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Ferraro L, La Cascia C, Quattrone D, Sideli L, Matranga D, Capuccio V, Tripoli G, Gayer-Anderson C, Morgan C, Sami MB, Sham P, de Haan L, Velthorst E, Jongsma HE, Kirkbride JB, Rutten BPF, Richards AL, Roldan L, Arango C, Bernardo M, Bobes J, Sanjuan J, Santos JL, Arrojo M, Tarricone I, Tortelli A, Szöke A, Del-Ben CM, Selten JP, Lynskey M, Jones PB, Van Os J, La Barbera D, Murray RM, Di Forti M. Premorbid Adjustment and IQ in Patients With First-Episode Psychosis: A Multisite Case-Control Study of Their Relationship With Cannabis Use. Schizophr Bull 2020; 46:517-529. [PMID: 31361020 PMCID: PMC7147569 DOI: 10.1093/schbul/sbz077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychotic patients with a lifetime history of cannabis use generally show better cognitive functioning than other psychotic patients. Some authors suggest that cannabis-using patients may have been less cognitively impaired and less socially withdrawn in their premorbid life. Using a dataset comprising 948 patients with first-episode psychosis (FEP) and 1313 population controls across 6 countries, we examined the extent to which IQ and both early academic (Academic Factor [AF]) and social adjustment (Social Factor [SF]) are related to the lifetime frequency of cannabis use in both patients and controls. We expected a higher IQ and a better premorbid social adjustment in psychotic patients who had ever used cannabis compared to patients without any history of use. We did not expect such differences in controls. In both patients and controls, IQ was 3 points higher among occasional-users than in never-users (mean difference [Mdiff] = 2.9, 95% CI = [1.2, 4.7]). Both cases and control daily-users had lower AF compared to occasional (Mdiff = -0.3, 95% CI = [-0.5; -0.2]) and never-users (Mdiff = -0.4, 95% CI = [-0.6; -0.2]). Finally, patient occasional (Mdiff = 0.3, 95% CI = [0.1; 0.5]) and daily-users (Mdiff = 0.4, 95% CI = [0.2; 0.6]) had better SF than their never-using counterparts. This difference was not present in controls (Fgroup*frequency(2, 2205) = 4.995, P = .007). Our findings suggest that the better premorbid social functioning of FEP with a history of cannabis use may have contributed to their likelihood to begin using cannabis, exposing them to its reported risk-increasing effects for Psychotic Disorders.
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Affiliation(s)
- Laura Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,To whom correspondence should be addressed; Via Gaetano La Loggia, 1, 90129 Palermo, Italy; tel: 091-6555175, fax: 091-6555164, e-mail:
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Lucia Sideli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Domenica Matranga
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Veronica Capuccio
- Department of Economic, Management and Statistical Sciences (DSEAS) University of Palermo, Palermo, Italy
| | - Giada Tripoli
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Musa B Sami
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Pak Sham
- Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,Psylife Group, Division of Psychiatry, University College London, London, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Laura Roldan
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Julio Sanjuan
- Department of Psychiatry, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz,” Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris, France,INSERM, Créteil, France
| | | | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands,Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
| | - Michael Lynskey
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jim Van Os
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | | | - Robin M Murray
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Marta Di Forti
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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402
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Olayinka O, Ojimba C, Alemu B, Olaolu O, Edomias D, Popoola O, Kallikkadan J, Tumenta T, Gayam V, Valbrun L, Olupona T, Hershberger J. Cannabis Use in Inpatients With Schizophrenia Spectrum Disorders at a Community Hospital. J Clin Med Res 2020; 12:243-250. [PMID: 32362972 PMCID: PMC7188370 DOI: 10.14740/jocmr4110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022] Open
Abstract
Background Cannabis is the second most used recreational drug in the United States and one of the most used substances in patients with schizophrenia spectrum disorder (SSD). Unfortunately, the increased use is likely to continue as more states legalize recreational use of cannabis. Although the association between cannabis and schizophrenia has been studied extensively, the understanding of the relationship is still evolving. In this study, we sought to determine the prevalence and potential factors associated with cannabis use (CU) among inpatients with SSD at a community teaching hospital. Methods We performed a retrospective review of the electronic medical charts of patients discharged from the psychiatric unit of our hospital from July 1, 2017 through October 31, 2017. Patients were included in this study if: 1) They were ≥ 18 years old; 2) They had discharge diagnosis of SSD; and 3) They had urine drug testing performed. Pertinent sociodemographic and clinical variables, including substance use status and hospital length of stay (LOS), were abstracted. Univariate frequencies and summary statistics were performed. Odds ratios (ORs) were determined by logistic regression analysis of bivariate and multivariate analyses. Results Three hundred sixty-five (52.2%) patients had a discharge diagnosis of SSD, and only 322 had urine toxicology result for cannabinoids and were included in analysis. Of the 322 patients, 41.5% (n = 133) screened positive for cannabinoids. Of the 133 patients, 78% were African American, 15% were Hispanic and 5% were White; 77% were male and the median age was 36 years. Bivariate analyses showed tobacco use (OR: 2.8, 95% confidence interval (CI): 1.7 - 4.6), alcohol use (OR: 3.4, 95% CI: 2.9 - 7.0), younger age (OR: 2.8, 95% CI: 1.8 - 4.5), male gender (OR: 2.9, 95% CI: 2.2 - 3.2), unemployment (OR: 3.91, 95% CI: 3.49 - 7.35), homelessness (OR: 3.18, 95% CI: 2.76 - 3.84) and LOS (OR: 3.46, 95% CI: 2.93 - 4.31) were significantly associated with CU. Result of multivariate analysis was similar to that found in bivariate analysis. Conclusions CU appears to be prevalent among patients with SSD. Clinicians and public health professionals are encouraged to understand the health implications of its use in patients with mental illness especially against the backdrop of current marijuana laws.
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Affiliation(s)
- Olaniyi Olayinka
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Chiedozie Ojimba
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Brook Alemu
- Integrated Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Olalekan Olaolu
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Desta Edomias
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Olusegun Popoola
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jisha Kallikkadan
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Terence Tumenta
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Vijay Gayam
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Leon Valbrun
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Tolu Olupona
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jason Hershberger
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, NY, USA
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403
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Cash MC, Cunnane K, Fan C, Romero-Sandoval EA. Mapping cannabis potency in medical and recreational programs in the United States. PLoS One 2020; 15:e0230167. [PMID: 32214334 PMCID: PMC7098613 DOI: 10.1371/journal.pone.0230167] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
Cannabis related online searches are associated with positive attitudes toward medical cannabis, particularly when information is obtained from dispensaries. Since pain is the main reason for medicinal cannabis use, information from dispensary websites has the potential to shape the attitude of pain patients towards cannabis. This is relevant because cannabis has demonstrated efficacy in neuropathic pain with low tetrahydrocannabinol (THC) concentrations (< 5-10%), in contrast to potent cannabis (>15% THC), which is highly rewarded in the recreational realm. The role of CBD in pain is not clear, however it has gained popularity. Thus, we hypothesize that the potency of medical cannabis that is advertised online is similar to the cannabis advertised for recreational purposes, which would potentially create a misconception towards medical cannabis. The current lack of knowledge surrounding advertised potencies in the legal cannabis market limits the ability to generate clear policies regarding online advertising to protect patients that are willing to use cannabis for their condition. Thus, we evaluated the advertised THC and CBD content of cannabis products offered online in dispensaries in the United States to determine products' suitability to medicinal use and compare the strength of products offered in legal medical and recreational programs. We recorded THC and CBD concentrations for all herb cannabis products provided by dispensary websites and compared them between or within states. Four Western states (CA, CO, NM, WA) and five Northeastern states (ME, MA, NH, RI, VT) were included. A total of 8,505 cannabis products across 653 dispensaries were sampled. Despite the clear differences between medicinal and recreational uses of cannabis, the average THC concentration advertised online in medicinal programs was similar (19.2% ±6.2) to recreational programs (21.5% ±6.0) when compared between states with different programs, or between medicinal and recreational programs within the same states (CO or WA). Lower CBD concentrations accompanied higher THC products. The majority of products, regardless of medicinal or recreational programs, were advertised to have >15% THC (70.3% - 91.4% of products). These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain. This data is consistent with reports in which THC and CBD in products from legal dispensaries or in nationwide products from the illegal market were actually measured, which indicates that patients consuming these products may be at risk of acute intoxication or long-term side effects. Our study offers grounds to develop policies that help prevent misconceptions toward cannabis and reduce risks in pain patients.
