77
Journal of Mental Health &Human Behavior,2007ORIGINAL ARTICLE
Cannabis induced psychosis –A Phenomenological perspective
Ajeet Sidana,Mamta,BS Chavan
Abstract:Cannabis abu is a growing health concern.Cannabis dependence is associated with two-fold increa in psychotic symptoms.The current study is an attempt to highlight the phenomenology of cannabis-induced psychosis and its temporal correlation with heavy cannabis intake in 20patients of cannabis dependence syndrome.The mean age of the patients was 24years with average duration of 4years for cannabis abu.The average interval between heavy cannabis intake and psychosis was 24-48hours.Majority of the patients had delusional thinking (90%),followed by delusion of grandio identity of Lord Shiva (65%),delusion of percution (60%)and reference (30%).关于写事的作文
Key words:Cannabis,psychosis and phenomenology
INTRODUCTION
There has been a recent increa in the u of cannabis in many developed societies.1Recent studies suggest that up to two-thirds of young people u cannabis at least once,with nearly 10%developing cannabis dependence.2,3The incread u of cannabis has led to growing rearch interest to study the effects of heavy u of cannabis on health.4The most heated debates in cannabis rearch is the possibility of existence of distinct nosological annabis psychosis.In fact the existence of this entity has been dismisd by various authors for the poor quality of information on cannabis u,temporal correlation,premorbid and family history.5-8However,there are number of ca reports in the literature showing evidence of ‘cannabis induced psychosis’describing the ways in which the ont of psychotic episodes was preceded by the heavy u of cannabis.9A study has shown that cannabis psychosis is to be short lasting with predominant polymorphic picture,prence of more odd and bizarre behaviour,violence,panic attacks with reactive and congruent affect and less evidence of
schizophrenic formal thought disorder and generally there is complete recovery as compared to schizophrenia.10It means that cannabis psychosis is an independent entity.However,cannabis u is associated with an incread risk of experiencing schizophrenia like symptoms,even after psychotic symptoms preceding the ont of cannabis u are controlled for,indicating that cannabis u is not
condary to a pre-existing psychosis.11In a study the authors reported a comparison of 15“bhang”urs with psychotic symptoms with 10bhang urs without psychosis and found that the patients of bhang urs with psychotic symptom were more likely to be uncooperative and had symptoms of excitement,hostility,grandiosity,hallucinations,disorientation and unusual thought content.12
A retrospective study compared the prevalence of hallucinations,delusions and hospitalizations between the active cannabis urs and psychotic patients who had never ud cannabis.13There was high rate of continuous hallucinations and delusions,and more hospitalizations among active cannabis urs.
JMHHB 2007 12(2) : 77 - 80
Psychiatric disturbances associated with cannabis u range from minor psychological respons such as anxiety and panic attacks14, depressive disorders15to more rious mental illness such as the putative cannabis psychosis16,acute functional psychosis17and poorly validated entity of“amotivational syndrome”18.
Whilst considerable attention has been paid to the association between cannabis u and psychotic
disorders10,19,20relatively little is known about the impact of cannabis abu on phenomenology of psychotic symptoms. Moreover there is no clear cut time interval between heavy cannabis intake and ont of psychosis.So,this study is an attempt to evaluate the hypothesis that heavy cannabis u is associated with psychosis having distinct phenomenology and it is cloly associated with heavy cannabis intake.The study was planned with the aims:
1.To study the clinical prentation and
phenomenology of cannabis induced psychosis.怎么和前任复合
2.To study the temporal correlation between
heavy consumption of cannabis and ont of psychosis.
METHODOLOGY
A total of20patients who visited the psychiatry department,Government Medical College& Hospital,Sector-32,Chandigarh were included in the study
Inclusion Criteria:1.Patients fulfilling the criteria of DSM-IV21for cannabis-induced psychosis-[ICD-10
also has similar information under the heading of substance induced psychotic disorder (F12.5)].2.Recent u of within past30days.3.Age18or more.
Exclusion Criteria:1.Patient with history of past psychiatric illness.2.Patients having co-morbid psychiatric illness,co-exiting personality disorder and consumption of substance other than cannabis.However,nicotine u was not the exclusion criteria.3.History of psychiatric illness in family.4.Mental retardation and other organic disorders.
