PSYCHOTIC DISORDERS IN PEOPLE USING SYNTHETIC CANNABINOIDS (SPICE)

Abstract Background Cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) are the two principal ingredients of natural cannabis with counteracting functions. Synthetic cannabinoids (SCs) are much more potent than natural cannabis, since they act as a more potent full agonist at the cannabinoid subtype 1 receptor than THC, and they also lack cannabinoids such as CBD that may otherwise counteract psychoactive properties of THC. Therefore, SCs may induce a more severe clinical presentation than natural cannabis does: the use of SCs may be associated with agitation, anxiety, tachycardia, hallucinations, irritability, memory and cognitive impairment, violent behavior, unresponsiveness, and psychosis. Clinical characteristics, specificity of the disease course and patient profile of the SC-induced psychoses are still poorly characterized in the scientific literature. The present study was therefore designed to evaluate the psychotic disorders in patients with synthetic cannabinoid use disorder in terms of patient profile and clinical characteristics with reference to their follow-up. Methods A total of 60 male patients (n=60; mean (standard deviation [SD]) age: 23.6 (3.5) years) diagnosed with psychotic disorder induced by the SC use who were hospitalized at the intensive care unit or emergency department of the Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare were included in this single-centre, longitudinal, observational cohort study. The catamnestic follow-up period was up to 2 years. Results We evaluated different clinical cases of SC-induced psychoses and identified four clinical types of them on the ground of leading psychopathological syndrome during the patient’s entire length of hospitalization: Then we performed a catamnestic follow-up of patients to reveal the possible schizophrenic process manifestation in patients who use SC. Catamnestic follow-up revealed that manifestation of the schizophrenic process was present in 8 patients (13% of cases). Discussion Our results revealed that SC-induced psychoses affect young adults primarily. Consistent with the statement that the majority of first-time SC users are experienced marijuana smokers, SC was used following other transitional substances rather than as the first substance in the majority of our patients, with cannabis being the most popular antecedent substance. SC was not the first substance used in the majority of our patients, and it had been preceded by use of other transitional substances, such as cannabis in most cases. Despite the exogenous nature, structurally such psychoses are often endoformic. For instance, even the delirium is atypical and includes the elements of Kandinsky-Clerambault’s syndrome. Psychopathologically hallucinations and delusions dominate in the clinical presentation of the psychoses (with predominant hallucinatory symptoms or affective paranoid symptoms). Development of substance-induced psychoses is often associated with the manifestation of the schizophrenic process (in our study it was revealed in 13% of cases). It is extremely difficult to create a differential diagnosis between such psychotic disorders and a primary endogenous psychotic episode. In such cases the appearance of deficit symptoms specific for schizophrenia becomes crucial.

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Clinical Variants of Psychopathological Disorders in Users of Synthetic Cannabinoids (Spices)

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2146 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S199-S200

Author(s):

N. Bokhan ◽

G.Y. Selivanov

Keyword(s):

Psychotic Disorders ◽

Late Onset ◽

Paranoid Schizophrenia ◽

Synthetic Cannabinoids ◽

Designer Drug ◽

Addiction Psychiatry ◽

Continuous Type ◽

Icd 10 ◽

Group 5 ◽

Group 2

IntroductionThe problem of mental health of synthetic (“designer”) drug or “spice” users draws the increasing attention of experts of various areas in psychiatry, addiction psychiatry and psychotherapy.Research objective To classify and describe the psychotic states arising after the use of “spice”; to define the personality changes and probable consequences of the use observed in patients in the conditions of a hospital.Material and methodsOne hundred and one patients (93 men and 8 women; mean age 27.8 ± 7.6 years) with dependence on “spice” revealed between 2014 and 2015 were examined. History taking, clinical-psychopathological investigation and experimental psychological testing were used.Results and discussionAs a result of research the patients were divided into 5 groups according to criteria of ICD-10:– group 1: acute intoxication with delirium (n = 16; 15.84%);– group 2: residual and late-onset psychotic disorders like flashbacks (n = 9; 8.92%);– group 3: withdrawal state with delirium (n = 32; 31.68%);– group 4: psychotic disorder, mainly hallucinatory (n = 30; 29.70%);– group 5: paranoid schizophrenia (n = 14; 13.86%).The use of synthetic cannabinoids (“spice”) can initiate transient psychotic episodes, serve as the contributing factor of development of paranoid schizophrenia, continuous type of the course, leads to “accentuation” of schizoid, paranoid and psychopathic traits of the personality. It is proposed to make up a question of the possibility of additional use of the clarifying designation “synthetic cannabinoids/spice” at reference of patients using synthetic cannabinoids to the section of ICD-10 F12 “Mental and behavioural disorders due to use of cannabinoids” the agenda of clinicians.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Clinical analysis of the case of the psychotic disorder due to the combined abuse of psychoactive substances

