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| {{CMG}};{{AE}}{{Vbe}} | | {{CMG}};{{AE}}{{Vbe}} |
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| ==Classification of suicidal ideation==
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|
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| {| class="wikitable"
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
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|
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| |-
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|
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| |'''Suicidal events'''
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| Completed suicide
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|
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| |A self-injurious behavior that resulted in fatality and
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| was associated with at least some intent to die as a
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| result of the act.
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|
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|
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| |
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| example:1) After a long argument with his girlfriend, which resulted in the
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| end of their relationship, the patient collected a rope and rode his
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| bike to an isolated area where he fatally hanged himself. A suicide
| |
| note was later found. 2) After four documented attempts at suicide,
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| the patient stole his uncle’s gun and shot himself and was fatally injured
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|
| |
| |-
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| |[[Suicide attempt]]
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|
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| |A potentially self-injurious behavior, associated with
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| at least some intent to die, as a result of the act.
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| Evidence that the individual intended to kill him/
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| herself, at least to some degree, can be explicit or
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| inferred from the behavior or circumstance. A suicide
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| attempt may or may not result in actual injury
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|
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|
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|
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| |'''Example''':fter a fight with her friends at school, in which they discontinued
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| speaking with her, the patient ingested approximately 16 aspirin
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| and eight other pills of different types on the school
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| grounds. She said that she deserved to die, which was why she
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| swallowed the pills. 2) The patient used a razor blade to lacerate
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| his wrists, his antecubital fossae, and his back bilaterally. He told
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| his therapist that the “the main objective was to stop feeling like
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| that,” and he knew that he could die but didn’t care. According to
| |
| the patient, he also ingested a bottle of rubbing alcohol because
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| in his health class he heard “that the medulla will get more suppressed
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| that way,” thereby increasing y increasing the chances that he would
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| be “successful” and die
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|
| |
| |-
| |
| |[Preparatory acts
| |
| towards imminent suicidal behavior
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| |The individual takes steps to injure him- or herself,
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| but is stopped by self or others from starting the
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| self-injurious act before the potential for harm has begun
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|
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|
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| |
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| her had gone to school and retrieved a recent “bad” report card.
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| He was fearful of his father’s reaction. Upon his return home, a 5-
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| to 6-hour argument with his parents ensued, and he took a vegetable
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| (broad, sharp) knife and went to his room. He reported putting
| |
| the knife to his wrist but never puncturing the skin. 2) The patient
| |
| stated that he “couldn’t stand being depressed anymore”
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| and “wanted to die.” He decided to hang himself. He tied a telephone
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| cord to the door knob and placed the cord loosely around
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| his neck. Then, he stopped himself and did not follow through
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| with the attempt.
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|
| |
| |-
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| |[[Suicidal ideation]]
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| |Passive thoughts about wanting to be dead or active
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| thoughts about killing oneself, not accompanied
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| by preparatory behavior.a
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| |
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| * Active: The patient reported to the doctor that he was thinking
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| about hanging himself in the closet. He was taken to the hospital
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| and admitted.
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| * Passive: The patient reported ideas about wanting
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| to be dead but denied acting on these feelings.
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|
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|
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|
| |
| |}
| |
|
| |
| ==Classification of suicidal ideation==
| |
|
| |
| {| class="wikitable"
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
| |
|
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| |-
| |
|
| |
| |''' Non-Suicidal events'''
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| Self-injurious
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| behavior, no
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| suicidal intent
| |
|
| |
| |Self-injurious behavior associated with no intent to
| |
| die. The behavior is intended purely for other reasons,
| |
| either to relieve distress (often referred to as
| |
| “self-mutilation,” e.g., superficial cuts or scratches,
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| hitting/banging, or burns) or to effect change in
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| others or the environment
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|
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|
| |
| |
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| The patient was feeling ignored. She went into the family kitchen
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| where her mother and sister were talking. She took a knife out of
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| the drawer and made a cut on her arm. She denied that she
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| wanted to die at all (“not even a little”), but she just wanted them
| |
| to pay attention to her. 2) The patient reported feeling agitated
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| and anxious after a fight with her parents. She went into her
| |
| room, locked the door, and made several superficial cuts on the
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| inside of her arms. She stated that she felt relieved after cutting
| |
| herself and that she did not want to die. She reported that she
| |
| had done this before at times of distress and that it usually helped
| |
| her feel better. 3) The patient was in class, where a test was about
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| to begin, and stabbed himself with a pencil in order to be taken
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| to the nurse’s office. 4) A 14-year-old girl wrote her name on her
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| arm with a penknife and said that she often does so in order to reduce
| |
| her anxiety. 5) The patient was noted to have multiple superficial
| |
| burns on his arms. Upon questioning, he denied trying to kill himself
| |
| |-
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| |Other, no
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| deliberate
| |
| self-harm
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|
| |
| |No evidence of any suicidality or deliberate self-injurious
| |
| behavior associated with the event. The
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| event is characterized as an accidental injury, psychiatric
| |
| or behavioral symptoms only, or medical
| |
| symptoms or procedure only
| |
|
| |
| |1) The patient had a cut on the neck from shaving. 2) The patient
| |
| was hospitalized for worsening of OCD or depressive symptoms
| |
| with no suicidal thoughts or actions or 3) aggressive behavior.
