Lokesh Agrawal's document discusses cannabis-related disorders. It covers the introduction to cannabis, its preparations from the Cannabis sativa plant including methods of use. Problems from cannabis use are discussed such as intoxication, anxiety, cognitive impairment, and effects on respiratory, cardiovascular and muscular systems. Signs and symptoms, causes, and psychosocial factors associated with cannabis use disorders are described. The document concludes with sections on diagnosis and clinical features for treating cannabis-related disorders.

1. NAME : LOKESH AGRAWAL
CCT-ID : 9034
SEMESTER : 6th
TOPIC : CANNABIS RELATED
DISORDERS
6/3/2014
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2. CANNABIS-RELATED
DISORDERS :
 CONTENTS :
 INRODUCTION:
 CANNABIS PREPARATIONS :
 SOURCE
 CHEMICAL NATURE
 METHODS OF USE
 NATURE OF DISEASE :
 PROBLEMS OCCUR TO CANNABIS USE :
 SIGNS AND SYMPTOMS :
 ETIOLOGY :
 PSYCHOSOCIAL REGIONS :
 TREATMENT :
 DIAGNOSTIC
 CLINICAL FEATURES
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3. Introduction :
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 Cannabis, more commonly called marijuana, refers to the
several varieties of Cannabis sativa , or Indian hemp plant,
that contains the psychoactive drug delta-9-
tetrahydrocannabinol (THC). Cannabis-related disorders refer
to problems associated with the use of substances derived
from this plant.
 Description
 Cannabis—in the form of marijuana, hashish (a dried
resinous material that seeps from cannabis leaves and is
more potent than marijuana), or other cannabinoids—is
considered the most commonly used illegal substance in the
world. Its effects have been known for thousands of years,
and were described as early as the fifth century B.C., when
the Greek historian Herodotus told of a tribe of nomads who,
after inhaling the smoke of roasted hemp seeds, emerged
from their tent excited and shouting for joy.

4. PREPARATION OF CANNABIS
:
 SOURCE : Cannabis preparations are obtained from the plant
CANNABIS SATIVA ,which has been used in china ,india and
europe.It is introduced in europe in early 19th century by napolean’s
army returning from egypt.
 Canabis was most often used for fiber and therapeutic purposes.
 Chemical nature : most commonly used canabinoids are Delta-9-
tetrahydrocannabinol(THC) and cannabidiols(CBD).
-BOTH ARE NEUROPROTECTIVE THROUGH THEIR
ANTIOXIDATIVE ACTIVITY.
-RECEPTORS : THERE ARE AT LEAST TWO TYPES OF
RECEPTORS CB1 AND CB2 .
-CB1 PRESENT IN BRAIN AND MEDIATES THE PSYCHOLOGICAL
AND BEHAVIORAL EFECTS
-CB2 RECEPTORS IS ASSOCIATED WITH THE IMMUNE SYSTEM
AND APPEARS TO MODULATE INFLAMMATORY RESPONCES.
-MOST COMMON PREPARATIONS ARE MARIJUANA,HASHISH
AND HASH OIL.
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5. METHODS OF USE :
- Cannabis smoked as marijuana in hand-rolled
cigarettes , in joint tobacco to assist burning.
- Hashish may be mixed with tobacco as a joint in
pipe.
- Oral route of administration may also be used
by eating hashish backed in brownies and
cookies.
- Hashes oil also used in smoking substances
due to high potent effect.
-In india bhang is a common form , that is used
frequently at various occasions.
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6. Problems related to cannabis
use :
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Intoxication Delirium : psychotic symptoms ,such
as delusions and hallucinations ,are appear at
very high dose of THC. Visual and auditory
hallucination,delusional ideas are reported by
using heavy dose of cannabis.
Cannabis-induced Anxiety disorder: these
effects are most commonly reported by new
users who are unfamiliar with the effect of the
drug. Cannabis induced palpitations and
feeling of faintness are interpreted .

7. Problems related to cannabis
use :
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Cognitive impairment : long term cannabis use
produces more subtle form of impairment in
higher cognitive functions of memory ,
attention ,organization and integration of
complex information.
Effect on Cardiovacular system : within 3 to 15
minutes after cannabis is smoked or
swallowed, THC increase heart rate by 20 to
50 percent for up to3 hours . Blood pressure
also increases while the person is sitting and
decreases while standing.

