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Troyer J, Tanco K. Review of the Use of Medicinal Cannabis Products in Palliative Care. Cancers (Basel) 2024; 16:1412. [PMID: 38611090 PMCID: PMC11011126 DOI: 10.3390/cancers16071412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions.
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Affiliation(s)
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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2
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Gabarin A, Yarmolinsky L, Budovsky A, Khalfin B, Ben-Shabat S. Cannabis as a Source of Approved Drugs: A New Look at an Old Problem. Molecules 2023; 28:7686. [PMID: 38067416 PMCID: PMC10707504 DOI: 10.3390/molecules28237686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Cannabis plants have been used in medicine since ancient times. They are well known for their anti-diabetic, anti-inflammatory, neuroprotective, anti-cancer, anti-oxidative, anti-microbial, anti-viral, and anti-fungal activities. A growing body of evidence indicates that targeting the endocannabinoid system and various other receptors with cannabinoid compounds holds great promise for addressing multiple medical conditions. There are two distinct avenues in the development of cannabinoid-based drugs. The first involves creating treatments directly based on the components of the cannabis plant. The second involves a singular molecule strategy, in which specific phytocannabinoids or newly discovered cannabinoids with therapeutic promise are pinpointed and synthesized for future pharmaceutical development and validation. Although the therapeutic potential of cannabis is enormous, few cannabis-related approved drugs exist, and this avenue warrants further investigation. With this in mind, we review here the medicinal properties of cannabis, its phytochemicals, approved drugs of natural and synthetic origin, pitfalls on the way to the widespread clinical use of cannabis, and additional applications of cannabis-related products.
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Affiliation(s)
- Adi Gabarin
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Ludmila Yarmolinsky
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Arie Budovsky
- Research and Development Authority, Barzilai University Medical Center, Ashkelon 7830604, Israel;
| | - Boris Khalfin
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
| | - Shimon Ben-Shabat
- The Department of Clinical Biochemistry & Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; (A.G.); (L.Y.); (B.K.)
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Cannabinoid Type 1 Receptors in the Basolateral Amygdala Regulate ACPA-Induced Place Preference and Anxiolytic-Like Behaviors. Neurochem Res 2022; 47:2899-2908. [PMID: 35984590 DOI: 10.1007/s11064-022-03708-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/28/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
The number of cannabis users is increasing in the world. However, the mechanisms involved in the psychiatric effects and addiction formation remain unclear. Medical treatments against cannabis addiction have not yet been established. Δ9-Tetrahydrocannabinol (THC), the main active substance in cannabis, binds and affects cannabinoid type 1 receptors (CB1R) in the brain. The mice were intraperitoneally (i.p.) administered arachidonylcyclopropylamide (ACPA), a CB1R-selective agonist, and then two behavioral experiments on anxiety and addiction were performed. Administration of ACPA caused anxiolytic-like behavior in the elevated plus maze test. In addition, ACPA increased place preference in a conditioned place preference (CPP) test. The basolateral amygdala (BLA), which is the focus of this study, is involved in anxiety-like behavior and reward and is reported to express high levels of CB1R. We aimed to reveal the role of CB1R in BLA for ACPA-induced behavior. AM251, a CB1R selective antagonist, was administered intra-BLA before i.p. administration of ACPA. Intra-BLA administration of AM251 inhibited ACPA-induced anxiolytic-like behavior and place preference. These results suggest that CB1R in the BLA contributes to behavior disorders caused by the acute or chronic use of cannabis.
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Russo M, Calisi D, De Rosa MA, Evangelista G, Consoli S, Dono F, Santilli M, Gambi F, Onofrj M, Di Giannantonio M, Parruti G, Sensi SL. COVID-19 and first manic episodes: a systematic review. Psychiatry Res 2022; 314:114677. [PMID: 35716481 PMCID: PMC9181635 DOI: 10.1016/j.psychres.2022.114677] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 01/07/2023]
Abstract
Sars-CoV-2 is a respiratory virus that can access the central nervous system, as indicated by the presence of the virus in patients' cerebrospinal fluid and the occurrence of several neurological syndromes during and after COVID-19. Growing evidence indicates that Sars-CoV-2 can also trigger the acute onset of mood disorders or psychotic symptoms. COVID-19-related first episodes of mania, in subjects with no known history of bipolar disorder, have never been systematically analyzed. Thus, the present study assesses a potential link between the two conditions. This systematic review analyzes cases of first appearance of manic episodes associated with COVID-19. Clinical features, pharmacological therapies, and relationships with pre-existing medical conditions are also appraised. Medical records of twenty-three patients fulfilling the current DSM-5 criteria for manic episode were included. Manic episodes started, on average, after 12.71±6.65 days from the infection onset. Psychotic symptoms were frequently reported. 82.61% of patients exhibited delusions, whereas 39.13% of patients presented hallucinations. A large discrepancy in the diagnostic workups was observed. Mania represents an underestimated clinical presentation of COVID-19. Further studies should focus on the pathophysiological substrates of COVID-19-related mania and pursue appropriate and specific diagnostic and therapeutic workups.
