Persistent Psychosis Induced by Cannabis Withdrawal

[Chip (OP)]

https://www.psychiatrist.com/pcc/comment-persistent-psychosis-induced-cannabis-withdrawal/?utm_source=Klaviyo&utm_medium=email&utm_campaign=news_wmr&_kx=va3uRF3O8-7Dg_zjrKMZJk0wdery-TOTVyZ3l8muM1g.VpkqxC

Comment on “Persistent Psychosis Induced by Cannabis Withdrawal”

March 13, 2025

Psychiatrist.com Logo
Back to top
Open menu
arrow
Primary Care Companion for CNS Disorders
The Primary
Care Companionfor CNS Disorders

Access icon
Addiction
Psychotic Disorders
Letter to the Editor
March 13, 2025

Comment on “Persistent Psychosis Induced by Cannabis Withdrawal”
David A. Gorelick, MD, PhD

Prim Care Companion CNS Disord 2025;27(2):25lr03933

See case report by Vaseel and Uvais and reply letter by Vaseel and Uvais

To the Editor: Recently in the PCC, Vaseel and Uvais1 presented a case of paranoid psychosis beginning within 3 days of discontinuation of heavy, prolonged cannabis use, which they diagnosed as “cannabis withdrawal psychosis.”

I believe a more accurate diagnosis would be cannabis-induced psychotic disorder with onset during withdrawal.

The patient they describe seems to meet the DSM-5 diagnostic criteria for this disorder, although some relevant clinical details are not provided in the case report.

The patient developed paranoid delusions (criterion A) within 3 days of abrupt cessation of cannabis use (criterion B1); cannabis is known to induce psychosis (criterion B2). Medical and psychiatric evaluation ruled out others causes of psychosis (criterion C).

There is no mention of evaluation for delirium, but I assume that delirium would have been mentioned if observed (absence of delirium is criterion D).

It is unclear whether the patient fully met the DSM-5 diagnostic criteria for cannabis withdrawal, which require experiencing at least 3 from a list of 7 common signs and symptoms of cannabis withdrawal (criterion B).

As described, the patient had only 2: irritability (criterion B1) and insomnia (criterion B3).

The persistence of this patient’s psychosis for at least 2 months (until resolved by antipsychotic treatment) is unusual in the literature.

A recent systematic review identified 112 cases of psychosis associated with cannabis withdrawal: 44 published cases (not including the present case) and 68 cases identified via medical records search of a large health care system.

In no case was psychosis reported to persist longer than 3–6 weeks, although this duration was almost always truncated by antipsychotic treatment (as in the present case).

Persistence of cannabis-induced psychotic disorder for longer than 1–2 months raises the possibility that cannabis use triggered the onset of an independent psychotic disorder.

Can the authors provide psychiatric follow-up on their patient?

Go to https://doi.org/10.4088/PCC.25lr03933