8. Problems related to cannabis
use :
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Cannabis-related disorders reflect the problematic use of
cannabis products to varying degrees. These dis orders
include:
 • Cannabis dependence: The compulsive need to use
the drug, coupled with problems associated with chronic
drug use.
 • Cannabis abuse: Periodic use that may cause legal
problems, problems at work, home, or school, or danger
when driving.
 • Cannabis intoxication: The direct effects of acute
cannabis use and reactions that accompany it such as
feeling "high," euphoria, sleepiness, lethargy,
impairment in short-term memory, stimulated appetite,

9. Problems related to cannabis
use :
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Effect on respiratory system :regular cannabis smoking
impairs the functioning of the large airways and
causes symptoms of chronic bronchitis such as
coughing , sputum etc.
Effect on muscle spasticity :muscle spasticity is the
increased resistance to passive stretching of muscles
and increased deep tendon muscles.
Adverse effect of cannabis use :
Movement disorder : movement disorder caused by
abnormalities in areas of the brain that are connected
to the motor cortex , that result in abnormal skeleton
muscle movement in the face ,limbs and trunk.
Medical use of cannabis are dystonia ,huntington’s
disease , parkinson’s disease , and Tourette’s
syndrome.

10. Problems related to cannabis
use :
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Epilepsy: cannabis can controle epileptic
seizures , and one observational study
that suggested that cannabis use was
protective against seizures.
Glucoma: Elevated intraocular pressure
(IOP) is a chronic condition that produces
blindness if untreated . IOP must be
controlled by taken cannabis and THC
orally or intravenously, reduce IOP by
25%.

11. Signs and Symptoms :
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 central features of cannabis dependence are compulsive use,
tolerance of its effects, and withdrawal symptoms. Use may
interfere with family, school, and work, and may cause legal
problems.
 Regular cannabis smokers may show many of the same respiratory
symptoms as tobacco smokers. These include daily cough and
phlegm, chronic bronchitis, and more frequent chest colds.
Continued use can lead to abnormal functioning of the lung tissue,
which may be injured or destroyed by the cannabis smoke.
 smoking marijuana has the potential to cause severe increases in
heart rate and blood pressure, particularly if combined with cocaine
use. Even with marijuana use alone, however, the heart rate of
subjects increased an average of 29 beats per minute when
smoking marijuana.
 users has shown that critical skills related to attention, memory, and
learning can be impaired, even after use is discontinued for at least
24 hours. Heavy users, compared to light users, made more errors
on tasks and

12. Signs and Symptoms :
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 Recent studies have found that babies born to
mothers who used marijuana during
pregnancy were smaller than those born to
nonusing mothers. Smaller babies are more
likely to develop health problems. Additionally,
nursing mothers who use marijuana pass
some of the THC to the baby in their breast
milk. Research shows that use of marijuana
during the first month of breastfeeding can
impair an infant's motor development.

13. CAUSES :
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Cannabis-related disorders share many of the same root causes with other
addictive substances. The initial desire for a "high," combined with the widely
held perception that cannabis use is not dangerous, often leads to
experimentation in the teen years.
 Recent research challenges the notion that cannabis use is not physically
addictive. According to the National Institute of Drug Abuse (NIDA), daily
cannabis users experience withdrawal symptoms including irritability,
stomach pain, aggression, and anxiety. Many frequent cannabis users are
believed to continue using in order to avoid these unpleasant symptoms.
Long-term use may lead to changes in the brain similar to those seen with
long-term use of other addictive substances. It is believed that the greater
availability, higher potency, and lower price for cannabis in recent years all
contribute to the increase in cannabis-related disorders.
 Beginning in the 1990s, researchers began to discover that cannabis-like
compounds are naturally produced in various parts of the human body.
These compounds, called "endocannabinoids," appear to suppress

14. PSYCHOSOCIAL REGIONS:
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 The frequency of cannabis use were obtained for
the period from age 14–21 years, together with
measures of psychosocial outcomes including
property/violent crime, depression, suicidal
ideation, suicide attempt and other illicit drug use.
 Particularly regular or heavy use, was associated
with increased rates of a range of adjustment
problems in adolescence/ young adulthood—other
illicit drug use, crime, depression and suicidal
behaviours—with these adverse effects being
most evident for school-aged regular users. The
findings reinforce public health concerns about
minimizing the use of cannabis among school-
aged populations.

15. TREATMENT :
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 Diagnosis
 Diagnosis of cannabis-related disorders is made in a number of ways. Intoxication is
easiest to diagnose because of clinically observable signs, including reddened eye
membranes, increased appetite, dry mouth, and increased heart rate. It is also
diagnosed by the presence of problematic behavioral or psychological changes such
as impaired motor coordination, judgment, anxiety, euphoria, and social withdrawal.
Occasionally, panic attacks may occur, and there may be impairment of short-term
memory. Lowered immune system resistance, lowered testosterone levels in males,
and chromosomal damage may also occur. Psychologically, chronic use of marijuana
has been associated with a loss of ambition known as the "amotivational syndrome."
 Cannabis use is often paired with the use of other addictive substances, especially
nicotine, alcohol, and cocaine. Marijuana may be mixed and smoked with opiates,
phencyclidine ("PCP" or "angel dust"), or hallucinogenic drugs. Individuals who
regularly use cannabis often report physical and mental lethargy and an inability to
experience pleasure when not intoxicated (known as "anhedonia"). If taken in
sufficiently high dosages, cannabinoids have psychoactive effects similar to
hallucinogens such as lysergic acid diethylamide (LSD), and individuals using high
doses may experience adverse effects that resemble hallucinogen-induced "bad
trips." Paranoid ideation is another possible effect of heavy use, and,
occasionally, hallucinations and delusions occur. Highly intoxicated individuals may
feel as if they are out-side their body ("depersonalization") or as if what they are
experiencing isn't real ("derealization"). Fatal traffic accidents are more common

