Cannabis Use Disorder

Question 1

There is particularly rapid progression from recreational cannabis use to cannabis use disorder in. . .

Answer 1

. . . adolescents

This persists into young adulthood

Question 2

Tetrad of acute cannabis intoxication

Answer 2

• Dry mouth
• Conjunctival injection
• Tachycardia
• Increased appetite

A fifth component commonly present is anxiety

Question 3

Symptoms of canabis intoxication onset within. . .

Answer 3

. . . minutes if smoked, ~2-3 hours if ingested

If psychosis is present (usually in the form of hallucinations), it may persist beyond the duration of physiological effects

Question 4

Cannabidiol

Answer 4

A phytocannabinoid that can be extracted from the hemp plant and is NOT psychoactive

It has some recognized medical utility, such as for resistant epilepsy.

Question 5

Cannabinoid

Answer 5

A family of more than 80 different terpenophenolic compounds, some of which are psychoactive

Question 6

Cannabis

Answer 6

A genus of flowering plant thought to have originated in central Asia.

Some strains contain THC as the pincipal psychoactive component.

Question 7

delta-9 THC

Answer 7

Available by perscription for several medical indications (antiemetic for nausea/vomiting caused by chemotherapy, orexigen for anorexia and weight loss in individuals with AIDS)

Question 8

Hashish

Answer 8

A concentrated extraction of the cannabis plant

Higher concentrations of cannabis

Question 9

Cannabis withdrawal syndrome

Answer 9

• Three or more of the following developing within 1 week of cessation:
  
  • At least one of: abdominal pain, shakiness/tremors, sweating, fever, chills, headache
  • Decreased appetite or weight loss
  • Depressed mood
  • Irritability, anger, or aggression
  • Nervousness or anxiety
  • Restlessness
  • Sleep difficulty

Question 10

Symptoms of cannabis intoxication usually last. . .

Answer 10

. . . Generally ~3-4 hours, slightly longer if used orally

However, beause cannabinoids are fat soluble, the effects may occasionally persist or recur for 12-24 hours

Question 11

THC and anxiety

Answer 11

Appears to decreased anxiety at lower doses, but increase anxiety at higher doses

Question 12

Sequellae of cannabis use

Answer 12

If smoked, just as bad as smoking tobacco for lung cancer, vasculse disease, etc.

Cannabis use can contribute to the onset of an acute psychotic episodes, exacerbate psychotic symptoms, and aversely affect the treatment of major psychotic illnesses.

Assocaited with high rates of depression, anxiety disorders, suicidality, and conduct disorder. The causal arrow here still seems to be unclear. It is likely that these individuals are likely to self-medicate with cannabis, but also that cannabis exacerbates these issues chronically.

Cannabis hyperemesis syndrome, cannabis-induced anxiety disorder, and “amotivational syndrome” are also seen.

Question 13

___ is a common psychotic symptom of cannabis intoxication

Answer 13

Paranoid delusion is a common psychotic symptom of cannabis intoxication

Question 14

Diagnosing cannabis use disorder

Answer 14

Obviously u-tox is helpful in the acute setting

A careful history is necessary to determine if cannabis use is actually pathological in the individual, as most patients who smoke cannabis do not have CUD.

Question 15

Amotivational syndrome

Answer 15

Secondary to chronic cannabis intake

Characterized by lack of motivation

May appear similar to persistent depressive disorder, but importantly depressed mood is absent

Question 16

__ in low doses may resemble cannabis intoxication

Answer 16

Hallucinogens in low doses may resemble cannabis intoxication

Question 17

Treatment of cannabis use disorder

Answer 17

• CBT and motivational approaches (with relapse prevention)
  
  • Emphasize identification and anagement of incremental patterns of thoughts and external triggers that lead to use
• Education
• Family or group therapy