Ukrains'kyi Visnyk Psykhonevrolohii ◽

10.36927/2079-0325-v27-is4-2019-19 ◽

2019 ◽

Author(s):

Lyudmyla Yuryeva ◽

Viktor Kokashynskyi ◽

Tetiana Rachynska

Keyword(s):

Substance Abuse ◽

Psychotic Disorder ◽

Clinical Picture ◽

Psychotic Disorders ◽

Bipolar Affective Disorder ◽

Synthetic Cannabinoids ◽

Clinical Analysis ◽

Psychoactive Substances ◽

Second Generation Antipsychotic ◽

Mental And Behavioral Disorders

The clinical and social pathomorphism of mental and behavioral disorders due to the use of psychostimulants and cannabinoids actualized the problem of diff erential diagnosis and therapy of these patients. The most popular among young people are cannabinoids (including synthetic cannabinoids), psychostimulants and hallucinogens. In clinical practice, intoxication psychoses are more and more common due to the use of psychoactive substances, often occurring as schizophrenic-like disorders, which entails the diffi culties of diff erential diagnosis with endogenous disorders. The relevance of the "problem of psychotic potential" of psychostimulants is also due to the discussion about the advisability of medical use of cannabinoids in a number of serious diseases. The article describes the clinical picture and dynamics of the development of psychotic disorder due to the combined (cannabinoids, psychostimulants, hallucinogens) substance abuse. The presented clinical analysis and diff erential diagnosis between psychotic disorders due to substance abuse with schizophreniform symptoms and psychoses of endogenous origin (schizophrenia, bipolar affective disorder. The relevance of this case is the similarity of the clinical picture with endogenous disorders and the resulting diagnosis difficulties, differential and treatment of these disorders. The article discusses aspects of the use of second-generation antipsychotic drug olanzapin (Egolanza) in the treatment of psychotic disorders of exogenous etiology. Key words: cannabinoids, psychostimulants, hallucinogens, diff erential diagnosis of intoxication and endogenous psychoses, psychotic disorder, dependence on psychoactive substances, therapeutic tactics, olanzapine

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New psychoactive substances: psychiatrist's view

Interactive science ◽

10.21661/r-497066 ◽

2019 ◽

pp. 57-67

Author(s):

Andrey Viktorovich Antsyborov ◽

Irina Vladimirovna Dubatova

Keyword(s):

Opioid Receptors ◽

Psychotic Disorders ◽

Synthetic Cannabinoids ◽

Designer Drugs ◽

New Psychoactive Substances ◽

Psychoactive Substances ◽

Gaba A ◽

Psychoactive Effects ◽

Legal High ◽

Derivatives Of

Appearing not long ago, new psychoactive substances (designer drugs), including synthetic cannabinoids, derivatives of cathinone, phenethylamines, new stimulants, synthetic opioids, tryptamine derivatives, phencyclidine, piperazine, the GABA (A/B) receptors agonists, have become a serious problem for consumers and for physicians. Consumers of these substances are attracted primarily by the intensity of psychoactive effects, and the «legal high» declared by the black manufacturers, which indicates that significant difficulties in a laboratory identification of new surfactants. Designer drugs, when ingested, can be influenced on many neurotransmitter pathways/receptors: dopamine, cannabinoid (CB1), GABA (A/B), 5-HT2A, glutamate, and k-opioid receptors (KOR), the imbalance of which leads to the development of polymorphic psychotic disorders.

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Use of Synthetic Cannabinoids in Patients With Psychotic Disorders: Case Series

Journal of Dual Diagnosis ◽

10.1080/15504263.2014.929364 ◽

2014 ◽

Vol 10 (3) ◽

pp. 168-173 ◽

Cited By ~ 30

Author(s):

Andreja Celofiga ◽

Jure Koprivsek ◽

Janez Klavz

Keyword(s):

Psychotic Disorders ◽

Synthetic Cannabinoids ◽

Case Series

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Psychotic Disorders in Patients Who Use Synthetic Cannabinoids

Journal of Psychiatric Practice ◽

10.1097/pra.0000000000000429 ◽

2019 ◽

Vol 25 (6) ◽

pp. 485-490

Author(s):

VALENTIN Y. SKRYABIN ◽

MARIA A. VINNIKOVA

Keyword(s):

Psychotic Disorders ◽

Synthetic Cannabinoids

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The Role of Cannabinoids in Schizophrenia: Where Have we Been and Where are we Going?

