Comment on “Persistent Psychosis Induced by Cannabis Withdrawal”

See case report by Vaseel and Uvais and reply letter by Vaseel and Uvais

To the Editor: Recently in the PCC, Vaseel and Uvais¹ presented a case of paranoid psychosis beginning within 3 days of discontinuation of heavy, prolonged cannabis use, which they diagnosed as “cannabis withdrawal psychosis.” I believe a more accurate diagnosis would be cannabis-induced psychotic disorder with onset during withdrawal. The patient they describe seems to meet the DSM-5 diagnostic criteria for this disorder,² although some relevant clinical details are not provided in the case report.

The patient developed paranoid delusions (criterion A) within 3 days of abrupt cessation of cannabis use (criterion B1); cannabis is known to induce psychosis (criterion B2). Medical and psychiatric evaluation ruled out others causes of psychosis (criterion C). There is no mention of evaluation for delirium, but I assume that delirium would have been mentioned if observed (absence of delirium is criterion D). It is unclear whether the patient fully met the DSM-5 diagnostic criteria for cannabis withdrawal,² which require experiencing at least 3 from a list of 7 common signs and symptoms of cannabis withdrawal (criterion B). As described, the patient had only 2: irritability (criterion B1) and insomnia (criterion B3).

The persistence of this patient’s psychosis for at least 2 months (until resolved by antipsychotic treatment) is unusual in the literature. A recent systematic review identified 112 cases of psychosis associated with cannabis withdrawal: 44 published cases (not including the present case) and 68 cases identified via medical records search of a large health care system.³ In no case was psychosis reported to persist longer than 3–6 weeks, although this duration was almost always truncated by antipsychotic treatment (as in the present case). Persistence of cannabis-induced psychotic disorder for longer than 1–2 months raises the possibility that cannabis use triggered the onset of an independent psychotic disorder.⁴ Can the authors provide psychiatric follow-up on their patient?

Article Information

Published Online: March 13, 2025 https://doi.org/10.4088/PCC.25lr03933
© 2025 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2025;27(2):25lr03933
To Cite: Gorelick DA. Comment on “persistent psychosis induced by cannabis withdrawal.” Prim Care Companion CNS Disord 2025;27(2):25lr03933
Author Affiliation: Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.
Corresponding Author: David A. Gorelick, MD, PhD, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, MPRC–Tawes Building, Catonsville, MD 21228 ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.