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Cannabis-Associated Psychosis

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Abstract

Cannabis has been used for recreational, medicinal and religious purposes in different cultures since ancient times. There have been various reports of adverse effects due to or associated with cannabis consumption, including psychotic episodes. Historically, our understanding of these clinical observations has been significantly hindered by a lack of knowledge regarding their underlying neurobiological and pharmacological processes. However, the discovery of the endogenous cannabinoid system has allowed a greater understanding of these adverse effects to develop.

From a clinical perspective, toxic or transient psychotic reactions to the administration of herbal cannabis preparations or specific cannabinoid compounds have to be differentiated from longer-lasting, persistent schizophrenia-like disorders associated with the use of cannabis/cannabinoids. The latter are most likely to be associated with a predisposition or vulnerability to schizophrenia. Interestingly, the recently suggested role of the endogenous cannabinoid system in schizophrenia not related to previous cannabinoid consumption introduces an additional perspective on the mechanism underlying cannabis-associated schizophrenia-like disorders, as well as on the effects of cannabis consumption in schizophrenia.

At present, acute psychopharmacological treatment options for cannabis-associated transient and persistent schizophrenia-like psychotic episodes are similar and are based on the use of benzodiazepines and antipsychotics. However, new pharmacological strategies using the endogenous cannabinoid system as a primary target are under development. Long-term psychotherapeutic treatment options involve case management strategies and are mainly based on specialised psychotherapeutic programmes to encourage cannabis users to stop their use of the drug.

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References

  1. Voth EA. Cannabis is not equivalent to cannabinoids [letter]. Anesth Analg 2000; 91(2): 496

    PubMed  CAS  Google Scholar 

  2. Russo EB, McPartland JM. Cannabis is more than simply delta(9)-tetrahydrocannabinol. Psychopharmacology 2003; 165(4): 431–2

    PubMed  CAS  Google Scholar 

  3. Leweke FM, Schneider U, Thies M, et al. Effects of synthetic Δ[9]-tetrahydrocannabinol on binocular depth inversion of natural and artificial objects in man. Psychopharmacology 1999; 142(3): 230–5

    Article  PubMed  CAS  Google Scholar 

  4. Meyer ME. Psychiatric consequences of marijuana use: the state of the evidence. In: Tinklenberg JR, Tinklenberg JRS, editors. Marijuana and health hazards: methodologic issues in current research. New York: Academic Press, 1975: 133–52

    Google Scholar 

  5. Warnock J. Insanity from hasheesh. J Ment Sci 1903; 49: 96–110

    Google Scholar 

  6. Ames F. A clinical and metabolic study of acute intoxication with cannabis sative and its role in the model psychoses. J Ment Sci 1958; 104: 972–99

    PubMed  CAS  Google Scholar 

  7. Talbott JA, Teague JW. Marijuana psychosis: acute toxic psychosis associated with the use of cannabis derivatives. JAMA 1969; 210: 299–302

    Article  PubMed  CAS  Google Scholar 

  8. Thacore VR. Bhang psychosis. Br J Psychiatry 1973; 123: 225–9

    Article  PubMed  CAS  Google Scholar 

  9. Ghodse AH. Cannabis psychosis. Br J Addict 1986; 81(4): 473–8

    Article  PubMed  CAS  Google Scholar 

  10. Mathers DC, Ghodse AH, Caan AW. Cannabis use amongst a large sample of acute psychiatric admissions. Br J Addict 1991; 86: 779–84

    Article  PubMed  CAS  Google Scholar 

  11. Thornicroft G. Cannabis and psychosis: is there epidemiological evidence for an association? Br J Psychiatry 1990; 157: 25–33

