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  • Print publication year: 2011
  • Online publication date: November 2011

18 - The acute effects of cannabinoids in patients with psychotic illness


To explore whether cannabis has a potential role in actually causing bipolar disorder, a general population cohort study design is informative. Cahill et al. reviewed the interactions between chronic cannabis use and cognitive compromise in bipolar disorder. In trying to understand the interaction between the cannabis and bipolar disorder, attention has been given to the endocannabinoid system. Ashton et al. have detailed the mechanisms of the endocannabinoid system that have been implicated in brain reward pathways, pain, sleep, mood and anxiety. The authors have acknowledged the difficulties with studying the cannabinoids, including issues with doses, mode of administration and tolerance. There is no doubt a great deal of comorbidity between bipolar disorder and cannabis use. There is also a growing body of evidence regarding the deleterious effects of cannabis use in patients with bipolar disorder.

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Addington, J. and Duchak, V. (1997) Reasons for substance use in schizophrenia. Acta Psychiatr Scand, 96: 329–33.
Allebeck, P., Adamsson, C., Engström, A. and Rydberg, U. (1993) Cannabis and schizophrenia: a longitudinal study of cases treated in Stockholm County. Acta Psychiatr Scand, 88:21–4.
Arndt, S., Tyrrell, G., Flaum, M. and Andreasen, N.C. (1992) Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychol Med, 22:379–88.
Baigent, M., Holme, G. and Hafner, R.J. (1995) Self reports of the interaction between substance abuse and schizophrenia. Aust N Z J Psychiatry, 29:69–74.
Baker, A., Lewin, T., Reichler, H., et al. (2002). Motivational interviewing among psychiatric in-patients with substance use disorders. Acta Psychiatr Scand, 106:233–40.
Barkus, E. and Lewis, S. (2008) Schizotypy and psychosis-like experiences from recreational cannabis in a non-clinical sample. Psychol Med, 38:1267–76.
Barkus, E., Stirling, J., Hopkins, R.S. and Lewis, S. (2006) Cannabis-induced psychosis-like experiences are associated with high schizotypy. Psychopathology, 39:175–8.
Bersani, G., Orlandi, V., Kotzalidis, G.D. and Pancheri, P. (2002) Cannabis and schizophrenia: impact on onset, course, psychopathology and outcomes. Eur Arch Psychiatry Clin Neurosci, 252:86–92.
Brandt, J. (1991) The hopkins verbal learning test: Development of a new memory test with six equivalent forms. The Clinical Neuropsychologist, 5:125–42.
Buhler, B., Hambrecht, M., Löffler, W., an der Heiden, W. and Häfner, H. (2002) Precipitation and determination of the onset and course of schizophrenia by substance abuse – a retrospective and prospective study of 232 population-based first illness episodes. Schizophr Res, 54:243–51.
Cantor-Graae, E., Nordstrom, L. and McNeil, T.F. (2001). Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res, 48:69–82.
Compton, M.T., Kelley, M.E., Ramsay, C.E., et al. (2009) Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry, 166:1251–7.
Compton, W.M., Grant, B.F., et al. (2004) Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. JAMA, 291:2114–21.
Corkin, S., Milner, B., Colliver, J.B, Glantz, M.D. and Stinson, F.S. (1964) Effects of different cortical excisions on sensory thresholds in man. Trans Am Neurol Assoc, 89:112–16.
Cuffel, B., Heithoff, K. and Lawson, W. (1993) Correlates of patterns of substance abuse among patients with schizophrenia. Hosp Community Psychiatry, 44:247–51.
D’Souza, D.C., Abi-Saab, W.M., Madonick, S., et al. (2005). Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biol Psychiatry, 57:594–608.
D’Souza, D.C., Ranganathan, M., Braley, G., et al. (2008) Blunted psychotomimetic and amnestic effects of delta-9-tetrahydrocannabinol in frequent users of cannabis. Neuropsychopharmacology, 33:2505–16.
Dekker, N., Linszen, D. and De Haan, L. (2009) Reasons for Cannabis Use and Effects of Cannabis Use as Reported by Patients with Psychotic Disorders. Psychopathology, 42:350–60.
