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Sadaka AH, Canuel J, Febo M, Johnson CT, Bradshaw HB, Ortiz R, Ciumo F, Kulkarni P, Gitcho MA, Ferris CF. Effects of inhaled cannabis high in Δ9-THC or CBD on the aging brain: A translational MRI and behavioral study. Front Aging Neurosci 2023; 15:1055433. [PMID: 36819730 PMCID: PMC9930474 DOI: 10.3389/fnagi.2023.1055433] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
With the recent legalization of inhaled cannabis for medicinal and recreational use, the elderly represents one of the newest, rapidly growing cohorts of cannabis users. To understand the neurobiological effects of cannabis on the aging brain, 19-20 months old mice were divided into three groups exposed to vaporized cannabis containing ~10% Δ9-THC, ~10% CBD, or placebo for 30 min each day. Voxel based morphometry, diffusion weighted imaging, and resting state functional connectivity data were gathered after 28 days of exposure and following a two-week washout period. Tail-flick, open field, and novel object preference tests were conducted to explore analgesic, anxiolytic, and cognitive effects of cannabis, respectively. Vaporized cannabis high in Δ9-THC and CBD achieved blood levels reported in human users. Mice showed antinociceptive effects to chronic Δ9-THC without tolerance while the anxiolytic and cognitive effects of Δ9-THC waned with treatment. CBD had no effect on any of the behavioral measures. Voxel based morphometry showed a decrease in midbrain dopaminergic volume to chronic Δ9-THC followed but an increase after a two-week washout. Fractional anisotropy values were reduced in the same area by chronic Δ9-THC, suggesting a reduction in gray matter volume. Cannabis high in CBD but not THC increased network strength and efficiency, an effect that persisted after washout. These data would indicate chronic use of inhaled cannabis high in Δ9-THC can be an effective analgesic but not for treatment of anxiety or cognitive decline. The dopaminergic midbrain system was sensitive to chronic Δ9-THC but not CBD showing robust plasticity in volume and water diffusivity prior to and following drug cessation an effect possibly related to the abuse liability of Δ9-THC. Chronic inhaled CBD resulted in enhanced global network connectivity that persisted after drug cessation. The behavioral consequences of this sustained change in brain connectivity remain to be determined.
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Affiliation(s)
- Aymen H. Sadaka
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States
| | - Justin Canuel
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States
| | - Marcelo Febo
- Department of Psychiatry and Neuroscience, University of Florida College of Medicine, Gainesville, FL, United States
| | - Clare T. Johnson
- Psychological and Brain Sciences, Program in Neuroscience, Indiana University, Bloomington, IN, United States
| | - Heather B. Bradshaw
- Psychological and Brain Sciences, Program in Neuroscience, Indiana University, Bloomington, IN, United States
| | - Richard Ortiz
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, NM, United States
| | - Federica Ciumo
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States
| | - Praveen Kulkarni
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States
| | - Michael A. Gitcho
- Department of Biological Sciences, Delaware Center for Neuroscience Research, Delaware State University, Dover, DE, United States
| | - Craig F. Ferris
- Center for Translational NeuroImaging, Northeastern University, Boston, MA, United States,Departments of Psychology and Pharmaceutical Sciences, Northeastern University, Boston, MA, United States,*Correspondence: Craig F. Ferris,
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Marchi M, Galli G, Fiore G, Mackinnon A, Mattei G, Starace F, Galeazzi GM. Machine-Learning for Prescription Patterns: Random Forest in the Prediction of Dose and Number of Antipsychotics Prescribed to People with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:450-461. [PMID: 35879029 PMCID: PMC9329108 DOI: 10.9758/cpn.2022.20.3.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Objective We aimed to predict antipsychotic prescription patterns for people with schizophrenia using machine learning (ML) algorithms. Methods In a cross-sectional design, a sample of community mental health service users (SUs; n = 368) with a primary diagnosis of schizophrenia was randomly selected. Socio-demographic and clinical features, including the number, total dose, and route of administration of the antipsychotic treatment were recorded. Information about the number and the length of psychiatric hospitalization was retrieved. Ordinary Least Square (OLS) regression and ML algorithms (i.e., random forest [RF], supported vector machine, K-nearest neighborhood, and Naïve Bayes) were used to estimate the predictors of total antipsychotic dosage and prescription of antipsychotic polytherapy (APP). Results The strongest predictor of the total dose was APP. The number of Community Mental Health Centers (CMHC) contacts was the most important predictor of APP and, with APP omitted, of dosage. Treatment with anticholinergics predicted APP, emphasizing the strong correlation between APP and higher antipsychotic dose. RF performed better than OLS regression and the other ML algorithms in predicting both antipsychotic dose (root square mean error = 0.70, R2 = 0.31) and APP (area under the receiving operator curve = 0.66, true positive rate = 0.41, and true negative rate = 0.78). Conclusion APP is associated with the prescription of higher total doses of antipsychotics. Frequent attenders at CMHCs, and SUs recently hospitalized are often treated with APP and higher doses of antipsychotics. Future prospective studies incorporating standardized clinical assessments for both psychopathological severity and treatment efficacy are needed to confirm these findings.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Galli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Fiore
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Giorgio Mattei
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Starace
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale (AUSL) Modena, Modena, Italy
| | - Gian M. Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale (AUSL) Modena, Modena, Italy
- Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL-IRCSS di Reggio Emilia, Reggio Emilia, Italy
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Prescription of antipsychotic and concomitant medications for adult Asian schizophrenia patients: Findings of the 2016 Research on Asian Psychotropic Prescription Patterns (REAP) survey. Asian J Psychiatr 2019; 45:74-80. [PMID: 31520884 DOI: 10.1016/j.ajp.2019.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/11/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Regular surveys are important to monitor the use of psychotropic medications in clinical practice. This study examined the psychotropic prescription patterns in adult Asian schizophrenia patients based on the data of the Research on Asian Psychotropic Prescription (REAP) 2016 survey. METHODS This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire. RESULTS Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ± 11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ± 376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics. CONCLUSIONS Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.
