Cannabis-Induced Psychosis - Case Study Example

ritiсаl Аnаlysis - Саnnаbis Induсеd Рsyсhоsis Name: Institute: Critical Analysis – Cannabis-Induced Psychosis Introduction Is cannabis perilous? Cannabis is professed as a harmless remedy in numerous circles because of its connection with spiritual and cultural sacraments, and with the verity that unlike heroin, alcohol, or cocaine, it hardly ever brings entities to the edge of penury (Altable et al., 2005; Stirling et al., 2008). Nonetheless, this insight is shifting. In Arendt et al. (2008) study they accounted that cannabis, akin to most abused drugs, heightens dopamine discharge in the accumbens located in the nucleus. Furthermore, the mounting influence of accessible cannabis has steered the acknowledgment of a withdrawal syndrome, attributed by tetchiness, agitation, sleeplessness, and anorexia, which may possibly persist more than a few weeks after stop using cannabis (Stirling et al., 2008). Cannabis, similar to tobacco smoking, as well heightens the threat of getting lung cancer among the young persons. With regard to mental wellbeing, cannabis smoking is purported to draw out psychotic disorders in persons at risk. For this reason, cannabis role in psychiatric diseases has remained to be an area of concern with epidemiological studies proving that the rate of cannabis misuse heightens, so does the threat for Psychiatry like schizophrenia (Okoro et al., 2007). Research has as well revealed that marijuana is the most frequently misused drug in the midst of those diagnosed with schizophrenia. Analyzing the psychoactive agent’s pharmacokinetics known as 9-THC9 (9-tetrahydrocannabinol), its upshots are discernible within several minutes (Khan & Akella, 2009). According to Müller et al. (2010), 9-THC is enormously lipid soluble plus it can accrue in tissues full of fat hitting the highest concentrations point in four to five days. Afterwards, it is gradually discharged back to the body, which includes the brain, attaining sky-scraping concentrations in the sensory, neocortical, motor, and limbic areas. Khan et al. (2012) note that the tissue removal half-life of 9-tetrahydrocannabinol is roughly one week, and complete removal of a single dose may perhaps last a whole month. Fascinatingly, the 9-THC plasma levels inadequately associate with the levels of urine, making the toxicology screen of urine a completely inexact examination. Essentially, intoxication of cannabis steers severe psychosis in a lot of people and can generate temporary exacerbations of available psychotic illnesses (Henquet et al., 2009). What’s more, cannabis abuse leads to symptoms of terror of dying, depersonalization, unreasonable terror, and fearful concepts, which correspond with severe intoxication. In Lutz (2009) survey, it was accounted that 15% of marijuana users recognized psychotic-resembling signs, the most familiar being having gratuitous emotions of harassment or hearing voices. Evidently, most available research has been unsuccessful to prove if use of cannabis is an effect or source of psychiatric disorders. Case Study Meet Mr. Richard a 22-year-old, African-American male who was presented in Greater Binghamton Health Centre (GBHC) located in New York for his subsequent psychiatric hospital care. Richard was discharged seven days before one month stay and was diagnosed with cannabis-induced Psychosis. Essentially, Richard begun using marijuana soon after that and turned out to be indicative with more distinct illusions and psychotic conduct. For this reason, he was taken back to GBHC, for showing antagonistic and ostentatious behaviour at a neighbouring café where he rejected to settle his bills for the reason that he had “more than ten billion dollars” in his savings account. According to eye witness, Richard had demanding speech, racing opinions, restlessness, truck full of ideas, and illusions of opulence that he “owns an infirmary” and that he was a “flourishing rap musician.” The doctor reported that Richard’s physical test was normal apart from toxicology of his urine, which proved that he has been using cannabis. What’s more, Richard refused all his prescriptions, together with a positive purified protein derivative (PPD) isoniazid (INH) that had a negative x-ray of the chest; thus, Richard was taken to court of law to get treatment over objection order. Richard was not hospitalized for 60 days and continued to show the above symptoms contrary to his initial admittance where his psychosis had prorogued rather hastily (Khan & Akella, 2009). Richard past Psychiatric History At the time of his foremost psychotic break, Richard was taken to a Psychiatric Emergency Program by law enforcement seven days before his subsequent admission. Richard girlfriend informed the law enforcement that Richard had been hallucinating recently and was afraid that he may perhaps be a danger to others. What’s more, she informed the law enforcement that he was acting more and more apparitional and doubtful since his journey from Africa claiming that the government was against him and had inserted a microchip in his