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Affiliation(s)
- Mirella Russo
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,CAST - Center for Advanced Studies and Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Dario Calisi
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Matteo A. De Rosa
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Stefano Consoli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Fedele Dono
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,CAST - Center for Advanced Studies and Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Matteo Santilli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Francesco Gambi
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,CAST - Center for Advanced Studies and Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,CAST - Center for Advanced Studies and Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Giustino Parruti
- Department of Infectious Diseases, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Stefano L. Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,CAST - Center for Advanced Studies and Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,ITAB - Institute of Advanced Biomedical Technology, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy,Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States,Corresponding author at: Department of Neurosciences, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
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Bolton S, Joyce DW, Gordon-Smith K, Jones L, Jones I, Geddes J, Saunders KEA. Psychosocial markers of age at onset in bipolar disorder: a machine learning approach. BJPsych Open 2022; 8:e133. [PMID: 35844202 PMCID: PMC9344222 DOI: 10.1192/bjo.2022.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown. AIMS We aim to identify psychosocial factors associated with bipolar disorder AAO. METHOD Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure. RESULTS We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = -0.2855), regular cannabis use in the year before onset (β = -0.2765), death of a close family friend or relative in the 6 months before onset (β = -0.2435), family history of suicide (β = -0.1385), schizotypal personality traits (β = -0.1055) and irritable temperament (β = -0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575). CONCLUSIONS The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
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Affiliation(s)
- Sorcha Bolton
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Dan W Joyce
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | | | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
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Diep C, Bhat V, Wijeysundera DN, Clarke HA, Ladha KS. The Association between Recent Cannabis Use and Suicidal Ideation in Adults: A Population-based Analysis of the NHANES from 2005 to 2018. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:259-267. [PMID: 33641436 PMCID: PMC9014669 DOI: 10.1177/0706743721996112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE With the increasing prevalence of cannabis use, there is a growing concern about its association with depression and suicidality. The aim of this study was to examine the relationship between recent cannabis use and suicidal ideation using a nationally representative data set. METHODS A cross-sectional analysis of adults was undertaken using National Health and Nutrition Examination Survey data from 2005 to 2018. Participants were dichotomized by whether or not they had used cannabis in the past 30 days. The primary outcome was suicidal ideation, and secondary outcomes were depression and having recently seen a mental health professional. Multiple logistic regression was used to adjust for potential confounders, and survey sample weights were considered in the model. RESULTS Compared to those with no recent use (n = 18,599), recent users (n = 3,127) were more likely to have experienced suicidal ideation in the past 2 weeks (adjusted odds ratio [aOR] 1.54, 95% CI, 1.19 to 2.00, P = 0.001), be depressed (aOR 1.53, 95% CI, 1.29 to 1.82, P < 0.001), and to have seen a mental health professional in the past 12 months (aOR 1.28, 95% CI, 1.04 to 1.59, P = 0.023). CONCLUSIONS Cannabis use in the past 30 days was associated with suicidal thinking and depression in adults. This relationship is likely multifactorial but highlights the need for specific guidelines and policies for the prescription of medical cannabis for psychiatric therapy. Future research should continue to characterize the health effects of cannabis use in the general population.
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Affiliation(s)
- Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hance A Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, Ontario, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Patel RS, Cheema Z, Singla A, Cornejo M, Verma G. Cannabis Use is an Independent Risk Factor for Manic Episode: A Report from 380,265 Bipolar Inpatients. Subst Use Misuse 2022; 57:344-349. [PMID: 34895014 DOI: 10.1080/10826084.2021.2012690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the odds for bipolar disorder (BP) mania and depression-related hospitalization due to cannabis use disorders (CUD). METHODS We conducted a cross-sectional study using the national inpatient sample (NIS), and included adult BP hospitalizations sub-grouped by manic (N = 209,785) versus depressive episodes (N = 170480). A logistic regression model was used to evaluate adjusted odds ratio (aOR) of association between CUD and BP-mania-related hospitalizations and was adjusted for demographics confounders, psychiatric comorbidities and other substance use disorders (SUD). RESULTS Comorbidities were less prevalent in BP mania compared to BP depression: anxiety disorders (22.7% vs. 35.3%), PTSD (8.7% vs. 14.3%), and personality disorders (15.4% vs. 20.5%). Among SUD, methamphetamine (aOR 1.27, 95%CI 1.22 - 1.32) and CUD (aOR 1.53, 95%CI 1.50 - 1.56) had increased odds for hospitalization for BP mania. CONCLUSION CUD increases the odds for hospitalization for BP manic episode by 53%. Due to the rising prevalence of cannabis use among patients with BP it is important to provide substance use counseling/psychoeducation and discourage cannabis use among youth to prevent long-term adverse consequences.