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| 4) Hospitalization was because of an infection, rhinoplasty, or
| |
| pregnancy
| |
| |}
| |
|
| |
| ==Classification of suicidal ideation==
| |
|
| |
| {| class="wikitable"
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
| |
|
| |
| |-
| |
|
| |
| |''' Indeterminate or
| |
| potentially
| |
| suicidal events'''
| |
| Self-injurious
| |
| behavior,
| |
| suicidal intent
| |
| unknown
| |
| |Self-injurious behavior where associated intent to
| |
| die is unknown and cannot be inferred. The injury
| |
| or potential for injury is clear, but why the individual
| |
| engaged in that behavior is unclear.
| |
|
| |
|
| |
| | 1) The patient cut her wrists after an argument with her boyfriend.
| |
| 2) The patient was angry at her husband. She took 10 to 15 diazepam
| |
| tablets and flushed the rest down the toilet. Her husband
| |
| called the police for help, and she was taken to the hospital. She
| |
| was groggy and stayed overnight in the hospital. 3) A 9-year-old
| |
| patient had spoken about suicide frequently. After learning that
| |
| his baseball coach was retiring, he began scratching his arm with
| |
| a pencil.
| |
|
| |
| |-
| |
| |Not enough
| |
| information
| |
|
| |
| |Insufficient information to determine whether the
| |
| event involved deliberate suicidal behavior or ideation.
| |
| There is reason to suspect the possibility of
| |
| suicidality but not enough to be confident that the
| |
| event was not something other, such as an accident
| |
| or psychiatric symptom. An injury sustained
| |
| on a place on the body consistent with deliberate
| |
| self-harm or suicidal behavior (e.g., wrists), without
| |
| any information as to how the injury was received,
| |
| would warrant placement in this category
| |
|
| |
| |1) A child who “stabbed himself in [the] neck with a pencil.” The
| |
| event may have been deliberate as opposed to accidental, as suggested
| |
| by “stabbed,” but not enough information was provided to
| |
| determine whether the event was deliberate. 2) A cut on the neck.
| |
|
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|
| |
|
| |
|
| |
|
| |
| |}
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|
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|
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| ===Causes by Organ System===
| |
| {|
| |
|
| |
|
| |
| |
| |
| |-
| |
| | style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| |
| | style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Chemical / poisoning'''
| |
| | bgcolor="Beige" | [[Mesothelioma]]
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| |'''Drugs'''
| |
| |bgcolor="Beige"|Alcohol, Dextromethorphan, antihistamines at high doses,Barbiturates, Benzodiazepines, Cimetidine,Pergolide, Sodium oxybate,Anticholinergic drugs,Atropine, scopalamine, Jimson weed, Antidepressants, Antiepileptics,Isotretinoin, Varenicline, Ziconotide,Cocaine,Amphetamines, LSD, Psilocybin, Mescaline,
| |
| MDMA (ecstasy), PCP
| |
|
| |
|
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| | bgcolor="Beige" | [[AIDS]],Leprosy, Malaria, Mumps, Flu, Lyme disease, Syphilis
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| | bgcolor="Beige" | [[Amyotropic lateral sclerosis]], [[Ewing's sarcoma]], [[Polyradiculitis]]
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| | bgcolor="Beige" | [[Multiple sclerosis]], [[Alzheimer's disease]], [[Parkinsons]], [[ Lewy bodydementia ]]Adult-onset vanishing white matter leukoencephalopathy, Late-onset metachromatic leukodystrophy
| |
|
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| | bgcolor="Beige" | Brain tumor
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| | bgcolor="Beige" |
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| | bgcolor="Beige" | Hypocalcemia, Hypernatremia, Hyponatremia, Hypokalemia, Hypomagnesemia, Hypermagnesemia, Hypophosphatemia
| |
|
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| | bgcolor="Beige" | [[Lupus]]
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| | bgcolor="Beige" | No underlying cause
