Tag Archives: schizophrenia

Emerging research on the mental health risks associated with cannabis consumption

Rates of cannabis usage have more than doubled in the past decade. Medical marijuana is now legal in half of the United States and is increasing in accessibility to current and future users. Cannabis is now the most widely used illicit substance in the US, more popular than alcohol and cigarettes. Frequent use of cannabis is now twice as common among young people in the 16-24 year old age range. In spite of government and media warnings about health risks, many people believe cannabis to be a harmless substance that helps people to relax and, unlike, alcohol and cigarettes, might even be good for you. Although it is controversial, I believe cannabis should be avoided by the mental health patient and anyone who wants to prevent possible brain dysfunction that can significantly impact basic functioning.

Here are some facts to consider before reaching for cannabis:

What is the chemical makeup of cannabis?  

There are about 400 chemical compounds in an average cannabis plant. The four main ones are delta-9 tetrahydrocannabinol (delta-9-THC), cannabidiol (CBD), delta-8-tetrahydrocannabinol and cannabinol. All but the CBD are psychoactive (known to affect brain function).

What about stronger varieties?

In herbal cannabis, the concentration of the main psychoactive ingredient, THC, varies hugely — from 1% to 15%. The newer strains can have up to 20%. The newer varieties on the whole are 2-3 times stronger than those available 30 years ago.  Some users may even use these stronger varieties as substitutes for Ecstasy or LSD.

Immediate pleasant effects:

A “high” — a sense of relaxation, happiness, sleepiness. Colors appear more intense, music sounds better.

Unpleasant effects:

Even though THC can produce relaxation in many people, that isn’t the case with all people, particularly those who have a family history of mental illness.  In some people, it can have the opposite effect and may cause unpleasant experiences including confusion, hallucinations, anxiety, and paranoia, depending on mood and circumstances. Some people may experience psychotic symptoms with hallucinations and delusions lasting a few hours. Even though these unpleasant effects typically don’t last long, the drug can stay in the system for weeks and have longer lasting effects than users realize. In some genetically predisposed people, it may trigger the onset of Schizophrenia or Bipolar Disorder. This is a bigger risk for people who started using cannabis in childhood or adolescence and into the mid twenties, critical brain development stages.

Long term risks:

Over time, cannabis can have a depressant effect and reduce motivation and the abilities to concentrate, organize information, and use information. A recent review of the literature on cannabis’s effect on pilots showed that those who used cannabis made far more mistakes, both major and minor. The worst were in the first four hours after use, though mistakes persisted for at least 24 hours when the pilot had no sense of “feeling high.”  Recent research published in the Journal of Alzheimer’s Disease found that cannabis users have noticeable deficiencies of blood flow in the brain. Notably, the research showed diminished blood flow in the right hippocampus, the area of the brain that helps with memory formation and learning. This is the area severely affected in those that have Alzheimer’s Disease. Other smaller studies of perfusion imaging in marijuana users show lower amounts of frontal, temporal, and occipital lobe blood flow.

Is cannabis addictive?

Yes, it can be. Current evidence now suggests that it can be, particularly if used regularly. Cannabis has the same features of other addictive drugs, such as the development of:

Tolerance: Tolerance means having to take more and more to get the same effect. Heavy users can experience withdrawal symptoms such as anxiety, cravings, decreased appetite, sleep difficulty, weight loss, aggression, irritability, restlessness, and strange dreams. For regular long-term users, 3 out of 4 experience cravings, half become irritable, and 7 out of 10 switch to tobacco in an attempt to stay off cannabis.  The irritability, anxiety, and insomnia usually appear 10 hours after the last joint and peak around one week after last usage.

Compulsive use: Eventually, many regular users become more compulsive in their usage. The user feels they have to have it and spends much of their life seeking, buying, and using cannabis. They cannot stop even when other important parts of their life such as family, friends, school, and work suffer.

How to know if you have a dependency and/or addiction:

Cannabis can become a significant problem for some people. Marijuana-anonymous.org says people have realized they have an addiction when “cannabis controls our lives and our thinking, and … our desires center around marijuana — scoring it, dealing it, and finding ways to stay high so that we lose interest in all else.”

Cannabis is similar to alcohol addiction.  Here are some questions to ask oneself to see if cannabis is a problem. Yes to any of these questions indicates a problem:

  1. Has smoking pot stopped being fun?
  2. Do you ever get high alone?
  3. Is it hard to imagine a life without marijuana?
  4. Do you choose or lose friends based on your marijuana usage?
  5. Do you smoke marijuana to avoid dealing with your problems?
  6. Do you smoke pot to cope with your feelings?
  7. Does your marijuana use let you live in a privately defined world?
  8. Have you ever failed to keep promises you made about cutting back or controlling your pot smoking?
  9. Has marijuana caused problems with memory, concentration, or motivation?
  10. When your stash is nearly empty, do you feel anxious or worried about how to get more?
  11. Do you plan your life around your marijuana use?
  12. Have friends or relatives ever complained that your pot smoking is damaging your relationship with them?

Other reasons not to use cannabis (even if you are not addicted):

Besides the reasons mentioned above, street cannabis may be laced with other more dangerous drugs that could be deadly.  Additionally, there are drug-drug interactions that may make  it unsafe to use with other types of medications. As cannabis over time tends to have a depressant effect and may even increase anxiety, it can counteract any medication your provider prescribes for you. Your provider may ask or even require that you drastically cut down or discontinue your pot use (along with other drugs and alcohol).  Additionally, as it affects motivation, it interferes with the ability to eat healthy, exercise, do psychotherapy, and practice other healthy habits that contribute to mental health.