    Article  PubMed  CAS  Google Scholar 

  12. Weller MP, Ang PC, Latimer-Sayer DT, et al. Drug abuse and mental illness [letter]. Lancet 1988; I(8592): 997

    Article  Google Scholar 

  13. Solomons K, Neppe VM, Kuyl JM. Toxic cannabis psychosis is a valid entity. S Afr Med J 1990; 78(8): 476–81

    PubMed  CAS  Google Scholar 

  14. Chaudry HR, Moss HB, Bashir A, et al. Cannabis psychosis following bhang ingestion. Br J Addict 1991; 86(9): 1075–81

    Article  PubMed  CAS  Google Scholar 

  15. Wylie AS, Scott RT, Burnett SJ. Psychosis due to “skunk’ [letter]. BMJ 1995; 311(6997): 125

    Article  PubMed  CAS  Google Scholar 

  16. Eva J. Cannabis psychosis. Psychiatric Bull 1992; 16: 310–1

    Article  Google Scholar 

  17. Cohen SI. Cannabis consumption and schizophrenia. Br J Psychiatry 1994; 165: 410–1

    Article  PubMed  CAS  Google Scholar 

  18. Peralta V, Cuesta MJ. Influence of cannabis abuse on schizophrenic psychopathology. Acta Psychiatr Scand 1992; 85: 127–30

    Article  PubMed  CAS  Google Scholar 

  19. Cleghorn JM, Kaplan RD, Szechtman B, et al. Substance abuse and schizophrenia: effect on symptoms but not on neurocognitive function. J Clin Psychiatry 1991; 52(1): 26–30

    PubMed  CAS  Google Scholar 

  20. Arndt S, Tyrrell G, Flaum M, et al. Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychol Med 1992; 22(2): 379–88

    Article  PubMed  CAS  Google Scholar 

  21. Warner R, Taylor D, Wright J, et al. Substance use among the mentally ill: prevalence, reasons for use, and effects on illness. Am J Orthopsychiatry 1994; 64(1): 30–9

    Article  PubMed  CAS  Google Scholar 

  22. Test MA, Wallisch LS, Allness DJ, et al. Substance use in young adults with schizophrenic disorders. Schizophr Bull 1989; 15(3): 465–76

    Article  PubMed  CAS  Google Scholar 

  23. Drake RE, Wallach MA. Substance abuse among the chronic mentally ill. Hosp Community Psychiatry 1989; 40(10): 1041–6

    PubMed  CAS  Google Scholar 

  24. Fowler IL, Carr VJ, Carter NT, et al. Patterns of current and lifetime substance use in schizophrenia. Schizophr Bull 1998; 24(3): 443–55

    Article  PubMed  CAS  Google Scholar 

  25. Andréasson S, Allebeck P, Rydberg U. Schizophrenia in users and nonusers of cannabis: a longitudinal study in Stockholm County. Acta Psychiatr Scand 1989; 79: 505–10

    Article  PubMed  Google Scholar 

  26. Treffert DA. Marijuana use in schizophrenia: a clear hazard. Am J Psychiatry 1978; 135: 1213–5

    PubMed  CAS  Google Scholar 

  27. Linszen DH, Dingemans PM, Lenior ME. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry 1994; 51: 273–9

    Article  PubMed  CAS  Google Scholar 

  28. Dixon L, Haas G, Weiden PJ, et al. Drug abuse in schizophrenic patients: clinical correlates and reasons for use. Am J Psychiatry 1991; 148: 224–30

    PubMed  CAS  Google Scholar 

  29. Martinez-Arevalo MJ, Calcedo-Ordoñez A, Varo-Prieto JR. Cannabis consumption as a prognostic factor in schizophrenia. Br J Psychiatry 1994; 164: 679–81

    Article  PubMed  CAS  Google Scholar 

  30. Bland RC, Newman SC, Orn H. Schizophrenia: lifetime comorbity in a community sample. Acta Psychiatr Scand 1987; 75(4): 383–91

    Article  PubMed  CAS  Google Scholar 

  31. Thacore VR, Shukla SR. Cannabis psychosis and paranoid schizophrenia. Arch Gen Psychiatry 1976; 33: 383–6

    Article  PubMed  CAS  Google Scholar 

  32. Mathers DC, Ghodse AH. Cannabis and psychotic illness. Br J Psychiatry 1992; 161: 648–53

    Article  PubMed  CAS  Google Scholar 

  33. Rottanburg D, Robins AH, Ben-Arie O, et al. Cannabis-associated psychosis with hypomanic features. Lancet 1982; II: 1364–6

