Psychotic Symptoms in Marijuana Smokers

When marijuana use triggers psychosis, there may be several different symptoms, all characterized by a break with reality. Common symptoms of cannabis-induced psychosis are paranoid delusions, suspiciousness, and a sense of grandiosity. Other potential symptoms include hallucinations, dissociation or a feeling of detachment and unreality, disorganized and disturbed thoughts, inappropriate emotional responses, and unusual changes in behavior. In most cases symptoms resolve once drug use is stopped.

Psychotic symptoms are all characterized by a loss of touch with reality. While most people who use marijuana will never experience this, use of cannabis can trigger an episode of psychosis. It can cause symptoms like hallucinations, delusions, disordered thoughts, unusual behaviors and emotional responses, paranoia, suspicion, and others.

When cannabis triggers psychosis the episode is usually acute and resolves soon after the psychoactive substances in the drug have left the body. In some cases, though, there may be an underlying mental illness that made it more likely the drug would cause psychotic symptoms. In either case it is important to seek help from a mental health professional, for immediate treatment, for mental health screening, for substance abuse treatment, and, if necessary, for ongoing treatment for a mental illness or psychotic condition.

Psychosis Defined


Psychosis is not a mental illness; rather, it is a set of symptoms often caused by mental illness and that make a person feel detached from reality in some way. One of the most common types of psychotic conditions is schizophrenia, but many other mental illnesses may trigger psychosis. For instance, the manic phase of bipolar disorder can cause psychosis, as can severe episodes of major depression or postpartum depression.

Psychotic symptoms, regardless of their cause, are characterized by a break from reality. Two of the most characteristic symptoms of psychosis are hallucinations and delusions. To hallucinate is to hear, see, feel, or in other ways sense something that isn’t real. To be delusional means to have persistent false beliefs, even when there is evidence to contradict those beliefs. Psychosis can also cause chaotic thoughts, changes in emotional affect, feelings of detachment, and a sense that things or people aren’t real.

Cannabis-Induced Psychosis


While psychosis is most often associated with other mental illnesses, substances can also trigger it. Marijuana may trigger an episode of psychosis, although this reaction is not very common. In most cases when it does occur, the psychosis is acute. This means it begins suddenly and stops once the drug has left the individual’s system. Some people may need emergency treatment, as the symptoms can be very distressing. Treatment usually involves placing the person in a calm environment and administering antipsychotic medication.

While cannabis-induced psychosis is usually acute, for some people the psychotic episode may be more chronic. This is more likely in a person who has an underlying mental illness. There is a connection between marijuana use and psychotic conditions like schizophrenia. It is not known if marijuana use contributes to the development of schizophrenia, but evidence does suggest that it can trigger episodes in someone who has schizophrenia or it may cause the onset of the illness in someone predisposed to it. It is also well known that someone with a mental illness is more likely to use marijuana, probably as a way to self-medicate.

Pre-Psychosis Symptoms


When marijuana use triggers psychosis the symptoms often set in quickly and without much warning. But everyone’s experience is unique and there may be warning signs that someone is beginning to develop psychotic symptoms. This is called pre-psychosis or early psychosis. Some of the characteristics and early warning signs include:

  • Depression
  • Anxiety
  • Withdrawal
  • Paranoia
  • Anger and agitation
  • Inappropriately strong emotional reactions
  • Lack of emotional response
  • Difficulty thinking clearly or concentrating
  • Speech that doesn’t make sense

Someone who is experiencing these signs while using marijuana could be vulnerable to experiencing a more severe psychotic episode. It is important to be aware of the possibility and to seek medical attention if necessary. Psychosis can be distressing and can in some cases cause someone to be at risk of harming themselves or others. If medical or mental health care can be given during an early stage of psychosis it may be possible to help the individual feel safe and secure in the event symptoms get worse.

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Symptoms of Cannabis-Induced Psychosis


Cannabis-induced psychosis is a real mental health condition, although it is one that typically does not persist. It can be diagnosed using the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders. The diagnostic manual states that the condition causes psychotic symptoms either during use of marijuana, during withdrawal from it, or within one month after using it. The symptoms must be severe enough to cause impairment in a person’s ability to function, and they cannot be better explained by another mental illness, like schizophrenia. Symptoms that cannabis-induced psychosis causes include:

  • Delusions. Delusions are beliefs that are false. A person who is delusional continues to have these beliefs even without any evidence they are true and even when there is clear evidence that they are false. With marijuana-induced psychosis, paranoia and suspicion of other people are common delusions. Another common delusion is one of grandiosity, that a person can do more or is capable of more than they really are.
  • Hallucinations. Psychosis also often causes hallucinations, which are sensations that a person believes are real but don’t actually exist. These can be auditory, such as hearing voices, or they can be visual, causing images and scenes that aren’t really there. Hallucinations may also involve other senses, including touch and smell.
  • Dissociation. Dissociation is a sense that one is not connected to the real world in some way. One type, depersonalization, makes a person feel they’re outside of their own body. De-realization occurs when a person believes the things and people around them aren’t real.
  • Disorganized thoughts. Disordered and chaotic thought processes as well as persistent and disturbing thoughts are common characteristics of psychosis. It can become very difficult to think clearly or to focus on anything during a psychotic episode. To an observer, this psychosis symptom makes it seem as if a person is speaking nonsense. Speech can be garbled or jump around to so many different things that it is difficult to understand what they are saying.
  • Affect and behavioral changes. Affect, or the experience of emotions, can be disturbed by psychosis. This can cause a person to react, behave, or express emotions in ways that seem inappropriate. The changes can be exaggerated, such as when a person becomes highly agitated, angry, or irritable. Psychosis can also cause affect to be less than it should. It can cause a person to be flat or unemotional and, in extreme cases, even catatonic.

Can Psychotic Symptoms Be Dangerous?


By far, most people who experience psychosis are not dangerous. There is, however, always a possibility that someone who has lost touch with reality will exhibit behaviors that pose a risk to themselves or to those around them. Delusional thinking, for instance, may cause someone to firmly believe that their best friend is out to get them, and they may feel they need to protect themselves. Paranoia is one of the more common delusions triggered by marijuana use.

Another possibility is that a person may have delusions of grandiosity that lead them to engage in behaviors that are very risky and dangerous. This might include reckless driving, jumping from a height, or any other activity they would normally not attempt. In this way, psychosis can potentially cause harm to the person experiencing it. It is important to get help if someone has these symptoms and it seems as if they might cause harm or do something dangerous.

Treating the Symptoms of Cannabis-Induced Psychosis


Not everyone who experiences psychosis from marijuana use will seek treatment. But, when the symptoms are severe, treatment can help calm the individual and keep them safe. Emergency treatment involves helping the person to an environment that is quiet and calm, with restraint if necessary. They may also be given an antipsychotic medication to relieve the symptoms.

This kind of treatment is a short-term solution. It helps an individual in the moment, but many people who have psychotic episodes can benefit from ongoing care. Treatment to help them stop using marijuana and other substances, and screening and treatment for any underlying mental illnesses, are important for long-term wellness.

Psychosis caused by marijuana may truly be a one-time incident, never to be repeated. But, in many instances, cannabis-induced psychosis is indicative of other mental illnesses, substance use disorders, or both. It is important to be evaluated by a mental health professional so that treatment can be planned to help with these issues and to minimize the risk of having another psychotic episode.