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| | bgcolor="Beige" | No underlying causes
| |
| |-
| |
| |- bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| | bgcolor="Beige" | Sarcoidosis
| |
| |}
| |
|
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|
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| ====Psychoactive drugs====
| |
| Psychotic states may occur with [[Psychoactive drug]] [[intoxication]] or [[withdrawal]]. Drugs whose use, abuse or withdrawal are implicated include:
| |
| *[[Ethanol|Alcohol]]<ref name=alcohol>{{cite web | url = http://www.emedicine.com/med/topic3113.htm | title = Alcohol-Related Psychosis |accessmonthday = [[September 27]] | accessyear = 2006 | last = Larson | first = Michael | date = 2006-03-30 | work = eMedicine | publisher = WebMD}}</ref><ref name=>{{cite journal | last = Soyka | first = Michael | year = 1990 | month = March | title = Psychopathological characteristics in alcohol hallucinosis and paranoid schizophrenia. | journal = Acta Psychiatrica Scandanavica | volume = 81 | issue = 3 | pages = 255-9 | id = {{PMID|2343749}}}}</ref><ref name=Gossman_2005>{{cite web | url = http://www.emedicine.com/EMERG/topic123.htm | title = Delirium Tremens | accessmonthday = October 16 | accessyear = 2006 | last = Gossman | first = William | date = November 19, 2005 | work = eMedicine | publisher = WebMD}}</ref>
| |
| *OTC drugs, such as:
| |
| **[[Dextromethorphan]]
| |
| **Certain [[antihistamine]]s at high doses.<ref name=diphenhydramine_trip_therapeutic>{{cite journal | last = Sexton | first = J. D. | coauthors = D. J. Pronchik | year = 1997 | month = September | title = Diphenhydramine-induced psychosis with therapeutic doses | journal = American Journal of Emergency Medicine | volume = 15 | issue = 5 | pages = 548-549 | id = {{PMID|9270406}} | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=pubmed_AbstractPlus&cmd=Retrieve&db=pubmed&list_uids=9270406&dopt=ExternalLink | accessdate = 2006-09-29}}</ref><ref name=diphenhydramine_trip_supratherapeutic>{{cite journal | last = Lang | first = K. | coauthors = H. Sigusch, and S. Muller | date = [[December 8]], [[1995]] | title = [An anticholinergic syndrome with hallucinatory psychosis after diphenhydramine poisoning] | journal = Deutsche medizinische Wochenschrift | volume = 120 | issue = 49 | pages = 1695-1698 | id = {{PMID|7497894}}}}</ref><ref name=diphenhydramine_poisoning_psychosis>{{cite journal | last = Schreiber | first = W. | coauthors = A. M. Pauls and J. C. Kreig | date = [[February 5]], [[1988]] | title = [Toxic psychosis as an acute manifestation of diphenhydramine poisoning] | journal = Deutsche medizinische Wochenschrift | volume = 113 | issue = 5 | pages = 180-183 | id = {{PMID|3338401}}}}</ref><ref name=Promethazine>{{cite journal | last = Timnak | first = Charles | coauthors = Ondria Gleason | year = 2004 | month = January-February | title = Promethazine-Induced Psychosis in a 16-Year-Old Girl | journal = Psychosomatics | volume = 45 | issue = 1 | pages = 89-90 | id = {{PMID|14709767}} | url = http://psy.psychiatryonline.org/cgi/content/full/45/1/89 | accessdate = 2006-09-29}}</ref>
| |
| **Cold Medications<ref>[http://pediatrics.aappublications.org/cgi/content/full/108/3/e52 Official Journal of American Pediatrics - PEDIATRICS Vol. 108 No. 3 September 2001, p. e52 ]</ref> (ie. containing [[PPA]], or [[phenylpropanolamine]])
| |
| *prescription drugs, such as:
| |
| **[[Barbiturate]]s<ref name=de_Paola_et_al_2004>{{cite journal | last = de Paola | first = Luciano | coauthors = Maria Joana Mäder, Francisco M.B. Germiniani, Patrícia Coral, Jorge A.A. Zavala, Djon J. Watzo, Jorge Kanegusuku, Carlos E.S. Silvado, and Lineu C. Werneck | year = 2004 | month = June | title = Bizarre behavior during intracarotid sodium amytal testing (Wada test): Are they predictable? | journal = Arquivos de Neuro-Psiquiatria | volume = 62 | issue = 2B | pages = 444-448 | doi = 10.1590/S0004-282X2004000300012 | id = {{PMID|15273841}} | url = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2004000300012&tlng=es&lng=en&nrm=iso | accessdate = 2006-10-15}}</ref><ref name=Sarrecchia_et_al_1998>{{cite journal | last = Sarrecchia | first = C. | coauthors = P. Sordillo, G. Conte, and G. Rocchi | year = 1998 | month = October-December | title = [Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication] | journal = Annali Italiani di Medicina Interna | volume = 13 | issue = 4 | pages = 237-239 | id = {{PMID|10349206}}}}</ref>