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Affiliation(s)
- Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma, USA
| | - Zainab Cheema
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma, USA
| | - Ashima Singla
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma, USA
| | - Miglia Cornejo
- School of Osteopathic Medicine, Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Geetika Verma
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma, USA
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The Prevalence of Cannabis Use Disorder Comorbidity in Individuals With Bipolar Disorder: A Systematic Review and Meta-Analysis. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaggwa MM, Bongomin F, Najjuka SM, Rukundo GZ, Ashaba S. Cannabis-Induced Mania Following COVID-19 Self-Medication: A Wake-Up Call to Improve Community Awareness. Int Med Case Rep J 2021; 14:121-125. [PMID: 33658866 PMCID: PMC7920595 DOI: 10.2147/imcrj.s301246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/12/2021] [Indexed: 12/14/2022] Open
Abstract
Context Self-medication is becoming common during the coronavirus disease −2019 (COVID-19) pandemic due to the increasing popularity of home-based management of asymptomatic and mild cases. In this case report, we describe a patient who developed manic symptoms as a result of self-medication with a regimen containing cannabis to manage COVID-19 symptoms. Case Details A 52-year-old man with no prior history of a mental disorder, presented with a one-week history of talking more than usual, poor sleep, destructiveness, irritability, and altered mental status, following use of homemade remedies containing oranges, garlic, ginger, onions, honey, lemon, and cannabis to treat COVID-19 related symptoms over a 2-week period. This was his index presentation with such symptoms in his life. He had never used any substance of addiction before, did not have any known chronic medical condition, and had no family member with a history of any known mental illness. He was a suspect because his father had tested positive for COVID-19 and was undergoing treatment. He tested negative for COVID-19 after 3-weeks of initial COVID-19 like symptoms, urine sample was positive for tetrahydrocannabinol (THC), and he had normal investigations. He was managed with a mood stabilizer (oral carbamazepine at a dose of 200mg three times daily), antipsychotic (chlorpromazine 200mg twice daily), a sedative (diazepam 10mg at before bedtime), and occupational therapy. All manic symptoms resolved in a period of two weeks. Conclusion Cannabis induced mental illness following self-medication for COVID-19 like symptoms is on the rise in the population. Due to increasing COVID-19 cases globally, hospital congestion, the popularity of home-based care guidelines for asymptomatic and mild COVID-19 to reduce hospital burden in many countries, and easy access to cannabis. With no approved cure for COVID-19, patients are turning to natural remedies to relieve symptoms of COVID-19. Emphasis on prevention of this insalubrious self-medication among the COVID-19 patients is needed to stop complication related to cannabis use.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Muzaffar A, Ullah S, Subhan F, Nazar Z, Hussain SM, Khuda F, Khan A, Khusro A, Sahibzada MUK, Albogami S, El-Shehawi AM, Emran TB, Javed B, Ali J. Clinical Investigation on the Impact of Cannabis Abuse on Thyroid Hormones and Associated Psychiatric Manifestations in the Male Population. Front Psychiatry 2021; 12:730388. [PMID: 34925083 PMCID: PMC8678041 DOI: 10.3389/fpsyt.2021.730388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Cannabis abuse is a common public health issue and may lead to considerable adverse effects. Along with other effects, the dependence on cannabis consumption is a serious problem which has significant consequences on biochemical and clinical symptoms. This study intends to evaluate the harmful effects of the use of cannabis on thyroid hormonal levels, cardiovascular indicators, and psychotic symptoms in the included patients. This prospective multicenter study was conducted on cannabis-dependent patients with psychotic symptoms (n = 40) vs. healthy control subjects (n = 40). All participants were evaluated for psychiatric, biochemical, and cardiovascular physiological effects. Patients were selected through Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria and urine samples, exclusively for the evaluation of cannabis presence. Serum thyroid stimulating hormone (TSH), T3, and T4 levels were measured using the immunoassay technique. Patients were assessed for severity of depressive, schizophrenic, and manic symptoms using international ranking scales. Various quantifiable factors were also measured for the development of tolerance by cannabis. Among the patients of cannabis abuse, 47.5% were found with schizophrenia, 20% with schizoaffective symptoms, 10% with manic symptoms, and 22.5% with both manic and psychotic symptoms. In the group-group and within-group statistical analysis, the results of thyroid hormones and cardiovascular parameters were non-significant. The psychiatric assessment has shown highly significant (p < 0.001) difference of positive, negative, general psychopathology, and total scores [through Positive and Negative Syndrome Scale (PANSS) rating scales] in patients vs. the healthy control subjects. The study revealed that cannabis abuse did not significantly alter thyroid hormones and cardiovascular parameters due to the development of tolerance. However, the cannabis abuse might have a significant contributing role in the positive, negative, and manic symptoms in different psychiatric disorders.
