Persistent Amotivation After Cannabis-Related Psychosis: Diagnostic Challenges and Clinical Course With Electroconvulsive Therapy: A Case Report.
- 1Department of Psychiatry, Nara Medical University, Kashihara, Nara, Japan.
Abstract
Background
Cannabis use may cause psychotic symptoms, such as hallucinations and delusions, as well as persistent amotivation with reduced motivation, inactivity, and cognitive impairment. Although described as cannabis-related amotivational syndrome, it is not recognized as an independent diagnostic entity and overlaps clinically with the negative symptoms of schizophrenia and mood disorders. We report a case of persistent amotivation following cannabis-related psychosis that improved after electroconvulsive therapy (ECT).Case
A 19-year-old man developed auditory hallucinations, persecutory delusions, and agitation associated with cannabis use and was admitted to a psychiatric hospital. Antipsychotic treatment improved the psychotic symptoms, but marked amotivation and inactivity, accompanied by low performance on cognitive screening, and significantly impaired daily functioning. Depressed mood and appetite loss were not evident. Although negative symptoms of schizophrenia remained a differential diagnosis, the presentation was consistent with cannabis-related amotivational syndrome. Amantadine produced limited improvement. Following ECT, the Apathy Scale score improved from 24 to 7 and the Mini-Mental State Examination score increased from 19 to 26, with improvements in motivation, activity, and daily functioning.Discussion
This case demonstrates that clinically significant amotivation may persist after cannabis-related psychotic symptoms improve. Persistently reduced motivation and inactivity should not be assumed to represent primary negative symptoms of schizophrenia; rather, clinicians should carefully consider mood symptoms and cannabis-related amotivation in the differential diagnosis. This case also suggests that ECT may represent a treatment option for severe, persistent amotivation following cannabis-related psychosis. However, because this was a single case, further validation through additional cases and long-term follow-up is required.
Related
- Rapid Improvement of Persistent Catatonia Temporally Associated With Amantadine After Benzodiazepine Intolerance and Discontinuation of Electroconvulsive Therapy: A Case Report.
- Diagnostic and Sex Effects on Frontostriatal Brain Wiring Structural Organization in Early Psychosis Affective Subjects Compared to Healthy Controls
- Protocol for: Diagnostic trajectories of patients receiving unspecified psychosis-spectrum diagnoses. A retrospective, longitudinal, register-based study in a large UK secondary mental healthcare service from 2007 to 2024
- Attention-Deficit/Hyperactivity Disorder With Family Relational Challenges and Persistent Gender-Nonconforming Expression in a Preadolescent Girl: A Case Report
- Struma Ovarii: Radiological Features and Diagnostic Challenges
BibTeX
@article{kitano2026persistent,
title = {{Persistent Amotivation After Cannabis-Related Psychosis: Diagnostic Challenges and Clinical Course With Electroconvulsive Therapy: A Case Report.}},
author = {Yukina Kitano and Ryohei Takada and Minobu Ikehara and Kiyori Yamanaka and Yuka Sunami and Takashi Okada},
journal = {Neuropsychopharmacology reports},
year = {2026},
month = oct,
doi = {10.1002/npr2.70181},
url = {https://europepmc.org/article/MED/42963078},
note = {CC BY},
}
RIS
TY - JOUR
TI - Persistent Amotivation After Cannabis-Related Psychosis: Diagnostic Challenges and Clinical Course With Electroconvulsive Therapy: A Case Report.
AU - Yukina Kitano
AU - Ryohei Takada
AU - Minobu Ikehara
AU - Kiyori Yamanaka
AU - Yuka Sunami
AU - Takashi Okada
PY - 2026
DA - 2026/10/30
JO - Neuropsychopharmacology reports
DO - 10.1002/npr2.70181
UR - https://europepmc.org/article/MED/42963078
AB - Background Cannabis use may cause psychotic symptoms, such as hallucinations and delusions, as well as persistent amotivation with reduced motivation, inactivity, and cognitive impairment. Although described as cannabis-related amotivational syndrome, it is not recognized as an independent diagnostic entity and overlaps clinically with the negative symptoms of schizophrenia and mood disorders. We report a case of persistent amotivation following cannabis-related psychosis that improved after electroconvulsive therapy (ECT).Case A 19-year-old man developed auditory hallucinations, persecutory delusions, and agitation associated with cannabis use and was admitted to a psychiatric hospital. Antipsychotic treatment improved the psychotic symptoms, but marked amotivation and inactivity, accompanied by low performance on cognitive screening, and significantly impaired daily functioning. Depressed mood and appetite loss were not evident. Although negative symptoms of schizophrenia remained a differential diagnosis, the presentation was consistent with cannabis-related amotivational syndrome. Amantadine produced limited improvement. Following ECT, the Apathy Scale score improved from 24 to 7 and the Mini-Mental State Examination score increased from 19 to 26, with improvements in motivation, activity, and daily functioning.Discussion This case demonstrates that clinically significant amotivation may persist after cannabis-related psychotic symptoms improve. Persistently reduced motivation and inactivity should not be assumed to represent primary negative symptoms of schizophrenia; rather, clinicians should carefully consider mood symptoms and cannabis-related amotivation in the differential diagnosis. This case also suggests that ECT may represent a treatment option for severe, persistent amotivation following cannabis-related psychosis. However, because this was a single case, further validation through additional cases and long-term follow-up is required.
SN - 2574-173X
ER -