Increased emergency room visits without corresponding rehospitalizations in cannabis users with psychosis
O. Martin-Santiago, M. Calvo-Valcarcel, P. Martinez.Gimeno, C. Alario-Ruiz, B. Arribas-Simón
European Psychiatry April 1, 2024 DOI: 10.1192/j.eurpsy.2024.799 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 109 |
| Population | Patients discharged from a psychiatric hospitalization unit diagnosed with schizophrenia and other psychotic disorders |
| Duration | 1-year follow-up after hospital discharge |
| Topics | Cannabis |
| Key findings | Patients with psychosis who consumed cannabis had readmission rates and time to readmission similar to non-consumers, but were more likely to require emergency care (54.2% vs 33.7%) and had a shorter time to first urgent visit (about 60 vs 106 days). Most cannabis consumers' ER visits (73.6%) did not result in admission. The authors propose that cannabis-related psychotic episodes may be managed in the ER or resolve with reduced cannabis use, and argue for personalized, multidisciplinary care. |
Abstract
Introduction Epidemiological studies have established a complex relationship between cannabis consumption and a heightened risk of psychotic disorders, including schizophrenia. However, this connection is multifaceted, influenced by genetics, environment, and individual psychology. Surprisingly, despite a surge in emergency room (ER) visits associated with cannabis consumption and psychosis, there haven’t been significant increases in hospital readmissions. This rise in ER visits can be attributed to the increasing social acceptance of cannabis and its legalization in some regions, increasing the likelihood of adverse effects. Furthermore, the higher potency of contemporary cannabis can trigger psychotic reactions, particularly in those consuming elevated levels of THC, its primary psychoactive component.ObjectivesThis study aimed to compare the rates of readmissions and ER visits one year after hospital discharge among patients diagnosed with schizophrenia and other psychotic disorders, stratified by cannabis consumption.MethodsWe collected sociodemographic and clinical data from 109 patients after discharge from a psychiatric hospitalization unit.ResultsPatients who consumed cannabis (N=35) were younger than non-consumers (M=31.4; SD=10.0 vs M=44.3; SD=11.4; t(107)=5.71; p<.01), with no significant gender differences, hospital stay durations, or proportions of schizophrenia diagnoses (33.3%). The readmission rates and time to readmission were similar between both groups. Interestingly, 54.2% of cannabis consumers required emergency care (X2(1, N = 109)= 4.1, p = .04), with 73.6% not needing admission (X2(1, N = 109)= 5.5, p = .01), in contrast to 33.7% and 56% in the non-consumer group. The time to the first urgent care visit was shorter in the consumer group (M=59.5; SD=56.3) compared to the non-consumer group (M=105.8; SD=93.1; t(107)=1.92; p=.03).Conclusions This study reveals that patients with psychosis and cannabis consumption tend to visit ER services more frequently despite utilizing fewer hospital resources like hospitalizations. Notably, despite the increased ER visits, there hasn’t been a corresponding rise in hospital readmissions. These would be due to individuals experiencing cannabis-related psychotic episodes receiving suitable assessment and treatment in the ER, obviating the need for prolonged hospitalization. Furthermore, some psychotic episodes may naturally resolve over time, particularly with reduced or discontinued cannabis consumption. Our result highlights the need for personalized care approaches targeting this group, effectively addressing acute episodes related to cannabis use and psychosis. Addressing this trend requires a multidisciplinary approach involving mental health professionals, addiction specialists, and emergency response teams.Disclosure of InterestNone Declared
Comparable studies
Other observational and cohort studies on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| High-potency cannabis and the risk of psychosis People with first episode of psychosis and healthy controls from the local population | 2009 | Case-control study | n = 454 |
| Ayahuasca-Assisted Therapy for Addiction: Results from a Preliminary Observational Study in Canada Rural aboriginal population | 2013 | Observational study | |
| Impaired cognitive performance in drug free users of recreational ecstasy (MDMA) Otherwise healthy young people | 2000 | Observational | |
| Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study Individuals from the general population in Germany aged 14-24 at baseline | 2011 | Observational cohort | n = 1,923 |
| Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases Patients treated for cannabis-induced psychotic symptoms in Denmark between 1994 and... | 2005 | Observational cohort | n = 535 |