensland Brain Institute, University of Queensland, Australia, and colleagues studied 3,801 young adults born between 1981 and 1984. At a 21-year follow-up, when participants were an average age of 20.1, they were asked about cannabis use in recent years and assessed using several measures of psychotic outcomes (including a diagnostic interview, an inventory of delusions and items identifying the presence of hallucinations).

At the 21-year follow-up, 17.7 percent reported using cannabis for three or fewer years, 16.2 percent for four to five years and 14.3 percent for six or more years. Overall, 65 study participants received a diagnosis of "non-affective psychosis," such as schizophrenia, and 233 had at least one positive item for hallucination on the diagnostic interview.

Among all the participants, a longer duration since the first time they used cannabis was associated with multiple psychosis-related outcomes.
"Compared with those who had never used cannabis, young adults who had six or more years since first use of cannabis (i.e., who commenced use when around 15 years or younger) were twice as likely to develop a non-affective psychosis and were four times as likely to have high scores on the Peters et al Delusions Inventory [a measure of delusion]," the authors write. "There was a 'dose-response' relationship between the variables of interest: the longer the duration since first cannabis use, the higher the risk of psychosis-related outcomes."

In addition, the researchers assessed the association between cannabis use and psychotic symptoms among a subgroup of 228 sibling pairs. The association persisted in this subgroup, "thus reducing the likelihood that the association was due to unmeasured shared genetic and/or environmental influences," the authors continue.

"The nature of the relationship between psychosis and cannabis use is by no means simple," they write. Individuals who had experienced hallucinations early in life were more likely to have used cannabis longer and to use it more frequently. "This demonstrates the complexity of the relationship: those individuals who were vulnerable to psychosis (i.e., those who had isolated psychotic symptoms) were more likely to commence cannabis use, which could then subsequently contribute to an increased risk of conversion to a non-affective psychotic disorder."

The findings should encourage further research to elucidate the mechanisms underlying the relationship between psychosis and cannabis use, the authors conclude.

This work was funded by the National Health and Medical Research Council of Australia. Co-author Dr. Alati is funded by a National Health and Medical Research Council Career Development Award in Population Health.



Journal Reference:

1. John McGrath; Joy Welham; James Scott; Daniel Varghese; Louisa Degenhardt; Mohammad Reza Hayatbakhsh; Rosa Alati; Gail M. Williams; William Bor; Jake M. Najman. Association Between Cannabis Use and Psychosis-Related Outcomes Using Sibling Pair Analysis in a Cohort of Young Adults. Arch Gen Psychiatry, 2010; 0 (2010): 2010. 6 [link]
Generally, studies like this that start with an agenda to paint a substance in a negative light are biased, and slanted from the get go, and from a clinical standpoint these studies are particularly difficult to take seriously.

First of all the studies always track individuals who had a psychotic episode as the result of marijuana use, and not the general population of users.

So the real question becomes: Would these individuals who had a psychotic reaction to marijuana, not have had any psychosis without marijuana, or, were they individuals who already had a predisposition towards non-affective psychotic disorders? Unfortunately the studies cannot address this question.

What this ultimately means is, that these tests may be quite relevent to individuals who have been shown to have acute psychopathological issues associated with smoking marijuana, but has little bearing on the majority of the smoking population which do not have these issues.

Also tests like Peters et al Delusions Inventory need to be taken with a grain of salt. Lets not forget that according to tests like this creative individuals are also many more times likely to score high on these tests.


Does this mean that we should stop trying to be creative, because it might make us psychotic and predisposed to delusions?

"


Creativity and psychopathology: higher rates of psychosis proneness and nonright-handedness among creative artists compared to same age and gender peers.

Preti A, Vellante M.
Source

Department of Psychology, University of Cagliari, Cagliari, Italy. apreti@tin.it
Abstract

Creative people have been found to score higher on psychopathologic scales in standardized tests, particularly on the scales that measure traits of psychoticism, and to be more likely to report an excess of nonright handedness compared with controls. However, results are inconsistent across surveys and methodologies, and the contribution of substance abuse has rarely been measured. In this study, 80 creative artists were compared with 80 matched noncreative controls on the Annett Hand Preference Questionnaire (HPQ), the Peters et al. Delusions Inventory, and the General Health Questionnaire. Creative artists were statistically more likely to admit the use of the left hand on the HPQ, with more widespread left hand use reported by artists involved in the creative activities traditionally associated with the right hemisphere (music and painting). They also scored higher on the Peters et al. Delusions Inventory independently from the level of psychopathology (measured with the General Health Questionnaire), from their laterality score (measured with the HPQ), and from their higher use of both licit and illicit drugs.

"

source: Creativity and psychopathology: higher rates... [J Nerv Ment Dis. 2007] - PubMed - NCBI


With that said, I have seen several people have psychotic breaks after smoking Haze.
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Old 01-06-2012, 04:28 AM
coop
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Quote:
Originally Posted by joshuahazen View Post
Generally, studies like this that start with an agenda to paint a substance in a negative light are biased, and slanted from the get go, and from a clinical standpoint these studies are particularly difficult to take seriously.

First of all the studies always track individuals who had a psychotic episode as the result of marijuana use, and not the general population of users.

So the real question becomes: Would these individuals who had a psychotic reaction to marijuana, not have had any psychosis without marijuana, or, were they individuals who already had a predisposition towards non-affective psychotic disorders? Unfortunately the studies cannot address this question.......

With that said, I have seen several people have psychotic breaks after smoking Haze.
I don't have the source off hand, but its quite well researched that people with psychosis issues choose to self medicate with cannabis then get the help they need.

I had a friend growing up who now is a schizophrenic., It definitely used to come out when she smoked when we where younger. A few years later when she did have her breakdown or whatever, whenever she choose to smoke her symptoms would get worse
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Old 01-06-2012, 06:13 AM
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Still don't know how to quote but have the tools now and will get there, so bear with me. But, Coop very nice to see articles like this on an honest forum. Joshuahazen quoted the most telling
part for me, and I would have quoted the bolded parts. Chronic usage during adolescence is one of, if not the, most important organizational study areas in terms of it's relevancy to the current
movement towards de-criminalization in my eyes. The importance of the phases of brain development up to the age of twenty-one can not be discounted as we move forward. Neuronal pruning
or the streamlining of synaptic configurations via the reduction of total neurons and hence total synapses is influenced by environmental factors, and any substance that affectes this process has
the potential to cause deleterious psychological consequences. Now the problem with studies like these, and is stated, is the differentiation of existing condition, and the link to the potentiation
of the degredation of the normal process of this pruning by introduced substance. This cytogeny of synaptic organization which is necessary to the evolution of proper learning and mental
development is so vital, that any substance that can adversely affect this should be denied if possible. Where we have failed as a society, in my opinion, is the psychology of prohibition.
Why is it that a thirteen year old who is at such risk, can get these substances easier then I, as a middle aged man whom is not so affected by the above processes? And, why aren't these studies so
widely published? Now, I don't want to discount any study that anatomized the formation of a young persons mental state, but to me, to study this without addressing the implicating factors of
it's development, and directly linking the two, can be, and usually is, an excersice in the cultivation and advancement of the issue that caused the problem to begin with, which in my eyes is
prohibition, period……Wag the dog, Oh! wag the dog……can't see the truth….so wag the dog…….such is our government….gonna leave the fog…..ya dig? GDaBud

Last edited by GDaBud; 01-06-2012 at 06:30 AM.
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