    Article  Google Scholar 

  34. Chopra GS, Smith JW. Psychotic reactions following cannabis use in East Indians. Arch Gen Psychiatry 1974; 30: 24–7

    Article  PubMed  CAS  Google Scholar 

  35. Imade AG, Ebie JC. A retrospective study of symptom patterns of cannabis-induced psychosis. Acta Psychiatr Scand 1991; 83: 134–6

    Article  PubMed  CAS  Google Scholar 

  36. Thornicroft G, Meadows G, Politi P. Is “cannabis psychosis” a distinct category? Eur Psychiatry 1992; 7: 277–82

    Google Scholar 

  37. McGuire PK, Jones P, Harvey I, et al. Cannabis and acute psychosis. Schizophr Res 1994; 13(2): 161–7

    Article  PubMed  CAS  Google Scholar 

  38. McGuire PK, Jones P, Harvey I, et al. Morbid risk of schizophrenia for relatives of patients with cannabis-associated psychosis. Schizophr Res 1995; 15(3): 277–81

    Article  PubMed  CAS  Google Scholar 

  39. Rolfe M, Tang CM, Sabally S, et al. Psychosis and cannabis abuse in The Gambia: a case-control study. Br J Psychiatry 1993; 163: 798–801

    Article  PubMed  CAS  Google Scholar 

  40. Spencer DJ. Cannabis induced psychosis. Br J Addict 1970; 65: 369–72

    Article  Google Scholar 

  41. Bernhardson G, Gunne LM. Forty-six cases of psychosis in cannabis abusers. Int J Addict 1972; 7(1): 9–16

    PubMed  CAS  Google Scholar 

  42. Tennant FS, Groesbeck CJ. Psychiatric effects of hashish. Arch Gen Psychiatry 1972; 27(1): 133–6

    Article  PubMed  Google Scholar 

  43. Harding T, Knight F. Marijuana modified mania. Arch Gen Psychiatry 1973, 7

  44. Palsson A, Thulin SO, Tunving K. Cannabis psychoses in south Sweden. Acta Psychiatr Scand 1982; 66: 311–21

    Article  PubMed  CAS  Google Scholar 

  45. Carney MW, Bacelle L, Robinson B. Psychosis after cannabis abuse [letter]. Br Med J (Clin Res Ed) 1984; 288: 1047

    Article  CAS  Google Scholar 

  46. Drummond L. Cannabis psychosis: a case report. Br J Addict 1986; 81(1): 139–40

    Article  PubMed  CAS  Google Scholar 

  47. Onyango RS. Cannabis psychosis in young psychiatric inpatients. Br J Addict 1986; 81: 419–23

    Article  PubMed  CAS  Google Scholar 

  48. Tunving K. Psychiatric aspects of cannabis use in adolescents and young adults. Pediatrician 1987; 14(1–2): 83–91

    PubMed  CAS  Google Scholar 

  49. Thomas H. Psychiatric symptoms in cannabis users. Br J Psychiatry 1993; 163: 141–9

    Article  PubMed  CAS  Google Scholar 

  50. Moreau de Tours J-J. Du hachisch et de l’aliénation mentale: études psychologiques. Paris: Fortin et Masson, 1845

    Google Scholar 

  51. Andréasson S, Allebeck P, Engstrom A, et al. Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet 1987; II: 1483–6

    Article  Google Scholar 

  52. Cohen SI, Johnson K. Psychosis from alcohol or drug abuse. BMJ 1988; 297(6658): 1270–1

    Article  PubMed  CAS  Google Scholar 

  53. Hall W. Cannabis use and psychosis. Drug Alcohol Rev 1998; 17: 433–44

    Article  PubMed  CAS  Google Scholar 

  54. Nuechterlein KH, Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 1984; 10(2): 300–12

    Article  PubMed  CAS  Google Scholar 

  55. Cuffel BJ. Prevalence estimates of substance abuse in schizophrenia and their correlates. J Nerv Ment Dis 1992; 180(9): 589–92

