Cannabis-Induced Depersonalization Disorder in Adolescence

Hürlimann, F; Kupferschmid, Stephan; Simon, Andor E.

doi:10.1159/000334605

Cited by 21 publications

(23 citation statements)

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“…The relationship of the latter with depersonalization is well documented in literature [21,22], occasionally following cannabis use [23]. Importantly, one of the symptom dimensions of depersonalization disorder that emerged from two recent factor analytical studies was anomalous body experience [24] or body distortion [25], respectively.…”

Section: Anxiety and Cenesthopathy In Adolescencementioning

confidence: 98%

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Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Simon

Borgwardt

Lang

et al. 2014

Comprehensive Psychiatry

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Objective: To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods: Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results: The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion: As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum. We would like to thank the reviewer for raising this important point. As we did not follow specific guidelines "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines (Moher et al., 2009), we agree with your comment that this a selective and not systematic review. Therefore, we now removed the term "systematic" and clearly state that this is a "critical" review. Furthermore, we have rephrased the methods in more detail on page 4, line 21, to page 5, line 9. We also acknowledge that including a discussion of somatization is an important aspect. This now features on page 9, lines 3 to 19. We did not include a discussion of the Briquet"s syndrome. This is a specific somatization disorder with multiple symptoms, and our above mentioned paragraph includes the general concept of somatization, thus also Briquet"s syndrome. We however now included the concept of somatic delusions in our section on "cenesthopathy and psychosis" that we have restructured substantially (see page 12, lines 13 to 24). We now also reference somatic delusions on page 16, line 7 (references 52 and 53). The main conclusion of the paper is that there is the risk that the DSM-5 attenuated psychosis syndrome may be over-diagnosed given the fact that unusual body experiences seem to be an aspecific feature of several disorders not only psychosis. I did not find a solid argument for this conclusion in the discussion. Also could the authors offer any suggestions to avoid this problem of overdiagnosis and propose alternate methods of assessment and appraisal of distortions ...

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Section: Anxiety and Cenesthopathy In Adolescencementioning

confidence: 98%

“…Anxiety-induced cenesthopathy can lead to adolescents suffering considerable social and vocational disintegration [23]. Similarly, hypochondriasis is commonly associated with a high degree of affect that impact negatively on social and vocational functioning [28].…”

Section: Level Of Functioningmentioning

confidence: 99%

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Simon

Borgwardt

Lang

et al. 2014

Comprehensive Psychiatry

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Section: Depersonalization Disordermentioning

confidence: 99%

“…The majority of cases are male, and most often begin between the ages of 15 and 19, though adult occurrences are not rare, and cases have also been reported after single-use exposure to high potency THC [19][20][21].…”

Section: Depersonalization Disordermentioning

confidence: 99%

“…The patients at highest risk are those who abuse high potency varieties or synthetic cannabinoids, and those who consume high doses during adolescence. Other risk factors include experiencing cannabis-induced panic attacks and/or transient psychosis while using [18,19].The majority of cases are male, and most often begin between the ages of 15 and 19, though adult occurrences are not rare, and cases have also been reported after single-use exposure to high potency THC [19][20][21].NMDA (N-methyl-D-aspartate) receptor antagonists (such as ketamine) will readily induce depersonalization and derealization. NMDA receptors are widely distributed in the cortex, hippocampus and amygdala, and known to mediate associative processes.…”

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confidence: 99%

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Cannabis Induced Psychopathology

Farah¹

2017

J Addict Res Ther

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The recent trend towards legalization and commercialization of marijuana in the US has resulted in a significant drop in the perceived risks of cannabis use among all age groups. Thus, legalization has further advances the common misperception that cannabis abuse and dependence are generally safe and devoid of neuropsychiatric sequelae. Yet there are numerous acute, as well as numerous long-term neuropsychiatric consequences of cannabis use. In addition to acute psychosis and agitation, this review will discuss the long-term issues of cognitive decline, permanent psychotic disorders, syndromes of prolonged depersonalization, as well as psychological and physical dependence, and related withdrawal symptoms.Cannabis use, particularly repeated exposure, is an established contributory cause of schizophrenia by way of a classic gene-environment interaction, with the vulnerabilities associated with cannabis-induced schizophrenia involving multiple genes. There is also evidence that in utero cannabinoid exposure will impair brain maturation in developing infants and predispose them to neurodevelopmental disorders during childhood. This summary will inform clinicians of the most prevalent consequences associated with cannabis abuse and dependence, and better equip them to educate patients as to these risks. Further, there are treatments that may help patients achieve abstinence, and even neuroprotective strategies to employ in cases of new-onset cannabisinduced psychosis, as well as for cases of in utero exposure.Keywords: Schizophrenia; Cannabis abuse; Paranoia; Anxiety; Psychosis Acute Cannabis Induced PsychopathologyFor some individuals, cannabis use does not produce a calming sensation; rather, it will induce anxiety and, in some, panic attacks [1]. Numerous case reports indicate that typical panic attack symptoms often present with intense depersonalization [2]. Though possibly related to an underlying genetic vulnerability, the specifics of this interaction have yet to be discerned, however, individuals who do experience panic and anxiety symptoms during abuse are more likely to abstain from cannabis in the future [3].The mechanism of cannabis-induced paranoia and hallucinations while abusing is believed to involve the relationship between dopamine activity and endocannabinoid transmitters. Stimulation of D2 receptors in the striatum will result in the synthesis and release of endocannabinoids, which act in a retrograde fashion to inhibit GABA and glutamate activity. Researchers have speculated that due to the number of key physiological processes within the striatum dependent on D2 to endocannabinoid signaling, this process is vital for normal functions of the striatum in health [4].They further theorized that the reason antipsychotics are less effective for acute cannabis-induced psychosis is because they exert their effects through D2 blockade, while THC enters the pathway "downstream" from D2 receptors [4]. Further, acute psychosis is often a harbinger of future psychopathology, as those who experience...

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