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Affiliation(s)
- Mary Catherine Cash
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America
| | - Katharine Cunnane
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Chuyin Fan
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America
| | - E. Alfonso Romero-Sandoval
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- * E-mail:
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404
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405
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Kroon E, Kuhns L, Hoch E, Cousijn J. Heavy cannabis use, dependence and the brain: a clinical perspective. Addiction 2020; 115:559-572. [PMID: 31408248 PMCID: PMC7027478 DOI: 10.1111/add.14776] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
Abstract
AIMS To summarize and evaluate our knowledge of the relationship between heavy cannabis use, cannabis use disorder (CUD) and the brain. METHODS Narrative review of relevant literature identified through existing systematic reviews, meta-analyses and a PubMed search. Epidemiology, clinical representations, potential causal mechanisms, assessments, treatment and prognosis are discussed. RESULTS Although causality is unclear, heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments that seem to recover after a period of abstinence. Evidence regarding other cognitive domains and neurological consequences, including cerebrovascular events, is limited and inconsistent. Abstinence after treatment is only achieved in a minority of cases; treatment targeted at reduction in use appears have some success. Potential moderators of the impact of CUD on the brain include age of onset, heaviness of use, CUD severity, the ratio of ∆9-tetrahydrocannabinol to cannabidiol and severity of comorbid disorders. CONCLUSIONS Current evidence of long-term effects of daily cannabis use and cannabis use disorder on brain-related outcomes is suggestive rather than conclusive, but use is associated with psychiatric morbidity and with cognitive impairments that recover after a period of abstinence.
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Affiliation(s)
- Emese Kroon
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Lauren Kuhns
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig Maximilan UniversityMunichGermany
- Division of Clinical Psychology and Psychological Treatment, Department of PsychologyLudwig Maximilian University MunichMunichGermany
| | - Janna Cousijn
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
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406
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Online patient-provider cannabis consultations. Prev Med 2020; 132:105987. [PMID: 31954143 PMCID: PMC7035882 DOI: 10.1016/j.ypmed.2020.105987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022]
Abstract
Cannabis has been legalized, decriminalized, or medicalized in over half the U.S. states. With restrictions on cannabis research, accepted standards to guide clinical practice are lacking. Analyzing online communications through a digital health platform, we characterized patient questions about cannabis use and provider responses. Coded for content were 4579 questions posted anonymously online between March 2011 through January 2017, and the responses from 1439 U.S. licensed clinicians. Provider responses to medical cannabis use questions were coded for sentiment: "negative", "positive", and "mixed." Responses could be "thanked" by patients and receive "agrees" from providers. The most frequent themes were detection of cannabis use (25.3%), health harms (19.9%), co-use with other substances (9.1%), and medical use (8.2%). The 425 medical cannabis use questions most frequently related to treatment of mental illness (20.3%), pain (20.0%), and cancer care (6.7%). The 762 provider responses regarding medical cannabis use were coded for sentiment as 59.6% negative, 28.6% mixed, and 11.8% positive. Provider sentiment was most positive regarding cannabis use for palliative care and most negative for treating respiratory conditions, poor appetite, and mental illness. The proportion of positive sentiment responses increased from 17.6% to 32.4%. Provider responses coded as negative sentiment received more provider "Agrees" (mean rank = 280) than those coded as positive (mean rank = 215), beta coefficient = 0.33; 95% CI: 0.05, 0.62; p = .02. Cannabis use is a health topic of public interest. Variability in provider responses reflects the need for more research and consensus building to inform evidence-based clinical guidelines for cannabis use in medicine.
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407
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Gonçalves-Pinho M, Bragança M, Freitas A. Psychotic disorders hospitalizations associated with cannabis abuse or dependence: A nationwide big data analysis. Int J Methods Psychiatr Res 2020; 29:e1813. [PMID: 31808250 PMCID: PMC7051837 DOI: 10.1002/mpr.1813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We aimed to describe and correlate the hospital panorama of psychotic disorders (PD) with cannabis use (CU) trends in all Portuguese public hospitals. METHODS We conducted a retrospective observational study that analysed all hospitalizations that occurred in Portuguese public hospitals from 2000 to 2015. Hospitalizations with a primary diagnosis of PD or schizophrenia were selected based on Clinical Classification Software diagnostic single-level 659. Episodes associated with CU were identified by the International Classification of Diseases Version 9, Clinical Modification code 304.3/305.2 that correspond to cannabis dependence/cannabis abuse. RESULTS The number of hospitalizations with a primary diagnosis of PD and schizophrenia associated with CU rose 29.4 times during the study period, from 20 to 588 hospitalizations yearly (2000 and 2015, respectively) with a total of 3,233 hospitalizations and an average episode cost of €3,500. Male patients represented 89.8% of all episodes, and the mean/median age at discharge were 30.66/29.00 years, respectively. From all hospitalizations with a primary diagnosis of PD or schizophrenia, the ones with a secondary diagnosis of CU rose from 0.87% in 2000 to 10.60% in 2015. CONCLUSIONS The increase on secondary diagnosis coding and the change on cannabis patterns of consumption in Portuguese population with an increasing frequency of moderate/high dosage cannabis consumers may explain the rise on PD hospitalizations.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Bragança
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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408
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Miller NS, Ipeku R, Oberbarnscheidt T. A Review of Cases of Marijuana and Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051578. [PMID: 32121373 PMCID: PMC7084484 DOI: 10.3390/ijerph17051578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Marijuana is the most consumed illicit drug in the world, with over 192 million users. Due to the current legalization push of marijuana in the United States, there has been a lack of oversight regarding its public health policies, as marijuana advocates downplay the drug’s negative effects. This paper’s approach is from a public health perspective, focusing specifically on the cases of violence amongst some marijuana users. Here, we present 14 cases of violence with chronic marijuana users that highlight reoccurring consequences of: marijuana induced paranoia (exaggerated, unfounded distrust) and marijuana induced psychosis (radical personality change, loss of contact with reality). When individuals suffering from pre-existing medical conditions use marijuana in an attempt to alleviate their symptoms, ultimately this worsens their conditions over time. Although marijuana effects depend on the individual’s endocannabinoid receptors (which control behavioral functions, like aggression) and the potency level of tetrahydrocannabinol (THC) in the drug, scientifically documented links between certain marijuana users and violence do exist. Wider public awareness of the risks and side effects of marijuana, as well as a more prudent health policy, and government agency monitoring of the drug’s composition, creation, and distribution, are needed and recommended.