Di Forti, M., Morgan, C., Dazzan, P., et al. (2009) High-potency cannabis and the risk of psychosis. Brit J Psychiatry, 195: 88–491.
Dixon, L., Haas, G., Weiden, P., Sweeney, J. and Francis, A. (1990) Acute effects of drug abuse in schizophrenic patients: clinical observations and patients’ self-reports. Schizophr Bull, 16:69–79.
Dixon, L., Haas, G., Weiden, P., Sweeney, J. and Francis, A. (1991) Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am J Psychiatry, 148:224–30.
Elsohly, M.A. and Slade, D. (2005). Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci, 78:539–48.
Farrell, M., Howes, S., Taylor, C., et al. (1998). Substance misuse and psychiatric comorbidity: an overview of the OPCS National Psychiatric Morbidity Survey. Addict Behav, 23:909–18.
Fazio, R. and Zanna, M. (1981) Direct Experience and Attitude-Behavior Consistency. Advances in Experimental Social Psychology. L. Berkowitz. Chicago, University of Chicago Press: 161–186.
Ferdinand, R.F., Sondeijker, F., van der Ende, J., Selten, J.P., Huizink, A. and Verhulst, F.C. (2005) Cannabis use predicts future psychotic symptoms, and vice versa. Addiction, 100:612–8.
Fishbein, M. (1980). A theory of reasoned action: some applications and implications. Nebr Symp Motiv, 27:65–116.
Fowler, I., Carr, V., Carter, N.T. and Lewin, T.J. (1998) Patterns of current and lifetime substance use in schizophrenia. Schizophr Bull, 24:443–55.
Gearon, J. S., Bellack, A.S., Rachbeisel, J. and Dixon, L. (2001) Drug-use behavior and correlates in people with schizophrenia. Addict Behav, 26:51–61.
Gordon, M. (1986) Microprocessor-based assessment of attention deficit disorders (ADD). Psychopharmacol Bull, 22:288–90.
Goswami, S., Mattoo, S.K., Basu, D. and Singh, G. (2004) Substance-abusing schizophrenics: do they self-medicate?Am J Addict, 13:139–50.
Grech, A., Van Os, J., Jone, P.B, Lewis, S.W. and Murray, R.M. (2005) Cannabis use and outcome of recent onset psychosis. Eur Psychiatry, 20:349–53.
Green, A.I., Tohen, M.F., Hamer, R.M., et al. (2004) First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophr Res, 66:125–35.
Green, B., Kavanagh, D.J., and Young, R.M. (2004) Reasons for cannabis use in men with and without psychosis. Drug Alcohol Rev, 23:445–53.
Green, B., Young, R., and Kavanagh, D. (2005) Cannabis use and misuse prevalence among people with psychosis. Br J Psychiatry, 187:306–13.
Gregg, L., Barrowclough, C., and Haddock, G. (2009) Development and validation of a scale for assessing reasons for substance use in schizophrenia: the ReSUS scale. Addict Behav, 34:830–7.
Hambrecht, M. and Hafner, H. (1996) Substance abuse and the onset of schizophrenia. Biol Psychiatry, 40:1155–63.
Hekimian, L.J. and Gershon, S. (1968) Characteristics of drug abusers admitted to a psychiatric hospital. JAMA, 205:125–30.
Henquet, C., Krabbendam, L., Spauwen, J., et al. (2005) Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ, 330:11.
Henquet, C., Rosa, A., Krabbendam, L., et al. (2006) An experimental study of catechol-o-methyltransferase Val158Met moderation of delta-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology, 31:2748–57.
Jablensky, A., McGrath, J., Herrman, H., et al. (2000) Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Austr NZ J Psychiatry, 34:221–36.
Kapur, S., Mizrahi, R., and Li, M. (2005) From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophr Res, 79:59–68.
Kay, S.R., Opler, L.A., and Fizbein, A. (1986) Significance of positive and negative syndromes in chronic schizophrenia. Br J Psychiatry, 149:439–48.
Kessler, R., Foster, C., Saunders, W.B. and Stang, P.E. (1995) Social consequences of psychiatric disorders, I: Educational attainment. Am J Psychiatry, 152:1026–32.
Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K.R and Walters, E.E. (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62:617–27.
