First–Episode Mania With Psychotic Features Triggered By Synthetic Cannabinoid Use: A Clinical Case Report

This clinical case report presents a 19-year-old male with a first-episode manic episode with psychotic features (ICD-10: F30.2), admitted to an acute psychiatric unit following a rapid onset of behavioral disorganization, insomnia, emotional lability, and psychotic symptoms. The patient had no prior psychiatric history but reported a background of childhood trauma, intermittent cannabis use since adolescence, and recent exposure to synthetic cannabinoids shortly before symptom escalation. Initial clinical assessment revealed euphoric mood, psychomotor agitation, thought acceleration, and disorganized behavior. Psychotic symptoms included visual misperceptions and grandiose ideation described as a “mental enlightenment.” The patient exhibited partial disorientation to time, emotional incongruence, and poor insight. Physical and neurological examinations were unremarkable. A toxicology screen confirmed the presence of THC and benzodiazepines, the latter administered during emergency intervention. An electrocardiogram showed normal sinus rhythm, and a psychological assessment supported a manic cognitive profile with elevated abstract reasoning and thought disorganization. Pharmacological treatment included intramuscular haloperidol and diazepam during the acute phase, followed by lithium carbonate (titrated to 1125 mg/day) and quetiapine (25 mg/day) for maintenance and stabilization. The patient’s condition improved steadily with resolution of psychotic symptoms, normalization of sleep and appetite and partial restoration of insight. The patient was discharged in a clinically stable state with recommendations for continued outpatient psychiatric care, mood monitoring, psychotherapy and substance use counseling. This case highlights the complex interplay of trauma, substance use, affective dysregulation and underscores the importance of early intervention, multimodal assessment and sustained treatment planning in first-episode mania with psychotic features.