abdomen to transmit his ideas. In this regard, the physical test was normal apart from for his urine testing positive for cannabis, which he confessed he had been using while out of the country and recently. At Psychiatric Emergency Program, he required to be controlled a number of times, which impelled his relocation to Greater Binghamton Health Centre. While at GBHC, Richard did not show the similar violent and muddled symptoms as well he failed to support any emotional symptoms. Furthermore, Richard refused having any nervousness symptoms spectrum, but did admit that he had paranoia symptoms before arriving to Psychiatric Emergency Program. Moreover, he accepted that he was suspicious that government had “bugged” his apartment with microchips. Richard as well reported listening to voices from those microchips that were organising annotations based on his life whispering to him constantly “you’re dead.” Such acoustic delusions, which he termed as “reverb,” which just happens after smoking cannabis and that disappeared after being admitted at GBHC. Richard was diagnosed with cannabis-induced psychosis after his symptoms happened while he was smoking marijuana. In addition his first psychotic activities hastily collapsed after his arrival to GBHC, where he was tested for any alterations in rational status; not any was noted, and for that reason he was not provided with any medications. Richard was taken to a second psychologist to gain perceptions into his individuality and analysis. Report from this step displayed that he showed persecutory thoughts, was at risk of developing an ostentatious individuality, addictive disorder, and a flippant perception of authority. Anchored in the examination, Richard was diagnosed with attributes of cluster B with main rebellious features on Axis-II. Therefore, Richard was discharged with advice to report to psychiatrist located in the nearby institution of higher education. Substance Abuse/Use History Richard began using cannabis at the age of 16. Although, he just used it infrequently in the past, but started using it day after day recently and in larger quantities. Furthermore, Richard started using alcohol at the age of 14, whereby he often guzzled (“a small number of beers”) during the weekends and did not account losing consciousness or withdrawal attacks. Richard denied any other illegal drug abuse and beforehand he was in perfect condition, tall in height, and with a well-built body. During the interview, Richard was elegant and dressed properly for the climate and all through the interview he made no eye contact. Importantly, he was still protected and required to be more encouraged by inspiring words. He inappropriately expressed amusement often but hastily attuned his behaviour when questioned. Gentle psychomotor disturbance was seen and he constantly reported that his mind-set was “all right.” Even though no emotional symptoms were expressed at the time of interview, Richard did not demonstrate severe problem to the interviewers: rather he would express amusement at himself one second and was in tears after that. Richard spoke normally but at a lower voice and his reflection procedure was linear but restricted to just few-word responses. Notably, his reflection content entailed numerous hallucinations, like being a wealthy as a result of his flourishing music career. Moreover, he claimed he owned Greater Binghamton Health Centre plus its employees and that his biological father wished for him to be dead due to his flourishing career; however, no acoustic or visual delusions were expressed (Khan & Akella, 2009). Discussion Quite a few longitudinal studies and case studies have demonstrated the connection flanked by severe psychosis related with cannabis. According to Arendt et al. (2008), the most well-known symptoms obtained are aural delusions, suspicious thoughts of being hunted, depersonalization, unconsciousness, nervousness, ostentation, and tetchiness. Presently, there is a heated argument on whether or not marijuana can lead to schizophrenia in a healthy person. Cannabis use seems to start at a progressively premature age. Founded on the 2002–2003 Substance Abuse and Mental Health Service Administration (SAMHSA) study, more than 90 million grown-ups in U.S (43%) people who were less than 18 old had used cannabis no less than once in their life span. In their midst, 2 percent had accounted their first experience before attaining an age of 12, 53 percent were an age between 12 and 17, and 45 percent were above an age of 18 (Khan et al., 2012). In the equivalent analysis, 12 percent of people above 18 years who had used cannabis were grouped as having a severe psychosis disease. Additionally, 21 percent of grown-ups who used cannabis prior to an age of 12 were grouped as enduring a grave psychosis disease, rather than 10.5 percent of grown-ups who used cannabis after reaching 18 years. Severely with regard to psychosis, outcomes from the Benson et al. (2007) Study emphasize that day by day cannabis smokers were 2.5 times more probable to experience cannabis-induced psychosis as