Cannabis and Psychosis Through the Lens of DSM-5

Evidence links cannabis use to psychotic outcomes ranging from mild to severe and from minutes to years. Because studies vary widely in exposures and measures, a coherent account is difficult. This review organizes the association using DSM-5 diagnoses: Cannabis Intoxication, Cannabis-Induced Psychotic Disorder, and Schizophrenia. Cannabis intoxication can progress to Cannabis-Induced Psychotic Disorder when severity and duration criteria are met, and that disorder is strongly associated with future schizophrenia diagnoses. The framework suggests a continuum of cannabis-related psychosis.

Study at a glance

Abstract

Evidence for an association between cannabis and psychosis has been documented in literature in many forms including experimental studies, epidemiological data, and case series. The association has implications for psychotic outcomes ranging from mild to severe and occurring over minutes to years. Due to the huge variety of exposures and outcome measures reported, creating a coherent account of all the available information is difficult. A useful way to conceptualize these wide-ranging results is to consider the association between cannabis and psychosis as it occurs within the context of widely used DSM-5 diagnoses. In the present review we examine cannabis/psychosis associations as they pertain to Cannabis Intoxication, Cannabis-Induced Psychotic Disorder, and Schizophrenia. This allows for an understanding of the cannabis and psychosis association along something approaching a continuum. Cannabis intoxication becomes Cannabis-Induced Psychotic Disorder once certain severity and duration criteria are met and Cannabis-Induced Psychotic Disorder is heavily associated with future schizophrenia diagnoses.