This is my first blog. I never intended to write a blog because I always felt if I had the extra attentional resources after teaching as a professor (and related duties) and seeing clients as a therapist (and related duties), such resources would be best utilized for my research endeavors, including publications as a research neuroscientist. However, I have decided to use this platform as a much-needed distraction from my work. I plan to write these posts without leaving the reader mired in the technicalities of scientific and medical jargon; yet, I will still utilize this platform as an educator explaining such terms in simple language. For these posts, I have decided to share my organic thought processes around reading a scientific article (or related media) that interested me and explain how I have integrated the information with my cumulative knowledge (in psychology, this is called crystallized intelligence) and experience to make sense of it.
This article is a case study about a woman who used synthetic cannabinoids once and developed catatonia and paranoia (Puri, Costanzo, Rivera & Bujdos, 2024). Here is a link. In simplest terms, catatonia is often seen where an individual appears physically frozen or immobilized in a position, often for hours at a time. Such individuals tend to be unresponsive to others or the environment around them. Paranoia is a term used to describe false beliefs (not based in reality) that include mistrust of other people and/or their actions to the point of fearing for one's safety or security, and is part of psychosis which includes schizophrenia. Synthetic cannabinoids are man-made substances that work on the same neurochemical system as marijuana (THC), but are much more potent which can lead to extreme effects.
As a senior in high school (1988-1989), I took a psychology course as an elective. In that course, we studied many things. I remember learning about various types of schizophrenia, including catatonic schizophrenia. The teacher gave the example of catatonia in the character, Chief Bromden, from the 70s movie One Flew Over the Coocoo's Nest (Forman, 1975). That was when I first learned about catatonia.
On October 12, 2013, as a postdoc in neurology at BU working with those with Parkinson's disease (a movement disorder), I attended a clinical training "Bridging Neurology & Psychiatry: Movement Disorders" by The Society for Worldwide Medical Exchange at Harvard Medical School (Friedman, 2013). That was when I first learned about catatonia being treated and even reversed with the use of high-dose benzodiazepines. In this case study, this was the primary treatment for the catatonia.
In January 2014, I first learned about marijuana being related to psychosis and schizophrenia after submitting my DNA sample to 23andme. I exported my data and ran it through various anonymous databases to look for more information than was provided by the medical info on 23andme. I discovered a gene [rs 6277] was associated with schizophrenia and THC use. From there, I traveled down a rabbit hole of research suggesting a correlation, not necessarily causation, between THC use and psychotic symptoms and even schizophrenia. [For information on scientific research, refer to PubMed.]. However, based on the latest research from the aforementioned link, it appears to be a causal relationship and that there are some genes whose expressions can be changed by the environmental influence of chronic THC use; this results in the phenotype of schizophrenia. This gene-environment interaction is called epigenetics. [genotype × environment (GxE) interaction effect]
To understand any behavior (phenotype; most psychiatric disorders and behaviors), we need to look at the interaction of various genes (genetic
variants or genotypes) with one another and their
interaction with numerous environmental factors.
In my opinion, much of the controversy surrounding this connection comes from people enjoying THC so much that this caused cognitive dissonance (a conflict between one's behavior and concern about external evidence and possible risk). In other words, people refuse to accept the possibility of an increased risk of developing schizophrenia as they enjoy using marijuana too much to stop; thus, they rid themselves of this conflict or dissonance with denial.
A schoolmate of mine developed schizophrenia and had used THC chronically for decades. He argued with me on social media repeatedly that there was no connection and that THC made his schizophrenia better. Although, he did not have schizophrenia in any obvious way until after years of chronic THC use. Again, the current research suggests this is not just correlation but actual causation. Furthermore, this appears to be present in this very case study, with clear paranoia and catatonia associated with the use of a synthetic cannabinoid.
Additionally, in my opinion, many people feel marijuana is safe for everyone simply because it is legal now in most states. There are many things that are legally available for consumption that are not safe for everyone. Caffeine has a pressor effect (raises blood pressure) and may neither be safe for those with hypertension (high blood pressure) nor helpful for those with anxiety disorders due to stimulation of the sympathetic nervous system leading to a fight-or-flight response. Refined carbohydrates might not be ideal for consumption in large quantities by those with diabetes. Alcohol might not be ideal for those with an alcohol use disorder (AUD, AKA alcoholism) or those with cirrhosis of the liver. Finally, marijuana and synthetic cannabinoids may not be safe for use by everyone, especially those with a personal psychiatric history, a family psychiatric history of psychosis or schizophrenia, or those with specific genes that change their expression due to chronic exposure to THC. Don't get me started on what THC does to users whose frontal lobes are not fully myelinated (i.e., those under 30) or those with frontal lobe disorders like ADHD!
References
Forman, M. (Director). (1975) One flew over the cuckoo's nest. [Film]. Fantasy Films.
Friedman, J. H. (2013). Announcing a new continuing medical education course: “Bridging
neurology and psychiatry: Movement disorders." Cognitive and Behavioral Neurology,
26(2), 56–58. https://doi.org/10.1097/wnn.0b013e31829af2fb
Puri, A., Costanzo, F., Rivera, J., & Bujdos, J. (2024). Catatonia induced by first-time use of
synthetic cannabinoids: A case report. Cureus. 16(1): e53324.
doi: 10.7759/cureus.53324
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