First-Episode of Synthetic Cannabinoid-Induced Psychosis in a Young Adult, Successfully Managed with Hospitalization and Risperidone (original) (raw)
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Consumption of synthetic mind-altering compounds, also known as " new psychoactive substances, " is increasing globally at an alarming rate. Synthetic cannabinoids (SCs) are among the most commonly used new psychoactive substances. They are usually purchased as marijuana-like drugs, marketed as herbal blends and perceived as risk-free by inexperienced users. Yet, contrary to Δ 9-tetrahydrocannabinol, SCs may lead to severe health consequences, including anxiety, tachycardia, hallucinations, violent behavior, and psychosis. This review focuses on the latest (2010–2015) evidence of psychotic symptoms induced by ingestion of products containing SCs. Reports suggesting that SCs may either exacerbate previously stable psychotic symptoms (in vulnerable individuals) or trigger new-onset psychosis (in individuals with no previous history of psychosis) are reviewed. Pharmacology and toxicology of these compounds are discussed, with particular reference to their psychoactive effects.
Brain Sciences
Background: Novel Psychoactive Substances (NPS) are a heterogeneous class of synthetic molecules including synthetic cannabinoid receptor agonists (SCRAs). Psychosis is associated with SCRAs use. There is limited knowledge regarding the structured assessment and psychometric evaluation of clinical presentations, analytical toxicology and clinical management plans of patients presenting with psychosis and SCRAs misuse. Methods: We gathered information regarding the clinical presentations, toxicology and care plans of patients with psychosis and SCRAs misuse admitted to inpatients services. Clinical presentations were assessed using the PANSS scale. Vital signs data were collected using the National Early Warning Signs tool. Analytic chemistry data were collected using urine drug screening tests for traditional psychoactive substances and NPS. Results: We described the clinical presentation and management plan of four patients with psychosis and misuse of SCRAs. Conclusion: The formul...
The adverse health effects of synthetic cannabinoids with emphasis on psychosis-like effects
Journal of psychopharmacology (Oxford, England), 2015
Cannabis use is associated with an increased risk of psychosis in vulnerable individuals. Cannabis containing high levels of the partial cannabinoid receptor subtype 1 (CB1) agonist tetrahydrocannabinol (THC) is associated with the induction of psychosis in susceptible subjects and with the development of schizophrenia, whereas the use of cannabis variants with relatively high levels of cannabidiol (CBD) is associated with fewer psychotic experiences. Synthetic cannabinoid receptor agonists (SCRAs) are full agonists and often more potent than THC. Moreover, in contrast to natural cannabis, SCRAs preparations contain no CBD so that these drugs may have a higher psychosis-inducing potential than cannabis. This paper reviews the general toxicity profile and the adverse effects of SCRAs with special emphasis on their psychosis-inducing risk. The review shows that, compared with the use of natural cannabis, the use of SCRAs may cause more frequent and more severe unwanted negative effect...
Synthetic Cannabinoid-Induced Psychosis: Two Adolescent Cases
Journal of Child and Adolescent Psychopharmacology, 2012
W hen used appropriately, marijuana and its structurally analogous derivatives have medicinal properties that humans have exploited for centuries. Unfortunately, D9-THC-based drugs beget both therapeutic and undesirable psychotropic actions by activating CB1 cannabinoid receptors (CB1Rs) in the central nervous system (CNS), which can potentially lead to psychotic symptoms. K2, also called Spice, is an emerging drug of abuse that is advertised as ''legal marijuana.'' Although it is structurally distinct from D9-THC, the synthetic cannabinoid compounds in K2 products are derivatives of the well-characterized aminoalkylindole (AAI) class of ligands that also bind and activate CB1Rs (Huffman and Duncan 1997; Huffman et al. 2003, 2005; Seely et al. 2011). Synthetic cannabinoid compounds were initially developed by some pharmaceutical industries and academic laboratories > 40 years ago, as possible pharmaceutical agents for the treatment of debilitating pain. It was difficult, however, to separate the therapeutic properties from the unwanted psychoactive effects. In recent years, synthetic cannabinoids compounds are sprayed on ''herbal incense'' for the purpose of achieving intoxication from smoking; this is similar to, and in most cases more potent than, cannabis (EMCDDA 2009; Nutt 2009). Reported here are two adolescent cases of synthetic cannabinoid-induced psychosis.