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Affiliation(s)
- Norman S. Miller
- CEO of Health Advocates PLLC, East Lansing, MI 48823, USA
- Department of Psychiatry Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-(517)-507-0407
| | - Redon Ipeku
- College of Law, Michigan State University, East Lansing, MI 48823, USA;
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409
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Michel L, Nguyen LT, Nguyen AK, Ekwaru JP, Laureillard D, Nagot N, Phan O, Khuat OTH. Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions. Harm Reduct J 2020; 17:13. [PMID: 32093700 PMCID: PMC7038548 DOI: 10.1186/s12954-020-00357-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. Methods A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16–24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. Results Seven hundred and three YPUD aged 16–24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had “ever” injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at “low-risk” as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. Conclusions The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.
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Affiliation(s)
- Laurent Michel
- CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
| | - Linh T Nguyen
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam
| | - An K Nguyen
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam
| | - John P Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Didier Laureillard
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Olivier Phan
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Oanh T H Khuat
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam.
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410
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van der Steur SJ, Batalla A, Bossong MG. Factors Moderating the Association Between Cannabis Use and Psychosis Risk: A Systematic Review. Brain Sci 2020; 10:E97. [PMID: 32059350 PMCID: PMC7071602 DOI: 10.3390/brainsci10020097] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
Increasing evidence indicates a relationship between cannabis use and psychosis risk. Specific factors, such as determinants of cannabis use or the genetic profile of cannabis users, appear to moderate this association. The present systematic review presents a detailed and up-to-date literature overview on factors that influence the relationship between cannabis use and psychosis risk. A systematic search was performed according to the PRISMA guidelines in MEDLINE and Embase, and 56 studies were included. The results show that, in particular, frequent cannabis use, especially daily use, and the consumption of high-potency cannabis are associated with a higher risk of developing psychosis. Moreover, several genotypes moderate the impact of cannabis use on psychosis risk, particularly those involved in the dopamine function, such as AKT1. Finally, cannabis use is associated with an earlier psychosis onset and increased risk of transition in individuals at a clinical high risk of psychosis. These findings indicate that changing cannabis use behavior could be a harm reduction strategy employed to lower the risk of developing psychosis. Future research should aim to further develop specific biomarkers and genetic profiles for psychosis, thereby contributing to the identification of individuals at the highest risk of developing a psychotic disorder.
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Affiliation(s)
| | | | - Matthijs G. Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, 3584CX Utrecht, The Netherlands
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411
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Kolar K, Elton-Marshall T, Mann RE, Hamilton HA. Routes of cannabis administration among adolescents during criminal prohibition of cannabis in Canada. DRUGS: EDUCATION, PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1715920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Kat Kolar
- School of Nursing, The University of British Columbia, British Columbia, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Epidemiology and Biostatistics, Western University, Toronto, Canada
| | - Robert E. Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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412
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Sarris J, Sinclair J, Karamacoska D, Davidson M, Firth J. Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry 2020; 20:24. [PMID: 31948424 PMCID: PMC6966847 DOI: 10.1186/s12888-019-2409-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 12/15/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known. METHODS The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted). RESULTS The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding. CONCLUSIONS There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia.
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, The University of Melbourne, Melbourne, Australia.
| | - Justin Sinclair
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Maggie Davidson
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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413
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Smyth BP, Cannon M, Molodynski A, Curran HV, Eastwood N, Winstock AR. Would decriminalising personal use of cannabis lead to higher rates of mental illness? BMJ 2020; 368:l6975. [PMID: 31941646 DOI: 10.1136/bmj.l6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mary Cannon
- Royal College of Surgeons in Ireland, Dublin, Ireland
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414
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Shum C, Dutan L, Annuario E, Warre-Cornish K, Taylor SE, Taylor RD, Andreae LC, Buckley NJ, Price J, Bhattacharyya S, Srivastava DP. Δ 9-tetrahydrocannabinol and 2-AG decreases neurite outgrowth and differentially affects ERK1/2 and Akt signaling in hiPSC-derived cortical neurons. Mol Cell Neurosci 2020; 103:103463. [PMID: 31917333 DOI: 10.1016/j.mcn.2019.103463] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 12/26/2022] Open
Abstract
Endocannabinoids regulate different aspects of neurodevelopment. In utero exposure to the exogenous psychoactive cannabinoid Δ9-tetrahydrocannabinol (Δ9-THC), has been linked with abnormal cortical development in animal models. However, much less is known about the actions of endocannabinoids in human neurons. Here we investigated the effect of the endocannabinoid 2-arachidonoyl glycerol (2AG) and Δ9-THC on the development of neuronal morphology and activation of signaling kinases, in cortical neurons derived from human induced pluripotent stem cells (hiPSCs). Our data indicate that the cannabinoid type 1 receptor (CB1R), but not the cannabinoid 2 receptor (CB2R), GPR55 or TRPV1 receptors, is expressed in young, immature hiPSC-derived cortical neurons. Consistent with previous reports, 2AG and Δ9-THC negatively regulated neurite outgrowth. Interestingly, acute exposure to both 2AG and Δ9-THC inhibited phosphorylation of serine/threonine kinase extracellular signal-regulated protein kinases (ERK1/2), whereas Δ9-THC also reduced phosphorylation of Akt (aka PKB). Moreover, the CB1R inverse agonist SR 141716A attenuated the decrease in neurite outgrowth and ERK1/2 phosphorylation induced by 2AG and Δ9-THC. Taken together, our data suggest that hiPSC-derived cortical neurons express CB1Rs and are responsive to exogenous cannabinoids. Thus, hiPSC-neurons may represent a good cellular model for investigating the role of the endocannabinoid system in regulating cellular processes in developing human neurons.
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Affiliation(s)
- Carole Shum
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Lucia Dutan
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Emily Annuario
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Katherine Warre-Cornish
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Samuel E Taylor
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; Centre for Developmental Neurobiology, King's College London, London, UK
| | - Ruth D Taylor
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; Centre for Developmental Neurobiology, King's College London, London, UK
| | - Laura C Andreae
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; Centre for Developmental Neurobiology, King's College London, London, UK
| | | | - Jack Price
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK; National Institute for Biological Standards and Control, South Mimms, UK
| | | | - Deepak P Srivastava
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
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415
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Wright A, Cather C, Gilman J, Evins AE. The Changing Legal Landscape of Cannabis Use and Its Role in Youth-onset Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:145-156. [PMID: 31708043 DOI: 10.1016/j.chc.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rapidly changing landscape of cannabis in terms of availability, potency, and routes of administration, as well as the decrease in risk perception and changing norms, have contributed to an increase in the popularity of cannabis. Cannabis use is associated with a poorer recovery from a psychotic disorder, increasing the risk of relapse, rehospitalization, and lower social functioning. Data are mixed regarding cannabis use as a component cause of psychosis in people at risk for psychotic disorder. Care providers, parents, and schools must educate youth and adolescents about the risks of cannabis use.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA USA.