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Affiliation(s)
- Anum Muzaffar
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Sami Ullah
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Fazal Subhan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Zahid Nazar
- Department of Psychiatry, Lady Reading Hospital MTI Peshawar, Peshawar, Pakistan
| | | | - Fazli Khuda
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Abuzar Khan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Ameer Khusro
- Research Department of Plant Biology and Biotechnology, Loyola College, Chennai, India
| | | | - Sarah Albogami
- Department of Biotechnology, College of Science, Taif University, Taif, Saudi Arabia
| | - Ahmed M El-Shehawi
- Department of Biotechnology, College of Science, Taif University, Taif, Saudi Arabia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Binish Javed
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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11
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Sex differences in bipolar disorder: Impact of lifetime cannabis use on clinical course, functioning, and quality of life in bipolar disorder. J Affect Disord 2020; 266:258-262. [PMID: 32056886 DOI: 10.1016/j.jad.2020.01.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex. METHODS Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life. RESULTS A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p<0.005) than those without LCU, regardless of sex. Among women, LCU was associated with being single (p = 0.006), worse sexual functioning (p = 0.006), financial functioning (p = 0.009), QoL [bodily pain (p = 0.009), vitality (p = 0.027), social functioning (p = 0.037), emotional role (p = 0.038), mental health (p = 0.001), and mental summary component (p = 0.012)]. After controlling for confounders, among women, LCU was associated with worse QoL, specifically on bodily pain (p = 0.049) and mental health (p = 0.016) subscales. Among males, no statistically significant differences were found between LCU and no LCU (NLCU) in any of the variables of the study. LIMITATIONS This study was a secondary analysis not powered specifically to analyze cannabis use. CONCLUSIONS LCU was associated with a younger age at first hospitalization in both women and men, while only women reported worse QoL on bodily pain and mental health subscales. Clinicians and public health providers should be aware of this and inform their patients and the general population of these detrimental effects.
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12
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Etyemez S, Currie TT, Hamilton JE, Weaver MF, Findley JC, Soares J, Selek S. Cannabis use: A co-existing condition in first-episode bipolar mania patients. J Affect Disord 2020; 263:289-291. [PMID: 31818791 DOI: 10.1016/j.jad.2019.11.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND An association between first-episode presentation of bipolar mania and concurrent cannabis use disorder has been well established in the current literature (Bally et al., 2014, Baethge et al., 2008). Previous studies have shown that 30-70% of patients admitted for a first manic episode had concurrent cannabis use (Bally et al., 2014). The exact mechanism of this association has yet to be confirmed. AIMS We aim to evaluate the prevalence of cannabis use in patients with bipolar disorder (BD) admitted to UTHealth Harris County Psychiatric Center (HCPC) for a first manic episode. METHODS In this retrospective cohort study, 15,969 inpatient records of patients admitted to HCPC between 2012-2013 were examined to identify patients admitted with a first manic episode according to ICD-9 criteria (single episode mania). The prevalence of multiple sociodemographic and clinical variables including cannabis positivity in urine drug screening (UDS) were examined. RESULTS Twenty patients were admitted for a first manic episode. Half of the patients were females; mean age was 28.65 ± 10.56 years and mean length of stay (LOS) was 7.15 ± 3.72 days. Fifteen patients received a UDS. Of these fifteen, seven were positive for cannabinoids (47%). One patient was positive for phencyclidine (in addition to cannabis) and one patient was positive for amphetamine (but not cannabis). CONCLUSIONS The prevalence of cannabis use was higher in first-episode mania patients compared to the general population. The influence of cannabis on the first episode of mania requires additional study.
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Affiliation(s)
- Semra Etyemez
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - Terrence T Currie
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - Jane E Hamilton
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - Michael F Weaver
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - J Chase Findley
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - Jair Soares
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
| | - Salih Selek
- McGovern Medical School at UTHealth Houston, 6431 Fannin St, Houston, TX 77030, USA.
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13
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Rognli EB, Bramness JG, von Soest T. Cannabis use in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, and antidepressants. Acta Psychiatr Scand 2020; 141:149-156. [PMID: 31560790 DOI: 10.1111/acps.13104] [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] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. RESULTS Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 - 18.87), mood stabilizers (OR = 5.36, 95 % CI 1.99 - 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 - 3.25), after accounting for sociodemographic variables, conduct problems, additional drug use, mental distress, and prescriptions the year before cannabis use was measured. CONCLUSIONS In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood stabilizers, and antidepressants.
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Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Institute for Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway.,Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Norway
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14
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Abstract
OBJECTIVE Bipolar disorder (BD) is a debilitating, lifelong neuropsychiatric illness characterised by unsteady mood states which vacillate from (hypo)mania to depression. Despite the availability of pharmaceutical agents which can be effective in ameliorating the acute affective symptoms and prevent episodic relapse, BD is inadequately treated in a subset of patients. The endocannabinoid system (ECS) is known to exert neuromodulatory effects on other neurotransmitter systems critical in governing emotions. Several studies ranging from clinical to molecular, as well as anecdotal evidence, have placed a spotlight on the potential role of the ECS in the pathophysiology of BD. In this perspective, we present advantages and disadvantages of cannabis use in the management of illness course of BD and provide mechanistic insights into how this system might contribute to the pathophysiology of BD. RESULTS We highlight the putative role of selective cannabinoid receptor 2 (CB2) agonists in BD and briefly discuss findings which provide a rationale for targeting the ECS to assuage the symptoms of BD. Further, data encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB-based options as probable treatment approaches. CONCLUSION The probable role of the ECS has been almost neglected in BD; however, from data available which suggest a role of ECS in mood control, it is justified to support conducting comprehensive studies to determine whether ECS manipulation could positively affect BD. Based on the limited available data, we suggest that activation of CB2 may stabilise mood in this disorder.