Table1
一岁半女宝宝身高体重标准
Socio-demographic and clinical variables Variables Mean Range
(Years)
Age of patient2418-35years Education10.18th-12th Age of ont of
cannabis u18.915-27years Duration of continuous42days-cannabis u20years
Table2
Temporal correlation and phenomenology Phenomenological Percentage variables(n=20)
Delusional thinking90
Delusion of Grandiosity75(65%had
delusion of
Bhola Shankar) Delusion of percution60
Delusion of reference30
Interval between heavy24-48hrs. consumption of cannabis
and ont of psychosis头发色板图片大全
RESULTS
All the patients were male;in the age group of18-35years and majority were matriculate.The mean age of starting cannabis was18.9years and mean duration of cannabis u was4years (range2days–20years).
Out of the20patients,40%(n=8)gave recreational and experimental reasons for using
Sidana et al:Cannabis induced psychosis
78 Journal of Mental Health&Human Behavior,2007
cannabis;another40%cited peer pressure and 20%ud it for elevation of mood.
Display of abnormal behavior in the form of violent and aggressive behavior,excessive talks obrved by family members were the reasons for establishing contact with the clinical rvices in all the cas.The treatment ime period between ont of psychosis and eking help was6.5months(Mean).Out of20patients,85 %(n=17)required hospitalization for the control of symptoms and rest were managed on OPD basis only.There was an average gap of24to48 hours between heavy cannabis intake and ont of full-blown psychosis.
On Mental State Examination,it was noticed that delusional thinking was prent in90%of cas;delusion of grandiosity was prent in 75%,followed by percutory(60%)and referential (30%)delusions.Out of patients reporting delusions of grandiosity,65%cas showed distinct over-religiosity with content related to Bhola Shankar Nath(Lord Shiva).However,none of patients reported any cognitive disorientation to time,place,person and forgetfulness.All the patients recovered completely with antipsychotic treatment within one month.
DISCUSSION吃西洋参的禁忌
The findings of current study suggest that all the patients did not have any past or family history of psychosis and might not have developed psychosis if they had not ud cannabis.It means that cannabis psychosis is an independent entity and which has been reported by other authors too9,10,16,19,20.The finding that20%of patients who restarted cannabis again developed cannabis psychosis,further substantiates the diagnosis.
Majority of the patients were younger and required hospitalization for control of psychotic symptoms,and recovered completely with achieving abstinence or with anti-psychotic treatment which is in accordance with other studies10,22,24.
It has been mentioned in the literature that psychosis develops after heavy intake of cannabis but exact temporal relationship has not been defined5,10,16,19,20.In the current study,the authors found strong correlation between heavy do of cannabis and ont of psychosis with the average gap of1-2days without any signs of confusion or disorientation.Out of the total sample,75% (n=15)of patients had manic symptomatology in the form of delusions of grandiosity(over-religiosity),and out of that,65%of patients had delusional identity of Bhola Shankar(Lord Shiva). None of the patient showed any formal thought disorder.
The current study showed predominantly manic symptomatology,which is similar to some earlier studies19,23but contrary to few studies14,15. The distinct delusion of identity of Bhola Shanker is reported first time in this study only.The following may be possible reasons for this-firstly; all the patients were Hindu and had belief in Shiva Bhakti.Lord Shiva is a Hindu god and synonymous with power and fulfilling the desire of devotee easily.Secondly;bhang(cannabis)is ud as Prasad(holly sweet)in Shiva temple and bhang is religiously associated with Shiva bhakti. This might be a possible reasons for the delusional identity with Lord Shiva,that god had given them special power for their worship. Probably this is why we do not e too many patients of cannabis abu from other religious communities.Additionally,60%of the patients had referential delusions and30%had auditory hallucinations(commanding type),which is similar to another study12.
Limitations of the prent study are,it was a retrospective analysis and no formal asssment was done for verity of dependence. Sample size was small.
