cbd schizophrenia forum

Dr Melissa Myers, Northern Human Services, Conway, New Hampshire.

Dr. Brunette’s institution received funding from Alkermes to conduct research on medications for schizophrenia and co-occurring alcohol use disorder. The other authors report no financial relationships with commercial interests.

Dr. Brunette’s institution received funding from Alkermes to conduct research on medications for schizophrenia and co-occurring alcohol use disorder. The other authors report no financial relationships with commercial interests.

Mr. D. is a 50-year-old man with well-controlled bipolar disorder and chronic back pain from a car accident that occurred 10 years earlier. When his pain recently worsened, his primary care provider (PCP) provided a marijuana card and guidance for use of medical marijuana for pain, which he used in the evening about three times weekly, with improvements in sleep and pain. Nine months later, however, he presented to his psychiatrist with concerns that he was “going crazy with side effects from the mood stabilizers.” He appeared confused, disorganized, and hypomanic. His psychiatrist learned that Mr. D. had increased his marijuana use to address increased pain, with his PCP’s advice, to three times daily. The psychiatrist provided education and discussed the potential risks of marijuana use with Mr. D., as she would when discussing any medicine. In this case, the destabilizing effects of THC on cognition and mood, in addition to its addiction liability, were particularly relevant. Even with this information, Mr. D. strongly wished to continue using marijuana for pain, so he and the psychiatrist agreed that he would switch to a high-CBD, low-THC product and reduce use to once in the evening. They agreed that if problems with cognition and hypomania continued, he would cut back further. The psychiatrist called the PCP to coordinate Mr. D’s care, and Mr. D.’s condition restabilized over the following weeks.

Footnotes

Dr Mary F. Brunette, Department of Psychiatry, Geisel School of Medicine, Dartmouth-Hitchcock, Concord, New Hampshire.

In our clinical experience, many people with serious mental illness access medical marijuana for an array of indications, and many of them have experienced problems, including worsening psychosis, anxiety, cognitive impairment, and addiction. Community clinicians may not fully understand the mental health and addiction liabilities of THC, and they may not coordinate their recommendation for marijuana use with other providers. Thus the potential benefits of CBD may be overemphasized compared with the potential harm from THC. The following case exemplifies the complications that people with serious mental illness may experience when using medical marijuana.

Consequently, careful consideration of the type and amount of marijuana constituents is needed when discussing marijuana’s possible effects on people with serious mental illness. Marijuana that is high in THC causes psychotic symptoms among people with and without psychosis. It is associated—when used heavily—with increased risk of schizophrenia among adolescents and worsens symptoms and course of illness among people with schizophrenia (5). Similarly, heavy use of high-THC marijuana is associated with increased risk of developing mania and depression as well as exacerbation of mania and depression among people with an existing mood disorder. Although many people believe that marijuana is helpful for people with posttraumatic stress disorder (PTSD), not a single prospective, controlled trial of any type of marijuana for people with PTSD has been published, and retrospective studies have reported mixed findings (6).

Acknowledgments

Thirty-three states and Washington, D.C., have substantially reduced legal barriers to using marijuana (1), either by legalizing medical or recreational marijuana or by reducing legal penalties for possession. As a result, the marijuana industry is booming—in Washington State alone, over 20,000 pounds of marijuana are produced each month. To advance sales, marijuana-related businesses have developed an array of new products, are advertising heavily, and are profiling consumers. These changes in the legal and commercial landscape introduce many questions for the mental health community. What is the evidence that cannabinoids can be harmful or helpful to people with serious mental illness? How will commercialization of recreational and so-called medical cannabis affect those who are vulnerable to addiction, such as persons with serious mental illness (2)?

Dr Jacob T. Borodovsky, Department of Psychiatry, Geisel School of Medicine, Dartmouth-Hitchcock, Concord, New Hampshire.

Cbd schizophrenia forum

Just because somebody is experiencing all of these changes does not necessarily mean that they are likely to be in the prodrome phase of psychotic episode. The prodrome cannot be “diagnosed” until after psychosis has developed. Up until that point, even professionals can only have a hunch that the changes may be the start of psychosis. Although the symptoms described above are typical of the prodrome phase of psychosis, they may also be due to other causes. If you are concerned about similar types of changes in yourself or someone else, it’s important to seek help.

DID YOU KNOW?
Although a psychotic episode is viewed as occurring in three phases, not all people will experience clear symptoms of all three phases. Each person’s experience will differ.

Psychotic episodes rarely occur out of the blue. Almost always, a psychotic episode is preceded by gradual non-specific changes in the person’s thoughts, perceptions, behaviours, and functioning. The first phase is referred to as the prodrome (or prodromal) phase. During this period the person starts to experience changes in themselves, but have not yet started experiencing clear-cut psychotic symptoms.

This is the stage when characteristic psychotic symptoms – such as hallucinations, delusions and very odd or disorganized speech or behaviours – emerge and are most noticeable. The experiences are often very distressing for the person. It is during this phase when appropriate treatment for psychosis needs to be started as soon as possible.

The second phase is the Acute Phase.

The changes that have been observed in the prodromal phase are very general and could be signs of many different things, including ordinary adolescent behaviour. It is not possible to predict from these symptoms if a person is going on to develop psychosis. The “Warning Signs of Psychosis” section provides information on changes that are more characteristic of psychosis and suggest even greater concern and need for professional assessment.

Prodrome symptoms vary from person to person and some people may not experience any of the changes. This phase can last from several months to a year or more.

The typical course of a psychotic episode can be thought of as having three phases: Prodrome Phase, Acute Phase, and Recovery Phase.

The first phase is called the Prodrome Phase.

Types of changes in feelings, thoughts, perceptions and behaviours include:

Within a few weeks or months of starting treatment, most people begin to recover. Many of the symptoms get less intense or disappear, and people are generally better able to cope with daily life. Some of the symptoms that emerged in the Acute Phase may linger in the Recovery Phase, but with appropriate treatments, the vast majority of people successfully recover from their first episode of psychosis.