Chesney Edward, Reilly Thomas J, Scott Fraser, Slimani Ikram, Sarma Ananya, Kornblum Daisy, Oliver Dominic, McGuire Philip
Department of Addictions, King's College London, UK.
Department of Psychosis Studies, King's College London, UK.
Br J Psychiatry. 2024 Dec 3:1-12. doi: 10.1192/bjp.2024.175.
Abrupt cessation of heavy cannabis use can cause a withdrawal syndrome characterised by irritability, anxiety, insomnia, reduced appetite and restlessness. Recent reports have also described people in whom cannabis withdrawal immediately preceded the acute onset of psychosis.
To identify cases of psychosis associated with cannabis withdrawal.
We completed a systematic review of the literature, which comprised case reports, case series and other studies. We also searched a large electronic database of psychiatric healthcare records.
The systematic review identified 44 individuals from 21 studies in whom cannabis withdrawal preceded the development of acute psychosis. In the health record study, we identified another 68 people, of whom 47 involved a first episode of psychosis and 21 represented further episodes of an existing psychotic disorder. Almost all people were daily cannabis users who had stopped using cannabis abruptly. Individuals who continued to use cannabis after the acute psychotic episode had a much higher risk of subsequent relapse than those who abstained (odds ratio 13.9 [95% CI: 4.1 to 56.9]; = 20.1, < 0.00001).
Abrupt cannabis withdrawal may act as a trigger for the first episode of psychosis and a relapse of an existing psychosis. Acute psychotic symptoms can emerge after the cessation, as well as following the use, of cannabis.
大量使用大麻后突然戒断可导致戒断综合征，其特征为易怒、焦虑、失眠、食欲减退和坐立不安。最近的报告还描述了一些在大麻戒断后紧接着出现精神病急性发作的人。
识别与大麻戒断相关的精神病病例。
我们对文献进行了系统综述，包括病例报告、病例系列和其他研究。我们还检索了一个大型精神病医疗记录电子数据库。
系统综述从21项研究中识别出44名在急性精神病发作前出现大麻戒断的个体。在健康记录研究中，我们又识别出68人，其中47人涉及精神病首次发作，21人代表现有精神障碍的再次发作。几乎所有人都是每日使用大麻者，且突然停止使用大麻。急性精神病发作后继续使用大麻的个体比戒断者后续复发风险高得多（比值比13.9[95%置信区间：4.1至56.9]；χ² = 20.1，P < 0.00001）。
突然停用大麻可能是精神病首次发作和现有精神病复发的触发因素。急性精神病症状可在停用大麻后以及使用大麻后出现。
