Psychotic patients who used cannabinoids showed different inflammation patterns linked to symptom severity | Research

The takeaway

Among 119 acutely psychotic inpatients, those who tested positive for cannabinoids showed a different relationship between inflammation (IL-6) and psychosis severity than cannabinoid-negative patients, and synthetic cannabinoid users were more likely to need emergency sedation.

Psychiatrists, emergency medicine physicians, and researchers studying inflammation in psychosis.

IL-6 negatively correlated with psychosis severity in cannabinoid users

What the researchers found

While PANSS psychosis scores were similar between groups, cannabinoid-positive patients showed a negative correlation between IL-6 levels and psychosis severity, meaning higher inflammation was associated with lower symptom scores. Synthetic cannabinoid-positive patients were more likely to require emergency agitation medication.

Why it matters

The inverse relationship between IL-6 and psychosis severity in cannabinoid users suggests that cannabinoids may alter the typical inflammation-psychosis connection, potentially through immunomodulatory effects.

The numbers in context

59 cannabinoid-positive vs. 60 cannabinoid-negative patients. IL-6 negatively correlated with PANSS total (p=0.040), positive (p=0.035), and negative (p=0.024) subscales in cannabinoid-positive group.

How the study worked

Cross-sectional study comparing 59 acutely psychotic inpatients with positive cannabinoid toxicology (natural and/or synthetic) to 60 patients with negative cannabinoid toxicology. Inflammatory markers and PANSS scores were measured.

What this study cannot tell us

Cross-sectional design cannot establish causation. The cannabinoid-positive group included both natural and synthetic users. IFN-gamma differences were not significant after adjusting for covariates.

How to read the evidence

Moderate: controlled comparison with objective toxicology, though cross-sectional and modest sample size.

When this study was published

Published in 2020 in Psychiatry Research.

The bigger picture

If cannabinoids modify the inflammatory component of psychosis, this could explain why some cannabinoid-using patients present differently from non-using patients and might respond differently to anti-inflammatory interventions.

Questions still open

Why is the IL-6-psychosis relationship reversed in cannabinoid users? Do synthetic cannabinoids pose a greater agitation risk than natural cannabis? Could anti-inflammatory treatments work differently in cannabinoid-using psychotic patients?

Common questions

Why did cannabinoid users need more emergency medication?

Particularly those who tested positive for synthetic cannabinoids were more likely to require PRN (as-needed) medication for agitation in the emergency room, suggesting synthetic cannabinoids may produce more acute behavioral disturbance.

What does the IL-6 finding mean?

Normally, higher IL-6 (an inflammatory marker) correlates with worse psychosis. In cannabinoid-positive patients, this relationship was reversed, possibly because cannabinoids have immunomodulating properties that change how inflammation relates to symptoms.

Read the original research

Cannabinoid use in psychotic patients impacts inflammatory levels and their association with psychosis severity.

Psychiatry research, 293, 113380

View on PubMed ↗Publisher’s paper ↗

Citation

Gibson, Claire L; Bassir Nia, Anahita; Spriggs, Sharron A; DeFrancisco, Daniel; Swift, Amy; Perkel, Charles; Zhong, Xiaobo; Mazumdar, Madhu; Fernandez, Nicolas; Patel, Manishkumar; Kim-Schulze, Seunghee; Hurd, Yasmin L. (2020). Cannabinoid use in psychotic patients impacts inflammatory levels and their association with psychosis severity.. Psychiatry research, 293, 113380. https://doi.org/10.1016/j.psychres.2020.113380