Knudsen, P. and Vilmar, T. (1984) Cannabis and neuroleptic agents in schizophrenia. Acta Psychiatr Scand, 69:162–74.
Konings, M. and Maharajh, H.D. (2006) Cannabis use and mood disorders: patterns of clinical presentations among adolescents in a developing country. Int J Adolesc Med Health, 18:221–33.
Koskinen, J., Lohonen, J., Koponen, H., Isohanni, M and Mietunnen, J. (2009) Rate of Cannabis Use Disorders in Clinical Samples of Patients With Schizophrenia: A Meta-analysis. Schizophr Bull, 36:1115–30.
Leweke, F., Koethe, D., et al. (2005) Cannabidiol as an Antipsychotic: A Double-Blind, Controlled Clinical Trial of Cannabidiol versus Amisulpiride in Acute Schizophrenia. 15th Annual Symposium on Cannabinoids. Clearwater Beach, FL, Cannabinoid Research Society.
Linszen, D. and van Amelsvoort, T. (2007) Cannabis and psychosis: an update on course and biological plausible mechanisms. Curr Opin Psychiatry, 20:116–20.
Linszen, D.H., Dingemans, P.M. and Lenior, M.E. (1994) Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry, 51:273–9.
Margolese, H., Malchy, L., Negrete, J.C., Tempier, R. and Gill, K. (2004) Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr Res, 67:157–66.
Mason, O., Morgan, C.J., Dhiman, S.K., et al. (2008) Acute cannabis use causes increased psychotomimetic experiences in individuals prone to psychosis. Psychol Med, 39:951–6.
Mauri, M., Volonteri, L., De Gaspari, I.F., Colasanti, A., Brambilla, M.A. and Cerruti, L. (2006) Substance abuse in first-episode schizophrenic patients: a retrospective study. Clin Pract Epidemiol Ment Health, 2:4.
McCreadie, R.G. (2002) Use of drugs, alcohol and tobacco by people with schizophrenia: case-control study. Br J Psychiatry, 181:321–5.
Missouri Department of Health and Senior Services (2010) Health Advisory: K2 Synthetic Marijuana Use Among Teenagers and Young Adults in Missouri. Jefferson City, MO, Missouri Department of Health and Senior Services.
Morgan, C.J. and Curran, H.V. (2008) Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis. Br J Psychiatry, 192:306–7.
Mueser, K., Bellack, A. and Blanchard, J.J. (1992) Comorbidity of schizophrenia and substance abuse: implications for treatment. J Consult Clin Psychol, 60:845–56.
Muller, H., Sperling, W., Köhrmann, M., Huttner, H.B., Kornhuber, J. and Maler, J.M. (2010) The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes. Schizophr Res, 118:309–10.
Myin-Germeys, I., Krabbendam, L., Jolles, J., Delespaul, P.A and van Os, J. (2002) Are cognitive impairments associated with sensitivity to stress in schizophrenia? An experience sampling study. Am J Psychiatry, 159:443–9.
Myin-Germeys, I., van Os, J., Schwartz, J.E., Stone, A.A. and Delespaul, P.A. (2001) Emotional reactivity to daily life stress in psychosis. Arch Gen Psychiatry, 58:1137–44.
Negrete, J.C., Knapp, W.P., Douglas, D.E. and Smith, W.B. (1986) Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey. Psychol Med, 16:515–20.
Peralta, V. and Cuesta, M.J. (1992) Influence of cannabis abuse on schizophrenic psychopathology. Acta Psychiatr Scand, 85:127–30.
Peters, B., de Koning, P., Dingemans, P., Becker, H., Linszen, D.H. and de Haan, L. (2009) Subjective effects of cannabis before the first psychotic episode. Aust N Z J Psychiatry, 43:1155–62.
Rabinowitz, J., Bromet, E.J., Lavelle, J., Carlson, G., Kovasznay, B. and Schwartz, J.E. (1998) Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients. Psychol Med, 28:1411–9.
Raine, A. (1991) The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr Bull, 17:555–64.
Ramaekers, J.G., Kauert, G., Theunissen, E.L., Toennes, S.W. and Moeller, M.R. (2009) Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. J Psychopharmacol, 23:266–77.
