Cannabis dependence

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Cannabis dependence

Psychological disorders

Mood disorders

Major depressive disorder

Suicide

Bipolar disorder

Seasonal affective disorder

Premenstrual dysphoric disorder

Anxiety disorders

Generalized anxiety disorder

Social anxiety disorder

Panic disorder

Agoraphobia

Phobias

Obsessive-compulsive disorders

Obsessive-compulsive disorder

Body focused repetitive disorders

Body dysmorphic disorder

Stress-related disorders and abuse

Post-traumatic stress disorder

Physical and sexual abuse

Psychotic disorders

Schizoaffective disorder

Schizophreniform disorder

Delusional disorder

Schizophrenia

Cognitive and dissociative disorders

Delirium

Amnesia

Dissociative disorders

Eating disorders

Anorexia nervosa

Bulimia nervosa

Personality disorders

Cluster A personality disorders

Cluster B personality disorders

Cluster C personality disorders

Somatoform and factitious disorders

Somatic symptom disorder

Factitious disorder

Substance use disorders and drugs of abuse

Tobacco dependence

Opioid dependence

Cannabis dependence

Cocaine dependence

Alcohol use disorder

Sleep disorders

Bruxism

Nocturnal enuresis

Insomnia

Night terrors

Narcolepsy (NORD)

Sexual dysfunction disorders

Erectile dysfunction

Male hypoactive sexual desire disorder

Orgasmic dysfunction

Female sexual interest and arousal disorder

Genito-pelvic pain and penetration disorder

Pediatric disorders

Attention deficit hyperactivity disorder

Disruptive, impulse control, and conduct disorders

Learning disability

Fetal alcohol syndrome

Tourette syndrome

Autism spectrum disorder

Rett syndrome

Shaken baby syndrome

Enuresis

Encopresis

Psychiatric emergencies

Suicide

Serotonin syndrome

Neuroleptic malignant syndrome

Psychological disorders review

Mood disorders: Pathology review

Amnesia, dissociative disorders and delirium: Pathology review

Personality disorders: Pathology review

Eating disorders: Pathology review

Psychological sleep disorders: Pathology review

Psychiatric emergencies: Pathology review

Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review

Malingering, factitious disorders and somatoform disorders: Pathology review

Anxiety disorders, phobias and stress-related disorders: Pathology Review

Trauma- and stress-related disorders: Pathology review

Schizophrenia spectrum disorders: Pathology review

Drug misuse, intoxication and withdrawal: Stimulants: Pathology review

Drug misuse, intoxication and withdrawal: Alcohol: Pathology review

Developmental and learning disorders: Pathology review

Childhood and early-onset psychological disorders: Pathology review

Assessments

Cannabis dependence

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Cannabis dependence

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Questions

USMLE® Step 1 style questions USMLE

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A 17-year-old boy is brought to the emergency department for evaluation of anxiety and paranoia. The patient was at a party where he started screaming at a girl because he believed she was going to harm him. Several minutes later, he felt restless and stated he felt like “the world was closing in on him.” Temperature is 37.2C (98.96F), heart rate is 115/minute, blood pressure is 145/90 mmHg, and respirations are 18/minute. Oxygen saturation is 99%. On physical examination, the patient appears anxious. Pupils are 3 mm and reactive to light bilaterally. The conjunctiva appears injected, and his coordination is slow. Which of the following is the most likely etiology of this patient’s presentation?

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Transcript

Content Reviewers

Rishi Desai, MD, MPH

Kelly Mackenzie, MA

Vincent Waldman, PhD

Contributors

Fergus Baird, MA

Tanner Marshall, MS

Vincent Waldman, PhD

Cannabis, or marijuana, is one of the most popular psychoactive substances worldwide, especially among teenagers.

Although the specifics of cannabis’ addictive qualities are still very much under debate, cannabis dependence disorder is officially classified in the DSM-5 and prolonged, heavy use of cannabis has been shown to cause some level of dependency.

Cannabis comes from the flowers of Cannabis sativa plants, which has oils with concentrations of tiny, fat-soluble, psychoactive molecules called cannabinoids.

The three main cannabinoids, tetrahydrocannabinol (also called THC), cannabidiol (also called CBD), and cannabinol (also called CBN), are each associated with unique psychoactive effects.

For example, THC is associated with high-grade recreational marijuana, and produces effects, like euphoria, analgesia, mild hallucinations, and an increased appetite.

Cannabidiol on the other hand does not have psychoactive effects and is commonly included in medical marijuana because it has a variety of effects including being analgesic, anti-inflammatory, anti-seizure, appetite stimulating, and anxiety-reducing.

To understand how cannabis works, let’s zoom in on a synapse of the brain to see how a stimulus response is induced generally, without drugs.

Normally, electrical signals, or action potentials, travel down the axon to the axon terminal, triggering the release of chemical messengers called neurotransmitters from synaptic vesicles into the synapse.

The neurotransmitters travel across the synapse and bind to receptors on the postsynaptic neuron, where they give the cell a message.

After the neurotransmitters have done their job, they unbind from the receptors and can simply diffuse away, be degraded by enzymes, or be picked up by proteins and returned to their release site in a process called reuptake.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "State of the Art Treatments for Cannabis Dependence" Psychiatric Clinics of North America (2012)
  5. "Cannabinoid Receptors: Where They are and What They do" Journal of Neuroendocrinology (2008)
  6. "Cannabinoids, hippocampal function and memory" Life Sciences (1999)
  7. "Pharmacokinetics and Metabolism of the Plant Cannabinoids, Δ9-Tetrahydrocannibinol, Cannabidiol and Cannabinol" Handbook of Experimental Pharmacology (undefined)
  8. "Bioanalytical procedures for determination of drugs of abuse in blood" Analytical and Bioanalytical Chemistry (2007)
  9. "Diagnostic and Statistical Manual of Mental Disorders: DSM-5" American Psychiatric Association (2013)
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