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA USA
| | - Jodie Gilman
- Harvard Medical School, Boston, MA USA; Massachusetts General Hospital, Center for Addiction Medicine, 101 Merrimac Street, Boston, MA 02114, USA
| | - Anne Eden Evins
- Harvard Medical School, Boston, MA USA; Massachusetts General Hospital, Center for Addiction Medicine, 101 Merrimac Street, Boston, MA 02114, USA
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416
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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417
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Amiet D, Youssef GJ, Hagg LJ, Lorenzetti V, Parkes L, Solowij N, Yücel M. Young Adults With Higher Motives and Expectancies of Regular Cannabis Use Show Poorer Psychosocial Functioning. Front Psychiatry 2020; 11:599365. [PMID: 33384630 PMCID: PMC7771276 DOI: 10.3389/fpsyt.2020.599365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/20/2020] [Indexed: 02/04/2023] Open
Abstract
Background: Young adults regularly using cannabis represent a uniquely vulnerable yet heterogeneous cohort. Few studies have examined user profiles using cannabis use motives and expectations. The association between user profiles and psychosocial functioning among only regular users remains unexplored. This exploration is important to improve public education efforts and design tailor treatment approaches. Methods: Regular cannabis users (at least weekly; n = 329) completed an online survey via Amazon Mechanical Turk. The survey measured levels of cannabis use, other substance use, motives and expectations of cannabis use, symptoms of psychosis, depression, anxiety and stress, and reckless behavior such as getting high before work or driving under the influence of cannabis. Latent class analysis was performed using motives and expectations to identify data driven patterns of regular cannabis use. Classes were then used to investigate mental health and behavioral correlates of differences in motives and expectations. Results: A 2-class solution provided the best fit to the data; Class 1: Low Motives and Expectancies (n = 158) characterized by lower endorsement across all motivation and expectation variables, and Class 2: High Motives and Expectancies (n = 171) characterized by endorsing multiple motivations, and higher positive and negative expectations of cannabis use. Classes differed in a range of cannabis use variables; e.g., greater proportion of peer use in Class 2. The High Motives and Expectancies users reported higher symptoms of psychosis (positive and negative symptoms), depression, anxiety, and stress. A higher proportion met the criteria for a cannabis use disorder compared with Low Motives and Expectancies users. High Motives and Expectancies users reported higher mean problems with nicotine dependence and illicit drug use other than cannabis and were more likely to get high before work and drive under the influence of cannabis. Conclusions: There is heterogeneity among young regular cannabis users in their motivations and expectancies of use and associated psychosocial functioning. Understanding motives and expectancies can help segregate which users are at higher risk of worse functioning. These findings are timely when designing targeted assessment and treatment strategies, particularly as cannabis is further decriminalized and accessibility increases.
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Affiliation(s)
- Danielle Amiet
- BrainPark, School of Psychological Sciences and Monash Biomedical Imaging Facility, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lauryn J Hagg
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction & Mental Health Program, Healthy Brain and Mind Research Centre, Faculty of Health Sciences, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Linden Parkes
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,The Australian Centre for Cannabinoid Clinical and Research Excellence, New Lambton Heights, NSW, Australia
| | - Murat Yücel
- BrainPark, School of Psychological Sciences and Monash Biomedical Imaging Facility, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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418
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Kastaun S, Hildebrandt J, Kotz D. Electronic Cigarettes to Vaporize Cannabis: Prevalence of Use and Associated Factors among Current Electronic Cigarette Users in Germany (DEBRA Study). Subst Use Misuse 2020; 55:1106-1112. [PMID: 32091941 DOI: 10.1080/10826084.2020.1729197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In Germany, cannabis is the most widely used illicit drug, and inhalation together with tobacco is most popular. However, it has been described that electronic cigarettes (ECs) are being used to vaporize cannabis (extract). No current data on EC cannabis use in the German population are yet available. Objectives: This study examines the prevalence of EC cannabis consumption for mood changing effects among current EC users, and associated consumer characteristics in Germany. Methods: We used data from the German Study on Tobacco Use (period: 8/2016-01/2019, DEBRA, www.debra-study.info), a nationally representative household survey. EC cannabis use for mood-changing effects was assessed in 504 current EC users (aged ≥ 18 years) of the total sample (N = 32,678). Ever use was defined by: (1) occasional or regular use, or (2) experimental consumption. Associations with socio-demographic consumer characteristics and tobacco smoking were analyzed using multivariable regression analyses. Results: Amongst current EC users, 7.2% had ever vaporized cannabis: 2.3% (95%CI = 1.2-3.9) reported occasional or regular use (1) and 4.8% (95%CI = 3.2-7.1) reported experimental use (2). Age was associated with ever EC cannabis use: highest prevalence rates were found among 18-24-year-olds: 6.5% (95%CI = 2.3-13.1) (1) and 8.0% (95%CI = 3.7-15.8) (2), respectively. The majority (90.2%) of ever EC cannabis users were current tobacco smokers. Conclusions: One in 14 current EC users in Germany has ever vaporized cannabis for mood-changing reasons, and almost all EC cannabis consumers also smoke tobacco. Highest usage rates can be observed among young adults. Hence, trends of EC drug misuse need to be monitored consequently, particularly in young people.
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Affiliation(s)
- Sabrina Kastaun
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany
| | - Daniel Kotz
- Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Düsseldorf, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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419
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Russian Federation medical student knowledge, attitudes and beliefs toward medical cannabis. Complement Ther Med 2020; 48:102274. [DOI: 10.1016/j.ctim.2019.102274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
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420
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Bonnet U, Specka M, Soyka M, Alberti T, Bender S, Grigoleit T, Hermle L, Hilger J, Hillemacher T, Kuhlmann T, Kuhn J, Luckhaus C, Lüdecke C, Reimer J, Schneider U, Schroeder W, Stuppe M, Wiesbeck GA, Wodarz N, McAnally H, Scherbaum N. Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others-A Perspective of German Addiction Medicine Experts. Front Psychiatry 2020; 11:592199. [PMID: 33192740 PMCID: PMC7649209 DOI: 10.3389/fpsyt.2020.592199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Over the past 15 years, comparative assessments of psychoactive substance harms to both users and others have been compiled by addiction experts. None of these rankings however have included synthetic cannabinoids or non-opioid prescription analgesics (NOAs, e.g., gabapentinoids) despite evidence of increasing recreational use. We present here an updated assessment by German addiction medicine experts, considering changing Western consumption trends-including those of NOAs. Methods: In an initial survey, 101 German addiction medicine physicians evaluated both physical and psychosocial harms (in 5 dimensions) of 33 psychoactive substances including opioids and NOAs, to both users and others. In a second survey, 36 addiction medicine physicians estimated the relative weight of each health and social harm dimension to determine the overall harm rank of an individual substance. We compared our ranking with the most recent European assessment from 2014. Results: Illicit drugs such as methamphetamine, heroin, cocaine and also alcohol were judged particularly harmful, and new psychoactive drugs (cathinones, synthetic cannabinoids) were ranked among the most harmful substances. Cannabis was ranked in the midrange, on par with benzodiazepines and ketamine-somewhat more favorable compared to the last European survey. Prescribed drugs including opioids (in contrast to the USA, Canada, and Australia) were judged less harmful. NOAs were at the bottom end of the ranking. Conclusion: In Germany, alcohol and illicit drugs (including new psychoactive substances) continue to rank among the most harmful addictive substances in contrast to prescribed agents including opioid analgesics and NOAs. Current laws are incongruent with these harm rankings. This study is the first of its kind to include comparative harm rankings of several novel abused substances, both licit/prescribed and illicit.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, Landschaftsverband Rheinland-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Landschaftsverband Rheinland-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Alberti
- Department of Psychiatry, Psychotherapy and Psychosomatic, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Stefan Bender
- Psychiatry, Psychotherapy and Psychosomatics, Landschaftsverband Westfalen-Lippe-Hospital Marsberg, Marsberg, Germany
| | - Torsten Grigoleit
- Psychiatry and Psychotherapy, Landschaftsverband Rheinland-Hospital Langenfeld, Langenfeld, Germany
| | - Leopold Hermle
- Clinic for Psychiatry and Psychotherapy, Christophsbad, Göppingen, Germany
| | - Jörg Hilger
- Clinic for Psychiatry, Psychotherapy, Psychosomatics and Neurology, Evangelische Stiftung Tannenhof, Remscheid, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.,Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Kuhlmann
- Clinic for Psychosomatics Bergisch-Gladbach, Bergisch Gladbach, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy and Psychosomatic, Johanniter Hospital Oberhausen, Oberhausen, Germany.,Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Luckhaus
