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Ask the Mental Health Expert Archives 2001-2004

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Alternative Therapy

Q. I am an Occupational therapist and am interested on your views about cannibis-induced psychosis and the alternate use of naturopathy rather than pharmaceutical medication (his request). He is 19-years-old and has had 1 suicide attempt. Are there any legal implications for me or him? What natural alternatives exist, if any?

A. There are few if any controlled studies of treatments for cannabis-induced psychosis (CIP). However, CIP usually remits on its own within a few days. Thus, if your patient/client has had prolonged (weeks or months) psychotic symptoms, such as hallucinations or delusions, I would be looking at other diagnostic possibilities. It is possible that marijuana spiked with phencyclidine (PCP, angel dust) or other contaminants may produce more prolonged psychotic episodes (weeks or longer), despite removal of the offending substance, but other diagnoses, such as underlying schizophrenia or a mood disorder with psychotic features, need to be ruled out.

The presence of a suicide attempt history in this case would certainly raise my suspicion of an underlying major depressive disorder. Of course, these diagnoses would need to be assessed carefully by a psychiatrist or other mental health professional-- ideally, one with strong expertise in the dual diagnosis field. If CIP does not remit on its own, it may be treated with either conventional antipsychotic agents, such as haloperidol, or with newer atypical agents, such as olanzapine (see Berk et al, Int Clin Psychopharmacol May 1999, pp. 177-80). Carbamazepine (Tegretol) is also reported to be helpful in the treatment of schizophrenia-like psychosis related to cannabis abuse (Leweke & Emrich, Int Clin Psychopharmacol Jan 1999, pp. 37-9).

I know of no evidence that herbal or natural agents are useful in the treatment of CIP. However, if anxiety is a large component of the syndrome and the patient refuses treatment with standard anti-anxiety agents, it might be reasonable to see if the herb valerian is helpful. That is not to say that valerian or any other natural remedy has been proved safe or effective for CIP, and many herbal remedies may have side effects or drug-drug interactions of their own. Thus, I think the safest bet in a case like this is to encourage the individual to seek psychiatric evaluation and treatment. I'm not in a position to advise you regarding legal implications for you or your patient, but you might want to contact the Bazelon Center for Mental Health Law in Washington DC (202-467-5730) if you have specific legal questions.

July 2001

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