Influence of Cannabis Abuse Variables on Psychotic Symptoms

ascertain of hangmans rope Abuse Variables on Psychotic SymptomsInfluence of variables of halter offense on psycho symptoms and their severity an Indian experienceAbstractContext Cannabis is probably the most cat valiumly used illicit medicine. While not all marihuana users pay mental health problems, heavy hangmans rope use may increase the encounter of cognitive abnormalities, psychotic disorder, and mood unhealthinesss. Cannabis-induced psychosis is not easily distinguishable from schizophrenic symptomatology, although it is characterized by more bizarre behaviour, violence, panic, more agitation, and less(prenominal) blunting of affect, and incoherent speech.Aims To evaluate severity of various psychotic symptoms in relation to variables of halter hatred.Settings and Design A cross sectional study of 30 male patients admitted at tertiary psychiatric centre, with diagnosis of halter induced psychosis was carried out.Methods and Material Cannabis villainy variables along with psychotic symptoms severity on BPRS scale was obtained.statistical analysis used SPSS-17 was used for analysis, and significance level was at p-value Results The symptoms that were associated with increase severity in legal be on of patients were disgust (83%), excitement (77%), and high-minded mood, grandiosity, suspiciousness and motor hyperactivity were preset in more than 60% of individuals in range of severe to real severe form.Conclusions Patients with long sequence and early on encroachment of hangmans halter abuse were takeed with more severe form of psychosis. Frequency of hangmans rope use was not portentously correlated with fit BPRS score, although get spent over hangmans rope was significantly associated with total BPRS score. Family history of cannabis abuse predicted early onset of cannabis abuse.IntroductionCannabis is probably most commonly used illicit drug. 1,2 It is entire used in India and is an integral part of Indian culture and rel igious customs.3,4 The correlation between cannabis and negative mental health outcomes has been unequivocally established 1,5,6,7,12. While not all cannabis users present mental health problems, 5 epidemiological studies suggest that heavy cannabis use during adolescence may increase the happen of cognitive abnormalities and psychotic disorders.1,8-10 Use of cannabis at early age and superior frequency be associated with a greater risk of problems 5,7,11. Arendt et al. consider that this cannabis-induced psychosis is an early expression of schizophrenia in vulnerable individuals alternatively than part of the differential diagnosis 12. Moores review reported a 40% higher(prenominal) risk of psychosis in subjects who occasionally used cannabis and a probability of 50% to 200% higher in regular cannabis users 13. Swedish Conscripts Study (Andreasson et al.) of inductees into the military reported a risk for schizophrenia 2.4 generation higher among those who had used cannabis by 18 years than among non-users 14,24. This cannabis-induced psychosis is not easily distinguishable from schizophrenic symptomatology, 15,19 although it has been characterized by more bizarre behavior, violence, panic, more hypomanic symptoms and agitation, and fewer hallucinations and less blunting of affect and incoherent speech.20,21Need of the circulating(prenominal) studyStudies vex found cannabis associated psychosis a constellation of affective symptoms (euphoria, increased psychomotor activity), 16,17,18 whereas others have found similarity with schizophrenic symptomology of social drug withdrawal, thought disorder and disorganized behavior 19,22 so in that respect is immense need to define the presenting features of this disorder in Indian population. Additionally phenomenology of the cannabis use disorder need to be explored to clearly define, identify and manage this population. Despite widespread use of cannabis there is lack of research data from most part of the w orld including India.Aims and objectivesBased on the existing literary productions we formulated following hypothesis that Patients with cannabis associated psychosis have different symptom compose than other common psychiatric disorders, relating to variables of cannabis abuse e.g. dose, frequency, continuance.To test the hypothesis following objectives were formulatedTo assess variables of cannabis abuse in patients with cannabis associated psychosis.To explore the relationship between variables of cannabis abuse, and individual symptom profile and total BPRS score.Subjects and MethodsPatients in whom there was temporal association of cannabis use with onset of psychotic illness were included in the study. The study included 30 consequentially admitted, Hindi speaking patients of 18-50 years of age at tertiary psychiatric centre in north India from March 2011 to July 2011. Patients with mental lag, a significant medical checkup condition compromising ability to participate, h istory of head injury with whatsoever documented cognitive sequele, and inability to provide informed consent were excluded from study. Patients having history of psychiatric illness prior to onset of cannabis abuse, predominant abuse/dependence of other psychoactive substance and having any other significant medical illness were also excluded from study.Study designA cross sectional study of subjects who satisfied the inclusion body criteria was carried out. After recording socio demographic data, each participant in the study was subjected to questionnaire regarding his cannabis abuse and outline psychiatric rating scale (BPRS). To measure the quantity of cannabis intake by individual substantiative measure in form of mediocre amount (INR) spent daily was inquired. The age of onset, duration of abuse, and slip of onset- accidental, casual, peer group and offer by elder family members were recorded. The history of cannabis abuse as well(p) as psychiatric illness in other fam ily members was inquired.ResultsMajority of the participants were young male adults of the rural background. roughly 47 % (n-14) of them were unmarried and 60 % (n-18) were belonged to joint family. All the study participants were formally educated and at least(prenominal) one family member of about 43% (n-13) of participants had history of cannabis abuse.As it has been shown in table 2 majority of the study participants were abusing cannabis for more than 10 years with mean duration of cannabis abuse 14.2 years. 