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How To Handle Cannabis Triggered Psychosis?

Updated: Dec 6, 2022

Cannabis-induced psychosis disorder (CIPD) generally involves severe hallucinations or delusions that appear during cannabis use or shortly after. The word psychosis describes a condition that affects the mind, where there has been some loss of contact with reality. Those experiencing a psychotic episode may be seeing or hearing things other people cannot see or hear (hallucination) and believing things that are not true (delusions). Paranoid delusion or delusions of grandeur are two examples of psychotic delusions. A person with psychosis will often believe an individual or organisation is making plans to hurt or kill them. This type of irrational and delusion thoughts can lead to unusual behaviours.


Up to 25-30% of people who visit the emergency department due to cannabis use will have symptoms such as anxiety, suicidal thoughts and psychosis to varying degrees.


SYMPTOMS OF CIPD


Besides hallucinations and delusions, other symptoms of CIPD might include the following: - Disorganised speech - Unusual thoughts - Confusion - Memory Loss - Grandiosity

- Difficulties feeling or expressing emotions

- Unusual excitement

- Uncooperativeness


According to the criteria outlined in DSM-5, a diagnosis of CIPD requires that the symptoms:

- linger after the cannabis "high" fades (in some cases, the symptoms last for several days or even weeks);

- cause enough distress to get in the way of daily activities, like working and socializing;

- are not better explained by another cause, like schizophrenia.


This means that milder symptoms of psychosis may not necessarily translate into a CIPD diagnosis. "Bad trips" are common among those who experiment with or use cannabis in an unregulated manner. Bad trips usually mean mild delusions (e.g. paranoia) or brief hallucinations while using cannabis. Usually, users will recognise these hallucinations and delusions for what they are (a bad trip), and these symptoms usually disappear along with the high. With CIPD, the user would not have the same insights, so the hallucinations and delusions will seem completely real.


RISK FACTORS


Scientific evidence suggests a few key factors may play a part in the link between cannabis and psychosis.


Age

The younger you experiment with cannabis, the higher your risk of psychosis. Studies also indicate that people who start using cannabis in adolescence are more likely to experience symptoms of psychosis or receive a diagnosis of schizophrenia later in life.


Frequency

How frequent the use of cannabis can also contribute to the risk of developing psychosis. In one 2003 study, for example, researchers found evidence to suggest young adults with cannabis dependency at ages 18 and 21 also experienced symptoms of psychosis at higher rates.


A 2009 study compared 280 people hospitalized with a first episode of psychosis with a control group of 174 adults. The results suggest symptoms of psychosis were more common in study participants who used cannabis more frequently and for a longer period of time.


Potency

The 2009 study mentioned above also supported cannabis potency as a risk factor. The study participants experiencing psychosis tended to report a preference for higher-potency cannabis or cannabis with THC levels of up to 18 per cent. On the other hand, those in the control group more often used cannabis with a THC concentration of around 3.4 per cent. Study authors believe THC, the psychoactive component that produces the cannabis high, plays a significant part in psychosis risk. More recent research from 2013 supports this connection between cannabis potency and the risk of psychosis.


Genetics

A 2012 study compared 489 people hospitalized with a first episode of psychosis with a control group of 278 adults. According to the results, participants with a particular variant (C/C) of the AKT1 gene were seven times more likely to develop psychosis when using cannabis daily.


A small 2007 study also raises the possibility of an indirect link between a family history of mental health conditions and CIPD. Most of the 20 participants reported a family history of substance use disorders or other mental health conditions. Study authors note that while this history is a key risk factor for dependence on cannabis or other substances, not enough evidence supports it as a risk factor for CIPD.


HOW LONG DO THE PSYCHOTIC SYMPTOMS LAST?


According to a report from the National Institute on Drug Abuse (NIDA), cannabis use, especially in high doses, can cause a short-lived psychotic reaction in people without schizophrenia. As the drug wears off, the symptoms fade.


Symptoms such as paranoia, anxiety, or psychosis may be present during the initial stage of intoxication. Impaired coordination and learning and sleep problems are among the effects that can last longer but may not be permanent.


Repeated use of cannabis can have cumulative effects that can cause long-term symptoms.

Doctors may diagnose cannabis intoxication when recent cannabis use has significantly changed a person’s behaviour or mind. Cannabis intoxication can occur within minutes if a person inhales the drug, but it takes hours to appear following ingestion.


The duration of symptoms can depend on a person’s tolerance and the dose they take. Although they typically last for 3–4 hours, they can persist for up to 24 hours. Many people who present to the emergency department with psychotic symptoms relating to cannabis use will need hospitalization. Up to 50% of these individuals will develop schizophrenia.


WHAT ARE THE PRE-PSYCHOTIC SYMPTOMS?


Psychosis usually develops over time, with a person experiencing gradual changes in their thoughts and perceptions. They may be unaware of these changes.