Synthetic Cannabinoid Induced Psychosis in a Previously Nonpsychotic Patient
The American Journal on Addictions, 2012
Synthetic cannabinoids are relatively new substances that have become rapidly popular among young adults. Despite their legal status in most states, they are virtually unregulated and unstudied. Nevertheless, recent case studies have brought new attention to their potentially harmful side effects, such as psychosis, agitation, and withdrawal. This case report examines the acute psychosis displayed by a psychiatric patient after smoking "Spice," a substance comprised of various synthetic cannabinoids, on three separate occasions. Furthermore, in comparing this patient's lack of psychotic symptoms after tetrahydrocannabinol (THC) use, to the episodes of psychosis experienced after "Spice" consumption this case study explores the possibility that synthetic cannabinoids are more potent than their organic counterpart. This is the first case report of synthetic cannabinoid-induced psychosis in a previously nonpsychotic patient. "Spice," comprised of various synthetic cannabinoids, is a growing trend within substance use in young adults. It has been tried by up to 6% of 15-to 18-year-olds in Germany. 1 Despite the current lack of data revealing the prevalence of "Spice" use within any age group in the United States, case reports are documenting a recent increase in emergency room and forensic presentations related to its use. 2,3 To date, there are no studies of inhaled synthetic cannabinoid use in humans. Nevertheless, recent case reports have shown a correlation between synthetic cannabinoid consumption and acute psychosis 2,4 and agitation. 3 Another study describes acute withdrawal in a patient smoking up to 3 g/day for 8 months. 5 Despite mounting public health concerns and concomitant legislative effort to remove it from the public domain, this compound is still legal in various forms in most states. Given its increased potency compared to harvested
Neuropsychiatric Disease and Treatment, 2016
Background: This study aimed to evaluate synthetic cannabinoid (SC)-induced psychosis in terms of patient profile and clinical characteristics with reference to concurrently hospitalized schizophrenic patients. Methods: A total of 81 male patients diagnosed with psychotic disorder induced by the use of SCs (n=50; mean (standard deviation [SD]) age: 25.9 (5.5) years) or with schizophrenia (n=31, mean (SD) age: 42.9 (11.6) years) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis criteria who were concurrently hospitalized at Erenköy Mental and Neurological Diseases Training and Research Hospital were included in this cross-sectional study. Data on sociodemographic characteristics, Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Frontal Assessment Battery (FAB), Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HAM-A) were recorded in all the patients. Results: Mean (SD) age at disease onset in SC-induced psychosis patients was 22.3 (5.6) years; 26.0% had suicidal ideation and 58.4% were hospitalized involuntarily. Marijuana was the most common first used substance (72.0%), and solitary use of SC was noted in 38.0% of patients. SC-induced psychosis patients had similar PANSS positive, BPRS, HRSD, and FAB scores and significantly lower PANSS negative scores (18.0 [6.5] vs 22.3 [6.0], P=0.004) than patients with schizophrenia, while they had similar HAM-A scores (17.8 [10.3] vs 21.6 [5.5], P=0.085) as young schizophrenics. Age at onset for SC (r=0.364, P=0.05) or substance (r=0.395, P=0.01) use was correlated positively with total FAB scores. Conclusion: In conclusion, our findings revealed SC-induced psychosis to influence young individuals and be associated with remarkable rates of suicidal ideation and involuntary hospitalization as well as similar clinical picture with schizophrenia in terms of PANSS positive, BPRS, HRSD, HAM-A, and FAB scores. Younger age at onset was associated with poorer frontal lobe functions overall, regardless of the type of substance, and with poorer inhibitory control and programming performance in case of SC use.
