Impact of Substance-Induced Psychosis on Adolescents

Abstract

Cannabis exposure during adolescence, the critical period of neurodevelopment, causes profound and often permanent neurobiological changes with negative long-term implications.These include reduced educational attainment, depression, anhedonia, anxiety, impulsive behavior, and problems with memory and attention.This review explores the effect of substance-induced psychosis (SIP) on adolescents, in particular adolescent cannabis users, who have an 8-fold higher incidence of psychosis than non-users, a vulnerability not seen in adults.Cannabis' influence on the endocannabinoid system (ECS) is of key importance for adolescents as CB1 receptor expression peaks between ages 14-17, increasing the tetrahydrocannabinol (THC) induced disruption of the endocannabinoid system.This has a profound effect on synaptic pruning and global excitationinhibition balance, directly impacting brain development, in particular, dopaminergic systems.SIP remains challenging to diagnose due to overlap with other psychotic disorders, and misdiagnosis is common, with 25% of people diagnosed with PPD in emergency departments having SIP.Both SIP and schizophrenia's symptoms include ideas of reference, persecutory delusions, and auditory hallucinations.Positive and negative psychotic symptoms caused by persistent cannabis use disorders increase in severity over time.Cannabis users exhibit poorer symptomatic outcomes than those who use other illicit substances.They have an earlier age of onset of psychosis and poorer social functioning than alcohol misusers.Cannabis induced psychotic disorders have a higher risk of conversion to schizophrenia than alcohol induced psychosis.Meta-analysis reveals that cannabis-induced psychosis (CIP) had the highest rate of progression to schizophrenia (34%) than all other substances, while alcohol had the lowest (9%). 1 Cognitive behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), rewards programs, and familial involvement are effective when treating adolescents with cannabis use disorders.The Adolescent Community Reinforcement Approach (A-CRA) is also an effective treatment for cannabis abstinence.Recreational Cannabis use (CU) in adolescents could be reduced by banning cannabis marketing, limiting retail expansion, and increasing its price and legal age of purchase.Adolescents can access support through rehabilitation centers offering cannabis detoxification and non-pharmacological treatments.Given the impact on neurodevelopment and high psychosis conversion rates, protecting adolescents from CU during this critical developmental window represents a public health priority.