However, the question remains as to why, in a general population of cannabis abusers, do only a small population exposed develop a psychiatric illness. Cannabis may play a role in the complex interactions involving dopamine, gamma aminobutyric acid (GABA), and glutamate transmission or other factors that cause psychotic disorders. 1, 18 Researchers now believe that cannabis consumption during critical phases of brain development can lead to a strong disturbance of the endocannabinoid system and ultimately cause an inappropriate hardwiring of the brain. 1, 5 It is now recognized that the endocannabinoid system represents a new signaling process in the nervous system that regulates neurotransmitter systems, energy metabolism, and immune function. Recent advances in cannabinoid receptors and endogenous ligands have renewed interest in the mechanisms by which cannabis can cause major psychiatric disorders. Another study reported that using cannabis at baseline can significantly increase the risk for manic symptoms during follow up. 16 Cannabis abuse prior to development of bipolar disorder has a significant effect on first-episode mania and on the course of the disease. 1, 15, 16 The Epidemiologic Catchment Area (ECA) study found that 41 percent of patients with bipolar disorder had a comorbid substance use with cannabis being the most frequently abused. Epidemiological studies have shown that bipolar disorder has the highest rate of substance abuse comorbidity of any axis I disorder. The role of cannabis in causing bipolar disorder is not well documented. 12, 13 Symptoms experienced during drug-free periods are rarely reported. 10, 11 Only two case studies have reported prolonged depersonalization after cessation of cannabis use. The second hypothesis is that cannabis use may precipitate psychosis in individuals who are predisposed to acquiring a psychotic disorder. 10 The first hypothesis is that cannabis use causes psychotic symptoms in an otherwise healthy individual that would not have occurred with abstinence. 9 Based on research reviews, looking at the connection between cannabis and psychosis, two hypotheses have been developed. 8 What research has failed to show is if cannabis use is a consequence or cause of psychiatric disorders. 7 In one survey, it was reported that 15 percent of cannabis users identified psychotic-like symptoms, the most common being hearing voices or having unwarranted feelings of persecution. 3– 6 Cannabis use also causes symptoms of depersonalization, fear of dying, irrational panic, and paranoid ideas, which coincide with acute intoxication and remitted quickly. 2Ĭannabis intoxication can lead to acute psychosis in many individuals and can produce short-term exacerbations of pre-existing psychotic diseases. Interestingly enough, the plasma levels of ∆9-THC poorly correlate with urine levels, making the urine toxicology screen a wholly unspecific test. 2 The tissue elimination half-life of ∆9-THC is about seven days, and absolute elimination of a single dose may take up to 30 days. It is then slowly released back into the body, including the brain, reaching high concentrations in the neocortical, limbic, sensory, and motor areas. ∆9-THC is extremely lipid soluble and can accumulate in fatty tissues reaching peak concentrations in 4 to 5 days. 1 Looking at the pharmacokinetics of the psychoactive agent ∆9-tetrahydrocannabinol (∆9-THC), its effects are perceptible within minutes. 1 Studies have also shown that cannabis is the most commonly abused drug among those diagnosed with bipolar disorder. Epidemiological studies have shown that as the frequency of cannabis abuse increases, so does the risk for a psychotic disorder such as schizophrenia. The role of cannabis in psychiatric illnesses has been an area of interest.
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