Clinical Case Study   –  Kevin Foster

Case 2.6  –  Psychosis and Cannabis

Kevin Foster, a 32-year-old white man with a history of bipolar disorder, was brought to the emergency room (ER) by police after his wife called 911 to report that he was threatening to jump out of their hotel window.

At the time of the episode, Mr. Foster and his wife were on vacation, celebrating their fifth anniversary. To commemorate the event, they decided to get tattoos. Afterward, they went to a nearby park, where Mr. Foster bought and smoked a marijuana cigarette. During the ensuing hour, Mr. Foster began to believe that the symbols in his tattoo had mysterious meaning and power. He became convinced that the tattoo artist was conspiring with others against him and that his wife was cheating on him. After returning to the hotel, the patient searched his wife’s phone for evidence of her infidelity and threatened to jump out the window. The patient’s wife, an ER physician, successfully convinced the patient to go to sleep, thinking that the episode would resolve.

The following day, the patient remained paranoid and delusional. He again threatened to jump out the window, and indicated that he would have no choice but to kill his wife the next time she slept. She called 911, and her husband was brought to the ER of a large nearby hospital. Later that day, he was admitted to an acute inpatient psychiatric unit with a diagnosis of unspecified psychotic disorder.

The patient had smoked cannabis sporadically from age 18 but began to smoke daily 5 years prior to this admission. He and his wife denied that he had ever used other illicit substances, and the patient indicated that he rarely drank alcohol. Until 1 year earlier, he had never seen a psychiatrist or been viewed by his friends and family as having significant psychiatric issues…….