    Article  PubMed  CAS  Google Scholar 

  56. Smith J, Hucker S. Schizophrenia and substance abuse. Br J Psychiatry 1994; 165(1): 13–21

    Article  PubMed  CAS  Google Scholar 

  57. Leweke FM, Giuffrida A, Wurster U, et al. Elevated endogenous cannabinoids in schizophrenia. Neuroreport 1999; 10(8): 1665–9

    Article  PubMed  CAS  Google Scholar 

  58. Caspari D. Cannabis and schizophrenia: results of a follow-up study. Eur Arch Psychiatry Clin Neurosci 1999; 249(1): 45–9

    Article  PubMed  CAS  Google Scholar 

  59. D’Souza DC, Abi-Saab W, Madonick S, et al. Cannabinoids & psychosis: evidence from studies with i.v. THC in schizophrenic patients and controls [abstract]. Schizophr Res 2000; 41(1): 33

    Google Scholar 

  60. Tien AY, Anthony JC. Epidemiological analysis of alcohol and drug use as risk factors for psychotic experiences. J Nerv Ment Dis 1990; 178(8): 473–80

    PubMed  CAS  Google Scholar 

  61. Thomas H. A community survey of adverse effects of cannabis use. Drug Alcohol Depend 1996; 42(3): 201–7

    Article  PubMed  CAS  Google Scholar 

  62. Hall W, Teesson M, Lynskey M, et al. The prevalence in the past year of substance use and ICD-10 substance use disorders in Australian adults: findings from the National Survey of Mental Health and Well-Being. Sydney: National Drug and Alcohol Research Centre, 1998

    Google Scholar 

  63. Degenhardt L, Hall W. The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being. Psychol Med 2001; 31(4): 659–68

    Article  PubMed  CAS  Google Scholar 

  64. Hambrecht M, Häfner H. Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Aust N Z J Psychiatry 2000; 34(3): 468–75

    Article  PubMed  CAS  Google Scholar 

  65. Nunez LA, Gurpegui M. Cannabis-induced psychosis: a cross-sectional comparison with acute schizophrenia. Acta Psychiatr Scand 2002; 105(3): 173–8

    Article  PubMed  CAS  Google Scholar 

  66. Bovasso GB. Cannabis abuse as a risk factor for depressive symptoms. Am J Psychiatry 2001; 158(12): 2033–7

    Article  PubMed  CAS  Google Scholar 

  67. Negrete JC. Cannabis and schizophrenia. Br J Addict 1989; 84: 349–51

    Article  PubMed  CAS  Google Scholar 

  68. Hall W, Solowij N. Adverse effects of cannabis. Lancet 1998; 352(9140): 1611–6

    Article  PubMed  CAS  Google Scholar 

  69. Zammit S, Allebeck P, Andreasson S, et al. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 2002; 325(7374): 1199

    Article  PubMed  Google Scholar 

  70. Arseneault L, Cannon M, Poulton R, et al. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. BMJ 2002; 325(7374): 1212–3

    Article  PubMed  Google Scholar 

  71. van Os J, Bak M, Hanssen M, et al. Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol 2002; 156(4): 319–27

    Article  PubMed  Google Scholar 

  72. Verdoux H, Sorbara F, Gindre C, et al. Cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Schizophr Res 2003; 59(1): 77–84

    Article  PubMed  Google Scholar 

  73. Devane WA, Dysarz FA, Johnson MR, et al. Determination and characterization of a cannabinoid receptor in rat brain. Mol Pharmacol 1988; 34: 605–13

    PubMed  CAS  Google Scholar 

  74. Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992; 258: 1946–9

    Article  PubMed  CAS  Google Scholar 

  75. Stella N, Schweitzer P, Piomelli D. A second endogenous cannabinoid that modulates long-term potentiation. Nature 1997; 388: 773–8

    Article  PubMed  CAS  Google Scholar 

  76. Snyder SH. The dopamine hypothesis of schizophrenia: focus on the dopamine receptor. Am J Psychiatry 1976; 133(2): 197–202

