Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

SCImago Journal Rank (SJR) 2018: 0.350
Source Normalized Impact per Paper (SNIP) 2018: 0.476

See all formats and pricing
More options …
Volume 26, Issue 2


Treatment of refractory substance-induced psychosis in adolescent males with a genetic predisposition to mental illness

Mariam Rahmani / Sean Paul / Mathew L. Nguyen
  • Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Florida Gainesville, FL 32606, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-04-24 | DOI: https://doi.org/10.1515/ijamh-2013-0505


This article presents two cases of adolescent males who were admitted to our inpatient psychiatric unit with a psychotic, disorganized presentation. Both males had a genetic vulnerability to mental illness and reported significant substance use. Their symptoms were refractory to treatment and required the use of clozapine. Both patients experienced significant side effects, which limited the maximum daily dose of clozapine. However, they responded to a dose that was much lower than that typically used in adults. There is significant evidence in the literature about cannabis use triggering psychotic breaks in vulnerable individuals. We speculate that substance use (including synthetic cannabinoids) triggers treatment-resistant psychosis that requires the use of clozapine. Further, lower doses of clozapine may be sufficient to treat the substance-induced psychotic symptoms than those typically used in adult schizophrenia.

Keywords: adolescent; cannabis; clozapine; psychosis; schizophrenia; spice (synthetic cannabinoid)


  • 1.

    Dulcan MK. Dulcan’s textbook of child and adolescent psychiatry. Arlington, VA: American Psychiatric Publishing, Inc., 2010.Google Scholar

  • 2.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., text rev. Washington, DC: American Psychiatric Association, 2000.Google Scholar

  • 3.

    Minzenberg MJ, Yoon JH, Carter CS. Schizophrenia. In: Hales RE, Yudofsky SC, Gabbard GO, editors. The American psychiatric publishing textbook of psychiatry, 5th ed. Arlington, VA: American Psychiatric Publishing Inc., 2008.Google Scholar

  • 4.

    Loranger AW. Sex difference in age at onset of schizophrenia. Archives of general psychiatry 1984;41:157–61.Google Scholar

  • 5.

    Anderson KK, Fuhrer R, Abrahamowicz M, Malla AK. The incidence of first-episode schizophrenia-spectrum psychosis in adolescents and young adults in Montreal: an estimate from an administrative claims database. Can J Psychiatry 2012;57: 626–33.Google Scholar

  • 6.

    Cantor-Graae E, Nordström LG, McNeil TF. Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res 2001;48:69–82.Google Scholar

  • 7.

    Gershman JA, Fass AD. Synthetic cathinones (“bath salts”): legal and health care challenges. P & T: A Peer Reviewed Journal for Formulary Management 2012;37:571–95.Google Scholar

  • 8.

    Joksovic P, Mellos N, van Wattum PJ, Chiles C. Bath salts-induced psychosis and serotonin toxicity. J Clin Psychiatry 2012;73:1125.Google Scholar

  • 9.

    Jerry J, Collins G, Streem D. Synthetic legal intoxicating drugs: the emerging “incense” and “bath salt” phenomenon. Clev Clin J Med 2012;79:258–64.Web of ScienceGoogle Scholar

  • 10.

    Striebel JM, Pierre JM. Acute psychotic sequelae of “bath salts”. Schizophr Res 2011;133:259–60.Web of ScienceGoogle Scholar

  • 11.

    Andréasson S, Allebeck P, Engström A, Rydberg U. Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet 1987;ii:1483–6.Google Scholar

  • 12.

    Bugra H, Rapp C, Studerus E, Aston J, Borgwardt S, et al. Can cannabis use increase the risk for schizophrenic psychoses? Fortschr Neurol Psyc 2012;80:635–43.Web of ScienceGoogle Scholar

  • 13.

    Every-Palmer S. Synthetic cannabinoid JWH-018 and psychosis: an explorative study. Drug Alcohol Depen 2011;117:152–7.Web of ScienceGoogle Scholar

  • 14.

    Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 2007;370: 319–28.Web of ScienceGoogle Scholar

  • 15.

    Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G. Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. Brit Med J 2002;325:1199.Google Scholar

  • 16.

    Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, et al. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. Brit Med J 2002;325:1212–3.Google Scholar

  • 17.

    Power BD, Dragovic M, Jablensky A, Stefanis NC. Does accumulating exposure to illicit drugs bring forward the age at onset in schizophrenia? Aust NZ J Psychiatry 2013;47:51–8.Web of ScienceGoogle Scholar

  • 18.

