How to treat cannabis-induced psychosis?

Treatment of Cannabis-Induced Psychosis

For cannabis-induced psychosis, treatment should focus on supportive care in a structured environment with symptomatic medication for withdrawal symptoms, followed by short-duration psychosocial interventions based on motivational principles. 1

Acute Management

Initial Stabilization

• Manage cannabis-induced psychosis in a supportive environment 1
• For agitation and acute psychotic symptoms:
  • Consider parenteral antipsychotics for severe agitation 2
  • Benzodiazepines may be used for symptom relief during the acute phase 1, 2
  • Monitor closely during withdrawal, as psychosis can occur or worsen 1

Withdrawal Management

• No specific medication is recommended for cannabis withdrawal 1
• Symptomatic treatment for:
  • Agitation
  • Sleep disturbance
  • Other withdrawal symptoms
• Duration: Provide symptomatic medication only for the period of the withdrawal syndrome 1

Post-Acute Treatment

Psychosocial Interventions

• Offer brief intervention as first-line treatment 1
  • Single session of 5-30 minutes
  • Include individualized feedback
  • Provide advice on reducing or stopping cannabis consumption
  • Offer follow-up

For Ongoing Cannabis Use Problems

• If patient does not respond to brief interventions, refer for specialist assessment 1
• Implement short-duration psychosocial support using motivational principles 1, 3
• Consider more intensive treatment options:
  • Cognitive Behavioral Therapy (CBT) 3
  • Contingency Management + Community Reinforcement Approach (CM+CRA) 3

Addressing Comorbidities

Antipsychotic Treatment

• For patients with persistent psychosis:
  • Be aware that cannabis use may reduce response to conventional antipsychotic treatment 4
  • Cannabis users often require more antipsychotic medications 4
  • Consider monitoring THC levels, as positive screens predict higher symptom acuity 2

Medication Considerations

• Limited evidence for specific pharmacological interventions for cannabis use disorder 5
• Potential options with some evidence:
  • Gabapentin (for both withdrawal and cannabis use disorder) 5
  • N-acetylcysteine (particularly in adolescents with cannabis use disorder) 5

Ongoing Management

Cannabis Cessation

• Emphasize the importance of cannabis discontinuation 6
• Discontinuing cannabis use is associated with:
  • Lower relapse rates of psychosis
  • Shorter hospital admissions
  • Less severe positive symptoms 6

Follow-up Care

• Regular monitoring for psychotic symptoms
• Continued psychosocial support
• Assess for treatment resistance if symptoms persist

Pitfalls to Avoid

• Failing to provide adequate supportive environment during withdrawal
• Neglecting to monitor closely for worsening psychosis during withdrawal
• Relying solely on pharmacological interventions without psychosocial support
• Not addressing continued cannabis use, which predicts worse outcomes 6
• Overlooking co-occurring mental health conditions that may complicate treatment 3

Remember that cannabis-induced psychosis requires both acute symptom management and longer-term strategies to address cannabis use. The evidence strongly supports cannabis discontinuation as a crucial intervention target to improve outcomes in patients with psychosis 6.