Real world clinical outcomes of treatment of cannabis-induced psychosis and prevalence of cannabis-related primary psychosis: a retrospective study
Onrumpha Chuenchom, Thanarat Suansanae, Lumsum Lukanapichonchut, Somporn Suwanmajo, Chuthamanee Suthisisang
BMC Psychiatry September 27, 2024 DOI: 10.1186/s12888-024-06075-6 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart review Peer reviewed |
|---|---|
| Sample size | 317 |
| Population | Patients aged over 12 years with cannabis-induced psychosis admitted to PMNIDAT, Thailand |
| Interventions | Antipsychotics Benzodiazepines Antidepressants |
| Dose | Mean equivalence dose of risperidone was 8.0 ± 5.9 mg/day |
| Duration | Average hospital stay 28 days; follow-up at 1.3 years for schizophrenia diagnosis |
| Measures | Brief Psychiatric Rating Scale (BPRS) |
| Topics | Cannabis |
| Registration | NCT04945031 |
| Key findings | Antipsychotics, primarily risperidone, were the main treatment for cannabis-induced psychosis and were associated with significant improvement in BPRS scores by day 22. |
Abstract
Abstract Background Current treatment of cannabis-induced psychosis (CIP) focus on the presenting symptoms of individual patient. Therefore, the objective of this study was to investigate the efficacy of pharmacological treatment for CIP in a retrospective manner.
Methods: A retrospective chart review study was conducted at the Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Thailand. Patients aged more than 12 years who met the International Classification of Disease-10 (ICD-10) criteria of CIP, had recorded of cannabis use in medical chart, and had positive urine test of cannabis on the first day of admission from October 2013 to September 2019 were enrolled. The primary outcome was the efficacy of pharmacological treatment of CIP. Brief Psychotic Rating Scale (BPRS) on the first day and weekly after receiving treatment were used to assess the primary outcome.
Results: Four hundred and three medical charts with diagnosis of CIP were enrolled into the study and only 317 charts were analyzed. Most of them were male with an average aged of 21.0 (19.0–24.0) years old. All of them used smoked cannabis from dried leaves and flowers of cannabis plant. The presented symptoms on admission were psychosis, mood symptoms, sleep problems, weight loss, and cognitive problems (100%, 64%, 61%, 11%, and 7%, respectively). Baseline BPRS score of the first day of admission was 55.2 ± 9.6. Majority of patients received antipsychotic (98.7%) followed by the combination of antipsychotics with benzodiazepines (34.5.%), antipsychotics with antidepressants (14.4%) and antipsychotics treatment with antidepressants and benzodiazepines (25.9%). Only few patients received antipsychotic monotherapy (17.9%). Risperidone was the most frequently prescribed antipsychotics (83.6%). Mean equivalence dose of risperidone was 8.0 ± 5.9 mg/day. The average hospital length of stay was 28 days (range 22-31). BPRS at 22 days significantly improved compared to the first day of admission (p < 0.001). Schizophrenia was diagnosed in 7% at 1.3 years of follow up.
Conclusion: Antipsychotics was still a key psychotropic drug for treatment of CIP. The symptoms were decreased rapidly and sustained among the treatment period. However, antidepressants and benzodiazepines were commonly used for treatment of other symptoms beyond psychosis. Trial registration ClinicalTrials.gov ID: NCT04945031 (Registration Date: 30 June, 2021).