Cannabis withdrawal clinically significant in schizophrenia

By Mark Cowen, Senior medwireNews Reporter

Cannabis withdrawal symptoms are clinically significant in schizophrenia patients as they are often associated with behavioral change, say researchers.

David Gorelick (National Institutes of Health, Baltimore, Maryland, USA) and team found that most cannabis-using schizophrenia patients report a variety of withdrawal symptoms when trying to quit the drug.

"More research is needed to evaluate the effects of cannabis in people with schizophrenia and how withdrawal symptoms affect psychosis, relapse to cannabis use, and quality of life," they write in the Journal of Psychiatric Research.

All 120 participants (76.7% men), who were aged at least 18 years, used cannabis on at least a weekly basis before their quit attempt. Of these, 16.7% met putative DSM-IV diagnostic criteria for cannabis abuse and 81.7% met criteria for cannabis dependence.

The 176-item Marijuana Quit Questionnaire (MJQQ) was used to assess all of the participants for withdrawal symptoms during an index quit attempt.

The team found that 94.2% of the participants reported experiencing withdrawal symptoms, with 74.2% reporting four or more symptoms.

The most common symptom was cannabis cravings (59.2%), followed by feeling anxious (52.6%), feeling bored (47.5%), feeling sad or depressed (45.8%), feeling irritable or jumpy (45.0%), feeling restless (43.3%), and difficulty falling asleep (33.3%).

There was a significant positive association between total number of withdrawal symptoms and the mean number of joints smoked on each occasion during the month prior to the quit attempt, the researchers note.

Overall, 92.0% of participants took some action to relieve at least one of their withdrawal symptoms, with 23.0% resuming cannabis use.

Almost two-thirds (63.3%) of patients relapsed after their index quit attempt, with a median time to relapse of 182 days.

Gorelick et al conclude: "These [cannabis] withdrawal symptoms warrant clinical attention because they are often associated with clinically significant behavior change, including relapse to cannabis use and increased tobacco use.

"Thus, our findings suggest that cannabis withdrawal is a clinically significant feature of cannabis use among people with schizophrenia, as it is among those without serious psychiatric illness, and deserves greater attention in treatment and research."

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