New-onset psychosis linked to synthetic marijuana use

Synthetic marijuana, known as “spice,” appears to have induced psychosis in 10 young service members in the US Naval Academy, in a case series from the naval Medical Center in San Diego.

“These are people who never had psychosis. They were so disorganized, so out of it, we had to lock them up [on our ward]. It’s pretty scary,” it was reported at the meeting.

Psychotic symptoms were resolved within eight days in seven patients. One of those patients has a past diagnosis of attention-deficit/hyperactivity disorder; the others have no psychiatric histories. Most have been daily users for weeks, months, or up to a year.

The remaining three patients still suffer lingering paranoid delusions and dysthymia after five months. One has a history of substance abuse and a family history of schizophrenia and has been using spice daily for a year and a half; another has a history of depression and had been using spice daily for a month. The third patient has no personal or family psychiatric history and has used spice about 20 times in two months.

The men, in their early 20s were each hospitalized for six to 10 days. Some had used alcohol, marijuana, or both, with spice.

The report is the first to link spice to new-onset psychosis in patients with no psychiatric histories. After they were admitted, seven of the 10 patients in the case series got atypical antipsychotics, usually for four days. Since writing the report, colleagues have seen about 20 additional cases and have noticed that patients – if they are going to recover – seem to do so regardless of antipsychotic use.

Because of that, we “started in our ward not to give them anything. You may give them an antipsychotic because behaviorally they are out of control, and need to tone it down. But if they’re calm, we are not giving them anything, and they are still clearing up in 4 to 8 days,” said the lieutenant commander and third-year psychiatry resident at the medical center.

In terms of presentation , “the most common theme is confusion” along with disorganized behavior and speech. Paranoid delusions also are common, but their focus can shift from minute to minute. Symptoms wax and wane as well, with patients cycling in and out of psychosis hour by hour, sometimes even quicker. Auditory and visual hallucinations, flat affect, thought-blocking, alogia, suicidal ideation, insomnia, psychomotor retardation, agitation and anxiety also were noted in the group.

“The role of spice in inducing these symptoms was determined by military command, friend, family member and/or patient report, as well as urine drug test,”

Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol, which is a partial cannabinoid agonist. The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out.

Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn and other brands. Spice is usually smoked, but is also sold as a crystalline powder. Users have no way of knowing how potent a particular product is.

The US Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, “because they pose a threat to public health,” according to the order.