A Diagnostic Dilemma Involving Dabs in First-Episode Psychosis.

Abstract

An 18-year-old female with no prior psychiatric history presented to a psychiatric unit with a self-inflicted neck stab wound secondary to experiencing command auditory hallucinations to inflict self-harm. In the initial interview, she had short, vague responses. She reported dabbing cannabis daily for 2 months before her presentation. Recent psychosocial stressors included a breakup with a boyfriend, the death of her dog, and unstable housing. She had no family history of psychiatric disorders. Her mother reported that 2 months ago she was at baseline attending high school and functioning independently, but more recently she began socially withdrawing, not attending school, and demonstrating speech latency. A video showed the patient internally preoccupied. Baseline serum laboratory results were fairly unremarkable with hypokalemia that resolved without intervention within 1 day (Table 1). A urine toxicology screen was positive for cannabis only. On presentation, she was managed with counseling and observation without an antipsychotic medication in hope that her symptoms would improve with cannabis abstinence. However, this approach was unsuccessful, and she was prescribed quetiapine, to which she responded poorly. She was transitioned to risperidone but continued to have evidence of psychosis marked by auditory hallucinations, delusions, thought insertion, speech latency, paranoia, and blunted affect. She required reminders to perform activities of daily living. After transitioning …