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16
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Cohen K, Weizman A, Weinstein A. Positive and Negative Effects of Cannabis and Cannabinoids on Health. Clin Pharmacol Ther 2019; 105:1139-1147. [DOI: 10.1002/cpt.1381] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Koby Cohen
- Department of Behavioral ScienceAriel University, Science Park Ariel Israel
| | | | - Aviv Weinstein
- Department of Behavioral ScienceAriel University, Science Park Ariel Israel
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17
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Mensen VT, Vreeker A, Nordgren J, Atkinson A, de la Torre R, Farré M, Ramaekers JG, Brunt TM. Psychopathological symptoms associated with synthetic cannabinoid use: a comparison with natural cannabis. Psychopharmacology (Berl) 2019; 236:2677-2685. [PMID: 30968175 PMCID: PMC6695363 DOI: 10.1007/s00213-019-05238-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Synthetic cannabinoids (SCs) are a class of new psychoactive substances that have been rapidly evolving around the world throughout recent years. Many different synthetic cannabinoid analogues are on the consumer market and sold under misleading names, like "spice" or "incense." A limited number of studies have reported serious health effects associated with SC use. In this study, we compared clinical and subclinical psychopathological symptoms associated with SC use and natural cannabis (NC) use. METHODS A convenience sample of 367 NC and SC users was recruited online, including four validated psychometric questionnaires: The Drug Use Disorders Identification Test (DUDIT), Insomnia Severity Index (ISI), Altman Mania Scale (Altman), and Brief Symptom Inventory (BSI). The two groups were compared with analysis of variance (ANOVA) and covariance (ANCOVA), chi2 tests, and logistic regression when appropriate. RESULTS The SC user group did not differ in age from the NC user group (27.7 years), but contained less females (21% and 30%, respectively). SC users scored higher than NC users on all used psychometric measures, indicating a higher likelihood of drug abuse, sleep problems, (hypo)manic symptoms, and the nine dimensions comprising the BSI, somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Odds ratios (95% CI) for the SC user group vs NC user group were, respectively, drug dependence 3.56 (1.77-7.16), (severe) insomnia 5.01 (2.10-11.92), (hypo-)mania 5.18 (2.04-13.14), and BSI psychopathology 5.21 (2.96-9.17). DISCUSSION This study shows that SC use is associated with increased mental health symptomatology compared to NC use.
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Affiliation(s)
| | - Annabel Vreeker
- University Medical Center Utrecht, Department of Psychiatry, University of Utrecht, Utrecht, The Netherlands
| | - Johan Nordgren
- Department of Social Work, Malmö University, Malmö, Sweden
| | - Amanda Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Magi Farré
- Integrative Pharmacology and Systems Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Tibor M Brunt
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Developmental Psychopathology, Radboud University, Nijmegen, The Netherlands.
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18
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Stiles BM, Fish AF, Vandermause R, Malik AM. The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:415-425. [PMID: 29952230 DOI: 10.1177/1078390318784360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN An integrative review was conducted using standard criteria for evaluating research articles. RESULTS Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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Affiliation(s)
- Brandie M Stiles
- 1 Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
| | - Anne F Fish
- 2 Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roxanne Vandermause
- 3 Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Azfar M Malik
- 4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA
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19
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Araos P, Vergara-Moragues E, González-Saiz F, Pedraz M, García-Marchena N, Romero-Sanchiz P, Ruiz JJ, Campos-Cloute R, Serrano A, Pavón FJ, Torrens M, Rodriguez De Fonseca F. Differences in the Rates of Drug Polyconsumption and Psychiatric Comorbidity among Patients with Cocaine Use Disorders According to the Mental Health Service. J Psychoactive Drugs 2017; 49:306-315. [PMID: 28682218 DOI: 10.1080/02791072.2017.1342151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cocaine continues to be a worldwide public health concern in Europe. To improve prognosis and intervention, it is necessary to understand the characteristics of the patients who depend on the services where they receive care. The objective is to analyze the differences among patients who use cocaine and between ambulatory and residential resources to better adapt treatment. This is a descriptive, observational study of two populations of cocaine users in treatment: the ambulatory therapeutic community (ATC) and the therapeutic community (TC). The PRISM diagnostic interview was used for both groups. An analysis of both populations indicates a high prevalence of cocaine, heroin, cannabis, sedative, psychostimulant, and hallucinogen use disorders in the TC population compared to the ATC. In alcohol use disorder, differences between both mental health services were not observed. The degree of severity of cocaine use disorders (CUD) is greater in the TC population. The prevalence of psychiatric comorbidity is not statistically significant between the two populations, except for primary psychotic disorders, which are more prevalent in the TC population. This difference in the prevalence of psychotic disorders may be related to the high prevalence of cannabis use disorders in TC patients. Differences in the prevalence of substance use disorders, severity of CUD, and psychiatric comorbidity may limit the efficiency of mental health services involved in substance use disorder therapeutics. These results suggest the need for careful and extensive phenotyping of patients to improve intervention and prognosis in a clinical resource-dependent manner.
