6.7 Cannabis-Induced Mania and Psychosis in Young Adult Males With Autism Spectrum Disorder: A Case Series and Literature Review

Abstract

This study reviews the current literature on cannabis use for behavioral concerns in autism spectrum disorder (ASD) and describes 3 young adult males with ASD who developed mania or psychosis after the consistent use of cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). The literature was searched using PubMed and Google Scholar for any studies on cannabis use for ASD behavioral symptoms. The key words used included: autism spectrum disorder, ASD, cannabis, CBD, THC, behavioral symptoms, irritability, agitation, aggression, self-injury, mania, and psychosis. We excluded manuscripts that were not in English. Three cases of cannabis-induced mania or psychosis in ASD patients were fully reported. The studies found included retrospective analyses of case series, multiple short review articles, and few experimental uncontrolled trials. Despite the potentially promising findings for behavioral symptoms, significant concerns and adverse effects such as restlessness, irritability, and psychoactive symptoms have been reported. Several studies implicate abnormalities in specific neurotransmitters in patients with ASD, which may be perpetuated by dysfunction in the endocannabinoid system. CBD and THC may propagate endocannabinoid dysregulation and GABA/glutamate imbalances in those with ASD, which may be linked to the development of bipolar and/or psychotic disorders. Also, there is significant genetic overlap between ASD, bipolar disorder, and schizophrenia. In the 3 cases we reported, there was a family history of mental health disorders. Each case was diagnosed with cannabis-induced mania or psychosis, after sustained use of mixtures of CBD and THC compounds. There is scant controlled research on the use of cannabis for the treatment of behavioral concerns in patients with ASD. Although cannabis has been beneficial in certain psychiatric and medical applications, there are many factors to consider when contemplating its use for the treatment of aggression, irritability, and other interfering symptoms in individuals with ASD. Caution should be used until larger-scale, replicated randomized controlled trials demonstrating efficacy, safety, and tolerability have been published. This is especially true in those with a family history of mental health disorders, as seen in the 3 cases presented.