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|Title||Mitigation of post-traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence.|
|Author(s)||Passie T, Emrich HM, Karst M, Brandt SD, Halpern JH.|
|Journal, Volume, Issue||Drug Test Anal. 2012 Jun 26. doi: 10.1002/dta.1377. [Epub ahead of print]|
|Major outcome(s)||Cannabis reduced course and intensity of symptoms.|
|Indication||Posttraumatic stress disorder||Abstract|
From about the age four, the patient was a victim of long-time sadistic sexual abuse by his father and paternal uncle, which continued until age 15 when he attempted to commit suicide for the second time following the first suicide attempt two years earlier. Since then, this patient has been closely followed in outpatient psychiatric clinics. Because he was not diagnosed with PTSD at first, he did not receive treatments specific to PTSD for years. We first saw the patient in April 2004 when he was admitted to an acute psychiatric ward of our department for safety and stabilization during a crisis with severe, uncontrolled flashbacks, panic attacks, and impulses for self-mutilation. His physical examination was without abnormalities and drug testing was negative. Usually, he was treated during/after these states with sublingual lorazepam up to 10mg/day. In a typical and severe flashback episode, this patient appeared in a dissociative state with complete loss of self-control. He would cry intensely, fall down, thrash about uncontrollably, and did not appear to have any cognitive or emotional control over re-experiencing past trauma. Immediately after such episodes, the patient would experience severe urges for self-mutilation. Such urges had resulted in severe self-injury in the past (mainly lacerations from cutting with knives). After a few days of treatment and stabilization he was referred back to the inpatient psychotherapy treatment centre, and following a few weeks of suffering from the same range of symptoms, his condition improved dramatically. This improvement, which surprisingly stabilized over the next months, could not be explained by any other means by the staff of the inpatient treatment center. The patient was re-admitted to our clinic in November 2004 with similar symptoms but this time he told the psychiatric team he could now control himself much more before and during the upcoming flashbacks. Drug testing was negative with the exception of THC. When he was asked what his idea was about the improvement of his condition, he confessed that he had learned to smoke cannabis resin from some other inpatients. He had discovered that he could prevent dissociative states by smoking cannabis when he first felt reactivation and intensification of traumatic memories experienced as flashbacks. Although he still experienced flashback phenomena after the use of cannabis, he would smoke cannabis to alter their course and intensity. The patient described that cannabis use would assist him with the increased ability to maintain cognitive control. Though it did not eliminate traumatic images, cannabis allowed the patient to view them on an ‘inner screen’ from a distance. It should be mentioned that this patient never underwent specific PTSD-screening procedures for the treatment of intrusive flashback memories. The urge for self-mutilation was also reduced when he smoked cannabis immediately after experiencing flashbacks. Sometimes he could not only prevent the urge to self-mutilate afterwards but could often feel cheerful instead. The patient stated that he found cannabis more useful than lorazepam because it worked better at targeting the very symptoms that were otherwise intensely painful and contributed to his self-injury and because he noticed that this occasional use of cannabis did not affect vigilance when compared to lorazepam. This was confirmed by his therapists and the fact that there had been no need for treatment of self-mutilation since he had started using cannabis in these critical states. His therapists at the inpatient psychotherapy treatment centre were not aware of his use of cannabis but noticed and charted the patient´s improved self-control and stability. It is evident from the case history that the patient experienced reduced stress, less involvement with flashbacks and a significant decrease of anxiety. In the following paragraphs, some key issues will be discussed that might be relevant for the mitigating effects of acute PTSD symptoms experienced by this patient. It is worth noting that the cannabis used was cannabis resin from turkey which is known to contain THC and a nearly equivalent amount of CBD.
|Participants||1 patient with posttraumatic stress disorder|
|Design||Uncontrolled case report|
|Type of publication||Medical journal|
|Address of author(s)||Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany; Laboratory for Integrative Psychiatry, Division of Alcohol and Drug Abuse, Harvard Medical School, McLean Hospital, Belmont, MA, USA. dr.passie@gmx.|