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Affiliation(s)
- P Araos
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Esperanza Vergara-Moragues
- b Researcher, Facultad de Ciencias Jurídicas, Sociales y Humanidades , Universidad Internacional de la Rioja , Logroño , La Rioja , Spain.,c Researcher, Addictive Disorders Network, Grupo de Investigación en Neurociencias Traslacional en Adicciones , Universidad de Granada , Andalucía , Spain
| | - Francisco González-Saiz
- c Researcher, Addictive Disorders Network, Grupo de Investigación en Neurociencias Traslacional en Adicciones , Universidad de Granada , Andalucía , Spain.,d Researcher, Community Mental Health Unit of Villamartín , Hospital de Salud Mental de Cádiz , Andalucía , Spain
| | - María Pedraz
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Nuria García-Marchena
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Pablo Romero-Sanchiz
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Juan Jesus Ruiz
- f Researcher, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques and Department of Psychiatry , Universitat Autònoma de Barcelona , Barcelona , Spain
| | | | - Antonia Serrano
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Francisco Javier Pavón
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Marta Torrens
- f Researcher, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques and Department of Psychiatry , Universitat Autònoma de Barcelona , Barcelona , Spain.,g Researcher, School of Medicine , Universitat Autónoma de Barcelona, Barcelona , Spain
| | - Fernando Rodriguez De Fonseca
- a Researcher, Management Unit of the Mental Health Clinical , Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga , Málaga , Spain
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20
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Borille BT, Marcelo MCA, Ortiz RS, Mariotti KDC, Ferrão MF, Limberger RP. Near infrared spectroscopy combined with chemometrics for growth stage classification of cannabis cultivated in a greenhouse from seized seeds. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2017; 173:318-323. [PMID: 27673500 DOI: 10.1016/j.saa.2016.09.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
Cannabis sativa L. (cannabis, Cannabaceae), popularly called marijuana, is one of the oldest plants known to man and it is the illicit drug most used worldwide. It also has been the subject of increasing discussions from the scientific and political points of view due to its medicinal properties. In recent years in Brazil, the form of cannabis drug trafficking has been changing and the Brazilian Federal Police has exponentially increased the number of seizures of cannabis seeds sent by the mail. This new form of trafficking encouraged the study of cannabis seeds seized germinated in a greenhouse through NIR spectroscopy combined with chemometrics. The plants were cultivated in a homemade greenhouse under controlled conditions. In three different growth periods (5.5weeks, 7.5weeks and 10weeks), they were harvested, dried, ground and directly analyzed. The iPCA was used to select the best NIR spectral range (4000-4375cm-1) in order to develop unsupervised and supervised methods. The PCA and HCA showed a good separation between the three groups of cannabis samples at different growth stages. The PLS-DA and SVM-DA classified the samples with good results in terms of sensitivity and specificity. The sensitivity and specificity for SVM-DA classification were equal to unity. This separation may be due to the correlation of cannabinoids and volatile compounds concentration during the growth of the cannabis plant. Therefore, the growth stage of cannabis can be predicted by NIR spectroscopy and chemometric tools in the early stages of indoor cannabis cultivation.
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Affiliation(s)
- Bruna Tassi Borille
- Laboratory of Analysis and Research in Toxicology, Department of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Rafael Scorsatto Ortiz
- Rio Grande do Sul Technical and Scientifical Division, Brazilian Federal Police, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kristiane de Cássia Mariotti
- Laboratory of Analysis and Research in Toxicology, Department of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Flôres Ferrão
- Chemistry Institute, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renata Pereira Limberger
- Laboratory of Analysis and Research in Toxicology, Department of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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21
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Walsh Z, Gonzalez R, Crosby K, S. Thiessen M, Carroll C, Bonn-Miller MO. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev 2017; 51:15-29. [DOI: 10.1016/j.cpr.2016.10.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 12/28/2022]
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22
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Kvitland LR, Ringen PA, Aminoff SR, Demmo C, Hellvin T, Lagerberg TV, Andreassen OA, Melle I. Duration of untreated illness in first-treatment bipolar I disorder in relation to clinical outcome and cannabis use. Psychiatry Res 2016; 246:762-768. [PMID: 27814886 DOI: 10.1016/j.psychres.2016.07.064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Abstract
There is little knowledge about the role of the duration of untreated bipolar (DUB) illness in first-treatment bipolar disorder I (BD I), its association with symptoms at start of first treatment, and development over the first year, and limited knowledge about factors that influence the length of DUB. Substance use has shown to delay identification of primary psychiatric disorders, and while cannabis use is common in BD the role of cannabis in relationship to DUB is unclear. The aim of the present study is to examine the associations between DUB and key clinical outcomes at baseline in BD I, and at one year follow-up, and to evaluate the influence of cannabis use. Patients with first-treatment BD I (N=62) completed comprehensive clinical evaluations, which included both DUB and the number of previous episodes. There were no significant associations between DUB and key clinical outcomes. Longer duration from first manic episode to treatment was associated with risk of starting excessive cannabis use after onset of the bipolar disorder. The main finding is the lack of significant associations between features of previous illness episodes and clinical outcomes. Long duration of untreated mania seems to increase the risk for later cannabis use.
