“Everything seems like a Cartoon”- Single, Oral ingested Cannabis induced Depersonalization-Derealization Disorder

Mr. B, a 22-year-old Caucasian male nursing student, ingested oral marijuana 100mg Pretzel for the first time under peer pressure.  Within 30 min he felt trippy with out of body experiences. He slept for 24 hours and woke feeling still as if out of his body looking at himself with disconnected, numb hands and feet; everyone and everything appeared cartoonish; and his voice was like an echo. He felt anxious with panic attacks, experienced eye floaters and could not tolerate sunlight so covered his bedroom windows with blankets and isolated himself from usual activities. His friends, who were not novice users, felt high for 24 hours but had no dissociative symptoms. The patient saw his PCP where UDS was positive only for tetrahydrocannabinol and all other lab tests were normal. He was treated with paroxetine 10mg, buspirone 15mg bid, and prn hydroxyzine 50mg for insomnia for 3 weeks but experienced nausea, vomiting, diarrhea, drowsiness and suicidal ideation. He was switched to escitalopram 5mg daily and lorazepam 0.5mg prn for anxiety for 2 weeks which resulted in 90% improvement in symptoms but when escitalopram was increased to 10mg he felt worse. When presenting to psychiatry he reported daily persistent anxiety worrying about having these symptoms for life and panic attacks every 3days relieved with lorazepam. He had a history of anxiety and panic attacks at the age of 8 around parental divorce with therapy for 6 months. There was a family history of anxiety and panic disorder. At 2, 4, 6-month follow-ups the patient reported thrice a week anxiety lasting 5 min but no panic attacks. He also had rare episodes of 2 min duration when everything around him seemed in high definition imagery. He felt stable on daily escitalopram and thrice a week lorazepam. Transient or prolonged cannabis induced Depersonalization-Derealization Disorder (DDD) is typically reported to occur after repeated use of inhaled cannabis with improvement with avoidance of the offending agent or use of SSRI, benzodiazepine, or rarely anti-psychotics. Cannabis’s psychoactive properties are primarily due to delta-9-tetrahydrocannabinol (Δ9-THC) which is the primary inhaled component, but metabolism by the liver after ingestion results in the more psychoactive 11 hydroxy-THC that has a slower onset but longer lasting effect. Cannabis’ potency has been increasing in recent years with current edible forms containing an average of 50% up to 90% THC. Our case emphasizes the importance of recognizing that even single use de novo marijuana can induce a protracted Depersonalization-Derealization Disorder. In this poster, we elaborate on the typical risk factors for DDD that include chronic use, adolescent age, cannabis potency, prior history of anxiety and panic attacks, precipitating stress, genetic vulnerability, and family history of anxiety/panic disorder. We also address the hypothesized neurochemistry underlying the association between dissociative states and cannabis use

Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample

Background Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. Aim To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Methods Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Outcomes Patients completed the Female Sexual Function Index, the Couple\u27s Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Results Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Clinical Implications Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. Strengths and Limitations The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples. Conclusion Greater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women. Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843–851