Catatonic Schizophrenia in a Cannabis-Dependent Adolescent
Catatonic Schizophrenia in a Cannabis-Dependent Adolescent
Introduction: Adolescents with psychoses usually have full recovery from their first psychotic episode, but the first relapse often arises within 2 years of the first episode. Cannabis-related psychoses are difficult to distinguish from schizophrenic psychoses. Here, we describe a particularly severe clinical case, with a first psychotic episode occurring after heavy cannabis smoking, an atypically long symptom-free duration, and a subsequent non-substance-related episode.
Case presentation: A 17-year-old male adolescent of Middle-East origin presented with delusions and hallucinations after extensive cannabis smoking. His first psychotic episode, with paranoid delusions and hallucinations, progressed into severe catatonic symptoms. His symptoms were treated with electroconvulsive therapy and risperidone and he was transferred to a residential substance abuse treatment center. He remained drug-free and non-psychotic for 3.5 years. Given the temporal association with extensive cannabis use, and his full remission of symptoms lasting several years, a cannabis-induced psychosis—though atypically extended—could be suspected. However, after 3.5 years without psychiatric care, and in a drug-free state, our patient again presented with positive psychotic symptoms, possibly induced by a period of severe psychosocial stress.
Conclusion: We here discuss whether a primary schizophrenic episode possibly induced by cannabis can increase the risk of subsequent non-drug-related schizophrenic episodes.
Adolescent schizophrenia, in comparison to the adult-onset forms, is associated with an increased family history of schizophrenia; male predominance; more premorbid anomalies in speech, psychomotor, and social development; intelligence below average; insidious onset; fewer systematic delusions and hallucinations; and more negative symptoms such as flattened affects and bizarre behavior. It can present with enuresis and incontinence during psychosis. The distinction between adolescent schizophrenia and other diagnoses, such as affective psychosis, may be difficult. Adolescents with schizophrenia usually make a full recovery after the first psychotic episode, but after 6 months of psychosis, the prognosis for full recovery is poor. The first relapse often arises within 2 years of the end of the first episode. Several potential predictors of relapse have been discussed, including rearing problems in the family, ethnicity, migrant status, urban upbringing, treatment discontinuation, social adjustment, and poor adaptation to school.
An acute and usually transient psychosis, including a confusional condition with delusions or hallucinations, has been associated with prolonged cannabis intoxication. Cannabis-related psychoses may be difficult to distinguish from schizophrenic psychoses, but may be partly distinguishable by a shorter duration than schizophrenic episodes (typically from hours to a few weeks) and, typically, an onset after intense cannabis smoking. Patients generally remain non-psychotic in the absence of drug relapse.
Here, we describe a severe clinical case of catatonic schizophrenia in a male adolescent with a history of substantial cannabis smoking, and with an atypically long period of remission between the first and second psychotic episodes. Our aim in presenting this case is to demonstrate the diagnostic challenge in cannabis-induced psychosis vis-à-vis schizophrenia, and to demonstrate the atypical course of a patient with a psychotic disorder but with a particularly long symptom-free period between his first and second psychotic episodes. We also highlight the discussion about whether cannabis might potentially increase the risk of subsequent non-cannabis-related psychotic episodes.
Abstract and Introduction
Abstract
Introduction: Adolescents with psychoses usually have full recovery from their first psychotic episode, but the first relapse often arises within 2 years of the first episode. Cannabis-related psychoses are difficult to distinguish from schizophrenic psychoses. Here, we describe a particularly severe clinical case, with a first psychotic episode occurring after heavy cannabis smoking, an atypically long symptom-free duration, and a subsequent non-substance-related episode.
Case presentation: A 17-year-old male adolescent of Middle-East origin presented with delusions and hallucinations after extensive cannabis smoking. His first psychotic episode, with paranoid delusions and hallucinations, progressed into severe catatonic symptoms. His symptoms were treated with electroconvulsive therapy and risperidone and he was transferred to a residential substance abuse treatment center. He remained drug-free and non-psychotic for 3.5 years. Given the temporal association with extensive cannabis use, and his full remission of symptoms lasting several years, a cannabis-induced psychosis—though atypically extended—could be suspected. However, after 3.5 years without psychiatric care, and in a drug-free state, our patient again presented with positive psychotic symptoms, possibly induced by a period of severe psychosocial stress.
Conclusion: We here discuss whether a primary schizophrenic episode possibly induced by cannabis can increase the risk of subsequent non-drug-related schizophrenic episodes.
Introduction
Adolescent schizophrenia, in comparison to the adult-onset forms, is associated with an increased family history of schizophrenia; male predominance; more premorbid anomalies in speech, psychomotor, and social development; intelligence below average; insidious onset; fewer systematic delusions and hallucinations; and more negative symptoms such as flattened affects and bizarre behavior. It can present with enuresis and incontinence during psychosis. The distinction between adolescent schizophrenia and other diagnoses, such as affective psychosis, may be difficult. Adolescents with schizophrenia usually make a full recovery after the first psychotic episode, but after 6 months of psychosis, the prognosis for full recovery is poor. The first relapse often arises within 2 years of the end of the first episode. Several potential predictors of relapse have been discussed, including rearing problems in the family, ethnicity, migrant status, urban upbringing, treatment discontinuation, social adjustment, and poor adaptation to school.
An acute and usually transient psychosis, including a confusional condition with delusions or hallucinations, has been associated with prolonged cannabis intoxication. Cannabis-related psychoses may be difficult to distinguish from schizophrenic psychoses, but may be partly distinguishable by a shorter duration than schizophrenic episodes (typically from hours to a few weeks) and, typically, an onset after intense cannabis smoking. Patients generally remain non-psychotic in the absence of drug relapse.
Here, we describe a severe clinical case of catatonic schizophrenia in a male adolescent with a history of substantial cannabis smoking, and with an atypically long period of remission between the first and second psychotic episodes. Our aim in presenting this case is to demonstrate the diagnostic challenge in cannabis-induced psychosis vis-à-vis schizophrenia, and to demonstrate the atypical course of a patient with a psychotic disorder but with a particularly long symptom-free period between his first and second psychotic episodes. We also highlight the discussion about whether cannabis might potentially increase the risk of subsequent non-cannabis-related psychotic episodes.
