The Cannabis-Psychosis Spectrum: Clinical Manifestations, Conversion Risk, and Therapeutic Strategies
Clinical Neuropsychopharmacology and Addiction August 6, 2025 DOI: 10.53941/cna.2025.100004 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Cannabis |
| Keywords | Psychosis Schizophrenia spectrum |
| Citations | 2 |
| Key findings | Cannabis-induced psychosis shows rising incidence rates of 2.7 to 6.1 per 100,000 person-years, with a 33–50% conversion rate to schizophrenia-spectrum disorders. |
Abstract
Cannabis-induced psychosis (CIP) represents a significant public health concern in the context of increasing global cannabis use and potency. This review synthesizes current evidence on the epidemiology, neurobiological mechanisms, clinical features, and treatment approaches for cannabis-induced psychotic disorders. Recent epidemiological data indicate rising incidence rates of CIP, with estimates ranging from 2.7 to 6.1 per 100,000 person-years in recent studies. The neurobiological mechanisms involve complex interactions between Δ9-tetrahydrocannabinol (THC) and the endocannabinoid system, affecting dopaminergic, GABAergic, and glutamatergic neurotransmission. Clinical manifestations typically include acute onset of paranoid delusions and hallucinations, often distinguishable from primary psychotic disorders by their temporal relationship to cannabis use and relatively preserved insight. Treatment remains challenging, with limited evidence-based guidelines, though second-generation antipsychotics and benzodiazepines show efficacy. The conversion rate to schizophrenia-spectrum disorders ranges from 33–50%, highlighting the importance of early identification and intervention. This review emphasizes the need for improved diagnostic criteria, treatment protocols, and prevention strategies as cannabis legalization continues worldwide.
Comparable studies
Other narrative reviews on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Causal association between cannabis and psychosis: examination of the evidence | 2004 | Review | |
| Cannabis sativa: A comprehensive ethnopharmacological review of a medicinal plant with a long history. General (historical and pharmacological review) | 2018 | Review | |
| Psychiatric effects of cannabis | 2001 | Review | |
| Beyond THC: The New Generation of Cannabinoid Designer Drugs | 2011 | Review | |
| Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug | 2006 | Review |
Citations in the library
Cited by 3
- The Relationship Between Cannabis Use and Schizophrenia As a Risk Factor or For Its Therapeutic Potential: A Systematic Review of Evidence Cureus September 20, 2025
- Beyond the Diagnostic Binary: A Translational Use of the Research Domain Criteria to Improve the Measurement of Anxiety in the Context of Cannabis Use Healthcare August 1, 2026
- Sex-specific vulnerabilities in cannabis-induced psychosis: A scoping review. Asian Journal of Psychiatry July 8, 2026
Cites 12
- Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases The British Journal of Psychiatry November 30, 2005
- Endocannabinoid system and psychiatry: in search of a neurobiological basis for detrimental and potential therapeutic effects Frontiers in Behavioral Neuroscience 2011
- Substance-related exogenous psychosis: a postmodern syndrome CNS Spectrums June 25, 2020
- Dissociable effects of cannabis with and without cannabidiol on the human brain’s resting-state functional connectivity Journal of Psychopharmacology April 23, 2019
- Rates and correlates of cannabis-associated psychotic symptoms in over 230,000 people who use cannabis Translational Psychiatry September 6, 2022
and 7 more in the library