Κάνναβη και Ψύχωση

Κάνναβη και Ψύχωση

Το παρακάτω κείμενο είναι μεταφορά μιάς ανασκόπησης που δημοσιεύτηκε στην επιστημονική διαδικτυακή πύλη “Psychiatric Times” 1

Η κάννναβη (χασίς) είναι η πιό διαδεδομένη παράνομη ουσία στις Ηνωμένες Πολιτείες της Αμερικής  και η χρήση της συνεχώς αυξάνεται (έχουμε βάσιμη πεποίθηση ότι αυτό ισχύει και για την Ελλάδα). Ταυτόχρονα αυξάνονται και οι ενδείξεις για τους κινδύνους που αυτή έχει για την ψυχική υγεία των χρηστών.2

Είναι πολλές οι ενδείξεις ότι η κάνναβη σχετίζεται με αρκετές ψυχικές διαταραχές και μάλιστα θεωρείται υπεύθυνη για μία ψυχωσική διαταραχή τύπου σχιζοφρένειας με ξεχωριστά δικά της χαρακτηριστικά. Η άγνοια αυτών των κινδύνων για την ψυχική υγεία, σε συνδυασμό με τις διάφορες παρεξηγήσεις που υπάρχουν γύρω από τη ιατρική χρήση της κάνναβης μπορεί να αποδειχτεί καταστροφική.

Πώς προκαλεί την ψύχωση η κάνναβη; (Νευροβιολογία)

Η χρήση της κάνναβης θεωρείται ένας παράγοντας που αυξάνει τις πιθανότητες εμφάνισης ψυχωτικού επεισοδίου ανάλογα και με τη διάρκεια και την ποσότητα που χρησιμοποιείται. Η ουσία που είναι υπεύθυνη γι αυτό είναι η 9δ-τετραϋδροκανναβινόλη (9delta-THC). Η ουσία αυτή παρεμβαίνει στο σύστημα ντοπαμίνης του εγκεφάλου όπως και η σχιζοφρένεια. Ο τρόπος που παρεμβαίνει όμως είναι διαφορετικός και εκεί φαίνεται ότι οφείλονται και τα διαφορετικά χαρακτηριστικά της 3 . Φαίνεται επίσης ότι και ορισμένοι γεννετικοί παράγοντες παίζουν ρόλο στο άν κάποιος χρήστης θα εμφανίσει ψύχωση από τη χρήση της κάνναβης 4 .

Ποιά είναι η εικόνα της ψύχωσης που προκαλεί η κάνναβη;

Μεγάλη συζήτηση έχει γίνει για το άν η ψύχωση που προκαλείται από την κάνναβη είναι κάτι το ξεχωριστό και όχι η αρχή μιάς σχιζοφρένειας. Πάντως είτε το ένα ισχύει είτε το άλλο, ένα πράγμα είναι σίγουρο: ότι υπάρχει μία σαφής σχέση ανάμεσα στην ψύχωση της κάνναβης και στη σχιζοφρένεια.

Παρόλα αυτά υπάρχουν και χαρακτηριστικά τα οποία διακρίνουν την ψύχωση που προκαλεί η χρήση της κάνναβης, από τη σχιζοφρένεια:

  • στην ψύχωση της κάνναβης έχουμε απότομη έναρξη των συμπτωμάτων δηλαδή των μεγάλων συναισθηματικών διακυμάνσεων (λύπη, χαρά, θυμός κλπ) αλλά και των παρανοϊκών συμπτωμάτων (“με κυνηγάνε”, “με δηλητηριάζουνε”, “με παρακολουθούνε” κλπ)
  • η ψύχωση της κάνναβης εμφανίζεται πολύ σύντομα (από μία μέρα έως μία εβομάδα) μετά τη χρήση
  • στην ψύχωση της κάνναβης έχουμε πιό συχνά τα λεγόμενα “θετικά” συμπτώματα όπως ιδέες μεγαλείου, παραληρήμα και ψευδαισθήσεις  και λιγότερο τα “αρνητικά” συμπτώματα όπως δυσχέρεια επικοινωνίας με το περιβάλλον, πτωχεία ιδεών και σκέψεων, διαταραχές του συνειρμού κλπ, τα οποία είναι και τα πιό χαρακτηριστικά της σχιζοφρένειας.
  • Το πιό χαρακτηριστικό ίσως σύμπτωμα το οποίο εμφανίζεται σε μεγάλο ποσοστό των ασθενών με ψύχωση από χρήση κάνναβης είναι η “κοινωνική φοβία” 5. Σχεδόν ο ένας στους 5 με ψύχωση που οφείλεται στη χρηση κάνναβης εμφανίζει αυτό το σύμπτωμα, ενώ στους “γνήσιους σχιζοφρενείς” το συμπτωμα αυτό εμφανίζεται σε ένα ποσοστό κάτω από το 4%.

Θεραπεία της ψύχωσης που προκαλείται από την κάνναβη

Τα φάρμακα που χρησιμοποιούνται για τη θεραπεία της ψύχωσης από κάνναβη είναι:

  • αλοπεριδόλη (Aloperidin)
  • oλανζαπίνη (Zyprexa)
  • ρισπεριδόνη (Risperdal)
  • αριπιπραζόλη (Abilify)
  • καρβαμαζεπίνη (Tegretol) *
Συμπέρασμα

Η θεραπεία της ψύχωσης από κάνναβη, είναι σε γενικές γραμμές δυσκολότερη από τη θεραπεία άλλων ψυχώσεων σχιζοφρενικού τύπου. Και ο λόγος είναι φανερός: πρέπει ο ασθενής, παράλληλα με τη θεραπεία που λαμβάνει, να απαλλαγεί και από την εξάρτησή του. Αυτό γίνεται κυρίως με ψυχοκοινωνικές παρεμβάσεις οι οποίες όμως έχουν περιορισμενη γενικά αποτελεσματικότητα.

Επειδή η νομιμοποίηση της χρήσης κάνναβης έστω για ιατρικούς λόγους, έχει παρατηρηθεί ότι αυξάνει τη χρήση και την κατάχρησή της, καλό είναι να έχουμε υπόψη μας και αυτόν το σημαντικό κίνδυνο.

DoctorBabis

Παραπομπές

1 Psychiatric Times. Access Date 25.7.2017
2 Fischer B, Imtiaz Z, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada–implications for public health focused intervention priorities. J Public Health. 2015;38:183-188.
3 Bloomfield MA, Morgan CJ, Egerton A, et al. Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biol Psychiatry. 2014;75:470-478.
4 Henquet C, Rosa A, Delespaul P, et al. COMT Val158Met moderation of cannabis-induced psychosis: a momentary assessment study of ‘switching on’ hallucinations in the flow of daily life. Acta Psychiatr Scand. 2009;119:156-160.
5 Ο όρος “κοινωνική φοβία” είναι συνώνυμος με τον όρο “αγοραφοβία”, που χαρακτηρίζεται από φόβο και μεγάλες ποσότητες άγχους όταν κάποιος εκτίθεται μπροστά στο κοινό: σε μιά ομιλία, σε μιά καφετέρια, σε μιά κοινωνική συνάντηση όπου νομίζει ότι όλοι ασχολούνται με αυτόν και ότι τον κριτικάρουν.
* Γιά λόγους αρχής, δίπλα στη δραστική ουσία αναγράφονται τα πρωτότυπα φάρμακα και όχι γενόσημα.

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