In conclusion, although cannabis may show short-term alleviation of anxiety symptoms, I believe in the long run it has more risks than benefits and do not recommend mental health patients use cannabis or medical marijuana.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

What causes psychosis?

There has been a lot in the news lately about people suffering from psychotic episodes. Recently, a man, whom many thought was under the influence of bath salts, took off his clothes and chewed off the face of a homeless man. Toxicology reports denied him being under the influence of bath salts but confirmed marijuana being in his system. Another news event broadcasted the sad episode of a Jet Blue pilot who started behaving in an erratic way,  talking in religion themes and Iraq and the end of the world. He had to be restrained by flight attendants and passengers on the airplane before the plane making an emergency landing.
What causes psychosis? Is this a biochemical or genetic condition? Are there environmental factors or health habits that contribute to it? What can be done to treat or prevent the condition from happening?

The definition of psychosis found in Wikepedia is: refers to an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.
The two major categories of mental illnesses we often associate with psychosis are the mood disorders such as Depression and Bipolar Disorder as its substypes as well as Schizophrenia. In Bipolar Disorder these psychotic episodes occur during the manic phases of the illness. There are other condtions that can cause psychosis. People under the influence of psychostimulants such as Ritalin or Cocaine or Methamphetamine may become psychotic, particularly if predisposed genetically to psychosis. Lately, in the news we have heard about people acting strangely under the influence of Bath Salts. And very recently, marijuana may have been a factor in the face eating incident.
In later years there is another cause that is being more and more recognized. Children who experience trauma may exhibit psychotic symptoms, particularly hearing voices. These children often don’t meet criteria for drug usage, mood disorders like Bipolar illness or Schizophrenia.
I personally have concerns about Marijuana. Many people would like to think that Marijuana is harmless. It is used for some chronic health issues like pain control and lack of appetite. Unfortunately, it is also being used inappropriately. I have had patients who come see me for an Anxiety problem who have complained to me that pot makes them anxious or even “crazy”. Pot will do this in people that are genetically predisposed toward psychosis. I once saw a promising young 18 year old man deterioriate and contract Schizophrenia, and Marijuana was believed to be the major culprit.

What is the treatment? It depends on the cause. If it is Bipolar Disorder, mood stabilizers and psychotherapy are the treatment of choice. Schizophrenia will probably require antipsychotic medication. If psychostimulants brought it on, they probably will need to be discontinued. For children with the history of trauma, medications may not be as effective as psychotherapy. Although many may find some benefit from both. Finally, the cause of the psychosis of the Jet Blue pilot was found to be the lack of sleep. I can’t emphasize enough the role of sleep in good mental health. I teach all my patients sleep hygiene who come to see me. A brain cannot heal or function optimally without a good nights sleep. What is the optimal amount? About 7-8 hours for most people.

Stimulants not always the answer for Attentive Deficit Hyperactivity Disorder

In my practice, I’m amazed about how many people come to me and have taken some test online and have self-diagnosed themselves with ADHD or ADD and want me to give them stimulants. It happens every week. I also don’t know how many times I’ve had to tell these same people that stimulants may not be the answer to their problems and can even make their mental health symptoms worse! Let me give you a case in point of when stimulants may have done more harm than good.

Larry, (not his real name) is a 53 year old male who reports that he has taken Adderall or the equivalent for 30 years. He reports it makes him organized. It makes him be able to focus and concentrate and complete tasks. I take careful note but also observe that this same guy is very rigid, angry and irritable during our visit. He has a history of attempted suicide and has been hospitalized several times. He also tries to hide the fact that he lived in a reclusive situation away from civilization for years and has been unable to work for authority figures. He also reports he is estranged from friends and family.

Yes, it is true that stimulants help many people with focus and concentration. It is also the fact that ADHD is not the only condition that makes a person disorganized, unfocused and unable to complete tasks. For instance the guy above ended up being diagnosed with Schizophrenia. Other conditions like Bipolar Disorder, Depression, anxiety disorders and Thyroid Disorders can look like ADHD. Giving the above patient stimulants can bring out his rigidness, his anger and irritability and even psychotic symptoms. If one has tendencies toward obsessive compulsive disorder it would be especially important to avoid taking stimulants. Stimulants can make the OCD worse. A better way to go might be to effectively treat the OCD symptoms and the patient may find that their ADHD like symptoms greatly improve.

Sadly, years of stimulant misuse for the above patient made him so rigid in his expectations that he was psychologically unable to consider other possibilities for his problems. This is why it is so important that when suffering from ADHD like symptoms that a specialist who works regularly with the various mental illnesses be called upon to do the initial evaluation. It can potentially prevent years of problems and help a person become quickly more functional to reach his goals. I wish this guy could have been spared all the pain he went through! Can you imagine the implications for posterity and other family members?

An aspirin a day keeps Schizophrenia away?

According to a recent article in the Journal of Clinical Psychiatry, aspirin therapy reduces symptoms of psychosis in Schizophrenia Spectrum Disorders. It is speculated that inflammation is causing havoc in the brain as well as the body now. This reminds me of a study published I believe in the early 2000’s that suggested Ibuprofen may prevent Alzheimer’s Disease, another prevalent brain disease. 

Does that mean that we should all start taking aspirin daily? I wouldn’t do this without consulting with your psychiatric mental health nurse practitioner or psychiatrist. For some people aspirin and other anti-inflammatories can actually irritate the digestive tract and may even cause inflammation, so if you are in the category you may not be a good candidate for aspirin. Like anything, it is important to weigh the benefits with possible consequences. No two people are alike… However, it is the middle of the day and I am feeling a little cognitively fuzzy (and I have Schizophrenia and Alzheimers in the family)…not much of a caffeine drinker—just an occasional diet coke—perhaps I should try an aspirin? Hmm….