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can cbd cause dissociation

There is no past psychiatric history; although he recalled 2 or 3 short lived, out of the blue, panic attacks during the previous year, not accompanied by depersonalization. He does not abuse alcohol and never tried other drugs.

Cases of prolonged depersonalization after cannabis use appeared in 2 case series, of 4 and 6 patients each [24,25]. These were all individuals who experienced the onset of symptoms in adolescence. Their symptom onset was associated to psychosocial stressors in all cases. In addition, in the Hurlimann case series, 5 out of 6 patients had prior diagnosis of social anxiety. Both case series report daily episodes, some persisting up to 7 months after smoking as little as 2 marijuana cigarettes [24]. As with our patient, there was no dose-dependent association, no psychotic illness was suspected (except in one case), no neurological abnormalities and no abnormal investigation results. Some of the Szymanski cases had a family history of substance abuse, and in one case a family member had depersonalization episodes under stress. This family history trend has been noted in one other study [9], however the Hurlimann series did not comment on any such finding. Our patient’s case stands out based on the 72 hours of the first episode duration, as well as the family history of his father’s substance-induced depersonalization episode. Our patient is also remarkable in that he does not have any pre-existing symptoms of anxiety, social or other. He did however experience the onset of symptoms in the context of increased anxiety levels based on his life events at the time. Abstinence and controlling the anxiety can result in complete symptom resolution, as with our patient, but recurrent use appears to precipitate recurrence.

Prenatal, birth, and developmental history are unremarkable. He was an easy baby. There is no history of parental conflict. He was always a good student, active in sports and well adapted socially. His past medical history is unremarkable and he was on no medications. He never had any head injuries.

Discussion

We presented the case of a 17 year old male who experienced 72 hours of depersonalization after cannabis use. It is proposed that cannabis abuse in young individuals with risk factors such as a family history of substance abuse and depersonalization, and a state of acute or chronic anxiety, increases the risk of prolonged dissociative states; these can recur for several months after the onset. The risk does not appear to be dose dependent. Little is known of the neurophysiology involved and further investigations are needed to elucidate the connection between dissociative states and cannabis use.

Millions of North Americans regularly use cannabis, most starting in adolescence. While cannabis’ connection to several psychiatric conditions is actively investigated, case reports on the topic of dissociative episodes induced by cannabis to date are scarce. We are presenting the case of a 17 year old male, who suffered a prolonged episode of dissociative symptoms in the context of cannabis abuse. We analyze the case and relate it to the available literature, and identify potential risk factors.

Conclusion

The depersonalization was initially accompanied by a sense of panic, as well as palpitations, shortness of breath, tightness in the chest, and numbness in the arms. These symptoms subsided after a few minutes but the feeling of depersonalization persisted for almost 72 hours. It appears that depersonalization was the initial symptoms, and triggered a panic attack. For the 72 hours, he slept and ate normally, and carried on activities such as watching TV. He reports that no one noticed any change, despite his confiding to some people about how he felt. There was no evidence of psychosis.

Over 16 million Americans regularly use cannabis, typically beginning in adolescence [1-3]. Cannabis comprises over 420 different compounds, of which cannabinoids, and especially THC (delta-9-tetrahydrocannabinol), mediate the psychotropic effects [4]. In 2003, the average THC concentration of marijuana had risen to 7% [5].

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