A psychiatry case study showed intravenous haloperidol effectively treated cannabinoid hyperemesis syndrome | Research

The takeaway

A case report of cannabinoid hyperemesis syndrome (CHS) required psychiatric consultation for diagnostic clarification and was successfully treated with intravenous haloperidol, highlighting an emerging role for psychiatrists in managing this cannabis-related disorder.

Emergency physicians and psychiatrists encountering treatment-resistant vomiting in cannabis users; gastroenterologists evaluating cyclic vomiting; patients with CHS.

IV haloperidol effectively resolved cannabinoid hyperemesis syndrome symptoms

What the researchers found

A patient with cannabinoid hyperemesis syndrome was initially misdiagnosed, requiring psychiatric consultation for proper identification.

CHS involves cyclic episodes of severe nausea and vomiting in chronic cannabis users, often with compulsive hot bathing for symptom relief. It resolves with cannabis cessation.

The patient was successfully treated with intravenous haloperidol, an antipsychotic not typically used for nausea but increasingly reported as effective for CHS.

The authors reviewed literature from emergency medicine, toxicology, and gastroenterology, including proposed diagnostic criteria and off-label treatment options for CHS, with emphasis on what consulting psychiatrists need to know about this condition.

Why it matters

CHS is increasingly common as cannabis use rises, but it is frequently misdiagnosed because many clinicians (including psychiatrists) are unfamiliar with it. Patients may undergo extensive and unnecessary gastrointestinal workups before the correct diagnosis is reached.

The numbers in context

Treatment with intravenous haloperidol was effective. Specific dosing and timeline details were reported in the case.

How the study worked

Single case report with literature review. Included proposed diagnostic criteria for CHS and review of treatment options across multiple medical specialties.

What this study cannot tell us

Single case report. Haloperidol effectiveness for CHS is based on case reports and small series, not randomized trials. The mechanism by which haloperidol helps CHS is not fully understood.

How to read the evidence

Preliminary. Single case report, though consistent with other case series reporting haloperidol effectiveness for CHS.

When this study was published

Published in 2018. CHS awareness and recognition has improved significantly since, with haloperidol becoming a more widely recognized treatment option.

The bigger picture

CHS challenges the perception that cannabis is without physical health consequences. As cannabis potency and daily use have increased, CHS has gone from a rare curiosity to a common emergency department presentation in areas with high cannabis use.

Questions still open

Is haloperidol more effective than traditional antiemetics for CHS? What percentage of chronic cannabis users eventually develop CHS? Could lower-potency cannabis products reduce CHS incidence?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition seen in chronic cannabis users involving repeated cycles of severe nausea, vomiting, and often abdominal pain. Many patients discover that hot showers or baths temporarily relieve symptoms. The only definitive treatment is stopping cannabis use.

Why would an antipsychotic help with vomiting?

Haloperidol acts on dopamine receptors in the brain, some of which are involved in the vomiting reflex. Cannabis affects the endocannabinoid system, which interacts with dopamine pathways. The exact mechanism for haloperidol effectiveness in CHS is still being studied, but it may work by resetting disrupted signaling in these pathways.

Read the original research

Cannabinoid Hyperemesis Syndrome and the Consulting Psychiatrist: A Case Study of Diagnosis and Treatment for an Emerging Disorder in Psychiatric Practice.

Journal of psychiatric practice, 24(1), 51-55

View on PubMed ↗Publisher’s paper ↗

Citation

Kast, Kristopher A; Gershengoren, Liliya. (2018). Cannabinoid Hyperemesis Syndrome and the Consulting Psychiatrist: A Case Study of Diagnosis and Treatment for an Emerging Disorder in Psychiatric Practice.. Journal of psychiatric practice, 24(1), 51-55. https://doi.org/10.1097/PRA.0000000000000279