Cannabis-Induced Catatonia Complicated by Rhabdomyolysis, Acute Kidney Injury, and Sympathetic Overactivity: A Case Report

Catatonia is a severe neuropsychiatric syndrome characterized by motor, behavioral, and autonomic disturbances. It can result in life-threatening complications such as rhabdomyolysis, venous thromboembolism, acute kidney injury, and autonomic instability. Substance use, particularly cannabis, is increasingly recognized as a precipitant, especially in vulnerable individuals with prior psychotic episodes. We report the case of a 21-year-old male patient with a history of cannabis-induced psychosis who presented with mutism, social withdrawal, psychomotor retardation, and poor oral intake following non-compliance with depot antipsychotics and recent cannabis use. On examination, he exhibited thought blocking, waxy flexibility, negativism, and stupor. Investigations revealed markedly elevated creatine kinase (CK), indicative of rhabdomyolysis, mild renal impairment(raised creatinine), and urine toxicology positive for tetrahydrocannabinol. Other laboratory investigations, including hematologic, hepatic, thyroid, and metabolic panels, along with CT head and chest X-ray, were unremarkable, helping to rule out alternative organic causes. A comprehensive evaluation ruled out primary psychiatric disorders, antipsychotic-induced catatonia, and organic causes. Psychotic symptoms emerged concurrently with catatonic features, with recent cannabis use preceding symptom onset and a prolonged symptom-free interval prior to presentation, supporting a diagnosis of cannabis-induced catatonia in a patient with a history of cannabis-related psychosis. The patient was managed with intravenous fluids, lorazepam, aripiprazole, and clonazepam. Close cardiac monitoring was implemented for recurrent tachycardia. Over the hospital stay, psychomotor function and catatonic features gradually improved, with normalization of CK and renal function. Residual mild psychomotor slowing and psychotic ideation persisted. This case report presents an instance of catatonia associated with cannabis use in a young adult with a prior history of cannabis-related psychosis. It explores the clinical reasoning used to distinguish this presentation from other potential causes, including mood disorders, antipsychotic-related effects, and medical or organic conditions, and discusses evidence-based management approaches aimed at minimizing medical complications and optimizing patient outcomes. It also highlights the need for patient education on cannabis-related neuropsychiatric risks and routine substance use screening in psychiatric populations.