The consumption of cannabinoids has increased exponentially in the young. The cannabis-induced psychotic disorder is a rare condition, with transient paranoid ideation being the most common manifestation. Symptoms of anxiety are the most common adverse reaction associated with the moderate use of smoked cannabis. Cocaine use, in turn, is related to the appearance of delusions and hallucinations in up to 50% of its customers, depending on the dosage, duration and personal sensitivity to the substance.

23 years old single male, jobless, without relevant personal history, who presented in for a psychiatry consultation because of auditory, visual, tactile, somatic and kinesthetic hallucinations, as well as delusional paranoid ideation, influence and self-referencing. Regular consumer of hashish since 15 years and with previous single cocaine use at 21 years old. After the treatment with Risperidone (2mg id); Aripiprazole (15 mg id) e Lorazepam (2,5 mg id in SOS), almost complete regression of hallucinatory symptoms and raving. However, the patient continued with regular use of cannabis as a form of social integration, without stoping the psychotropic medication.

Regular hashish use can induce long-term psychotic states. However, the question that arises is whether the single cocaine may have had a synergistic effect and / or ”triggering“ of psychosis in a patient already hash consumer, since there is reference to the start of hallucinatory symptoms and delusional after consumption of that. However, in this context, it is also difficult to excluded of paranoid schizophrenia since the patient as not completely abandoned the use of hash.