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Department of Psychiatry, Landschaftsverband Westfalen-Lippe University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Christel Lüdecke
- Lower Saxonian Psychiatric Hospital, Asklepios Hospital, Göttingen, Germany
| | - Jens Reimer
- Center for Interdisciplinary Addiction Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Health North Hospital Group Bemen, Bremen, Germany
| | - Udo Schneider
- Department of Psychiatry and Psychotherapy, Ruhr-University Bochum, Campus Ostwestfalen-Lippe, Luebbecke, Germany
| | | | - Markus Stuppe
- Department of Addiction Medicine, Helios Medical Center Schwerin, Carl-Friedrich-Flemming-Clinic, Schwerin, Germany
| | | | - Norbert Wodarz
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Heath McAnally
- Northern Anesthesia & Pain Medicine, Limited Liability Company, Eagle River, AK, United States.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Landschaftsverband Rheinland-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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421
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Abstract
Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Harriet Quigley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
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422
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Manza P, Yuan K, Shokri-Kojori E, Tomasi D, Volkow ND. Brain structural changes in cannabis dependence: association with MAGL. Mol Psychiatry 2020; 25:3256-3266. [PMID: 31695165 PMCID: PMC7200265 DOI: 10.1038/s41380-019-0577-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/20/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
Cannabis use is rising, yet there is poor understanding of biological processes that might link chronic cannabis use to brain structural abnormalities. To lend insight into this topic, we examined white matter microstructural integrity and gray matter cortical thickness/density differences between 89 individuals with cannabis dependence (CD) and 89 matched controls (64 males, 25 females in each group) from the Human Connectome Project. We tested whether cortical patterns for expression of genes relevant for cannabinoid signaling (from Allen Human Brain Atlas postmortem tissue) were associated with spatial patterns of cortical thickness/density differences in CD. CD had lower fractional anisotropy than controls in white matter bundles innervating posterior cingulate and parietal cortex, basal ganglia, and temporal cortex. The CD group also had significantly less gray matter thickness and density in precuneus, relative to controls. Sibling-pair analysis found support for causal and graded liability effects of cannabis on precuneus structure. Spatial patterns of gray matter differences in CD were significantly associated with regional differences in monoacylglycerol lipase (MAGL) expression in postmortem brain tissue, such that regions with higher MAGL expression (but not fatty-acid amide hydrolase or FAAH) were more vulnerable to cortical thinning. In sum, chronic cannabis use is associated with structural differences in white and gray matter, which was most prominent in precuneus and associated white matter tracts. Regions with high MAGL expression, and therefore with potentially physiologically restricted endogenous cannabinoid signaling, may be more vulnerable to the effects of chronic cannabis use on cortical thickness.
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Affiliation(s)
- Peter Manza
- National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Kai Yuan
- grid.94365.3d0000 0001 2297 5165National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD USA ,grid.440736.20000 0001 0707 115XSchool of Life Science and Technology, Xidian University, 710071 Xi’an, Shaanxi PR China
| | - Ehsan Shokri-Kojori
- grid.94365.3d0000 0001 2297 5165National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD USA
| | - Dardo Tomasi
- grid.94365.3d0000 0001 2297 5165National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD USA
| | - Nora D. Volkow
- grid.94365.3d0000 0001 2297 5165National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD USA ,grid.94365.3d0000 0001 2297 5165National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD USA
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423
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Beckmann D, Lowman KL, Nargiso J, McKowen J, Watt L, Yule AM. Substance-Induced Psychosis in Youth. Child Adolesc Psychiatr Clin N Am 2020; 29:131-143. [PMID: 31708042 PMCID: PMC8961695 DOI: 10.1016/j.chc.2019.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Youth experiencing psychosis also frequently misuse substances, making it clinically challenging to differentiate substance-induced psychosis (SIP) from a primary psychotic disorder (PPD), which has important implications for management and prognosis. This article presents practical considerations related to differentiating SIP from PPD, including information on substances associated with symptoms of psychosis. Recommendations for management of SIP are also reviewed, including screening for and treating comorbid substance use disorders and using evidence-based medication and psychosocial interventions.
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Affiliation(s)
- David Beckmann
- Addiction Recovery Management Service and First Episode and Early Psychosis Program, Massachusetts General Hospital, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street WACC 812, Boston, MA 02114
| | - Kelsey Leigh Lowman
- Department of Psychiatry, Massachusetts General Hospital, 101 Merrimac Street, Suite 320, Boston MA 02114
| | - Jessica Nargiso
- Addiction Recovery Management Service, Massachusetts General Hospital, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street WACC 812, Boston, MA 02114
| | - James McKowen
- Addiction Recovery Management Service, Massachusetts General Hospital, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street WACC 812, Boston, MA 02114
| | - Lisa Watt
- Addiction Recovery Management Service, Massachusetts General Hospital, Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street YAW 6A, Boston, MA 02114
| | - Amy M. Yule
- Addiction Recovery Management Service, Massachusetts General Hospital, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 15 Parkman Street YAW 6A, Boston, MA 02114
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424
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Matheson J, Le Foll B. Cannabis Legalization and Acute Harm From High Potency Cannabis Products: A Narrative Review and Recommendations for Public Health. Front Psychiatry 2020; 11:591979. [PMID: 33173527 PMCID: PMC7538627 DOI: 10.3389/fpsyt.2020.591979] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
Legalization and commercial sale of non-medical cannabis has led to increasing diversity and potency of cannabis products. Some of the American states that were the first to legalize have seen rises in acute harms associated with cannabis use, e.g. Colorado has seen increases in emergency department visits for cannabis-related acute psychological distress and severe vomiting (hyperemesis), as well as a number of high-profile deaths related to ingestion of high doses of cannabis edibles. Over-ingestion of cannabis is related to multiple factors, including the sale of cannabis products with high levels of THC and consumers' confusion regarding labelling of cannabis products, which disproportionately impact new or inexperienced users. Based on our review of the literature, we propose three approaches to minimizing acute harms: early restriction of cannabis edibles and high-potency products; clear and consistent labelling that communicates dose/serving size and health risks; and implementation of robust data collection frameworks to monitor harms, broken down by cannabis product type (e.g. dose, potency, route of administration) and consumer characteristics (e.g. age, sex, gender, ethnicity). Ongoing data collection and monitoring of harms in jurisdictions that have existing legal cannabis laws will be vital to understanding the impact of cannabis legalization and maximizing public health benefits.
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Affiliation(s)
- Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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425
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Quattrone D, Richards A, Reininghaus U, Vassos E, O'Donovan M, Lewis C, Di Forti M. Letter to the editor: Is polygenic risk for Parkinson's disease associated with less risk of first episode psychosis? Psychol Med 2020; 50:173-176. [PMID: 31533866 DOI: 10.1017/s0033291719002435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Alex Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Michael O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Cathryn Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
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426
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Müller-Oehring EM, Le Berre AP, Serventi M, Kalon E, Haas AL, Padula CB, Schulte T. Brain activation to cannabis- and alcohol-related words in alcohol use disorder. Psychiatry Res Neuroimaging 2019; 294:111005. [PMID: 31715379 PMCID: PMC6886708 DOI: 10.1016/j.pscychresns.2019.111005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022]
Abstract
Cannabis abuse commonly co-occurs with alcohol use disorder (AUD). With increased acceptance and accessibility to cannabis in the US, it is imperative to understand the psychological and neural mechanisms of concurrent alcohol and cannabis use. We hypothesized that neural alcohol-cue conditioning may extent to other drug-related stimuli, such as cannabis, and underwrite the loss of control over reward-driven behavior. Task-activated fMRI examined the neural correlates of alcohol- and cannabis-related word cues in 21 abstinent AUD and 18 control subjects. Relative to controls, AUD showed behavioral attentional biases and frontal hypoactivation to both alcohol- and cannabis-related words. This cue-elicited prefrontal hypoactivation was related to higher lifetime alcohol consumption (pcorrected < 0.02) and modulated by past cannabis use histories (p ≦ 0.001). In particular, frontal hypoactivation to both alcohol and cannabis cues was pronounced in AUD without prior cannabis exposure. Overall, frontal control mechanisms in abstinent AUD were not sufficiently engaged to override automatic alcohol and cannabis-related intrusions, enhancing the risk for relapse and potentially for alcohol and cannabis co-use with the increased social acceptance and accessibility in the US.
