Cannabis Triggered Catatonia So Severe It Caused Kidney Failure

What the researchers found

This case report describes a severe psychiatric emergency triggered by cannabis in a vulnerable individual. A 21-year-old male with a history of cannabis-induced psychosis had stopped taking his depot antipsychotic medication and resumed cannabis use. He then developed catatonia—a neuropsychiatric syndrome characterized by motor, behavioral, and autonomic disturbances.

His presentation included mutism, social withdrawal, psychomotor retardation, poor oral intake, thought blocking, waxy flexibility (limbs remaining in positions they're placed in), negativism, and stupor. These are classic catatonic features.

The catatonia then triggered a dangerous cascade of physical complications. Prolonged immobility led to rhabdomyolysis (muscle breakdown), evidenced by markedly elevated creatine kinase (CK). The muscle breakdown products damaged his kidneys (acute kidney injury with raised creatinine). He also developed sympathetic overactivity—autonomic instability that can be life-threatening.

Urine toxicology confirmed THC. Comprehensive workup (blood tests, CT head, chest X-ray) ruled out other organic causes, pointing to cannabis as the precipitant in the context of his psychiatric vulnerability.

This case illustrates the worst-case scenario of the gene-environment interaction: a genetically vulnerable individual (prior psychotic episode), non-compliant with treatment, re-exposed to cannabis, developing a cascade of psychiatric and medical emergencies.

Why it matters

Catatonia is under-recognized as a potential consequence of cannabis use, especially in psychiatrically vulnerable individuals. This case demonstrates that the psychiatric emergency (catatonia) can rapidly become a medical emergency (kidney failure, autonomic instability). Emergency physicians and psychiatrists need to consider cannabis as a catatonia precipitant and monitor for physical complications.

The numbers in context

21-year-old male. Prior cannabis-induced psychosis. Non-compliant with depot antipsychotics. Markedly elevated CK (rhabdomyolysis). Raised creatinine (AKI). Urine THC-positive. Comprehensive workup ruled out other causes.

How the study worked

Single case report of a 21-year-old male with prior cannabis-induced psychosis presenting with catatonia, rhabdomyolysis, AKI, and sympathetic overactivity. Diagnostic workup included CK, creatinine, urine toxicology, hematologic/hepatic/thyroid panels, CT head, and chest X-ray.

Who was studied

A 21-year-old male with a history of cannabis-induced psychosis.

What this study cannot tell us

Single case report—can't establish how common this cascade is. The patient had prior psychotic episodes and medication non-compliance, making it impossible to attribute the outcome solely to cannabis. No genetic testing was reported (RTHC-00202's CNR1 variant could have been informative). The severity of this case may not represent the typical cannabis-associated catatonia presentation.

How to read the evidence

Single case report—illustrates a rare but serious outcome in a vulnerable individual, not generalizable to typical cannabis users.

When this study was published

Published in 2025, adding to the case literature on severe cannabis-associated psychiatric emergencies.

The bigger picture

This represents the severe end of the cannabis-psychosis spectrum that RTHC-00201 quantified (4-fold risk, 10-fold with genetic vulnerability) and RTHC-00202 explored genetically. While most cannabis users never experience anything like this, individuals with prior psychotic episodes represent the highest-risk group. The treatment non-compliance dimension adds a clinical reality: patients with substance-use-driven psychosis frequently discontinue medications, creating a cycle of relapse and escalating severity.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

• How common is cannabis-precipitated catatonia in psychiatric populations? Should patients with cannabis-induced psychosis receive stronger counseling about the risks of re-exposure? Could early recognition and treatment of catatonia prevent the rhabdomyolysis-AKI cascade?

Read the original research

Cannabis-Induced Catatonia Complicated by Rhabdomyolysis, Acute Kidney Injury, and Sympathetic Overactivity: A Case Report.

Cureus, 17(11), e97507

Cureus is an open-access medical journal known for publishing case reports and clinical research.

Citation

Saira, Sidharth; Singh, Himanshi. (2025). Cannabis-Induced Catatonia Complicated by Rhabdomyolysis, Acute Kidney Injury, and Sympathetic Overactivity: A Case Report.. Cureus, 17(11), e97507. https://doi.org/10.7759/cureus.97507

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