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Caravaggio F, Iwata Y, Kim J, Shah P, Gerretsen P, Remington G, Graff-Guerrero A. What proportion of striatal D2 receptors are occupied by endogenous dopamine at baseline? A meta-analysis with implications for understanding antipsychotic occupancy. Neuropharmacology 2019; 163:107591. [PMID: 30940535 DOI: 10.1016/j.neuropharm.2019.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
Using molecular imaging techniques - positron emission tomography (PET) and single-photon emission computed tomography (SPECT) - in conjunction with an acute dopamine depletion challenge (alpha-methyl-para-tyrosine) it is possible to estimate endogenous dopamine levels occupying striatal dopamine D2 receptors (D2R) in humans in vivo. However, it is unclear what proportion of striatal D2R are occupied by endogenous dopamine under normal conditions. This is important since it has been suggested that in schizophrenia there may be a substantial proportion of striatal D2R which are occupied by endogenous dopamine and not accessible by therapeutic doses of antipsychotics. In order to clarify these issues, we conducted a meta-analysis of dopamine depletion studies using substituted benzamide radiotracers in healthy persons. This meta-analysis suggests that anywhere from 8 to 21% (weighted average 11%) of striatal D2R may be occupied by endogenous dopamine at baseline. Using these estimates, we propose an updated occupancy model and tentatively suggest that antipsychotics inhibit a smaller proportion of the total pool of striatal D2R in vivo than previously acknowledged. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
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Affiliation(s)
- Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Julia Kim
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Parita Shah
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 1 Kings College Circle, Toronto, Ontario, M5S 1A8, Canada
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Hatta K, Hasegawa H, Imai A, Sudo Y, Morikawa F, Katayama S, Watanabe H, Ishizuka T, Nakamura M, Misawa F, Fujita K, Ozaki S, Umeda K, Nakamura H, Sawa Y, Sugiyama N. Real-world effectiveness of antipsychotic monotherapy and polytherapy in 1543 patients with acute-phase schizophrenia. Asian J Psychiatr 2019; 40:82-87. [PMID: 30772732 DOI: 10.1016/j.ajp.2019.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The effectiveness of antipsychotic treatments in the acute phase of schizophrenia in actual clinical practice remains somewhat unclear. Therefore, the purpose of the present naturalistic, multi-center study conducted from 1 year starting in September 2017 was to examine the response rate to an initial or second antipsychotic in newly admitted patients with acute-phase schizophrenia, as well as the response rate and quality of augmentation with two antipsychotics in patients who failed to respond to both the initial and second antipsychotics. RESULTS In total, there were 660 (42.8%) and 243 (15.7%) responders to an initial and a second antipsychotic, respectively; thus, 58.5% of all patients were responders to an initial or second antipsychotic. Among 581 nonresponders (37.7%), the initial antipsychotic or a third antipsychotic was added to the second antipsychotic. Among these patients, 89.8% showed a Clinical Global Impression-Improvement score ≤3 (from 'minimally improved' to 'very much improved'). The rates of adverse events such as hyperglycemia, hyper-low-density lipoprotein cholesterolemia, hypertriglyceridemia, hyperprolactinemia, QTc prolongation, and extrapyramidal symptoms were not high in patients receiving augmentation with two antipsychotics compared with all patients, and no serious adverse events were reported. CONCLUSION Antipsychotic augmentation may be an option in acute-phase treatment for patients who do not respond to either an initial or a second antipsychotic.
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Affiliation(s)
- Kotaro Hatta
- Department of Psychiatry, Juntendo University Nerima Hospital, Tokyo, Japan.
| | - Hana Hasegawa
- Department of Psychiatry, Numazu Chuo Hospital, Numazu, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yasuhiko Sudo
- Department of Psychiatry, Tosa Hospital, Kochi, Japan
| | - Fumiyoshi Morikawa
- Department of Psychiatry, Asahikawa Keisenkai Hospital, Asahikawa, Japan
| | | | | | | | | | - Fuminari Misawa
- Department of Psychiatry, Yamanashi Prefectural Kita Hospital, Nirasaki, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, The Okehazama Hospital, Toyoake, Japan
| | - Shigeru Ozaki
- Department of Psychiatry, Toshima Hospital, Tokyo, Japan
| | - Kentaro Umeda
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yutaka Sawa
- Department of Psychiatry, Sawa Hospital, Osaka, Japan
| | - Naoya Sugiyama
- Department of Psychiatry, Numazu Chuo Hospital, Numazu, Japan
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Suzuki H, Hibino H, Inoue Y, Takaya A. Comparisons of the effects of long-acting injectable monotherapy and combination therapy of long-acting injectable treatment with oral antipsychotics on treatment retention in patients with chronic schizophrenia. Asian J Psychiatr 2019; 39:112-113. [PMID: 30605808 DOI: 10.1016/j.ajp.2018.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Hidenobu Suzuki
- Department of Psychiatry, Suzuki Clinic [H.S.], Tokyo 168-0065, Japan.
| | - Hiroyuki Hibino
- Department of Psychiatry, Fukui Kinen Hospital [H.H.], [A.T], Kanagawa 238-0115, Japan
| | - Yuichi Inoue
- Department of Psychiatry, Shakomae Kokorono Clinic [Y.I.], Tokyo 116-0011, Japan
| | - Atsuhiko Takaya
- Department of Psychiatry, Fukui Kinen Hospital [H.H.], [A.T], Kanagawa 238-0115, Japan
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