    PubMed  CAS  Google Scholar 

  77. Kim JS, Kornhuber HH, Schmid-Burgk W, et al. Low cerebrospinal fluid glutamate in schizophrenic patients and a new hypothesis on schizophrenia. Neurosci Lett 1980; 20(3): 379–82

    Article  PubMed  CAS  Google Scholar 

  78. Garbutt JC, van Kammen DP. The interaction between GABA and dopamine: implications for schizophrenia. Schizophr Bull 1983; 9(3): 336–53

    Article  PubMed  CAS  Google Scholar 

  79. Meltzer HY. Clinical studies on the mechanism of action of clozapine: the dopamine-serotonin hypothesis of schizophrenia. Psychopharmacology (Berl) 1989; 99Suppl. 1: S18–27

    Article  Google Scholar 

  80. Deckert J, Gleiter CH. Adenosinergic psychopharmaceuticals? Trends Pharmacol Sci 1989; 10(3): 99–100

    Article  PubMed  CAS  Google Scholar 

  81. Olney JW, Labruyere J, Price MT. Pathological changes induced in cerebrocortical neurons by phencyclidine and related drugs. Science 1989; 244(4910): 1360–2

    Article  PubMed  CAS  Google Scholar 

  82. Olney JW. Excitatory amino acids and neuropsychiatric disorders. Biol Psychiatry 1989; 26(5): 505–25

    Article  PubMed  CAS  Google Scholar 

  83. Wiegant VM, Ronken E, Kovacs G, et al. Endorphins and schizophrenia. Prog Brain Res 1992; 93: 433–53

    Article  PubMed  CAS  Google Scholar 

  84. Nemeroff CB, Bissette G. Neuropeptides, dopamine, and schizophrenia. Ann N Y Acad Sci 1988; 537: 273–91

    Article  PubMed  CAS  Google Scholar 

  85. Bissette G, Nemeroff CB. Neurotensin and the mesocorticolimbic dopamine system. Ann N Y Acad Sci 1988; 537: 397–404

    Article  PubMed  CAS  Google Scholar 

  86. Nair NP, Lal S, Bloom DM. Cholecystokinin and schizophrenia. Prog Brain Res 1986; 65: 237–58

    Article  PubMed  CAS  Google Scholar 

  87. Largent BL, Wikstrom H, Snowman AM, et al. Novel antipsychotic drugs share high affinity for sigma receptors. Eur J Pharmacol 1988; 155(3): 345–7

    Article  PubMed  CAS  Google Scholar 

  88. Walker JM, Bowen WD, Walker FO, et al. Sigma receptors: biology and function. Pharmacol Rev 1990; 42(4): 355–402

    PubMed  CAS  Google Scholar 

  89. Hudson CJ, Young LT, Li PP, et al. CNS signal transduction in the pathophysiology and pharmacotherapy of affective disorders and schizophrenia. Synapse 1993; 13(3): 278–93

    Article  PubMed  CAS  Google Scholar 

  90. Greengard P. The neurobiology of slow synaptic transmission. Science 2001; 294(5544): 1024–30

    Article  PubMed  CAS  Google Scholar 

  91. Greengard P. The neurobiology of dopamine signaling. Biosci Rep 2001; 21(3): 247–69

    Article  PubMed  CAS  Google Scholar 

  92. Emrich HM, Leweke FM, Schneider U. Towards a cannabinoid hypothesis of schizophrenia: cognitive impairments due to a dysregulation of the endogenous cannabinoid system. Pharmacol Biochem Behav 1997; 56: 803–7

    Article  PubMed  CAS  Google Scholar 

  93. Carlsson A, Waters N, Carlsson ML. Neurotransmitter interactions in schizophrenia-therapeutic implications. Eur Arch Psychiatry Clin Neurosci 1999; 249 Suppl. 4: 37–43

    Article  Google Scholar 

  94. Gaoni Y, Mechoulam R. Isolation, structure and partial synthesis of an active constituent of hashish. J Am Chem Soc 1964; 86: 1646–7