Sidana et al:Cannabis induced psychosis
79
Journal of Mental Health&Human Behavior,2007
REFERENCES
1.Hall W,Solowij N.Long-term Cannabis u and Mental
Health.Br J Psychiatry1997;171:107-108.
2.David M,Fergusson L,Horwood J.Does cannabis
u encourage other forms of elicit drug u?
Addiction2000;95(4):505–520.
3.Poulton RG,Brooke M,Moffitt TE et al.Prevalence
and correlates of cannabis u and dependence in young New Zealanders.New Zealand Med J 1997;110:68–70.
4.Hall W,Babor T.Cannabis and public health:asssing
the burden.Addiction2000;95:485-490.
5.Thornicroft G,Meadows G,Politi P.Is“cannabis
psychosis”a distinct category?European psychiatry 1992;7:277-282.
6.Gruber AJ,Pope HG.Cannabis psychotic disorder.
Does it exist?Am J Addiction1994;3:72-83.
7.Poole R,Brabbins C.Drug induced psychosis.Br J
Psychiatry1996,168:135-138.
8.Schukit M.A.Can marijuana cau a long-lasting
psychosis?Drug Abu Alcoholism Newsletter1994;
23:1-4.
9.Núñez LA,Gurpegui M.Cannabis-induced psychosis:
A cross-ctional comparison with.Acute
schizophrenia.Acta Psychiatr Scand2002,105:173–178.
10.Basu D,Malhotra A,BhagatA et al.Cannabis psychosis
and acute schizophrenia:a ca-control study.
European Add Res1999;5:71-73.
11.Louisa D,George C,Patton,Carolyn C.Cannabis u
and mental health in young people:cohort study,Br Med J2002;325:1195-1198.
12Chaudry H R,Moss H B,Bashir A et al.Cannabis psychosis following bhang ingestion.Br J Addiction 1991;86:1075–1081.13.Negrete J C,Knapp W P,Douglas D E et al.Cannabis
affects the verity of schizophrenic symptoms: Results of a clinical survey.Psychol Med 1986;16:515–520.
14.Thomas H.Psychiatric symptoms in cannabis urs.
Br J Psychiatry1993;163:141–149.
15.Troisi A,Pasini A,Saracco M et al.Psychiatric
symptoms in male cannabis urs not using other illicit drugs.Addiction1998;93:487–492.
16.Talbott J A,Teague J W.Marijuana psychosis.J Am
Med Asso1969;210:299-302.
17.Johns A.Substance misu:a primary risk and a
major problem of comorbidity.Int J Psychiatry1997;
9:233-241.
18.Hall W,Solowij N,Lemon J.The Health and Social
Conquences of Cannabis U.National Drug Strategy Monograph Series no25.Canberra: Australian Government Publishing Service,1994. 19.Thacore V R,Shukla S R P.Cannabis psychosis and
paranoid schizophrenia.Arch Gen Psychiatry 1976;33:383-386.
20.Chopra G S,Smith J W.Psychotic reactions following
cannabis u in East Indians.Arch Gen Psychiatry 1974;30:24-27.
21.Harold I,Kaplan MD.Comprehensive Text Book of
Psychiatry.VI th Ed.1994,814.
22.Linszen DH,Dingemans PM,Lenior ME.Cannabis
abu and the cour of recent ont schizophrenic disorders.Arch Gen Psychiatry1994;51:273–279.
23.Rottemberg DR,Robins AH,Ben-Arie O et al.Cannabis
associated psychosis with hypomanic features(ii).
Lancet1982;1364-1366.
24.Basu D,Malhotra A,Varma VK Cannabis related
psychiatric syndromes:A lective review.Indian J Psychiatry1994;36:121-128.
Ajeet Sidana,Senior Lecturer
Mamta,Senior Resident
BS Chavan,Professor&Head报告会主持词
Department of Psychiatry
Government Medical College&Hospital,Sector-32,Chandigarh.
Corresponding Address:
小书包Dr.Ajeet Sidana,Senior Lecturer
免费的简历模板Department of Psychiatry,
Government Medical College&Hospital,Sector-32,Chandigarh,
E-mail.***********************
Sidana et al:Cannabis induced psychosis
80 Journal of Mental Health&Human Behavior,2007
