Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, 10400, Thailand.
Department of Medicine, Princess Mother National Institute on Drug Abuse Treatment, Pathum Thani, 12130, Thailand.
BMC Psychiatry. 2024 Sep 27;24(1):626. doi: 10.1186/s12888-024-06075-6.
Current treatment of cannabis-induced psychosis (CIP) focus on the presenting symptoms of individual patient. Therefore, the objective of this study was to investigate the efficacy of pharmacological treatment for CIP in a retrospective manner.
A retrospective chart review study was conducted at the Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT), Thailand. Patients aged more than 12 years who met the International Classification of Disease-10 (ICD-10) criteria of CIP, had recorded of cannabis use in medical chart, and had positive urine test of cannabis on the first day of admission from October 2013 to September 2019 were enrolled. The primary outcome was the efficacy of pharmacological treatment of CIP. Brief Psychotic Rating Scale (BPRS) on the first day and weekly after receiving treatment were used to assess the primary outcome.
Four hundred and three medical charts with diagnosis of CIP were enrolled into the study and only 317 charts were analyzed. Most of them were male with an average aged of 21.0 (19.0-24.0) years old. All of them used smoked cannabis from dried leaves and flowers of cannabis plant. The presented symptoms on admission were psychosis, mood symptoms, sleep problems, weight loss, and cognitive problems (100%, 64%, 61%, 11%, and 7%, respectively). Baseline BPRS score of the first day of admission was 55.2 ± 9.6. Majority of patients received antipsychotic (98.7%) followed by the combination of antipsychotics with benzodiazepines (34.5.%), antipsychotics with antidepressants (14.4%) and antipsychotics treatment with antidepressants and benzodiazepines (25.9%). Only few patients received antipsychotic monotherapy (17.9%). Risperidone was the most frequently prescribed antipsychotics (83.6%). Mean equivalence dose of risperidone was 8.0 ± 5.9 mg/day. The average hospital length of stay was 28 days (range 22-31). BPRS at 22 days significantly improved compared to the first day of admission (p < 0.001). Schizophrenia was diagnosed in 7% at 1.3 years of follow up.
Antipsychotics was still a key psychotropic drug for treatment of CIP. The symptoms were decreased rapidly and sustained among the treatment period. However, antidepressants and benzodiazepines were commonly used for treatment of other symptoms beyond psychosis.
ClinicalTrials.gov ID: NCT04945031 (Registration Date: 30 June, 2021).
目前，大麻引起的精神病（CIP）的治疗主要针对个体患者的表现症状。因此，本研究旨在回顾性地研究药物治疗 CIP 的疗效。
在泰国 Princess Mother 国家药物滥用治疗研究所（PMNIDAT）进行了一项回顾性图表审查研究。纳入标准为年龄大于 12 岁，符合国际疾病分类第 10 版（ICD-10）CIP 标准，病历中有大麻使用记录，入院第一天尿液大麻检测呈阳性的患者。主要结局是评估药物治疗 CIP 的疗效。入院第一天和治疗后每周使用简明精神病评定量表（BPRS）评估主要结局。
共纳入 403 份 CIP 诊断的病历，但仅有 317 份进行了分析。他们大多为男性，平均年龄为 21.0（19.0-24.0）岁。他们均使用干大麻叶和花制成的烟雾状大麻。入院时的主要症状为精神病、情绪症状、睡眠问题、体重减轻和认知问题（100%、64%、61%、11%和 7%）。入院第一天的基线 BPRS 评分为 55.2±9.6。大多数患者接受了抗精神病药物治疗（98.7%），其次是抗精神病药物联合苯二氮䓬类药物（34.5%）、抗精神病药物联合抗抑郁药（14.4%）和抗精神病药物联合抗抑郁药和苯二氮䓬类药物（25.9%）。只有少数患者接受了抗精神病药单药治疗（17.9%）。利培酮是最常开的抗精神病药（83.6%）。利培酮的平均等效剂量为 8.0±5.9mg/天。平均住院时间为 28 天（范围 22-31）。与入院第一天相比，第 22 天的 BPRS 显著改善（p<0.001）。在 1.3 年的随访中，7%的患者被诊断为精神分裂症。
抗精神病药仍是治疗 CIP 的关键精神药物。在治疗期间，症状迅速减轻并持续缓解。然而，抗抑郁药和苯二氮䓬类药物常用于治疗精神病以外的其他症状。
ClinicalTrials.gov ID：NCT04945031（注册日期：2021 年 6 月 30 日）。
