Cannabis-Induced Catatonia Complicated by Rhabdomyolysis, Acute Kidney Injury, and Sympathetic Overactivity: A Case Report
Sidharth Saira, Himanshi Singh
Cureus November 22, 2025 DOI: 10.7759/cureus.97507 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 21-year-old male with a history of cannabis-induced psychosis |
| Interventions | Intravenous fluids lorazepam aripiprazole clonazepam |
| Topics | Cannabis |
| Citations | 2 |
| Key findings | The authors present this case as an instance of catatonia associated with cannabis use in a young adult with prior cannabis-related psychosis, arguing that recent cannabis use and antipsychotic non-compliance preceded symptom onset. Treatment with intravenous fluids, lorazepam, aripiprazole, and clonazepam was followed by gradual improvement in catatonic features and normalization of creatine kinase and renal function, though mild psychomotor slowing and psychotic ideation persisted. |
Abstract
Catatonia is a severe neuropsychiatric syndrome characterized by motor, behavioral, and autonomic disturbances. It can result in life-threatening complications such as rhabdomyolysis, venous thromboembolism, acute kidney injury, and autonomic instability. Substance use, particularly cannabis, is increasingly recognized as a precipitant, especially in vulnerable individuals with prior psychotic episodes. We report the case of a 21-year-old male patient with a history of cannabis-induced psychosis who presented with mutism, social withdrawal, psychomotor retardation, and poor oral intake following non-compliance with depot antipsychotics and recent cannabis use. On examination, he exhibited thought blocking, waxy flexibility, negativism, and stupor. Investigations revealed markedly elevated creatine kinase (CK), indicative of rhabdomyolysis, mild renal impairment(raised creatinine), and urine toxicology positive for tetrahydrocannabinol. Other laboratory investigations, including hematologic, hepatic, thyroid, and metabolic panels, along with CT head and chest X-ray, were unremarkable, helping to rule out alternative organic causes. A comprehensive evaluation ruled out primary psychiatric disorders, antipsychotic-induced catatonia, and organic causes. Psychotic symptoms emerged concurrently with catatonic features, with recent cannabis use preceding symptom onset and a prolonged symptom-free interval prior to presentation, supporting a diagnosis of cannabis-induced catatonia in a patient with a history of cannabis-related psychosis. The patient was managed with intravenous fluids, lorazepam, aripiprazole, and clonazepam. Close cardiac monitoring was implemented for recurrent tachycardia. Over the hospital stay, psychomotor function and catatonic features gradually improved, with normalization of CK and renal function. Residual mild psychomotor slowing and psychotic ideation persisted. This case report presents an instance of catatonia associated with cannabis use in a young adult with a prior history of cannabis-related psychosis. It explores the clinical reasoning used to distinguish this presentation from other potential causes, including mood disorders, antipsychotic-related effects, and medical or organic conditions, and discusses evidence-based management approaches aimed at minimizing medical complications and optimizing patient outcomes. It also highlights the need for patient education on cannabis-related neuropsychiatric risks and routine substance use screening in psychiatric populations.
Comparable studies
Other case reports and case series on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychotic Reactions Following Cannabis Use in East Indians Patients at an Indian drug addiction clinic who developed acute cannabis-related psychosis | 1974 | Descriptive report (case series of clinical observations) | n = 200 |
| Psychiatric effects of cannabis use Swedish cases of cannabis psychosis | 1985 | Case series | n = 70 |
| Forty-Six Cases of Psychosis in Cannabis Abusers Gunila Bernhardson Habitual cannabis users treated for psychosis at Swedish psychiatric clinics and mental... | 1972 | Case series (retrospective survey of psychiatric records) | n = 46 |
| 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 |
Citations in the library
Cites 3
- Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases The British Journal of Psychiatry November 30, 2005
- Cannabis-Induced Malignant Catatonia: A Medical Emergency and Review of Prior Case Series Cureus August 27, 2021
- Effects of Cannabis on Glutamatergic Neurotransmission: The Interplay between Cannabinoids and Glutamate. Cells June 29, 2024