50 % of the individuals experienced first cannabis intake before age of 13 years with average onset of cannabis use 14.5 years. Majority of the participants (66%) were daily cannabis abusers. More than 2/3 rd of the subjects was pass Rs. 15 per day on average over the cannabis. Onset of cannabis was occurred mostly due to limit of peer group (n-21). The symptoms that were associated with increased severity in majority of patients were hostility 25 (83%), excitement 23 ( 77%), and elevated mood, grandiosity, suspiciousness, distractibility and motor hyperactivity in more than 60% of individuals. another(prenominal) symptoms that were present in severe to very severe form in more than half individuals were hallucinations, unusual thought content, uncooperativeness, and self neglect. Suicidability and tension was remove in 28(93%) of patients, depression and motor retardation was absent in 25(83%) of participants, guilt was absent in 70% of patients and blunted affect, conceptual disorganization and emotional withdrawal were completely absent in 60% of individual patients. correlational statistics with duration of cannabis abuseLong duration of abuse was negatively correlated with depression and hostility but other symptoms like suspiciousness, hallucinations, unusual thought content were positively correlated. Duration of cannabis abuse was significantly associated with total BPRS score (p-0.002). Patients with long duration of cannabis were presen ted with more severe form of psychosis than patients with petty duration of cannabis abuse.Correlation with Age of onset of cannabis abuseOlder age of onset of cannabis use was significantly associated with depression (p Correlation with frequency of cannabis abuseFrequency of cannabis abuse was significantly associated with self neglect (p-0.007) and tension (p Correlation with amount spent over cannabisThe amount spent over cannabis was significantly correlated with anxiety (p-0.030), hallucinations (p-0.001), bizarre behavior (p newsThis study was aimed at determining clinical symptoms in relation to variables of cannabis abuse. All subjects were male. This could be due to low levels of substance use among females in general and cannabis in particular. Age range was wide and may be due to variation in genetic vulnerability to psychosis, dose of cannabis and duration of illness leading to variable age at presentation. Positive symptoms (motor hyperactivity, excitement, hostility , elevated mood, suspiciousness, grandiosity) were found at higher frequency than negative symptoms (blunted effect, emotional withdrawal and motor retardation). Hallucinations were present in only half of the participants. Other symptoms of the psychosis like conceptual disorganization and catatonic symptoms were absent. Our result was in support of Vani Kulhali and colleagues 23 finding that patients with cannabis associated psychosis had high positive scores (5) on respective BPRS items were hostility 25 (83%), excitement 23 (77%), and motor hyperactivity, elevated mood, grandiosity, suspiciousness, distractibility in more than 60% of individuals. The least common symptoms were suicidability and tension 2 (6), depression and motor retardation 5 (15%), guilt was present in 30% of patients and blunted affect, conceptual disorganization and emotional withdrawal were completely absent in 60% of individuals. Most studies have reported that cannabis produces psychosis with prominent po sitive symptoms 16,1718. Our findings argon in keeping with these studies. Scores on BPRS reflected both the total intensity and the profile of psychopathology. Thus our findings by and large confirm that reports of other authors that cannabis produces a psychosis with predominantly affective features and more of positive symptoms. Family history of drug disorders is regarded as risk factor for substance use including cannabis, whether it also results in increased vulnerability to cannabis psychosis is not clear.ConclusionsThe implication of this study is that cannabis contributes in causing and modifying psychosis. Several noteworthy findings emerged from this heterogeneous try out of cannabis associated psychosis. First the severity of psychotic episode was significantly associated with younger age of onset of cannabis abuse and increased spending was associated with more severe psychotic episode. Second family history of psychosis was not associated with increased severity of ca nnabis abuse, although family history of psychosis predicted more severe excitement, elevated mood and grandiosity and early onset of cannabis abuse.Limitations of the studyAs this was a cross sectional study and cannabis variables were obtained from interview hatchway of recall bias cant be ruled out.It was not possible to measure the amount of cannabis in unit time.Proxy used to represent this variable may not be representative of active ingredient of delta- 9THC.We have to rely on the subjects self- report of not using any other substances and were unable to objectively verify this report. Thus, the possibility that some symptoms were related to abstinence from other drugs cannot be completely excluded.Wide age range could be a drawback of study since homogeneity in duration of illness and amount of cannabis abuse could not be ensured.