| |
| **[[Benzodiazepine]]s<ref name=White_et_al_1982>{{cite journal | last = White | first = M. C. | coauthors = J. J. Silverman, and J. W. Harbison | year = 1982 | month = February | title = Psychosis associated with clonazepam therapy for blepharospasm | journal = Journal of Nervous and Mental Disease | volume = 170 | issue = 2 | pages = 117-9 | id = {{PMID|7057171}}}}</ref><ref name=Jaffe_et_al_1986>{{cite journal | last = Jaffe | first = R. | coauthors = E. Gibson | year = 1986 | month = June | title = Clonazepam withdrawal psychosis | journal = Journal of Clinical Psychopharmacology | volume = 6 | issue = 3 | pages = 193 | id = {{PMID|3711371}}}}</ref><ref name=Hallberg_et_al_1964>{{cite journal | last = Hallberg | first = R. J. | coauthors = K. Lessler and F. J. Kane | year = 1964 | month = August | title = KORSAKOFF-LIKE PSYCHOSIS ASSOCIATED WITH BENZODIAZEPINE OVERDOSAGE | journal = American Journal of Psychiatry | volume = 121 | issue = 2 | pages = 188-189 | doi = 10.1176/appi.ajp.121.2.188 | id = {{PMID|14194223}} | url = http://ajp.psychiatryonline.org/cgi/reprint/121/2/188 | format = PDF | accessdate = 2006-10-15}}</ref>
| |
| **[[Cimetidine]]
| |
| **[[ezogabine]]
| |
| **[[Pergolide]]
| |
|
| |
| **[[Sodium oxybate]]
| |
|
| |
| **Anticholinergic drugs
| |
| ***[[Atropine]]<ref name=Bergman_et_al_1980>{{cite journal | last = Bergman | first = K. R. | coauthors = C. Pearson, G. W. Waltz, and R. Evans III year = 1980 | month = December | title = Atropine-induced psychosis. An unusual complication of therapy with inhaled atropine sulfate | journal = Chest | volume = 78 | issue = 6 | pages = 891-893 | id = {{PMID|7449475}} | url = http://www.chestjournal.org/cgi/content/abstract/78/6/891 | format = Infotrieve | accessdate = 2006-10-15}}</ref><ref name=Varghese_et_al_1990>{{cite journal | last = Varghese | first = S. | coauthors = N. Vettath, K. Iyer, J. M. Puliyel, and M. M. Puliyel | year = 1990 | month = June | title = Ocular atropine induced psychosis--is there a direct access route to the brain? | journal = Journal of the Association of Physicians of India | volume = 38 | issue = 6 | pages = 444-445 | id = {{PMID|2384469}}}}</ref>
| |
| ***[[Scopolamine]]<ref name=Barak_and_Weiner_2006>{{cite journal | last = Barak | first = Segev | coauthors = Ina Weiner | date = [[September 13]], [[2006]] | title = Scopolamine Induces Disruption of Latent Inhibition Which is Prevented by Antipsychotic Drugs and an Acetylcholinesterase Inhibitor | journal = Neuropsychopharmacology | doi = 10.1038/sj.npp.1301208 | id = {{PMID|16971898}} | url = http://www.nature.com/npp/journal/vaop/ncurrent/full/1301208a.html | accessdate = 2006-10-15}}</ref>
| |
| ***[[Jimson weed]]<ref name=Kurzbaum>{{cite journal | last = Kurzbaum | first = Alberto | coauthors = Claudia Simsolo, Ludmilla Kvasha and Arnon Blum | year = 2001 | month = July | title = Toxic Delirium due to Datura Stramonium | journal = Israel Medical Association Journal | volume = 3 | issue = 7 | pages = 538-539 | id = {{PMID|11791426}} | url = http://www.ima.org.il/imaj/ar01jul-16.pdf | format = PDF | accessdate = 2006-10-17}}</ref>
| |
| **[[Antidepressants]]
| |
| **[[Antiepileptics]]<ref>Ettinger AB. "Psychotropic effects of antiepileptic drugs". Neurology. 2006 Dec 12;67(11):1916-25.</ref>
| |
| **Medications (usually cold medications) that contain [[phenylpropanolamine]] or [[PPA]] <ref>http://ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=3060884 Psychiatric side effects attributed to phenylpropanolamine, ''Pharmacopsychiatry'' 1988 Jul; 21(4):171-81</ref>
| |
| ** Other medications- [[Iloperidone]], [[Isotretinoin]], [[Varenicline]], [[Ziconotide]]
