| Journal | Cureus |
| Study Type | Clinical Study |
| Population | Human participants |
This case report highlights an underrecognized presentation of cannabis-induced psychosis that may challenge diagnostic acuity in clinical practice. Somatic delusions like delusional infestation can masquerade as dermatological or neurological conditions, potentially leading to delayed psychiatric intervention and unnecessary medical workups.
A 49-year-old man with chronic daily cannabis use developed Ekbom-like syndrome characterized by delusional infestation, persistent pruritus, and tactile hallucinations. Extensive medical workup including dermatological, neurological, laboratory, and imaging studies revealed no organic etiology. The patient demonstrated fixed somatic delusions with absent insight. Treatment with olanzapine and psychoeducation resulted in gradual symptomatic improvement, supporting a cannabis-induced psychotic etiology.
“This case reinforces my clinical experience that cannabis-induced psychosis can present in unexpected ways beyond the classic paranoid or disorganized presentations we typically recognize. The somatic nature of this patient’s delusions could easily mislead clinicians away from considering substance-induced psychosis as the underlying diagnosis.”
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Table of Contents
- FAQ
- What is the link between chronic cannabis use and psychosis risk?
- What is Ekbom-like delusional infestation and how does it relate to cannabis use?
- How should clinicians evaluate patients presenting with delusional infestation symptoms who use cannabis?
- What treatment approach is effective for cannabis-induced somatic delusions?
- Why might cannabis-induced somatic psychosis be diagnostically challenging?
FAQ
What is the link between chronic cannabis use and psychosis risk?
Chronic use of high-potency cannabinoids has been consistently associated with increased psychosis risk, particularly with early onset, daily use, and prolonged exposure. This risk includes both typical psychotic symptoms and atypical somatic presentations that may be underrecognized in clinical practice.
What is Ekbom-like delusional infestation and how does it relate to cannabis use?
Ekbom-like delusional infestation is characterized by persistent itching, tactile hallucinations, and fixed somatic delusions about being infested with parasites or insects. This case report demonstrates that cannabis-induced psychosis can present with these atypical somatic symptoms rather than classical psychotic features.
How should clinicians evaluate patients presenting with delusional infestation symptoms who use cannabis?
A comprehensive evaluation should include dermatological and neurological assessments, routine laboratory investigations, and neuroimaging to rule out organic causes. Mental status examination should assess for structured somatic delusions and evaluate insight, while taking a detailed substance use history.
What treatment approach is effective for cannabis-induced somatic delusions?
Treatment with antipsychotic medication (such as olanzapine) combined with psychoeducation has shown effectiveness. This case demonstrated gradual symptomatic improvement with this combined approach, emphasizing the importance of addressing both the psychotic symptoms and patient education.
Why might cannabis-induced somatic psychosis be diagnostically challenging?
Atypical somatic presentations of cannabis-induced psychosis may be underrecognized because they don’t present with classical psychotic symptoms. Patients may initially seek dermatological or medical care rather than psychiatric evaluation, potentially delaying appropriate diagnosis and treatment.