    Article  CAS  Google Scholar 

  95. Munro S, Thomas KL, Abu Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993; 365: 61–5

    Article  PubMed  CAS  Google Scholar 

  96. Giuffrida A, Desarnaud F, Piomelli D. Endogenous cannabinoid signaling and psychomotor disorders. Prostaglandins Other Lipid Mediat 2000; 61(1–2): 63–70

    Article  PubMed  CAS  Google Scholar 

  97. Ashton C. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry 2001; 178: 101–6

    Article  PubMed  CAS  Google Scholar 

  98. Elphick MR, Egertova M. The neurobiology and evolution of cannabinoid signalling. Philos Trans R Soc Lond B Biol Sci 2001; 356(1407): 381–408

    Article  PubMed  CAS  Google Scholar 

  99. Wilson RI, Nicoll RA. Endocannabinoid signaling in the brain. Science 2002; 296(5568): 678–82

    Article  PubMed  CAS  Google Scholar 

  100. Schlicker E, Kathmann M. Modulation of transmitter release via presynaptic cannabinoid receptors. Trends Pharmacol Sci 2001; 22(11): 565–72

    Article  PubMed  CAS  Google Scholar 

  101. Fernandez-Ruiz JJ, Muñoz RM, Romero J, et al. Time course of the effects of different cannabimimetics on prolactin and gonadotrophin secretion: evidence for the presence of CB1 receptors in hypothalamic structures and their involvement in the effects of cannabimimetics. Biochem Pharmacol 1997; 53(12): 1919–27

    Article  PubMed  CAS  Google Scholar 

  102. Manzanares J, Corchero J, Romero J, et al. Pharmacological and biochemical interactions between opioids and cannabinoids. Trends Pharmacol Sci 1999; 20(7): 287–94

    Article  PubMed  CAS  Google Scholar 

  103. Di Marzo V, Melck D, Bisogno T, et al. Endocannabinoids: endogenous cannabinoid receptor ligands with neuromodulatory action. Trends Neurosci 1998; 21(12): 521–8

    Article  PubMed  Google Scholar 

  104. Howlett AC. Pharmacology of cannabinoid receptors. Annu Rev Pharmacol Toxicol 1995; 35: 607–34

    Article  PubMed  CAS  Google Scholar 

  105. Herkenham M, Lynn AB, Little MD, et al. Cannabinoid receptor localization in brain. Proc Natl Acad Sci U S A 1990; 87: 1932–6

    Article  PubMed  CAS  Google Scholar 

  106. Herkenham M, Lynn AB, Johnson MR, et al. Characterization and localization of cannabinoid receptors in rat brain: a quantitative in vitro autoradiographic study. J Neurosci 1991; 11: 563–83

    PubMed  CAS  Google Scholar 

  107. Matsuda LA, Bonner TI, Lolait SJ. Localization of cannabinoid receptor mRNA in rat brain. J Comp Neurol 1993; 327: 535–50

    Article  PubMed  CAS  Google Scholar 

  108. Glass M, Faull RLM, Dragunow M. Cannabinoid receptors in the human brain: a detailed anatomical and quantitative autoradiographic study on the fetal, neonatal and adult human brain. Neuroscience 1997; 77(2): 299–318

    Article  PubMed  CAS  Google Scholar 

  109. Piomelli D, Giuffrida A, Calignano A, et al. The endocannabinoid system as a target for therapeutic drugs. Trends Pharmacol Sci 2000; 21(6): 218–24

    Article  PubMed  CAS  Google Scholar 

  110. Giuffrida A, Parsons LH, Kerr TM, et al. Dopamine activation of endogenous cannabinoid signaling in dorsal striatum. Nat Neurosci 1999; 2(4): 358–63

    Article  PubMed  CAS  Google Scholar 

  111. Boger DL, Henrikson SJ, Cravatt BF. Oleamide: an endogenous sleep-inducing lipid and prototypical member of a new class of biological signaling molecules. Curr Pharm Des 1998, 14

  112. Lambert DM, Di Marzo V. The palmitoylethanolamide and oleamide enigmas: are these two fatty acid amides cannabimimetic? Curr Med Chem 1999; 6(8): 757–73