| |
|
| |
| *"Street" drugs, such as:
| |
| **[[Cocaine]]<ref name=>{{cite journal | last = Brady | first = K. T. | coauthors = R. B. Lydiard, R. Malcolm, and J. C. Ballenger | year = 1991 | month = December | title = Cocaine-induced psychosis. | journal = Journal of Clinical Psychiatry | volume = 52 | issue = 12 | pages = 509-512 | id = {{PMID|1752853}}}}</ref>
| |
| **[[Amphetamine]]s
| |
| **[[Hallucinogens]] such as
| |
| ***[[LSD]]
| |
| ***[[Psilocybin]]
| |
| ***[[Mescaline]]
| |
| ***[[MDMA]] (ecstasy)
| |
| ***[[Nabilone]]
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| ***[[Phencyclidine|PCP]]<ref name=psychotic_PCP_rats>{{cite journal | last = Reynolds | first = Lindsay M. | coauthors = Susan M. Cochran, Brian J. Morris, Judith A. Pratt and Gavin P. Reynolds | date = [[March 1]], [[2005]] | title = Chronic phencyclidine administration induces schizophrenia-like changes in ''N''-acetylaspartate and ''N''-acetylaspartylglutamate in rat brain | journal = Schizophrenia Research | volume = 73 | issue = 2-3 | pages = 147-152 | doi = 10.1016/j.schres.2004.02.003 | id = {{PMID|15653257}} | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=pubmed_AbstractPlus&cmd=Retrieve&db=pubmed&list_uids=15653257&dopt=ExternalLink | accessdate = 2006-09-29}}</ref>
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| Intoxication with drugs that have general depressant effects on the [[central nervous system]] (especially alcohol and barbiturates) tend not to cause psychosis during use, and can actually decrease or lessen the impact of symptoms in some people. However, ''withdrawal'' from barbiturates and alcohol can be particularly dangerous, leading to psychosis or delirium and other, potentially lethal, withdrawal effects.
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| Some studies indicate that [[cannabis (drug)|cannabis]] use may lower the threshold for psychosis, and thus help to trigger full-blown psychosis in some people.<ref name = Deg> {{cite journal| last = Degenhardt | first = L | authorlink = | coauthors = Smith J, Steel R, Johnstone CE, Frith CD | title = Editorial: The link between cannabis use and psychosis: furthering the debate. | journal = Psychological Medicine| volume = 33| issue = | pages = 3-6| publisher = PubMed| date = 2003| url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12537030| doi = | id = PMID 12537030 | accessdate = 2006-08-19 }}</ref> Early studies have been criticized for failing to consider other drugs (such as [[LSD]]) that the participants may have used before or during the study, as well as other factors such as pre-existing ("comorbid") mental illness. However, more recent studies with better controls have still found a small increase in risk for psychosis in cannabis users.
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| It is not clear whether this is a causal link, and it is possible that cannabis use only increases the chance of psychosis in people already predisposed to it; or that people with developing psychosis use cannabis to provide temporary relief of their mental discomfort. The fact that cannabis use has increased over the past few decades, whereas the rate of psychosis has not, suggests that a direct causal link is unlikely for all users.<ref> {{cite paper| author = Degenhardt L, Hall W, Lynskey M | title = Comorbidity between cannabis use and psychosis: Modelling some possible relationships.| version = Technical Report No. 121. | publisher = Sydney: National Drug and Alcohol Research Centre.| date = 2001 | url = http://ndarc.med.unsw.edu.au/NDARCWeb.nsf/resources/TR_18/$file/TR.121.PDF| format = [[PDF]]| accessdate = 2006-08-19 }}</ref>
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| ==References==
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| Posner K, Melvin GA, Stanley B, Oquendo MA, Gould M: Factors
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| in the assessment of suicidality in youth. CNS Spectr 2007; 12:
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| 156–162
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