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Affiliation(s)
- Levi Røstad Kvitland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | | | - Sofie Ragnhild Aminoff
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway; Division of Mental Health Services, Department of Specialized Inpatient Treatment, Akershus University Hospital, Akershus, Norway.
| | - Christine Demmo
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Tone Hellvin
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ole Andreas Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway TOP Study, Oslo University Hospital, Building 49, Ullevål, Kirkeveien 166, PO Box 4956 Nydalen, 0424 Oslo, Norway.
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Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:321-330. [PMID: 27426694 DOI: 10.1016/j.jad.2016.06.051] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are common in people with a bipolar disorder (BD). This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in persons with BD based on national or international surveys of household populations. METHODS Studies published from 1990 to Dec 31, 2015 were identified from MEDLINE, EMBASE. psychINFO, and CINAHL databases and reference lists. We calculated prevalence rates and conducted meta-analysis with random-effects model. RESULTS We identified 9 unique surveys of which two surveys were repeated 10 years later using independent samples. The total sample size was 218,397 subjects. The mean prevalence for any illicit drug use disorder was 17%, for alcohol use disorder (AUD) it was 24% and SUD it was 33%. The strongest associations were found between BD and illicit drug use (pooled odds ratio (OR) 4.96, 95% CI 3.98-6.17) followed closely by BD and AUD (OR 4.09, 95% CI 3.37-4.96). The association was higher for BD respondents using illicit drugs compared to bipolar II respondents (ORs 7.48 vs. 3.30). LIMITATIONS Some of the meta-analysis grouped illicit substances together without taking into consideration types of substance use which may differ widely between countries and over time. All included studies were cross-sectional so onset and causality can not be determined. CONCLUSIONS The meta-analysis revealed that people with an alcohol use disorder were 4.1 times of greater risk of having a BD compared to those without an AUD. The risks were even higher for illicit drug users where they were 5.0 times of greater risk of having BD compared to non-users. These data confirm strong associations between co-occurring SUDs and BD, indicating a need for more informative studies to help develop better interventions in treating persons with BD and comorbid SUDs.
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Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:331-349. [PMID: 27476137 DOI: 10.1016/j.jad.2016.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/09/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
| | - Gin S Malhi
- Discipline of Psychiatry and CADE Clinic, Royal North Shore Hospital, University of Sydney, NSW, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, NSW, Australia.
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Dwyer S, Hieber R. Mania possibly linked with bupropion for smoking cessation: A case report. Ment Health Clin 2016; 6:314-317. [PMID: 29955488 PMCID: PMC6007537 DOI: 10.9740/mhc.2016.11.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Bupropion is an antidepressant thought to have a reduced risk of inducing mood switching as compared to other antidepressants. Minimal information is available on the induction of mood shifts when used for smoking cessation. This case describes a 38-year-old female who experienced mania following initiation of bupropion for smoking cessation. After completion of a thorough literature search, this appears to be the first case report describing mania induced by bupropion that was refractory to medications and was resolved with electroconvulsive therapy. This case highlights the need for clinicians to perform thorough histories of patients to avoid missing psychiatric history prior to starting bupropion as well as monitor for changes in mood or behavior after initiation of therapy.
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Affiliation(s)
- Stephanie Dwyer
- (Corresponding author) PGY1 Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois,
| | - Robin Hieber
- Clinical Pharmacist Specialist – Mental Health, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
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26
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Hanna RC, Perez JM, Ghose S. Cannabis and development of dual diagnoses: A literature review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:442-455. [PMID: 27612527 DOI: 10.1080/00952990.2016.1213273] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of cannabis has garnered more attention recently with ongoing efforts at marijuana legalization. The consequences of cannabis use are not clearly understood and remain a concern. OBJECTIVES To review the acute and persistent effects of cannabis use and associations with psychiatric disorders. METHODS Using Pubmed and PsychInfo, we conducted a narrative review of the literature on cannabis and psychiatric comorbidity using the keywords cannab*, marijuana, schizo*, psychosis, mood, depression, mania, bipolar, and anxiety. RESULTS There is substantial evidence of cannabis use leading to other illicit drug use and of an association between cannabis use and psychosis. A few reports suggest an association with bipolar disorder while the association with depression and anxiety disorders is mixed. CONCLUSIONS Whenever an association is observed between cannabis use and psychiatric disorders, the relationship is generally an adverse one. Age at the time of cannabis use appears to be an important factor with stronger associations observed between adolescent onset cannabis use and later onset of psychiatric disorders. Additional studies taking into account potential confounds (such as withdrawal symptoms, periods of abstinence, and other substance use) and moderators (such as age of initiation of cannabis use, the amount and frequency of drug use, prior history of childhood maltreatment, and gender) are needed to better understand the psychiatric consequences of cannabis use.
