Cannabis-induced obsessive-compulsive disorder: Is it a paradox?
Department of Psychiatry, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
Consultant Pediatrician, Ram Sagar Mishra Combined Hospital, Lucknow, Uttar Pradesh, India
Address for correspondence: Dr. Rashmi Shukla, Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Raebareli - 229 405, Uttar Pradesh, India. E-mail: drrashmikgmu06@gmail.comAbstract
The case of a 22-year-old man with cannabis-induced obsessive-compulsive disorder (OCD) is described in this case report. There is ample literature available regarding cannabis-induced psychotic and mood symptoms but there is dearth of literature about cannabis association with OCD. The importance of recognising cannabis-induced OCD is emphasized, given that in literature, it can be used in ameliorating OCD in a few studies. Nevertheless, further research is needed to explore the neurobiological underpinning of both cannabis abuse and OCD to find out the link and complex interplay between addictive, impulsive and compulsive behaviours before using it as a treatment option.
Cannabis use has been linked to psychiatric disorders. However, there is dearth of literature studying the link between cannabis use and obsessive-compulsive disorder (OCD). Only three case reports to date describe how cannabis affects OCD. Furthermore, these case reports utilize cannabinoids therapeutic potential.[1] On the other hand, an online survey with a large sample size infers that OCD severity is significantly and positively related to cannabis misuse.[2] Here, we report a case of cannabis-induced OCD mixed type to highlight the paradox of cannabis therapeutic potential in psychiatric disorders.
CASE DESCRIPTION
A 22-year-old male with no past psychiatric or family history presented with repetitive thoughts of contamination and hand washing for 3 years. He reported seeing images of dead people repetitively and images get cleared when he counts to any specific number. He expressed irrationality of thoughts along with the distress with feeling of relaxation following washing and counting. Further exploration revealed that he started consuming cannabis around the same time. Gradually, the intake increased from 1 pellet of around 2 g to 30 pellets over the period of the 5–6 months. Delineation of symptoms shows that the OCD symptoms started after 2–3 months of cannabis use and worsening of symptoms with increased intake. In between, due to family pressure, he was abstinent from cannabis for around a year. During this period, symptoms also disappeared. Unfortunately, under peer pressure, he again consumed cannabis, and this time, as soon as he started cannabis, OCD symptoms resurfaced with severe intensity, leading to the present consultation, which suggested temporal correlation of OCD symptoms due to cannabis use. Yale-Brown obsessive-compulsive scale (Y BOCS score 28) showed severe symptoms with limited functioning. Considering the severity, patient wish, and level of impairment, he was started on fluoxetine, increased up to 60 mg along with cannabis abstinence. In 6 weeks' follow-up, the YBOCS score came down to 23 with reduction in symptoms and improvement in functioning.
DISCUSSION
Recent data indicated that the endocannabinoid system may play a role in the pathophysiology of OCD.[3] One study found that cannabis use may worsen OCD symptoms during adolescence,[4] which is a similar finding in our case. On the other hand, a few other studies reported OCD symptoms subsided or reduced following treatment with cannabinoids.[567]
The potential therapeutic benefits and risks of cannabis were thoroughly evaluated in a recent report by the National Academies of Sciences, which came to the conclusion that there are still significant gaps in the scientific literature.[8] Additionally, some clinicians are directly prescribing cannabis for anxiety and depression, which seems worrying in the absence of strong evidence.[9]
At present, the evidence on the effects of cannabinoids on OCD is conflicting with paucity of literature investigating the link between the two. Therefore, it is still too early to say that cannabinoids have a beneficial effect in alleviating OC symptoms. Findings in our case indicate that there may be an association between OCD and cannabis misuse, which needs further research into the neurobiological underpinnings to establish its therapeutic or harmful potential.
Declaration of patient informed consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.