16. TREATMENT :
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 Urine tests can usually identify metabolites of
cannabinoids. Because cannabinoids are fat
soluble, they remain in the body for extended
periods. Individuals who have used cannabis may
show positive urine tests for as long as two to four
weeks after using.
 Examination of the nasopharynx and bronchial
lining may also show clinical changes due to
cannabis use. Marijuana smoke is known to
contain even larger amounts of carcinogens than
tobacco smoke. Sometimes cannabis use is
associated with weight gain.

17. TREATMENT :
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 Treatment options for individuals with cannabis-
related disorders are identical to those available
for people with alcohol and other substance abuse
disorders. The goal of treatment is abstinence.
Treatment approaches range from in-
patient hospitalization , drug and alcohol
rehabilitation facilities, and various outpatient
programs. Twelve-step programs such as
Narcotics Anonymous are also treatment options.
For heavy users suffering from withdrawal
symptoms, treatment with anti-anxiety and/or
antidepressant medication may assist in the
treatment process.

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Prognosis
 According to the DSM-IV-TR , cannabis dependence and abuse tend to
develop over a period of time. It may, however, develop more rapidly
among young people with other emotional problems. Most people who
become dependent begin using regularly. Gradually, over time, both
frequency and amount increase. With chronic use, there can sometimes be
a decrease in or loss of the pleasurable effects of the substance, along with
increased feelings of anxiety and/or depression. As with alcohol and
nicotine, cannabis use tends to begin early in the course of substance
abuse and many people later go on to develop dependence on other illicit
substances. Because of this, cannabis has been referred to as a "gateway"
drug, although this view remains highly controversial. There is much that
remains unknown about the social, psychological, and neurochemical basis
of drug use progression, and it is unclear whether marijuana use actually
causes individuals to go on to use other illicit substances.
 One long-term effect of chronic use has been termed the "amotivational
syndrome." This refers to the observation that many heavy, chronic users
seem unambitious in relation to school and/or career.

19. TREATMENT :
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 Prevention
 Many drug education programs focus strongly on discouraging marijuana
experimentation among young teenagers. Recent research reported by the
NIDA indicates that high-sensation-seekers—that is, individuals who seek
out new, emotionally intense experiences and are willing to take risks to
obtain these experiences— are at greater risk for using marijuana and
other drugs, and for using them at an earlier age. As a result, the NIDA
developed a series of public service announcements (PSAs) for national
television. These PSAs were dramatic and attention getting, and were aired
during programs that would appeal to high sensation-seekers, such as
action-oriented television shows. These PSAs were aired in a limited
television area and the results monitored. Marijuana use declined
substantially among teens during the PSA campaigns, and long-term
effects were shown for several months afterwards. In one county, marijuana
use decreased by 38%, and in another, by 26.7%.
 Drug education programs such as the "DARE" (Drug Awareness and
Resistance Education) programs target fifth graders. These and other
antidrug programs focus on peer pressure resistance and the use of older
teens who oppose drug use as models of a drug-free lifestyle. These
programs show mixed results.

20. REFERENCES :
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 ANTHONY JC,WARNER,KESSLER R: COMPARATIVE EPIDEMOLOGY OF
DEPENDENCE ON TOBACCO,ALCOHOL,CONTROLLED SUBSTANCES AND
INHALANTS.
 CASTLE DJ,MURRAY RM,EDS : MARIJUANA AND MADNESS : PSYCHIATRY AND
EUROBILOGY,CAMBRIDGE,UK.
 HALL WD,PACULA RL : CANNABIS USE AND DEPENDENCE.
 KALANT H,CORRIGAL W, HALL WD, SMART R , ENDS : HEALTH EFFECTS OF
CANNABIS : CENTER OF ADDICTION AND MENTAL HEALTH.
 INSTITUTE OF MEDICINE : MARIJUANA AND MEDICINE : ASSESSING THE
SCIENCE BASE,WASHINGTON DC: NATIONAL ACADEMY PRESS.
 ROFFMAN RA,STEPHENS RS ; CANNABIS DEPENDENCE : ITS NATURE ,
CONSEQUENSES AND TREAT MENT.
 THANK YOU