    Galvez-Buccollini JA, Proal AC, Tomaselli V, Trachtenberg M, Coconcea C, et al. Association between age at onset of psychosis and age at onset of cannabis use in non-affective psychosis. Schizophr Res 2012;139:157–60.Google Scholar

  • 19.

    FDA. FDA approves risperdal for two psychiatric conditions in children and adolescents. FDA news release, (2007). http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108969.htm

  • 20.

    Fischer-Cornelssen KA, Ferner UJ. An example of European multicenter trials: multispectral analysis of clozapine. Psychopharmacol Bull 1976;12:34–9.Google Scholar

  • 21.

    Honigfeld G, Patin J, Singer J. Clozapine: antipsychotic activity in treatment-resistant schizophrenics. Adv Ther 1984;1:77–97.Google Scholar

  • 22.

    Shopsin B, Klein H, Aaronsom M, Collora M. Clozapine, chlorpromazine, and placebo in newly hospitalized, acutely schizophrenic patients: a controlled, double-blind comparison. Arch Gen Psychiatry 1979;36:657–64.Google Scholar

  • 23.

    Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789–96.Google Scholar

  • 24.

    Cianchetti C, Ledda MG. Effectiveness and safety of antipsychotics in early onset psychoses: a long-term comparison. Psychiatry Res 2011;189:349–56.Google Scholar

  • 25.

    Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C. Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis. J Clin Psychopharm 2012;32:309–16.Web of ScienceGoogle Scholar

  • 26.

    Bachmann CJ, Gebhardt S, Lehr D, Haberhausen M, Kaiser C, et al. Subjective and biological weight-related parameters in adolescents and young adults with schizophrenia spectrum disorder under clozapine or olanzapine treatment. Z Kinder Jug-Psych 2012;40:151–9.Web of ScienceGoogle Scholar

  • 27.

    Maayan L, Correll CU. Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adol Psychop 2011;21:517–35.Web of ScienceGoogle Scholar

  • 28.

    Wehmeier PM, Heiser P, Remschmidt H. Pancreatitis followed by pericardial effusion in an adolescent treated with clozapine. J Clin Psychopharm 2003;23:102–3.Google Scholar

  • 29.

    Markovic J, Momcilov-Popin T, Mitrovic D, Ivanovic-Kovacevic S, Sekuli S, et al. Clozapine-induced pericarditis. Afr J Psychiatry (Johannesbg) 2011;14:236–8.Google Scholar

  • 30.

    Layland JJ, Liew D, Prior DL. Clozapine-induced cardiotoxicity: a clinical update. Med J Australia 2009;190:190–2.Google Scholar

  • 31.

    Raju P, Rao GK, Davis G. Pericardial effusion in patients with schizophrenia: are they on clozapine? Emerg Med J 2008;25:383–4.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 32.

    Marder SR, Wirshing DA. Chapter 28. Clozapine. In: Schattzberg AF, Nemeroff CB, editors. Textbook of Psychopharmacology, 4th ed. Arlington, VA: American Psychiatric Publishing, 2009.Google Scholar

About the article

Corresponding author: Mariam Rahmani, MD, Department of Psychiatry, University of Florida, 8491 NW 39th Avenue, Gainesville, FL 32606, USA, Phone: +(352) 265-8680, Fax: +(352) 265-8682, E-mail:

Received: 2013-02-18

Accepted: 2013-05-24

Published Online: 2014-04-24

Published in Print: 2014-05-01

Citation Information: International Journal of Adolescent Medicine and Health, Volume 26, Issue 2, Pages 297–301, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: https://doi.org/10.1515/ijamh-2013-0505.

Export Citation

©2014 by Walter de Gruyter Berlin/Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Huiqiong Deng, Christopher D. Verrico, Thomas R. Kosten, and David A. Nielsen
Psychiatry Research, 2018
Robert J. Tait, David Caldicott, David Mountain, Simon L. Hill, and Simon Lenton
Clinical Toxicology, 2016, Volume 54, Number 1, Page 1
Brooke Mills, Andres Yepes, and Kenneth Nugent
The American Journal of the Medical Sciences, 2015, Volume 350, Number 1, Page 59
Aengus OConghaile and Lynn E. DeLisi
Current Opinion in Psychiatry, 2015, Volume 28, Number 3, Page 249
Reactions Weekly, 2014, Volume 1504, Number 1, Page 11

Comments (0)

Please log in or register to comment.
Log in