Psychopharmacology, 2021
BACKGROUND Synthetic cannabinoids (SCs) are the largest class of novel psychoactive substances (NPS) and are associated with an increased risk of overdosing and adverse events such as psychosis. JWH-018 is one of the earliest SCs and still widely available in large parts of the world. Controlled studies to assess the safety and behavioural profiles of SCs are extremely scarce. AIM The current study was designed to assess the psychotomimetic effects of a moderate dose of JWH-018. METHODS Twenty-four healthy participants (10 males, 14 females) entered a placebo-controlled, double blind, within-subjects trial and inhaled vapour of placebo or 75μg/kg bodyweight JWH-018. To ascertain a minimum level of intoxication, a booster dose of JWH-018 was administered on an as-needed basis. The average dose of JWH-018 administered was 5.52 mg. Subjective high, dissociative states (CADSS), psychedelic symptoms (Bowdle), mood (POMS) and cannabis reinforcement (SCRQ) were assessed within a 4.5-h time...
Synthetic Cannabinoid Use in a Psychiatric Patient Population: A Pilot Study
European Addiction Research, 2017
Background: Consumption of natural cannabis (NC) and synthetic cannabinoids (SCs) has been associated with psychotic disorders. We compared the prevalence of use, consumer profiles, and psychosis-inducing potential of NC and SCs in a specific high-risk population. Methods: This prospective pilot study included 332 patients (18-64 years, mean 36.83, SD 13.33). Patients' sociodemographics and medical histories as well as illicit substance use and psychiatric symptom histories were collected using a drug consumption survey that assessed the use of new psychoactive substances and the Psychotic Symptoms Interview. Results: In total, 7.2% of all patients, 10.6% of psychotic patients, and 4.5% of nonpsychotic patients reported SC consumption. Compared with SCs, NC was consumed much more frequently by its users (mean 222.73, SD 498.27). NC and SC use induced persistent psychosis. Psychotic symptoms were first experienced by patients with a history of NC or SC use during intoxication and...
Open Journal of Psychiatry, 2022
The Association of Schizophrenia, psychosis, and Marijuana is decades old. Swedish Conscripts cohort study [1] was one of the earlier studies which reported dose-dependent associations between Marijuana use and schizophrenia. This landmark study was substantiated in other countries through research and systematic reviews [2], which further strengthened the dose-dependent association between Marijuana and Psychosis. The dose defined in these studies [1] was based on the frequency of use that is more times used means more risk of developing schizophrenia and or related psychosis. The concept of using highly concentrated marijuana is relatively new, especially in the light of episodes lasting longer than anticipated with treatment resistance. There is not much data on how it will change the course of psychosis and affect the current diagnostic criteria for Substance-induced psychosis, Schizophreniform Psychosis, and schizophrenia. Based on these challenges, we report a case of Dabs or concentrated Tetra Hydro Cannabinoid (THC)-induced prolonged psychosis with tachycardia and treatment resistance on two separate occasions. Both inpatient admissions were triggered using concentrated Tetra Hydro Cannabinoid (THC).
Therapeutic Potential of Cannabinoids in Psychosis
Biological Psychiatry, 2016
Over recent years, the interest in the endocannabinoid system (ECS) as a new target for the treatment of schizophrenia has evolved. The ECS represents one of the most relevant neurotransmitter systems in the brain and mainly fulfills a homeostatic role in terms of neurotransmission but also with respect to inflammatory processes. Two main approaches to the modulation of endocannabinoid functioning have been chosen so far. First, the selective blockade or inverse agonism of the type 1 cannabinoid receptor has been tested for the improvement of acute psychotic symptoms, as well as for the improvement of cognitive functions in schizophrenia. This was not effective in either case. Second, the modulation of endocannabinoid levels by use of the phytocannabinoid cannabidiol and selective fatty acid amide hydrolase inhibitors has been proposed, and the antipsychotic properties of cannabidiol are currently being investigated in humans. Unfortunately, for most of these trials that have focused on psychopathological and cognitive effects of cannabidiol, no published data are available. However, there is first evidence that cannabidiol may ameliorate psychotic symptoms with a superior side-effect profile compared with established antipsychotics. In conclusion, several clinical trials targeting the ECS in acute schizophrenia have either been completed or are underway. Although publicly available results are currently limited, preliminary data indicate that selected compounds modulating the ECS may be effective in acute schizophrenia. Nevertheless, so far, sample sizes of patients investigated are not sufficient to come to a final judgment, and no maintenance studies are available to ensure long-term efficacy and safety.