Behavioral Patterns of Psychiatric Patients Using Synthetic Cannabinoids

Synthetic cannabinoid use is rising in inner urban U.S. communities due to easy accessibility despite Schedule I classification. These substances can cause medical and psychiatric effects including vomiting, tachycardia, seizures, auditory hallucinations, aggressive behavior, and increased impulsivity. A retrospective case-control study of patients admitted to an inpatient psychiatric service over 7 months who reported smoking synthetic cannabinoids aimed to explore clinical risk factors, aggressive behavior during hospitalization, and whether use increases hospitalization duration. The authors highlight the need for further research to manage this patient population, noting that synthetic cannabinoid screening is not readily available and intoxication is diagnosed clinically.

Study at a glance

Abstract

Synthetic cannabinoids (SC) are analogs of natural cannabinoids that are chemically synthesized. These compounds are used frequently in the community as illicit substances. Literature review indicates that its use is increasing due to its easy accessibility despite it being placed under Schedule I of the Synthetic Drug Abuse Prevention Act of 2012. SC is readily found in most inner urban communities across the United States and its abuse is increasing at a high rate. Studies suggest that SC can result in medical and psychiatric manifestations including: vomiting, tachycardia, seizures, auditory hallucinations, aggressive behavior and an increase in impulsivity. The increase in prevalence compounded with the potentially devastating psychiatric sequelae raise concerns for mental health practitioners. While some literature exists that reviews the psychiatric manifestations of patients who use SC, there are no studies that review the presentation of patients of patients behavior’s while intoxicated At this time SC drug screening is not readily available in most hospital centers and intoxication with SC is primarily based on a clinical evaluation, patient’s self-report or collateral information. We conducted a retrospective case control study of patients who were admitted to the inpatient psychiatric service for a period of 7 months from who reported smoking SC. This paper will attempt to explore specific clinical risk factors of patients that use SC and the aggressive behavior of these patients while hospitalized as well as whether this increases duration of hospitalization and management on the unit In addition, we aim to bring to light the need for future investigations to better understand how to manage this difficult patient population. Introduction Synthetic cannabis is a designer drug in which herbs or other leafy materials are sprayed with lab-synthesized liquid chemicals to mimic the effect of tetrahydrocannabinol (THC), the psychoactive ingredient in the naturally grown marijuana plant (cannabis sativa). It acts as an agonist at cannabinoid receptors located throughout the brain therefore impacting mood, appetite, pain and immunity. Currently, there are over 700 researched cannabinoid (CB) receptors identified with CB1 and CB2 resulting in psychoactive effects [1]. The CB1 receptor is predominantly expressed presynaptically, modulating the release of neurotransmitters including GABA, dopamine, noradrenaline, glutamate and serotonin [1]. While SC use has been known to cause hallucinations and psychosis, the manner in which SC affects the release of these neurotransmitters is not fully understood and may entail abnormal dopaminergic transmission, serotonergic transmission and N-methyl-D-aspartate blockade, similarly to the drugs phencyclidine and Ketamine. Like THC, the psychoactive ingredient in marijuana, SC binds to CB1 receptors located throughout many brain regions including the hypothalamus, the cerebral cortex and the cerebellum. When SC binds, it acts as a full agonist, therefore activating a CB1 receptor on a brain cell with maximum efficacy, rather than partially as with THC [2]. Subsequently, SC can potentiate psych