From the Guidelines
For cannabis-induced psychosis, antipsychotic medications such as risperidone 2 mg/day or olanzapine 7.5–10.0 mg/day are recommended as the primary treatment. When considering treatment options, it's essential to prioritize the patient's safety and well-being, taking into account the potential risks and benefits of each medication 1. The goal of treatment is to alleviate psychotic symptoms, prevent harm to oneself or others, and promote recovery. Key considerations include:
- Starting with low doses of antipsychotic medication and gradually increasing as needed 1
- Monitoring for extrapyramidal side-effects and adjusting treatment accordingly 1
- Providing emotional support and practical advice to families, who are often in crisis at the point of initiation of treatment 1
- Considering physical illnesses that can cause psychosis before initiating treatment 1
- Encouraging complete cannabis cessation, which is essential for recovery Treatment typically lasts 3-6 months, with gradual tapering under medical supervision, and may be accompanied by psychotherapy and substance use counseling for comprehensive treatment. It's crucial to weigh the potential benefits of antipsychotic medication against the risks of side effects, such as weight gain, sedation, and metabolic changes, and to closely monitor patients for these adverse effects 1.
From the Research
Medication for Cannabis-Induced Psychosis
- The treatment of cannabis-induced psychosis often involves the use of antipsychotic medications, such as olanzapine, quetiapine, risperidone, and ziprasidone 2, 3, 4.
- A study comparing the effectiveness of olanzapine, quetiapine, and risperidone in the treatment of early psychosis found that all three medications had similar rates of treatment discontinuation, but olanzapine and risperidone had greater reductions in positive symptoms 3.
- Another study found that olanzapine, risperidone, and aripiprazole had advantages for the first-line treatment of first episode of psychosis in terms of effectiveness, with lower treatment discontinuation rates compared to other medications 4.
- The side effect profiles of antipsychotic medications can vary, with some medications having more sedating effects or causing more weight gain 2, 3, 4.
- Substance use, including cannabis use, can influence the side effects of antipsychotic medications, with some studies finding that patients with substance use have more increased dream activity, less reduced salivation, and more gynecomastia 2.
Clinical Characteristics of Cannabis-Induced Psychosis
- Cannabis-induced psychosis can have different clinical characteristics compared to schizophrenia, including a lower age of first admission due to psychosis and a greater presence of mania 5.
- A study comparing the clinical characteristics of patients with cannabis-induced schizophrenia spectrum disorder found that men were over-represented in the cannabis abuser group, and that patients without cannabis use spent more time in hospital and had a higher prevalence of suicidal attempts 6.
- The clinical pattern of cannabis-induced psychosis can be similar to that of schizophrenia, but with some distinct features, such as a lower age of onset and a greater presence of manic symptoms 5, 6.
Treatment Considerations
- The treatment of cannabis-induced psychosis should take into account the patient's substance use history and the potential for interactions between antipsychotic medications and substances of abuse 2, 6.
- A comprehensive treatment plan should include not only medication, but also psychotherapy and social support to address the underlying causes of the psychosis and to promote recovery 5, 4.
- Further research is needed to determine the most effective treatments for cannabis-induced psychosis and to develop personalized treatment plans that take into account the individual patient's needs and circumstances 5, 2, 6, 3, 4.