    PubMed  CAS  Google Scholar 

  113. Fernandez-Ruiz J, Berrendero S, Hernandez ML, et al. The endogenous cannabinoid system and brain development. Trends Neurosci 2000; 23(1): 14–20

    Article  PubMed  CAS  Google Scholar 

  114. Marsicano G, Wotjak CT, Azad SC, et al. The endogenous cannabinoid system controls extinction of aversive memories. Nature 2002; 418(6897): 530–4

    Article  PubMed  CAS  Google Scholar 

  115. Walter L, Stella N. Cannabinoids and neuroinflammation. Br J Pharmacol 2004; 141(5): 775–85

    Article  PubMed  CAS  Google Scholar 

  116. Turner CE, Hadley KW, Holley JH, et al. Constituents of Cannabis sativa L. VIII: possible biological application of a new method to separate cannabidiol and cannabichromene. J Pharmacol Sci 1975; 64(5): 810–4

    CAS  Google Scholar 

  117. Petitet F, Jeantaud B, Reibaud M, et al. Complex pharmacology of natural cannabinoids: evidence for partial agonist activity of delta-9-tetrahydrocannabinol and antagonist activity of cannabidiol on rat brain cannabinoid receptors. Life Sci 1998; 63: PL1–6

    Article  PubMed  CAS  Google Scholar 

  118. Allebeck P. Cannabis and schizophrenia: is there a causal association? In: Nahas G, Latour C, et al., editors. Physiopathology of illicit drugs: cannabis, cocaine, opiates. Oxford: Pergamon Press, 1991: 23–31

  119. Giuffrida A, Leweke FM, Gerth CN, et al. Cerebrospinal anandamide levels are elevated in acute schizophrenia and are inversely corerlated with psychotic symptoms. Neuropsychopharmacology. Epub 2004 Sep 8

  120. Dean B, Sundram S, Bradbury R, et al. Studies on [3H]CP-55940 binding in the human central nervous system: regional specific changes in density of cannabinoid-1 receptors associated with schizophrenia and cannabis use. Neuroscience 2001; 103(1): 9–15

    Article  PubMed  CAS  Google Scholar 

  121. Ujike H, Takaki M, Nakata K, et al. CNR1, central cannabinoid receptor gene, associated with susceptibility to hebephrenic schizophrenia. Mol Psychiatry 2002; 7(5): 515–8

    Article  PubMed  CAS  Google Scholar 

  122. Poncelet M, Barnouin M-C, Breliere J-C, et al. Blockade of cannabinoid (CB1) receptors by SR 141716 selectively antagonizes drug-induced reinstatement of exploratory behaviour in gerbils. Psychopharmacology 1999; 144(2): 144–50

    Article  PubMed  CAS  Google Scholar 

  123. Huestis MA, Gorelick DA, Heishman SJ, et al. Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716. Arch Gen Psychiatry 2001; 58: 322–8

    Article  PubMed  CAS  Google Scholar 

  124. Le Fur G. Effects of antagonists of endocannabinoid receptors on the reward system. World Congress on Biological Psychiatry; 2001 Jul 1–6; Berlin

  125. Meltzer HY, Arvantis L, Bauer O, Rein W, editor. Placebo-controlled evaluation of four novel compounds for the treatment of schizophrenia and schizoaffective disorder. Am J Psychiatry 2004; 161(6): 975–84

    Google Scholar 

  126. Voruganti LN, Slomka P, Zabel P, et al. Cannabis induced dopamine release: an in-vivo SPECT study. Psychiatry Res 2001; 107(3): 173–7

    Article  PubMed  CAS  Google Scholar 

  127. Carpenter WT, Buchanan RW, Kirkpatrick B, et al. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiatry 1999; 156(2): 299–303

    PubMed  Google Scholar 

  128. Diana M, Melis M, Muntoni AL, et al. Mesolimbic dopaminergic decline after cannabinoid withdrawal. Proc Natl Acad Sci U S A 1998; 95(17): 10269–73

