The endocannabinoid system (ECS) plays a significant role in the pathophysiology of psychotic disorders. Cannabis cannabinoids have the ability to regulate the functioning of this system, which is why the potential antipsychotic properties of CBD are being studied in numerous research centers around the world. Scientists are focusing their attention on various types and stages of psychotic disorders (including schizophrenia). They are also examining the potential benefits of CBD in people experiencing psychotic episodes associated with other conditions, such as Parkinson's disease. Let's take a look at selected research findings.

What are psychotic disorders?

The chapter "Schizophrenia Spectrum Disorders and Other Psychotic Disorders" of the DSM-5 describes as many as 12 types of disorders, which can vary in severity and stage. However, they share many common characteristics. Psychosis or a psychotic state is defined as a state of disruption in various areas of mental functioning, including perception of reality—oneself and the environment, way of thinking, experiencing and expressing emotions, and mood.

Psychotic disorders manifest themselves in the areas of consciousness, thought, perception, and behavior. A person suffering from psychosis fails to recognize that their thinking is inconsistent with reality or illogical, and is unable to critically examine their behavior.

Symptoms characteristic of psychotic disorders:

hallucinations, delusions,
thinking disorders: slowed thinking, distraction, irrationality,
indifference and lack of energy or strong agitation,
behavioral disorders:

ambivalence – contradiction between statement and behavior,

ambiendence – contradictory behavior,

paramimia – a contradiction between facial expressions and the emotions experienced,

antisocial.

Depending on the type of disorder, some symptoms may be more severe than others, some may be absent or may not occur concurrently with others. Psychotic disorders may involve more disturbances of perception—hallucinations—or thought disorders—abnormalities in the course and manner of thinking.

CBD in the treatment of psychosis

Commercially available antipsychotic medications work by blocking dopamine receptors. This leaves few alternatives available for those who don't respond to such treatments. At the same time, these medications often cause side effects, making some patients reluctant to take them. This is particularly problematic in the early stages of psychosis, when unpleasant experiences can influence patients' future attitudes toward treatment. However, no preventative treatment is available for individuals at clinically high risk of psychosis.

Studies have shown that CBD has a different mechanism of action (independent of the dopamine receptor) and therefore may constitute an entirely new class of antipsychotic drugs. The greatest benefit is the absence of certain side effects, such as muscle stiffness, tremors, gait disturbances, and elevated prolactin levels. Researchers also note that cannabidiol may enhance the effectiveness of antipsychotic drugs when used concurrently.

Evidence to date for the antipsychotic effects of CBD comes from preclinical animal studies, neuroimaging studies, studies in healthy volunteers, and relatively small clinical trials in people with psychotic disorders.

One clinical trial involved 88 people with schizophrenia. After six weeks of treatment, the CBD group had lower psychotic symptoms compared to the placebo group. Patients were more likely to be assessed as "improved" by their physicians. CBD was well tolerated, and the incidence of adverse events was similar in the CBD and placebo groups.

CBD may alleviate psychotic symptoms in Parkinson's disease

Psychotic symptoms can also occur in people with Parkinson's disease. A study conducted in patients demonstrated significant symptom improvement following treatment with cannabidiol. CBD did not worsen motor function or reduce the total scores on the Unified Parkinson's Disease Rating Scale. No adverse effects were observed during treatment. These preliminary data suggest that CBD may be effective, safe, and well-tolerated in the treatment of psychosis in Parkinson's disease.

CBD in Psychosis – Large Clinical Trials

A large-scale clinical trial will begin in 2023, encompassing three groups: individuals who have had a first psychotic episode, individuals at high risk for psychosis, and individuals with psychosis who do not respond to conventional treatment. The study will involve a total of 1,000 patients and will involve 35 research centers, primarily in Europe and North America.

According to researchers, cannabidiol is one of the most promising new treatments for people suffering from psychosis. This study will be the first to evaluate CBD in a large number of people with psychosis or psychotic symptoms and brings together many leading centers worldwide working in this field. In addition to treating established psychosis, the study will also examine whether cannabidiol can prevent the onset of psychosis in people at high risk of developing it.

The CBD used in the study is derived from cannabis. The drug consists of more than 99% of cannabidiol. Other cannabis components that may have adverse (in this case) psychoactive effects have been removed. The study will use a licensed form of cannabidiol, known as Epidyolex. The researchers emphasize that a major advantage of CBD over conventional antipsychotic medications is its lack of serious side effects.

Researchers also aim to identify biomarkers—biological signposts—that would indicate that a patient may respond well to treatment. This will allow for a better understanding of how CBD works in psychosis and the possibility of its greater personalization in the future.

The studies used high doses of CBD (ranging from 300 to 1,500 mg per day), and participants were under constant observation by scientists and doctors. Taking such large doses on your own is not a good idea. For your own safety, it's best to consult a doctor specializing in cannabis therapy.

Sources:

https://www.ox.ac.uk/news/2023-02-16-major-trials-test-effectiveness-cannabidiol-psychosis
https://www.mdpi.com/2077-0383/8/7/1058
https://journals.sagepub.com/doi/abs/10.1177/0269881108096519
https://link.springer.com/article/10.1007/s00213-021-05905-9
https://edraurban.pl/ssl/book-sample-file/zaburzenia-nalezace-do-spektrum-schizofrenii-i-inne-zaburzenia-psychotyczne-dsm-5-selections/pdf/schizofrenia_dsm-5.pdf
https://journals.sagepub.com/doi/full/10.1177/2045125319881916#bibr25-2045125319881916