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.117 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S277-S277

Author(s):

J. Reis ◽

G. Pereira

Keyword(s):

Cannabinoid Receptors ◽

Psychotic Disorders ◽

Cannabis Sativa ◽

Therapeutic Potential ◽

Age At Onset ◽

Synthetic Cannabinoids ◽

The Other ◽

Other Hand ◽

Increased Risk

IntroductionSeveral studies have shown that both endocannabinoid system (ECS) and synthetic cannabinoids (SC) might be involved in schizophrenia.ObjectivesTo review recent literature on the role of cannabinoids in schizophrenia. The review includes the evidence of cannabis use as a risk factor for the development of schizophrenia, but also the preliminary evidence for the use of cannabinoid-based compounds in the treatment of psychosis.MethodsThe authors made an online search on PubMed for clinical trials and reviews published in the last 12 months, using the keywords: “cannabinoids”, “endocannabinoids”, “phytocannabinoids” and “schizophrenia”.ResultsThe use of Cannabis sativa is associated with increased risk of developing psychotic disorders, including schizophrenia, and earlier age at onset of psychosis. Δ9-Tetrahydrocannabinol (THC) has multiple actions in the brain development, including impairment of neuroplasticity, dysregulation of dopamine and glutamate signaling, and, possibly, neurotoxicity. The ECS has been implicated in psychosis both related and unrelated to cannabis exposure. Cannabinoid receptors type 1 (CB1 R) and type 2 (CB2 R), as well as the endogenous ligand N-arachidonoylethanolamine (AEA) and 2-arachidonylglycerol (2-AG) levels, are most likely to be involved in the pathophysiology of this disorder. On the other hand, the antipsychotic effects of some cannabinoids have been investigated in recent studies. Cannabidiol (CBD) and Δ9-tetrahydrocannabivarin (THCV) may have therapeutic potential for the treatment of psychosis.ConclusionsEmerging evidence suggests an important role of ECB system and SC on schizophrenia. On the other hand, recent studies have shown some phytocannabinoids might represent therapeutic promises in this disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Synthetic Cannabinoids and Synthetic Cannabinoid-Induced Psychotic Disorders

The Complex Connection Between Cannabis and Schizophrenia ◽

10.1016/b978-0-12-804791-0.00009-4 ◽

2018 ◽

pp. 199-220 ◽

Cited By ~ 1

Author(s):

Papanti Duccio ◽

Schifano Fabrizio ◽

Orsolini Laura

Keyword(s):

Psychotic Disorders ◽

Synthetic Cannabinoids ◽

Synthetic Cannabinoid

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Psychosocial Risks and Management for Children and Adolescents With 22q11.2 Deletion Syndrome

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0002 ◽

2019 ◽

Vol 4 (4) ◽

pp. 633-640 ◽

Cited By ~ 1

Author(s):

Canice E. Crerand ◽

Ari N. Rabkin

Keyword(s):

Cognitive Abilities ◽

Psychotic Disorders ◽

Developmental Stages ◽

Early Adulthood ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

22Q11.2 Deletion ◽

Psychosocial Risks ◽

Empirically Supported ◽

Specific Education

Purpose This article reviews the psychosocial risks associated with 22q11.2 deletion syndrome, a relatively common genetic condition associated with a range of physical and psychiatric problems. Risks associated with developmental stages from infancy through adolescence and early adulthood are described, including developmental, learning, and intellectual disabilities as well as psychiatric disorders including anxiety, mood, and psychotic disorders. Other risks related to coping with health problems and related treatments are also detailed for both affected individuals and their families. Conclusion The article ends with strategies for addressing psychosocial risks including provision of condition-specific education, enhancement of social support, routine assessment of cognitive abilities, regular mental health screening, and referrals for empirically supported psychiatric and psychological treatments.

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Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2008.novdec01 ◽

2008 ◽

Vol 13 (6) ◽

pp. 1-7

Author(s):

Norma Leclair ◽

Steve Leclair ◽

Robert Barth

Keyword(s):

Mental Disorders ◽

Behavioral Disorders ◽

Psychotic Disorders ◽

Behavioral Disorder ◽

Behavioral Impairment ◽

Central Nervous System Damage ◽

Brain Functioning ◽

Sixth Edition ◽

Diagnostic And Statistical Manual ◽

Mental And Behavioral Disorders

Abstract Chapter 14, Mental and Behavioral Disorders, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines a process for assessing permanent impairment, including providing numeric ratings, for persons with specific mental and behavioral disorders. These mental disorders are limited to mood disorders, anxiety disorders, and psychotic disorders, and this chapter focuses on the evaluation of brain functioning and its effects on behavior in the absence of evident traumatic or disease-related objective central nervous system damage. This article poses and answers questions about the sixth edition. For example, this is the first since the second edition (1984) that provides a numeric impairment rating, and this edition establishes a standard, uniform template to translate human trauma or disease into a percentage of whole person impairment. Persons who conduct independent mental and behavioral evaluation using this chapter should be trained in psychiatry or psychology; other users should be experienced in psychiatric or psychological evaluations and should have expertise in the diagnosis and treatment of mental and behavioral disorders. The critical first step in determining a mental or behavioral impairment rating is to document the existence of a definitive diagnosis based on the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The article also enumerates the psychiatric disorders that are considered ratable in the sixth edition, addresses use of the sixth edition during independent medical evaluations, and answers additional questions.

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