Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

What is the relationship between marijuana use and bipolar disorder?

Marijuana itself can cause anxiety and depression, as can withdrawal from it. Another bad thing about marijuana is that it can work as a trigger for people more at-risk of developing a psychosis. Finally, people often believe that the marijuana they are smoking is clean, but then, have a bad trip, come to the emergency, and their urine test shows that they have PCP (or Angel Dust) in their system. That drug can trigger a lot of hallucinations. Marijuana is also cut with amphetamines, cocaine, all sorts of things.

The answer to that question is complicated. Would marijuana trigger an episode in someone who is predisposed to have a bipolar disorder because of his genetics and so on? Sure, that would be a good trigger factor. There’s an additional factor – the environmental factor – that would accelerate the process. Basically, you have genes interacting with environment, and, if you have some of the genes that predispose you to develop a bipolar disorder but you are very careful that you are controlling your stress level very well, you make sure that you sleep very well at night, do not have irregular life patterns and so on, and are avoiding drugs, you are more likely to never develop the disorder at all.

We derive this kind of knowledge from colon cancer research. If you have one predisposing gene, but a good environment and diet, then you probably won’t develop cancer. If you have two genes that predispose you to colon cancer, but are careful enough, you may have polyps that they can detect and remove if you get your colonoscopy every year. You will be lucky enough to be ok. But, if you don’t have a good diet and don’t eat enough fibre, eventually you will end up developing colon cancer. And if you have all three susceptibility genes to colon cancer, well, unfortunately, whatever you do, you are bound to get it. It’s this kind of interaction between genetics and environment that we are dealing with in medicine in general, not only in psychiatry. That’s the state of our knowledge so far.

-Serge Beaulieu, PhD, Mini-Psych School 2009

Who is it best to call when a person is in a manic state? The police?

That depends on the state of mania. If the person is really turning into a danger to themselves or others, then you should call the police. And when I say police, the ambulance and the police come together. The Civil Code of Québec (Sections 26 to 30) gives them the power to say that this person, in their opinion, is a danger to themselves or others. And they have the power to force someone to go to the hospital to have a psychiatric exam. They don’t need a judge anymore to do that. Do they do it? No, they are scared of lawsuits. If this patient is known to a doctor somewhere, they will do whatever they can to contact that doctor. Sometimes, I have to argue with the policeman in order to get them to bring the patient because the policeman insists that the patient is not that agitated, etc.

Most of the time, in these kind of situations where we are in a grey zone, the family or friends, or someone who has the interests of the patient in mind, will have to go to the court or the community clinic or the department of psychiatric justice, where they have a psychologist and social worker who know about that stuff, are in touch with the police, can intervene, know the procedures, and will ask you to describe the dangerous behaviour. You will get a court order asking for a psychiatric assessment. And then the person has to come.

But, you know what works the best? It’s the patient’s own signature. That’s what we do in psychoeducation. We ask them to sign a contract with someone whose judgement they respect. This person can then remind them they signed that piece of paper, telling them that now is the time to go in for an assessment. Most of the time, if we are able to do that, then we are able to fix things without too much drama. However, if they are really totally agitated or out of control, there is no insight, and they are getting irritable and violent, I think that then there is no other solution then asking the ambulance to intervene unfortunately.

-Serge Beaulieu, PhD, Mini-Psych School 2009

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