compared to non-frequent users, even subsequent to changing for sociodemographic aspects and psychiatric conditions. Statistics like these have generated the thought that cannabis may possibly not be as harmless as it has been beforehand perceived. Swedish based studies analyzed a group of 50,000 recruits and established a dose-reaction connection amid cannabis use at an age of 18 and a diagnosis of schizophrenia (Henquet et al., 2009). Heavy cannabis users” were 2.3 times probable to have a schizophrenia diagnosis as compared to the non-users 1.5 decade afterward (subsequent to regulating available psychosis). At the point where the examination was extended to 3 decades, heavy cannabis users were 7 times likely to suffer from schizophrenia as compared to non users. Limiting the examination to five years for the past cannabis users to analyze if cannabis use may be a prodromal psychosis result failed to alter those threats, compelling the authors to affirm that their outcomes were “steady with the underlying connection between schizophrenia and cannabis use (Arendt et al., 2005). Cannabis-Induced Schizophrenia The schizophrenia prodromal phase is plotted by steady but philosophical transformations in conduct, insight, and cognition, creating the question if use of cannabis may be an outcome of surfacing psychosis instead of its cause (Barkus et al., 2006). Even though diminutive contrary to the Swedish survey, the Hürlimann et al. (2012) study offered exceptional perceptions incidentally, reviewing a birth group of roughly 1000 persons born between 1972–73 in Dunedin, New Zealand, with more than 95 percent follow-up pace at an age of 26. During the study, data was collected on self-accounted psychotic occurrences at an age of 11, prior to the beginning of cannabis use, and on self-accounted utilisation of cannabis at an age of fifteen and eighteen. Every person was examined to generate Fourth Edition diagnoses of Diagnostic and Statistical Manual of Mental Disorders, in case it is available at an age of 26, permitting the examiners to note psychotic symptoms existence alongside a range or the existence of psychotic disorder that is properly diagnosed. Symptoms of Psychotic sourcing from other drugs such as alcohol were discarded. Use of cannabis by individuals aged 15 and 18, in that order, steered towering psychosis rates at 26 years of age than non-users, even subsequent to regulating psychotic incidents in the previous cannabis use (Stirling et al., 2008; Benson et al., 2007). According to Arendt et al. (2008), knowing the first time someone started using cannabis is an important aspect: given that ten percent of people who had previously used cannabis before an age of 15 years were diagnosed with a form of schizophrenia disorder when they attained the age of 26, as contrasted to three percent of controls. From this statistics, the threat for grown-up being diagnosed with schizophrenia disorder is still sky-crapping following the regulation for psychotic incidents at an age of 11, with an abnormal ratio of 3 is to1. Furthermore, use of cannabis before attaining an age of 15 failed to forecast despair at an age of 26, and use of other drugs did not front a threat for schizophrenia disorder on top of the one fronted by cannabis (Okoro et al., 2007). Moreover, use of cannabis starting from ages 15 as well as 18 was related with an increased threat for getting schizophrenia disorder, but just if headed by incidents of Psychotic at age of 11. Consequently, this survey supported the idea that cannabis use among the youth is riskier for they have a high chance of suffering schizophrenia at adulthood, particularly if used heavily before an age of 15 (Müller et al., 2010). This recommends both a sequential precedence between schizophrenia and early age cannabis use. Besides, the age concern should be taken into account, bearing in mind the fact that the developing brain may perhaps be vulnerable to alleged neurobiologic and trophic effects brought about by cannabis exposure, from which there is a building up proof. Khan and Akella (2009) performed a meta-analysis wherein it was observed that early cannabis exposure generated a high risk of cannabis-induced psychosis at a later age, compelling them to conclude that untimely exposure to cannabis is an autonomous psychotic and psychosis disorders. On the other hand, Benson et al. (2007) in their study among 500 patients diagnosed with cannabis-induced psychosis noted that nearly 50% of the patients had been diagnosed with schizophrenia a year afterwards. Okoro et al. (2007) in their 14 years follow-up study among 1500 individuals who at the beginning of the study were aged between 4 and16, noted a unique connection between psychosis and use of cannabis; in their conclusion, they claimed that cannabis-induced psychosis provide an early indication of schizophrenia instead of a different psychosis form. Besides that, for people with schizophrenia prodromal symptoms, cannabis heightens the occurrence and intensity of psychotic symptoms, particularly delusions, and happens shortly after using cannabis (Altable et al., 2005). In this regard, it is worth claiming that cannabis can exacerbate prodromal symptoms as well as augment the chances of being diagnosed with schizophrenia. Cannabis-Induced Psychosis Management Compared to psychosis that is not related to cannabis, cannabis-induced psychosis is turning out to be more difficult to care for. In well-known schizophrenia, cannabis steers to reduce devotion to management and heightens symptoms reappearance, aggression episodes, persecution (like being utilised as drug “channels” to transmit drugs), hospital care, as well as suicide (Benson et al., 2007; Barkus et al., 2006). Arguably, prior to advancing to possible medication actions, the action context deserves an exceptional mention. Mechanisms that incorporate psychotherapy for cannabis use, psychosocial help for mental infirmity, and prescription action offer the permanence and range that is more probable to foresee successful treatment with the sternly psychologically ill patients (Müller et al., 2010). According to Lutz (2009), the insertion of inspiring interviewing and cognitive-behavioural approaches improves the success of treatment. Aspects like crisis management, where self-restraint is prized with some awards, can as well increase success in management of cannabis-induced psychosis. However, for patients who are more intractable, lasting housing mechanisms must be taken into account. Conversely, some health centres lack adequate equipment to offer such wide-ranging services and a lot remains to be trounced to distribute such services all over the present mental health system as well as to an ever expanding population (Hürlimann et al., 2012). Presently, there are a number of guidelines with reference to the pharmacologic management of recurring cannabis use/abuse or reliance as well as psychotic illnesses. With regard to cannabis reliance itself, the competitor rimonabanto of cannabinoid receptor is exhibiting some hope in primate examinations to change cannabis-seeking actions. 12 mg of naltrexone has been noted to lessen the cannabis effect; a strategy that may perhaps give schizophrenia patients some hopes (Khan et al., 2012). Furthermore, dronabinol, buspirone, and Nefazodone have given some hope in reducing the symptoms of cannabis use abandonment. Nonetheless, this study is in the beginning stages, and still it is not apparent how these different mechanisms can be enforced in schizophrenia patients with cannabis reliance (Stirling et al., 2008). While psychosis has to be handled in any management approaches for cannabis-induced psychosis, anti-psychotics’ have notably featured in the endeavours to manage cannabis reliance and psychosis. The anti-psychotics that were generated first seem to encompass modest role in the management of other disorders brought about by use of cannabis, and without a doubt, there are details that they may possibly exacerbate abuse of the substance. Aged antipsychotics, particularly dopamine adversaries with high-potency, may further interrupt existing channels of dysregulated mesocorticolimbic dopamine, a trait ordinary to both drug dependence and schizophrenia. Cannabis use may superbly and rapidly ease fundamental shortfalls in schizophrenia patients, although it may possibly aggravate symptoms of psychotic (Arendt et al., 2008). Conclusion In spite of the main community health setbacks posed by use of cannabis, the burden of disability inflicted by schizophrenia, and the up-and-coming unanimity that use of cannabis, particularly at an early stage of life can bring about psychosis when they grow up. Furthermore, management approaches to patients suffering schizophrenia with heavy reliance on cannabis or for cannabis-induced psychosis are still extremely deficient. In this regard, any management approach will probably fail to deliver its pledge exclusive of suitable helpful and psychotherapeutic setting. Though medicines such as rimonabant or naltrexone could be relevant to the treatment or management to patients with schizophrenia and who are cannabis dependent as they are less probable to worsen psychosis. Moreover, clozapine provides the most excellent guarantee so far in the midst of antipsychotics to alleviate cannabis misuse and psychosis, both to patients with developing psychosis because of cannabis and people with schizophrenia. However, the complexities of utilising clozapine have abridged its suitability to cannabis-induced psychosis patients and also front a key obstacle to its more extensive application. Clozapine options that protect its advantages and get rid of its harsh responsibilities are more preferred. Nevertheless, a lot of work is needed to deal with the subject of cannabis-induced psychosis, particularly taking into account the threat of severe mental infirmity brought about by use of cannabis in young persons. Early intervention to impede the use of cannabis, as with general use of drug across the globe, must be a main concern and can symbolize an exclusive and noteworthy pre-emptive measure to protect mental wellbeing for people at risks. References Read More