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Affiliation(s)
- Eva M Müller-Oehring
- Neuroscience Program, SRI International, Menlo Park, CA, United States; Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Anne-Pascale Le Berre
- Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Matthew Serventi
- Neuroscience Program, SRI International, Menlo Park, CA, United States; Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Ember Kalon
- Neuroscience Program, SRI International, Menlo Park, CA, United States; Dept. of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Amie L Haas
- Dept. of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Claudia B Padula
- Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States; VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Tilman Schulte
- Neuroscience Program, SRI International, Menlo Park, CA, United States; Dept. of Psychology, Palo Alto University, Palo Alto, CA, United States.
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427
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Gentil V. Can we brace for a Canadian-type cannabis storm? BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:471-472. [PMID: 31826092 PMCID: PMC6899361 DOI: 10.1590/1516-4446-2019-0639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Valentim Gentil
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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428
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Noteworthy Professional News. Adv Neonatal Care 2019. [DOI: 10.1097/anc.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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429
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Trends in Opioid Misuse among Marijuana Users and Non-Users in the U.S. from 2007-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224585. [PMID: 31752436 PMCID: PMC6888158 DOI: 10.3390/ijerph16224585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 01/03/2023]
Abstract
Prescription-opioid misus e continues to be a significant health concern in the United States. The relationship between marijuana use and prescription-opioid misuse is not clear from the extant literature. This study examined national trends in prescription-opioid misuse among marijuana users and non-users using the 2007-2017 National Survey on Drug Use and Health. Cochran-Armitage tests were used to assess the statistical significance of changes in the yearly prevalence of prescription-opioid misuse and marijuana use. Multivariable logistic regression was used to examine the association between prescription-opioid and marijuana use adjusting for sociodemographic characteristics. From 2007 to 2017, marijuana use increased, while prescription-opioid misuse declined. Larger declines in prescription-opioid misuse were found among marijuana users than non-users. Marijuana ever-use was significantly associated with prescription-opioid misuse. Specifically, marijuana ever-users had higher odds of prescription-opioid misuse (ever-misuse [OR: 3.04; 95% CI, 2.68-3.43]; past-year misuse [OR: 3.44; 95% CI, 3.00-3.94]; and past-month misuse [OR: 4.50; 95% CI, 3.35-6.05]) compared to marijuana never-users. Similar results were found for the association of past-year and past-month marijuana use with prescription-opioid misuse. This study provides data on trends and associations about opioid misuse among marijuana users and non-users in a changing social environment of drug use in the United States. Future research should consider whether there is a causal relationship between marijuana use and prescription opioid misuse.
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430
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Khamenka N, Skuhareuski A, Reznik A, Isralowitz R. Medical Cannabis Pain Benefit, Risk and Effectiveness Perceptions Among Belarus Medical Students. Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-019-00152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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431
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Madras BK, Han B, Compton WM, Jones CM, Lopez EI, McCance-Katz EF. Associations of Parental Marijuana Use With Offspring Marijuana, Tobacco, and Alcohol Use and Opioid Misuse. JAMA Netw Open 2019; 2:e1916015. [PMID: 31755950 PMCID: PMC6902822 DOI: 10.1001/jamanetworkopen.2019.16015] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Marijuana use is increasing among adults and often co-occurs with other substance use; therefore, it is important to examine whether parental marijuana use is associated with elevated risk of substance use among offspring living in the same household. OBJECTIVE To examine associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used survey data from the 2015 through 2018 National Surveys on Drug Use and Health (NSDUH), which provide nationally representative data on adolescents or young adults living with a parent (the mother or the father). Annual average percentages were based on survey sampling weights. Final analyses were conducted September 21 through 23, 2019. EXPOSURES Parental marijuana use status. MAIN OUTCOMES AND MEASURES Offspring self-reported use of marijuana, tobacco, or alcohol or misuse of opioids. RESULTS Survey respondents included 24 900 father-offspring or mother-offspring dyads sampled from the same household. Among mothers living with adolescent offspring, 8.2% (95% CI, 7.3%-9.2%) had past-year marijuana use, while 7.6% (95% CI, 6.2%-9.2%) of mothers living with young adult offspring had past-year marijuana use. Among fathers living with adolescent offspring, 9.6% (95% CI, 8.5%-10.8%) had past-year marijuana use, and 9.0% (95% CI, 7.4%-10.9%) of fathers living with young adult offspring had past-year marijuana use. Compared with adolescents whose mothers never used marijuana, adjusted relative risk (ARR) of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.3; 95% CI, 1.1-1.6; P = .007), less than 52 days of past-year marijuana use (ARR, 1.7; 95% CI, 1.1-2.7; P = .02), or 52 days or more of past-year marijuana use (ARR, 1.5; 95% CI, 1.1-2.2; P = .02). Compared with young adults whose mothers never used marijuana, adjusted risk of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.4; 95% CI, 1.1-1.7; P = .001), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.3; P = .049), or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.3-2.5; P = .002). Compared with adolescents whose fathers never used marijuana, adolescents whose fathers had less than 52 days of past-year marijuana use were more likely to use marijuana (ARR, 1.8; 95% CI, 1.2-2.7; P = .006). Compared with young adults whose fathers never used marijuana, young adults whose fathers had 52 days or more of past-year marijuana use were more likely to use marijuana (ARR, 2.1; 95% CI, 1.6-2.9; P < .001). Compared with their peers whose parents never used marijuana and after adjusting for covariates, the adjusted risk of past-year tobacco use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.3; 95% CI, 1.0-1.6; P = .03), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.1; P = .04), or 52 days or more of past-year marijuana use (ARR, 1.6; 95% CI, 1.1-2.3; P = .03); adolescents whose fathers had lifetime marijuana use (ARR, 1.5; 95% CI, 1.1-1.9; P = .004) or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.2-2.7; P = .006); young adults whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.0-1.4; P = .04); and young adults whose fathers had 52 days or more of past-year marijuana use (ARR, 1.4; 95% CI, 1.0-1.9; P = .046). Compared with their peers whose parents had no past marijuana use and after adjusting for covariates, risk of past-year alcohol use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.1-1.4; P = .004), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.2-1.9; P = .002), or 52 days or more of past-year marijuana use (ARR, 1.3; 95% CI, 1.0-1.7; P = .04). After adjusting for covariates, parental marijuana use was not associated with opioid misuse by offspring. CONCLUSIONS AND RELEVANCE In this cross-sectional study, parental marijuana use was associated with increased risk of substance use among adolescent and young adult offspring living in the same household. Screening household members for substance use and counseling parents on risks posed by current and past marijuana use are warranted.
