403 medical charts with a diagnosis of CIP were screened, and only 317 charts with a positive urine test for cannabis were accepted for analysis. Eighty-six medical records were excluded because the urine test was negative for THC.
The average age was 21.0 years (19.0 to 24.0 years), and the majority were male (97.2%), single (86.7%), unemployed (56.2%), and enrolled in universal health insurance (83.9%). More than half of the patients (64.3%) completed secondary or high school level. Most patients (86.1%) had no underlying disease. Their baseline characteristics were summarized (Table 1).
Table 1 Baseline characteristics
The mean age of first-time cannabis users was 16.3 ± 3.4 years, with a minimum age of 9 years. All of them did not use cannabis for medical purposes, they all smoked cannabis from dried leaves or flowers of the cannabis plant, and the median duration of use was approximately 5 years (range 3-7 years). Data on prehospital drug use history were obtained from patient interviews recorded in medical records. Approximately 38% of patients reported using approximately 4 holes of cannabis per day prior to hospitalization. Some patients used cannabis in combination with other substances such as methamphetamine, alcohol, kratom, glue, heroin, and methadone (Table 2). Approximately 90% of patients smoked an average of half a pack of cigarettes per day.
Table 2 History of substances used before admission
When focusing on urine screening tests for substances on the first day of admission, we found that all patients had positive urine tests for THC, and some patients had positive urine tests for methamphetamine, benzodiazepines, and tramadol. (Figure 1). Urinary THC levels were performed in severely psychotic patients (N = 122/317; 38.5%), and the mean level was 110.5 (97.0-127.0) ng/mL.
Figure 1
Urine screening test results for cannabis and other substances
The most common chief complaints upon admission were hallucinations (84.9%), delusions (82.6%), sleep deprivation (61.2%), irritability (57.1%), and aggression (42.0%). These symptoms developed approximately 2 days after receiving the last dose of cannabis (range 1-5 days).
During the acute phase of treatment (treatment on the first day of hospitalization), nearly all patients received antipsychotic medication. Approximately 1.3% of hospitalized patients did not receive antipsychotic medication because they did not have psychosis as their primary symptom. More than half of them were receiving antipsychotics and benzodiazepines, with or without antidepressants (Table 3). A combination of intramuscular (IM) haloperidol and intravenous (IV) diazepam was commonly used to control psychotic symptoms. Frequently prescribed oral antipsychotics were risperidone (83.6%), haloperidol (19.9%), and perphenazine (7.9%).
Table 3 Comparison of drug treatment patterns in the acute and maintenance phases of CIP treatment (N = 317)
For maintenance treatment (treatment when patients are clinically stable, such as before discharge from hospital or during rehabilitation programs), antipsychotics remained the main treatment. The most commonly prescribed antipsychotic was risperidone (85.5%, median dose 2-4 mg/day), followed by haloperidol (47.3%, median dose 5-20 mg/day), and clozapine (14.8%, median dose 100-150 mg/day). ). Clozapine has only been prescribed in combination with other antipsychotics to target other symptoms beyond psychosis. Additionally, long-acting injectable antipsychotics were rarely prescribed in both acute (17/313, 5.4%) and maintenance (45/313, 14.4%) treatments. Most of them were haloperidol decanoate (9.8%; median dose 100 mg (range 50-100) per month). The mean doses of antipsychotic treatment expressed as risperidone equivalent doses on days 1, 8, 15, and 22 were 12.2 ± 6.9, 8.3 ± 5.3, 8.4 ± 5.9 and 8.4 ± 5.9 per day, respectively. It was 8.0±5.9mg.
In this study, antidepressants and benzodiazepines were combined with antipsychotics (Table 3). Few people received more than one type of psychotropic medication. During both the acute and maintenance phases of treatment, the most commonly prescribed antidepressant was sertraline, accounting for approximately 36.6% of prescriptions. The median dose of sertraline was 50 mg per day. After sertraline, fluoxetine was the next most commonly prescribed antidepressant (18.3%). The median dose of fluoxetine was 20 mg per day. Reboxetine, although less frequently prescribed, accounted for approximately 2% of prescriptions, with a median dose range of 4 to 6 mg per day. Furthermore, benzodiazepines were prescribed more frequently during the acute phase of treatment than during the maintenance phase. Clonazepam was most frequently prescribed (range 0.5–2 mg/day).
