Refer, in addition, to the text and criteria for Substance Intoxication (see p. 199). The essential feature of Cannabis Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, cannabis use (Criteria A and B). Intoxication typically begins with a "high" feeling followed by symptoms that include euphoria with inappropriate laughter and grandiosity, sedation, lethargy, impairment in short term memory, difficulty carrying out complex mental processes, impaired judgment, distorted sensory perceptions, impaired motor performance, and the sensation that time is passing slowly. Occasionally, anxiety (which can be severe), dysphoria, or social withdrawal occurs. These psychoactive effects are accompanied by two or more of the following signs, developing within 2 hours of cannabis use: conjunctival injection, increased appetite, dry mouth, and tachycardia (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D). Intoxication develops within minutes if the cannabis is smoked, but may take a few hours to develop if ingested orally. The effects usually last 3-4 hours, the duration being somewhat longer when the substance is ingested orally. The magnitude of the behavioral and physiological changes depends on the dose, the method of administration, and the individual characteristics of the person using the substance, such as rate of absorption, tolerance, and sensitivity to the effects of the substance. Because most cannabinoids, induding delta-9-THC, are fat soluble, the effects of cannabis or hashish may occasionally persist or reoccur for 12- 24 hours due to a slow release of psychoactive substances from fatty tissue or to enterohepatic circulation.
Specifier
The following specifier may be applied to a diagnosis of Cannabis Intoxication: With Perceptual Disturbances. This specifier may be noted when hallucinations with in tact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Illtact reality testing means that the person knows that the halluci nations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered.
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