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Affiliation(s)
- Bertha K. Madras
- McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Beth Han
- Substance Abuse and Mental Health Services Administration, Rockville, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Elizabeth I. Lopez
- Substance Abuse and Mental Health Services Administration, Rockville, Maryland
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432
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Meyer U. Neurodevelopmental Resilience and Susceptibility to Maternal Immune Activation. Trends Neurosci 2019; 42:793-806. [DOI: 10.1016/j.tins.2019.08.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/05/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022]
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433
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Barakji JA, Korang SK, Feinberg J, Maagard M, Gluud C, Mathiesen O, Jakobsen JC. Cannabinoids versus placebo or no intervention for pain: protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2019; 9:e031574. [PMID: 31676655 PMCID: PMC6830650 DOI: 10.1136/bmjopen-2019-031574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/07/2019] [Accepted: 10/04/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Pain is a frequent clinical symptom with significant impact on the patient's well-being. Therefore, adequate pain management is of utmost importance. While cannabinoids have become a more popular alternative to traditional types of pain medication among patients, the quality of evidence supporting the use of cannabinoids has been questioned. The beneficial and harmful effects of cannabinoids in patients with pain is unknown. Accordingly, we aim to assess the efficacy, tolerability and safety of cannabinoids (herbal, plant-derived extracts and synthetic) compared with placebo or no intervention for any type of pain. METHODS AND ANALYSES We will conduct a systematic review of randomised clinical trials with meta-analysis and Trial Sequential Analysis to assess the beneficial and harmful effects of cannabinoids in any dose, formulation and duration. We will accept placebo or no treatment as control interventions. We will include participants with any type of pain (acute and chronic pain, cancer-related pain, headache, neuropathic pain or any other types of pain). We will systematically search The Cochrane Library, MEDLINE, Embase, Science Citation Index and BIOSIS for relevant literature. We will follow the recommendations by Cochrane and the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The risk of systematic errors (bias) and random errors (play of chance) will be assessed. The overall certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Ethical approval is not a requirement since no primary data will be collected. The findings of this systematic review will be submitted for peer-reviewed publication and disseminated in national and international conferences. DISCUSSION Although cannabinoids are now being used to manage different pain conditions, the evidence for the clinical effects are unclear. The present review will systematically assess the current evidence for the benefits and harms of cannabinoids to inform practice and future research.
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Affiliation(s)
- Jehad Ahmad Barakji
- Copenhagen Trial Unit, Rigshospitalet, Department 7812, Center for Clinical Intervention Research, Copenhagen, Denmark
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Rigshospitalet, Department 7812, Center for Clinical Intervention Research, Copenhagen, Denmark
- Pediatric Department, Holbaek Hospital, Holbaek, Denmark
| | | | - Mathias Maagard
- Copenhagen Trial Unit, Rigshospitalet, Department 7812, Center for Clinical Intervention Research, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Rigshospitalet, Department 7812, Center for Clinical Intervention Research, Copenhagen, Denmark
| | | | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Rigshospitalet, Department 7812, Center for Clinical Intervention Research, Copenhagen, Denmark
- Cardiology Department, Holbaek Hospital, Holbaek, Denmark
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434
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Frau R, Miczán V, Traccis F, Aroni S, Pongor CI, Saba P, Serra V, Sagheddu C, Fanni S, Congiu M, Devoto P, Cheer JF, Katona I, Melis M. Prenatal THC exposure produces a hyperdopaminergic phenotype rescued by pregnenolone. Nat Neurosci 2019; 22:1975-1985. [PMID: 31611707 PMCID: PMC6884689 DOI: 10.1038/s41593-019-0512-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/11/2019] [Indexed: 12/21/2022]
Abstract
Increased legal availability of cannabis has led to a common misconception that it is a safe natural remedy for, amongst others, pregnancy-related ailments like morning sickness. Emerging clinical evidence, however, indicates that prenatal cannabis exposure (PCE) predisposes offspring to various neuropsychiatric disorders linked to aberrant dopaminergic function. Yet, our knowledge of how cannabis exposure affects the maturation of this neuromodulatory system remains limited. Here, we show that male, but not female, offspring of Δ9-tetrahydrocannabinol (THC)-exposed dams, a rat PCE model, exhibit extensive molecular and synaptic changes in dopaminergic neurons of the ventral tegmental area, including altered excitatory-to-inhibitory balance and switched polarity of long-term synaptic plasticity. The resulting hyperdopaminergic state leads to increased behavioral sensitivity to acute THC during pre-adolescence. The FDA-approved neurosteroid pregnenolone rescues synaptic defects and normalizes dopaminergic activity and behavior in PCE offspring, suggesting a therapeutic approach for offspring exposed to cannabis during pregnancy.
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Affiliation(s)
- Roberto Frau
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Vivien Miczán
- Momentum Laboratory of Molecular Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary.,Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Francesco Traccis
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Sonia Aroni
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy.,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Csaba I Pongor
- Nikon Center of Excellence for Neuronal Imaging, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Pierluigi Saba
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Valeria Serra
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Claudia Sagheddu
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Silvia Fanni
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Mauro Congiu
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Paola Devoto
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy
| | - Joseph F Cheer
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - István Katona
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Miriam Melis
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Italy.
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435
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Setién-Suero E, Neergaard K, Ortiz-García de la Foz V, Suárez-Pinilla P, Martínez-García O, Crespo-Facorro B, Ayesa-Arriola R. Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatr Scand 2019; 140:349-359. [PMID: 31381129 DOI: 10.1111/acps.13081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2 = 15.583, P ≤ 0.001; SAPS: x2 = 12.386, P = 0.002) and poorer functionality (DAS: x2 = 6.067, P = 0.048; GAF: x2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.
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Affiliation(s)
- E Setién-Suero
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - K Neergaard
- Department of Laboratoire Parole et Langage, Aix-Marseille Université, Marseille, France
| | - V Ortiz-García de la Foz
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - P Suárez-Pinilla
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - O Martínez-García
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.,Hospital Universitario Virgen del Rocio, IBiS, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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436
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Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry 2019; 18:247-258. [PMID: 31496097 PMCID: PMC6732691 DOI: 10.1002/wps.20655] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
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Affiliation(s)
- Craig Morgan
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gemma Knowles
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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437
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McDonald AJ, Roerecke M, Mann RE. Adolescent cannabis use and risk of mental health problems-the need for newer data. Addiction 2019; 114:1889-1890. [PMID: 31256420 DOI: 10.1111/add.14724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- André J McDonald
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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438
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A Century of Cannabis Research in Canada. CANADIAN JOURNAL OF ADDICTION 2019. [DOI: 10.1097/cxa.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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439
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Fabresse N, Becam J, Carrara L, Descoeur J, Di Mario M, Drevin G, Duval T, Hannas N, Lanot T, Marillier M, Palayer M, Senechal H, Salle S. Cannabinoïdes et thérapeutique. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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440
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Affiliation(s)
- Marco Leyton
- From the Departments of Psychiatry and Psychology, McGill University; the Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University; the Center for Studies in Behavioral Neurobiology, Concordia University; and the Research Unit on Children’s Psychosocial Maladjustment, Université de Montréal, Montreal, Que., Canada
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441
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442
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Sheridan Rains L, Marston L, Hinton M, Marwaha S, Craig T, Fowler D, King M, Omar RZ, McCrone P, Spencer J, Taylor J, Colman S, Harder C, Gilbert E, Randhawa A, Labuschagne K, Jones C, Stefanidou T, Christoforou M, Craig M, Strang J, Weaver T, Johnson S. Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial. BMC Med 2019; 17:161. [PMID: 31412884 PMCID: PMC6694526 DOI: 10.1186/s12916-019-1395-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cannabis is the most commonly used illicit substance amongst people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. METHODS CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at least one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. RESULTS Five hundred fifty-one participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99, 382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group; however, the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. CONCLUSIONS Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered.
