Cannabis was used as a medicinal plant in Asia before the Christian era. Nowadays, after 40years of a “war on drugs” with an illegal status, there is a big interest on the use of cannabis in some medical conditions. With more and more users revealing having used this substance to cope with certain psychiatric manifestations, researchers have tried to explore this substance in the psychiatric field where the actual pharmacological treatments and psychotherapy remain ineffective in some cases.

To Explore the medical use of cannabis in psychiatric disorders.

A literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar over the last 10 years.

Giving the interactions between cannabinoids and specific neurotransmitters, it has been suggested that cannabis may have medical effect on some psychiatric illnesses. In this direction, a significant overlap has been demonstrated between PTSD and cannabis use. CBD a non-psychotomimetic cannabinoid, seemed to show promising results as an enhancer of fear extinction and therapeutic consolidation of emotional memories. Military veterans are increasingly using it for reducing induced nightmares although this residual symptom remains difficult to treat. No benefit for improving depression was proved. One isolated study indicated a potential efficacy for cannabinoid combined with terpene in ADHD.

Studies exploring the possibility of using cannabis in the treatment of psychiatric illnesses are promising but it is premature to recommend this drug for the moment especially since it requires gradual titration, regular assessment and precaution in certain diseases.

No significant relationships.

Synthetic Cannabinoids were recognized as drugs of abuse since 2008, they are sold under various names (Kush, K2, Spice).

The Patient N., 17 years old male was admitted to the hospital with a first-time psychotic episode. He is fond of extreme sports (ski jumping, gymnastic and acrobatic elements).

The patient was fully examined.

Then he was taken to the admission department. About a week before admission he fell, injuring his leg and head. After that he did not sleep, became excited, aggressive, “said strange things”. During the admission patient showed disorganized behavior, agitation, paranoid ideation, beliefs that others were inserting thoughts into his head (“thought insertion”) and that his thoughts could be read by others (“thought broadcasting”), imperative “voices”, bizarre delusional thoughts. The UDT showed positive K2 analysis. The patient was prescribed Diazepam, Zuclopenthixol, Valproic acid. No improvement observed. Haloperidol was prescribed next day. Then Haloperodol was changed to Quetiapine, and after 10 days of treatment no improvement was observed. The patient started to show catatonia symptoms such as elective mutism, mild rigidity, signs of cog-wheeling or clasp-knife rigidity. He experienced anxiety, fear, did not take care of himself. Every day he started to be aggressive, impulsive, started to experience auditory hallucinations. Due to that fact it was decided to prescribe Haloperidol, Chlorpromazine, Phenazepame, Diphenhydramine.That treatment improved behavior.

Thus, the intensive treatment with antipsychotic medications in combination with benzodiazepines and diphenhydramine is much more preferable for the management of the cases of oneiroid catatonia due to the usage of Spice.

Designer drugs, as a term, first came about in the 1980s. Most of these “designer drugs” have synthetic cannabinoids and other psychoactive formulas difficulty to detect.

A 28 year man was referred to the hospital.

CT brain and EEG were also normal.

Among 7 days before attending the hospital the patient had a strange behaviour. He was staying like in changed reality. The day before admission he got irritable in the evening was reporting that he could hear animal’s imperative voices “we together with squirrel, dolphin visited giraffe, that someone told to jump from the window”. That symptoms were temporary after that he was shocked when realized that he was in a room. The patient has the history of marihuana use in the past 5 years, periodically. There is no evidence data about the usage of other narcotic substances. On examination he was alert, sitting on a same place looking at one point, sometimes trying to find something or suddenly standing and trying to go somewhere. He has a change of catatonic stupor and excitement. The psychomotor activity was changeable. While observing the patient during few days several times he disrobed all his clothes, staying or laying on a bed or suddenly freezing in one pose.

Taking into account clinical symptoms, the patient developed, the conclusion was made about connection of patients’ oneiroid catatonia with the usage of “Spice” or “Designer drug”. Thus, designer drugs may sound like a safer alternative, but often can lead to serious mental disturbances.

No significant relationships.