Cannabis-Induced Malignant Catatonia: A Medical Emergency and Review of Prior Case Series
Batool Sheikh, Tinu Hirachan, Kunal K. Gandhi, Saral R. Desai, Rimsha Arif, Oleg Isakov
Cureus August 27, 2021 DOI: 10.7759/cureus.17490 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 35-year-old African American male with heavy cannabis use |
| Interventions | Lorazepam Midazolam |
| Dose | 2 mg intramuscular midazolam; 2 mg intramuscular lorazepam initially; lorazepam increased up to 6 mg intramuscular per day |
| Measures | Bush-Francis Catatonia Rating Scale (BFCRS) |
| Topics | Cannabis |
| Citations | 5 |
| Key findings | The authors report a case of malignant catatonia following heavy cannabis use, with an initial Bush-Francis Catatonia Rating Scale score of 12 that rose to 18 after relapse, and symptoms that improved with intramuscular lorazepam increased to 6 mg per day. They state this is the first reported case of malignant catatonia associated with cannabis use. |
Abstract
Few case reports of catatonia associated with cannabis use are reported. Here, we describe a case of a 35-year-old African American male who developed malignant catatonia following heavy cannabis use. The patient was brought to the emergency department (ED) for altered mental status, hypertension, and erratic behavior. Before his ED presentation, he was smoking cannabis in heavy amounts, confirmed by positive urine toxicology in ED. Initial lab results showed leukocytosis, elevated creatine phosphokinase (CPK) levels. Head CT scans without contrast, including cerebrospinal fluid (CSF) analysis, were nonsignificant. In ED, the patient was agitated, combative, mute, and rigid. He was sedated using 2 mg of intramuscular (IM) midazolam. Psychiatric consultation services suspected catatonia, and the patient scored 12 points on Bush-Francis Catatonia Rating Scale (BFCRS). Although the patient's symptoms responded to 2 mg of IM lorazepam, the patient later relapsed, became tachycardic with blood pressure fluctuations, and his repeat BFCRS score was 18. At this point, the patient was diagnosed as having malignant catatonia, and his lorazepam dosage was increased up to 6 mg IM per day. After a few days of waxing and waning of his symptoms, he finally started to show constant improvement and gradually reduced his symptoms. Our case highlights the first-ever reported case of malignant catatonia associated with cannabis use.
Comparable studies
Other case reports and case series on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Hallucinogen persisting perception disorder after psilocybin consumption: a case study 18-year-old man with HPPD after mixed psilocybin and cannabis intoxication | 2005 | Case study | n = 1 |
| Cannabis‐induced Koro in Americans American men aged 22-26 with years of cannabis experience who reported negative... | 2001 | Case series | n = 3 |
| “Hallucinations” Following Acute Cannabis Dosing: A Case Report and Comparison to Other Hallucinogenic Drugs Healthy 30-year-old male | 2018 | Case study | n = 1 |
| Hallucinogen persisting perception disorder: A literature review and three case reports Patients with hallucinogen persisting perception disorder | 2018 | Case series | n = 3 |
| Cannabis Psychosis in Young Psychiatric Inpatients Consecutive psychiatric hospital admissions of patients aged 35 and under | 1986 | Case study | n = 25 |
Citations in the library
Cites 3
- Gone to Pot – A Review of the Association between Cannabis and Psychosis Frontiers in Psychiatry May 22, 2014
- Pharmacological and Toxicological Effects of Synthetic Cannabinoids and Their Metabolites Current Topics in Behavioral Neurosciences 2017
- Delta9-tetrahydrocannabinol is a full agonist at CB1 receptors on GABA neuron axon terminals in the hippocampus. Neuropharmacology 2010