    Article  PubMed  CAS  Google Scholar 

  129. Weil AT. Adverse reactions to marijuana, classification and suggested treatment. N Engl J Med 1970; 282: 997–1000

    Article  PubMed  CAS  Google Scholar 

  130. Leucht S, Pitschel-Walz G, Abraham D, et al. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo: a meta-analysis of randomized controlled trials. Schizophr Res 1999; 35(1): 51–68

    Article  PubMed  CAS  Google Scholar 

  131. Bornheim LM. Effects of unsaturated side-chain analogs of tetrahydrocannabinol on cytochromes P450. Biochem Pharmacol 2000; 60(7): 955–61

    Article  PubMed  CAS  Google Scholar 

  132. Bornheim LM, Lasker JM, Raucy JL. Human hepatic microsomal metabolism of delta 1-tetrahydrocannabinol. Drug Metab Dispos 1992; 20: 241–6

    PubMed  CAS  Google Scholar 

  133. König F, von Hippel C, Petersdorff T, et al. First experiences in combination therapy using olanzapine with SSRIs (citalopram, paroxetine) in delusional depression. Neuropsychobiology 2001; 43(3): 170–4

    Article  PubMed  Google Scholar 

  134. Burns MJ. The pharmacology and toxicology of atypical antipsychotic agents. J Toxicol Clin Toxicol 2001; 39(1): 1–14

    Article  PubMed  CAS  Google Scholar 

  135. Chakos M, Lieberman J, Hoffman E, et al. Effectiveness of second-generation antipsychotics in patients with treatment-resistant schizophrenia: a review and meta-analysis of randomized trials. Am J Psychiatry 2001; 158(4): 518–26

    Article  PubMed  CAS  Google Scholar 

  136. Green AI, Burgess ES, Dawson R, et al. Alcohol and cannabis use in schizophrenia: effects of clozapine vs risperidone. Schizophr Res 2003; 60(1): 81–5

    Article  PubMed  Google Scholar 

  137. Neppe VM. Carbamazepine in non-responsive psychosis. J Clin Psychiatry 1988; 49: S22–S8

    Google Scholar 

  138. Scher M, Neppe VM. Carbamazepine adjunct for nonresponsive psychosis with prior hallucinogenic abuse. J Nerv Ment Dis 1989; 177: 755–7

    Article  PubMed  CAS  Google Scholar 

  139. Leweke FM, Emrich HM. Carbamazepine as an adjunct in the treatment of schizophrenia-like psychosis related to cannabis abuse. Int Clin Psychopharmacol 1999; 14(1): 37–9

    Article  PubMed  CAS  Google Scholar 

  140. McLellan AT, Hagan TA, Levine M, et al. Does clinical case management improve outpatient addiction treatment. Drug Alcohol Depend 1999; 55(1–2): 91–103

    Article  PubMed  CAS  Google Scholar 

  141. Miller NS, Gold MS, Pottash AC. A 12-step treatment approach for marijuana (cannabis) dependence. J Subst Abuse Treat 1989; 6(4): 241–50

    Article  PubMed  CAS  Google Scholar 

  142. Copeland J, Swift W, Rees V. Clinical profile of participants in a brief intervention program for cannabis use disorder. J Subst Abuse Treat 2001; 20(1): 45–52

    Article  PubMed  CAS  Google Scholar 

  143. Morakinyo O. Aversion therapy of cannabis dependence in Nigeria. Drug Alcohol Depend 1983; 12(3): 287–93

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We appreciate the helpful assistance of Miriam A. Neatby, MD in the preparation of this manuscript. We are grateful to Dr Antje Jülicher, PhD and Elizabeth Morgan, MA for critical reading of the manuscript. We gratefully acknowledge the support of the Stanley Medical Research Institute, Bethesda, MD, USA. The authors have no conflicts of interest directly relevant to the content of this review.

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Correspondence to F. Markus Leweke.

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Leweke, F.M., Gerth, C.W. & Klosterkötter, J. Cannabis-Associated Psychosis. CNS Drugs 18, 895–910 (2004). https://doi.org/10.2165/00023210-200418130-00005

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