Pre-psychosis symptoms are early warning signs of psychosis. They include:

  • a worrying decline in school grades or work performance

  • difficulty concentrating or thinking clearly

  • feeling suspicious or uneasy around others

  • a decline in personal hygiene or self-care

  • spending much more time alone than usual

  • a lack of feelings or very strong, inappropriate emotions


IS IT POSSIBLE TO RECOVER?


CIPD is not always permanent. While there’s no go-to treatment, some evidence suggests stopping cannabis use may improve symptoms.


In a 2007 study, researchers found that after a full week of abstinence from cannabis use, all 20 study participants reported a significant decrease in symptoms like hallucinations, delusions of grandeur, and uncooperativeness. Antipsychotic medications might also help ease severe symptoms for some people. The antipsychotic aripiprazole, for example, could help prevent symptoms of psychosis if cannabis use can’t be avoided. Experts emphasize the need for more research into CIPD treatments, particularly for people who use cannabis to treat other symptoms. Experts do know that many people with a CIPD diagnosis eventually develop schizophrenia. In fact, according to a 2018 study of nearly 7,000 people diagnosed with substance-induced psychosis, CIPD converted to schizophrenia or bipolar disorder diagnosis in 47.4 per cent of participants.


Both those conditions are long-term, but symptoms often improve significantly with a combination of therapy, medication, and other treatments.

WHAT EXPERTS STILL DO NOT KNOW


While there’s a strong link between cannabis use and schizophrenia, experts have yet to discover the exact nature of that link. Does cannabis use cause schizophrenia? Or does it trigger the earlier onset of schizophrenia symptoms in some people who would have eventually developed the condition? More extensive research into CIPD may help answer these questions, not to mention offer more insight on CIPD risk factors, prevention, and treatment — including the potential use of CBD, the nonpsychoactive compound in cannabis, as a treatment for psychosis.


While experts don’t fully understand the link between cannabis use, psychosis, and schizophrenia, they do recognize a connection exists. If you’re concerned about your risk of CIPD, it may be worth considering cannabis strains with lower THC content and cutting back on daily cannabis use. If you do notice any symptoms of psychosis, it’s best to connect with a mental health professional as soon as possible.


360 TREATMENT FOR CANNABIS PSYCHOSIS EPISODE


For people in the early stages of psychosis, coordinated speciality care (CSC) may be an effective treatment. CSC involves a team of healthcare professionals working with the person and their family to provide:

  • family support and education

  • psychotherapy

  • peer support

  • support with education and employment

The treatment for psychosis or schizophrenia may include psychotherapy and medications, such as antipsychotic drugs. People may also require therapies that help reduce cannabis use. These may include:

  • Cognitive behavioural therapy (CBT): CBT is a type of psychotherapy that gives people strategies to identify and change negative patterns of thought and behaviour.

  • Contingency management: This approach involves frequent monitoring of the behaviour that a person is working to change and provides incentives or rewards for positive changes.

  • Motivational enhancement therapy: This therapy aims to motivate the person to use their internal resources to engage in treatment and create positive changes.


WHAT YOU CAN DO AT HOME ONCE YOU NOTICE SYMPTOMS OF PSYCHOSIS?


The strategy to deal with CIPD patients is similar to those with schizophrenia, bipolar or psychosis patients.


The difficulties that you will face include the following:

- it is difficult to understand and follow what the patient is saying;

- the patient may be speaking very quickly or very slowly;

- the patient changes topics very quickly;

- the patient has difficulties concentrating and remembering things;

- the patient may have beliefs that you do not share;

- the patient can get distracted by things they hear, see, or perceive that they do not sense;

- the patient may be lethargic or sluggish;

- the patient may be destructive and can hurt himself and others;

- the patient may use words or phrases that you might not understand.


To support them, you should:

- talk clearly and use short sentences in a calm and non-threatening voice;

- be empathetic with how the person feels about their beliefs and experiences;

- validate the person's own experience of frustration or distress, as well as the positives of their experience;

- listen to the way that the person explains and understands their experiences;

- not state any judgments about the content of the person's beliefs or experiences;

- accept if they do not want to talk to you, but be available if they change their mind;

- treat the person with respect;

- be mindful that the person may be fearful of what they are experiencing.


​​​If you are worried about someone showing signs of psychosis, you should approach them privately, somewhere without distractions, to talk about their experience. How the person behaves will determine how you need to interact with them. Please give them the space to feel comfortable and avoid touching them.


Note: If this type of discussion is outside the scope of your role, then it is essential to let your supervisor know of your observations. Also, ensure you follow your organisation’s reporting and recording requirements.


Disclaimer: The author is not against the use of marijuana for medical purposes. There is strong scientific evidence to support the benefits of marijuana for chronic pain issues and cancer treatment. But like any drug, the use of the drugs needs to be monitored closely by a professional therapist or a doctor.



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About the Author

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Dr. Lennie Soo

Founder and Clinical Director of 360 Wellness Hub.

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