Symptom resolution in acute mania with co-morbid cannabis dependence

Abstract

Context : Though the co-morbidity of cannabis use disorder is common in patients of bipolar disorder, there is a paucity of Indian studies evaluating the effects of cannabis on symptoms of bipolar disorder. Aim : To study pattern of resolution of symptoms of acute psychotic mania with and without co-morbid cannabis dependence. Materials and Methods : Thirty inpatients of acute psychotic mania with co-morbid cannabis dependence (Group-I) and 30 without co-morbid cannabis dependence (Group-II) were assessed on day-0, day-7, day-14, day-21, day-28, and day-42 for manic and psychotic symptoms with the help of Young Mania Rating Scale (YMRS) and the Brief Psychiatric Rating Scale (BPRS). Results : Acute phase treatment response was noticed around day 21-28 of admission in majority of the patients of both groups. Both the groups were comparable on manic and psychotic symptoms prior to day-28 assessment. Patients of Group-I obtained significantly higher mean score of the item 'irritability' of YMRS and 'psychological discomfort' subscale of BPRS on day 28 and day 42. Group-I patients required significantly higher doses of mood stabilizers and antipsychotics compared to Group-II patients. Conclusion : Patients of mania with co-morbid cannabis dependence showed delayed resolution of manic and psychotic symptoms, specifically irritability and psychological discomfort, and needed higher doses of medication for control of symptoms in comparison to mania patients without co-morbid cannabis dependence. Comprehensive evaluation of patients with bipolar disorder should include a detailed assessment for cannabis use disorder.