Understanding the dangers of synthetic cannabinoids

摘要

Here we present the case of a substance-induced mood disturbance resulting from the use of synthetic cannabi-noids. A 51-year-old man with a 30-year history of cannabis use and no psychiatric admissions presented with worsening passive suicidal ideation, anhedonia, and poor concentration. He had no family history of mood disorders. In addition, he had mood lability, agitation, irritability, and paranoia. Physical examination, laboratory examinations, and brain magnetic resonance imaging results were within normal limits. Urine toxicology was positive only for cannabis. He admitted to daily marijuana use; however, he indicated that 3 weeks before admission, he switched from marijuana to synthetic cannabis. He experienced no withdrawal symptoms from cessation of marijuana and found synthetic cannabis to have stronger euphoric and relaxation effects, only needing to smoke 1 joint, which was half of his typical daily use. He also mentioned the advantages of minimal odor and user-friendly delivery (smoked from a small pin-like device). He became more impulsive with subsequent interpersonal difficulties. He gradually improved with 200 mg of quetiapine taken over 1 week and attained eu-thymic mood with complete cessation of agitation, paranoia, and suicidal thoughts. This clinical improvement was sustained without psychotropics several months after discharge despite continued marijuana use and in the absence of any synthetic cannabinoids use.