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Affiliation(s)
| | - Louise Marston
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Mark Hinton
- Camden and Islington NHS Foundation Trust, 4 St Pancras Way, London, NW1 0PE, UK.,Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Steven Marwaha
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Thomas Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Paul McCrone
- Department of Health Services and Population Research, King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Spencer
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanne Taylor
- Division of Psychiatry, University College London, London, UK
| | - Sophie Colman
- Division of Psychiatry, University College London, London, UK
| | | | - Eleanor Gilbert
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Amie Randhawa
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Charlotte Jones
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Meghan Craig
- Division of Psychiatry, University College London, London, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Tim Weaver
- Mental Health Social Work & Inter-professional Learning, Middlesex University London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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443
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Ferraro L, Murray RM, Di Forti M, Quattrone D, Tripoli G, Sideli L, La Barbera D, La Cascia C. IQ differences between patients with first episode psychosis in London and Palermo reflect differences in patterns of cannabis use. Schizophr Res 2019; 210:81-88. [PMID: 31272907 DOI: 10.1016/j.schres.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
AIMS Cognitive impairment is a possible indicator of neurodevelopmental impairment, but not all psychotic patients are cognitively compromised. It has been suggested that heavy cannabis use may precipitate psychosis in those who show no such compromise. This study compares two samples of patients with first-episode psychosis and their respective non-psychotic controls, in London (UK) and Palermo (Italy), and examines whether different patterns of cannabis use are reflected in differences in IQ. METHODS The two studies used the same inclusion/exclusion criteria and instruments. The sample comprised 249 subjects from London (106 patients and 143 controls) and 247 subjects from Palermo (120 patients and 127 controls). ANCOVA was performed with IQ as the dependent variable and city and frequency of cannabis use as predictors. This was then repeated with the case group only, by adjusting for relevant confounders. RESULTS We found a greater amount of cannabis use in the London sample, compared to Palermo and patients from London had higher IQ than patients from Palermo, a difference that was more significant than that reflected between controls (Fgroup*city(1, 402) = 7.6, p = 0.006). Once corrected for symptomatology and treatment, patients from London who had never used cannabis were similar to patients from Palermo regarding IQ. Thus the higher IQ of patients from London was mainly due to the subgroup of cannabis-using patients (Fcannabis*city(2,145) = 4.6, p = 0.011). CONCLUSIONS We can speculate that a greater amount of cannabis-use may have contributed by precipitating psychosis in patients with a higher IQ in London but less so in patients from Palermo.
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Affiliation(s)
- Laura Ferraro
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Robin M Murray
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Mental Health Foundation Trust, UK.
| | - Marta Di Forti
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; South London and Maudsley NHS Mental Health Foundation Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Diego Quattrone
- South London and Maudsley NHS Mental Health Foundation Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, UK.
| | - Giada Tripoli
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Lucia Sideli
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy; Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy.
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and advanced Diagnostics (BiND), Psychiatry Section, University of Palermo. Via Gaetano La Loggia, 1, 90129, Palermo, Italy.
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444
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Early Parental Death and Risk of Psychosis in Offspring: A Six-Country Case-Control Study. J Clin Med 2019; 8:jcm8071081. [PMID: 31340495 PMCID: PMC6679091 DOI: 10.3390/jcm8071081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 11/17/2022] Open
Abstract
Evidence for early parental death as a risk factor for psychosis in offspring is inconclusive. We analyzed data from a six-country, case-control study to examine the associations of early parental death, type of death (maternal, paternal, both), and child’s age at death with psychosis, both overall and by ethnic group. In fully adjusted multivariable mixed-effects logistic regression models, experiencing early parental death was associated with 1.54-fold greater odds of psychosis (95% confidence interval (CI): 1.23, 1.92). Experiencing maternal death had 2.27-fold greater odds (95% CI: 1.18, 4.37), paternal death had 1.14-fold greater odds (95% CI: 0.79, 1.64), and both deaths had 4.42-fold greater odds (95% CI: 2.57, 7.60) of psychosis compared with no early parental death. Experiencing parental death between 11 and 16 years of age had 2.03-fold greater odds of psychosis than experiencing it before five years of age (95% CI: 1.02, 4.04). In stratified analyses, experiencing the death of both parents had 9.22-fold greater odds of psychosis among minority ethnic groups (95% CI: 2.02–28.02) and no elevated odds among the ethnic majority (odds ratio (OR): 0.96; 95% CI: 0.10–8.97), which could be due in part to the higher prevalence of early parental death among minority ethnic groups but should be interpreted cautiously given the wide confidence intervals.
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445
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Choi NG, Dinitto DM, Arndt S. Potential Harms of Marijuana Use Among Older Adults. ACTA ACUST UNITED AC 2019. [DOI: 10.1093/ppar/prz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin
| | - Diana M Dinitto
- Steve Hicks School of Social Work, The University of Texas at Austin
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City
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446
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The Potential of Cannabidiol as a Treatment for Psychosis and Addiction: Who Benefits Most? A Systematic Review. J Clin Med 2019; 8:jcm8071058. [PMID: 31330972 PMCID: PMC6678854 DOI: 10.3390/jcm8071058] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022] Open
Abstract
The endogenous cannabinoid (eCB) system plays an important role in the pathophysiology of both psychotic disorders and substance use disorders (SUDs). The non-psychoactive cannabinoid compound, cannabidiol (CBD) is a highly promising tool in the treatment of both disorders. Here we review human clinical studies that investigated the efficacy of CBD treatment for schizophrenia, substance use disorders, and their comorbidity. In particular, we examined possible profiles of patients who may benefit the most from CBD treatment. CBD, either as monotherapy or added to regular antipsychotic medication, improved symptoms in patients with schizophrenia, with particularly promising effects in the early stages of illness. A potential biomarker is the level of anandamide in blood. CBD and THC mixtures showed positive effects in reducing short-term withdrawal and craving in cannabis use disorders. Studies on schizophrenia and comorbid substance use are lacking. Future studies should focus on the effects of CBD on psychotic disorders in different stages of illness, together with the effects on comorbid substance use. These studies should use standardized measures to assess cannabis use. In addition, future efforts should be taken to study the relationship between the eCB system, GABA/glutamate, and the immune system to reveal the underlying neurobiology of the effects of CBD.
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Mellsop G, Tapsell R, Menkes DB. Testing a hypothesis arising from the epidemiology of schizophrenia in New Zealand. Gen Psychiatr 2019; 32:e100048. [PMID: 31179434 PMCID: PMC6551442 DOI: 10.1136/gpsych-2019-100048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Graham Mellsop
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
| | - Rees Tapsell
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
| | - David Benjamin Menkes
- Department of Psychological Medicine, University of Auckland, Waikato Clinical School, Hamilton, New Zealand
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Abstract
PURPOSE OF REVIEW This paper provides an update from the literature on understanding of the relationship between cannabis and schizophrenia. In particular, the paper focuses on the latest findings and remaining areas that require investigation. RECENT FINDINGS Three hypotheses have emerged as potential explanations for the association between cannabis and schizophrenia, namely cannabis can trigger schizophrenia, cannabis is used to mitigate symptoms of schizophrenia, and there are common factors which might account for the association. Biological and genetic factors dominate this field of research; this has been at the expense of exploring social and cultural contributory factors which influence cannabis and schizophrenia. The evidence for cannabis acting as a causal factor for schizophrenia has so far not been established. Research needs to extend beyond males drawn from western countries if we are to advance knowledge and understanding of the link between cannabis use and schizophrenia.
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Affiliation(s)
| | - Mark Monaghan
- Social Policy, University of Birmingham, Birmingham, UK
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