Psychotic Cannabis Withdrawal: A Clinical Case

Cannabis use has been associated with several psychiatric comorbidities and there appears to be a dose-response relationship between the intensity and duration of its use and the risk of psychosis. More commonly, acute episodes of cannabis induced-psychosis manifest immediately following exposure, are precipitated after the use of large amounts of cannabis, resolve with abstinence, and are of shorter duration than those observed with primary psychotic disorders. Cannabis withdrawal symptoms usually manifest when heavy, prolonged consumption of this substance is interrupted or significantly reduced. The withdrawal syndrome may include sympathetic autonomic hyperactivity, irritability, anxiety, sleep disturbance, and reduced appetite. On the other hand, cases of psychosis induced by cannabis withdrawal are rare. In this case, we present a 32-year-old healthy woman without personal or family psychiatric history who showed a heavy and continued consumption of cannabis since she was 10 years old, without developing any psychiatric symptoms. However, recently she experienced two brief psychotic episodes with disorganized behavior and persecutory delusions, both episodes happening a week after discontinuing cannabis consumption.