On the first day of admission, the mean BPRS total score, positive scale, negative scale, and general scale were 55.2 ± 9.6, 26.1 ± 4.9, 13.8 ± 3.2, and 15.3 ± 3.2, respectively. The highest scores for each item on the positive, negative, and general scales were suspiciousness, uncooperativeness, and tension, respectively. Median length of hospital stay was 28 days (range 22-31 days). The discharge rates for 8 days, 15 days, 22 days, and 22 days or more were 0.6%, 10.7%, 15.5%, and 73.2%, respectively. The mean total BPRS score, positive scale, negative scale, and general scale on hospital day 22 were 30.4 ± 10.8, 13.2 ± 5.3, 7.5 ± 2.8, and 9.7 ± 3.2, respectively (Figure 2). Total BPRS scores on days 8, 15, and 22 decreased statistically significantly from the first day of admission (p-values <0.001, <0.001, and <0.001, respectively).
Figure 2
Changes in total BPRS score (A), positive scale (B), negative scale (C), and general scale (D) after receiving psychotropic medication during the study period (n = 133)
For the hallucinations, grandiose, hostile, and disorganized thinking items, the scores on the day of admission were 3.6 ± 0.9, 2.8 ± 1.1, 3.6 ± 0.9, and 3.2 ± 0.9, respectively. At day 22, scores in these domains decreased by 1.8 ± 1.1, 1.2 ± 1.1, 1.8 ± 1.2, and 1.5 ± 1.1, respectively. On the other hand, individual items on the negative scale, such as emotional withdrawal, motor retardation, uncooperativeness, and emotional obtuse, ranged from 3.0 ± 0.9, 2.4 ± 0.9, 3.3 ± 1.0, 2.6 ± 0.9 to 1.8 ± 0.8, 1.3 ± 0.6. , decreased to 1.6 ±. The values were 0.7 and 1.5 ± 0.6 at admission and 22 days, respectively. In addition, individual item scores on general scales such as physical concerns, guilt, and depressed mood also improved on day 22 compared to the day of admission. By day 22, anxiety and tension improved slightly compared to the first day, with scores decreasing from 3.6 ± 0.8 and 3.6 ± 0.8 to 2.5 ± 0.7 and 2.1 ± 0.9, respectively.
The frequency of extrapyramidal symptoms (EPS) in our study was 4.4%, including dysarthria (1.9%), acute dystonia (0.9%), akathisia (0.6%), mild cogial rigidity (0.6%), and motor It was slow (0.3%). . Approximately 90.5% (287/317) of patients received oral trihexyphenidyl at a mean dose of 5.5 ± 3.3 mg per day along with antipsychotic treatment.
Linear regression analysis showed that factors (gender, age, THC level, duration of cannabis use, length of hospital stay) were associated with change in BPRS score on day 22 compared to day 1 for all subscales. It was shown that there is no.
Focusing on chronic use of cannabis-induced schizophrenia, we found that 7% (21 of 317) of these patients were later diagnosed with schizophrenia within the study period. Eighteen of the 21 cases (86%) involved the use of cannabis alone. The remaining subjects used cannabis in combination with tramadol or benzodiazepines, but the combination of these two drugs did not cause psychosis. The median time to onset of schizophrenia after discharge was 1.3 years (range 0.2-2.0 years). Among these, the mean age of patients who developed schizophrenia was 20.9 ± 4.9 years, and the first time they used cannabis was 15.2 ± 2.1 years. Approximately 76.2% were unemployed and had graduated from secondary school or high school. Most of them used approximately 4.0 holes of cannabis per day, and the duration of cannabis use was 4 years. Additionally, 80% of patients develop chronic cannabis use disorder (CUD), which typically results in an inability to stop using cannabis, cravings, a need to use larger amounts, and impaired social abilities. It was found that symptoms such as