Regier, D., Farmer, M., Rae, D.S., et al. (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) study.[comment]. JAMA, 264:2511–8.
Ringen, P., Lagerberg, T., Birkenaes, A.B., et al. (2008) Differences in prevalence and patterns of substance use in schizophrenia and bipolar disorder. Psychol Med, 38:1241–9.
Rottanburg, D., Robins, A.H., Ben-Arie, O., Teggin, A. and Elk, R. (1982) Cannabis-associated psychosis with hypomanic features. Lancet, 2:1364–6.
Schofield, D., Tennant, C., Nash, L., et al. (2006) Reasons for cannabis use in psychosis. Aust N Z J Psychiatry, 40:570–4.
Schwarcz, G., Karajgi, B. and Macarthy, R. (2009) Synthetic delta-9-tetrahydrocannabinol (dronabinol) can improve the symptoms of schizophrenia. J Clin Psychopharmacol, 29:255–8.
Sevy, S., Robinson, D.G., Holloway, S., et al. (2001) Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatr Scand, 104:367–74.
Silver, H. and Abboud, E. (1994) Drug abuse in schizophrenia: comparison of patients who began drug abuse before their first admission with those who began abusing drugs after their first admission. Schizophr Res, 13:57–63.
Solomons, K., Neppe, V.M. and Kuyl, J.M. (1990) Toxic cannabis psychosis is a valid entity. S Afr Med J, 78:476–81.
Spencer, C., Castle, D. and Michie, P.T. (2002) Motivations that maintain substance use among individuals with psychotic disorders. Schizophr Bull, 28:233–47.
Stefanis, N.C., Delespaul, P., Henquet, C., Bakoula, C., Stefanis, C.N. and van Os, J. (2004) Early adolescent cannabis exposure and positive and negative dimensions of psychosis. Addiction, 99:1333–41.
Stirling, J., Barkus, E.J., Nasobi, L., et al. (2008) Cannabis-induced psychotic-like experiences are predicted by high schizotypy. Confirmation of preliminary results in a large cohort. Psychopathology, 41:371–8.
Swartz, M., Wagner, H., Swanson, J.W., et al. (2006) Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study. J Nerv Ment Dis, 194:164–72.
Test, M.A., Wallisch, L.S., Allness, D.J. and Ripp, K. (1989) Substance use in young adults with schizophrenic disorders. Schizophr Bull, 15:465–76.
Treffert, D.A. (1978) Marijuana use in schizophrenia: a clear hazard. Am J Psychiatry, 135:1213–5.
Van Mastrigt, S., Addington, J. and Addington, D. (2004) Substance misuse at presentation to an early psychosis program. Soc Psychiatry Psychiatr Epidemiol, 39:69–72.
van Os, J., Bak, M., Hannsen, M., Bijl, R.V., de Graaf, R. and Verdoux, H. (2002) Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol, 156:319–27.
Vearrier, D. and Osterhoudt, K.C. (2010) A teenager with agitation: higher than she should have climbed. Pediatr Emerg Care, 26:462–5.
Veen, N.D., Selten, J.P., van der Tweel, I., Feller, W.G., Hoek, H.W. and Kahn, R.S. (2004) Cannabis use and age at onset of schizophrenia. Am J Psychiatry, 161:501–6.
Warner, R., Taylor, D., Wright, J., et al. (1994) Substance use among the mentally ill: prevalence, reasons for use, and effects on illness. Am J Orthopsychiatry, 64:30–9.
Weil, A.T. (1970) Adverse reactions to marihuana. Classification and suggested treatment. N Engl J Med, 282:997–1000.
Zuardi, A., Crippa, J.A., Hallak, J.E., et al. (2009) Cannabidiol for the treatment of psychosis in Parkinson’s disease. J Psychopharmacol, 23:979–83.
Zuardi, A.W., Hallak, J.E., Dursun, S.M., et al. (2006) Cannabidiol monotherapy for treatment-resistant schizophrenia. J Psychopharmacol, 20:683–6.
Zuardi, A.W., Morais, S.L., Guimarães, F.S. and Mechoulam, R. (1995) Antipsychotic effect of cannabidiol. J Clin Psychiatry, 56:485–6.