A 21-year-old male, an Engineering student, average in studies, with no family history of psychiatric illness, used to smoke Ganja (2–3 joints per day) since 2017, in gradually increasing amounts. In February 2018, he was not able to concentrate on his studies as earlier; also there was deterioration in his class performance. He developed sudden onset, gradually progressive suspiciousness that he is deliberately being targeted by people around him as he has the potential to become a great physicist. He started believing that some of his classmates are in collusion with unknown engineers and are trying to interfere with his studies using some dubbed-dormio device by which anyone's thought can be interfered with and can be read. By April 2018, his suspiciousness became firm and fixed that his thoughts are being interfered with by his persecutors and everyone around him is aware of whatever he was thinking and planning. During this period, he would not be able to move his right hand for hours together, believing that his persecutors had hacked his brain waves and thus paralyzed his hand. His family members took him to some traditional faith healer till July 2018, following which he had a gradual but complete recovery. From July 2018 to July 2019, he was occasionally consuming Ganja and was asymptomatic. From August 2019, he resorted back to 4–6 joints per day. In March 2020, he had relapse of symptoms in the form of sudden onset thought alienation, delusion of persecution, delusion of control with impaired judgment and insight. He was treated as an inpatient with tablet risperidone 3 mg and injection risperidone 50 mg fortnightly with which his symptoms resolved completely by August 2020. He stopped medications on his own in October 2020. Thereafter, he again resorted to his previous pattern of cannabis consumption, consuming 5–7 joints of Ganja per day. In January–February 2021, he developed sudden onset firm-fixed belief that his persecutors are using sound waves to interfere with his brain waves and extracting data out of his brain. He was convinced that they are doing it more in the night so as to hamper his sleep and to make him mad. He also believed that COVID pandemic is a big scam and instead of virus it is his persecutors only who have now started targeting other people also, making them seriously ill. He even filed a complaint to Cyber Crime Bureau on February 16, 2021. With these complaints, he was brought to OPD on February 10, 2021.

Physical examination was normal. Mental state examination revealed an ill-kempt individual with scanning looks. He had a fearful affect with restricted range and reactivity, congruent with his thought process. He had delusion of persecution and control. There were no disorders of form of thought, hallucinations, or illusions. He had a poor insight into his illness and had initial insomnia. Positive and Negative Syndrome Scale revealed P26N07G40. His hematological, biochemical parameters and magnetic resonance imaging brain were within normal limits. His urine drug screen test was positive for tetrahydrocannabinol.

A diagnosis of schizophrenia was considered, but in view of temporality, coherence of evidence, specificity of association, consistency of findings, biological plausibility, and dose-response relationship CIP could not be ruled out completely. He was treated with long-acting injectable, injection paliperidone 150 mg under cover of tablet risperidone 4 mg and short course of benzodiazepines. His symptoms resolved partially in the next 6 weeks. At present, he is in acute phase management on outpatient basis.