Cannabis-Associated Mania in Young Adult Males: A Case Series

A BSTRACT Cannabis is the most widely used illicit psychoactive substance worldwide. While cannabis-related psychosis is well documented, cannabis-associated mania is a relatively under-recognized clinical entity that poses diagnostic and therapeutic challenges. We describe three young adult males who presented with first-episode mania following a recent escalation of cannabis consumption. All patients exhibited classic manic symptoms, including elevated or irritable mood, grandiosity, decreased need for sleep, increased talkativeness, aggression, and risk-taking behaviour. None had a prior psychiatric illness or family history of bipolar disorder. Mental status examinations revealed grandiose ideation, impaired insight, and ongoing craving for cannabis. Treatment included antipsychotics, mood stabilizers, and benzodiazepines along with motivational enhancement therapy, resulting in symptomatic improvement within 1–2 weeks. The temporal association between cannabis escalation and manic symptoms, alongside the absence of prior mood episodes, supports a substance-induced aetiology. These cases underscore the importance of thorough substance-use assessment in patients presenting with first-episode mania, especially young adults. Clinicians should remain vigilant for cannabis-related mood disturbances in psychiatric settings.