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Affiliation(s)
- Rebecca C Hanna
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
| | - Jessica M Perez
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
| | - Subroto Ghose
- a Department of Psychiatry , UT Southwestern , Dallas , TX , USA
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27
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Seddon JL, Birchwood M, Copello A, Everard L, Jones PB, Fowler D, Amos T, Freemantle N, Sharma V, Marshall M, Singh SP. Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophr Bull 2016; 42:619-25. [PMID: 26536902 PMCID: PMC4838086 DOI: 10.1093/schbul/sbv154] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode of psychosis (FEP) and the link with symptomatic course and outcome over 1 year post psychosis onset. DESIGN AND SETTING One thousand twenty-seven FEP patients were recruited upon inception to specialized early intervention services (EIS) for psychosis in the United Kingdom. Participants completed assessments at baseline, 6 and 12 months. RESULTS The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psychosocial functioning. Continued use of cannabis following the FEP was associated with poorer outcome at 1 year for Positive and Negative Syndrome Scale total score, negative psychotic symptoms, depression and psychosocial functioning, an effect not explained by age, gender, duration of untreated psychosis, age of psychosis onset, ethnicity or other substance use. CONCLUSION This is the largest cohort study of FEP patients receiving care within EIS. Cannabis use, particularly "continued use," was associated with poorer symptomatic and functional outcome during the FEP. The results highlight the need for effective and early intervention for cannabis use in FEP.
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Affiliation(s)
- Jennifer L. Seddon
- National Drug & Alcohol Research Centre, UNSW, Sydney, Australia;,*To whom correspondence should be addressed; National Drug & Alcohol Research Centre, UNSW, Sydney 2052, Australia; tel: 61-2-9385-0357, fax: 61-2-9385-0222, e-mail:
| | - Max Birchwood
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, UK;,The Early Intervention Service, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Linda Everard
- The Early Intervention Service, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge and CAMEO, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), London, UK
| | - Vimal Sharma
- Early Intervention Service, Cheshire and Wirral NHS Foundation Trust, Chester, UK;,Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Max Marshall
- School of Medicine, University of Manchester, Manchester, UK
| | - Swaran P. Singh
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
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28
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Lagerberg TV, Icick R, Andreassen OA, Ringen PA, Etain B, Aas M, Henry C, Bjella TD, Melle I, Bellivier F. Cannabis use disorder is associated with greater illness severity in tobacco smoking patients with bipolar disorder. J Affect Disord 2016; 190:286-293. [PMID: 26544611 DOI: 10.1016/j.jad.2015.10.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/04/2015] [Accepted: 10/15/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cannabis use disorders (CUD) may influence the course of bipolar disorder (BD), but key confounding factors such as tobacco smoking have not been adequately addressed. This study examined whether CUD was associated with a more severe illness course in tobacco smoking BD patients. METHODS A sample of French and Norwegian tobacco smoking patients with BD I and II (N=642) was investigated. DSM-IV diagnoses and other characteristics were obtained through personal interviews using structured questionnaires. The association between CUD and illness course was assessed in regression analyses. RESULTS In bivariate analyses, CUD was associated with earlier BD onset, higher frequency of manic (in BD I) and depressive episodes and hospitalizations per illness year, and a higher occurrence of psychotic episodes. After controlling for potential confounders, the relationships with earlier BD onset (B=-5.60 95% CI=-7.65 to -3.64), and increased rates of manic episodes (OR=1.93, 95% CI: 1.15 to 3.23) and hospitalizations (OR=2.93, 95% CI: 1.85 to 4.64) remained statistically significant. LIMITATIONS Despite the multivariate approach, differences between the two samples may lead to spurious findings related to hidden confounders. Substance use and mood episode information was collected retrospectively, and potential birth cohort effects could not be controlled for. CONCLUSION Studies have found associations between tobacco smoking and poorer outcomes in BD. In this study on tobacco smoking BD patients we report an association between CUD and illness severity, suggesting that CUD exacerbates the disease evolution independently of tobacco smoking. Specific treatment and prevention programs addressing CUD in BD patients are warranted.
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Affiliation(s)
- T V Lagerberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway.
| | - R Icick
- Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France
| | - O A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - P A Ringen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - B Etain
- FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France
| | - M Aas
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Creteil F-94000, France; Inserm, U955, Equipe Psychiatrie Génétique, Créteil 94000, France; Université Paris Est, Faculté de médecine, Créteil 94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU PePsy, Pôle de psychiatrie, Créteil 94000, France
| | - T D Bjella
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - I Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction and Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-7 5006, France; Université Paris Diderot, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris F-75010, France; FondaMental Foundation, Creteil F-94000, France
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29
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O'Donoghue B, Lyne J, Madigan K, Lane A, Turner N, O'Callaghan E, Clarke M. Environmental factors and the age at onset in first episode psychosis. Schizophr Res 2015; 168:106-12. [PMID: 26232243 DOI: 10.1016/j.schres.2015.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/09/2015] [Accepted: 07/04/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Factors that influence the age at onset in psychotic disorders could provide valuable insights into precipitating or causative factors of the disorder. Despite being established risk factors, it is not yet known whether migration status, place of birth, social class at birth and season of birth influence the age at onset of psychotic disorders. This study aimed to determine whether these environmental factors, in addition to cannabis abuse and obstetric complications, influence the age at onset. Additionally, we investigated whether environmental factors could have a cumulative effect on the age at onset. METHOD Data was obtained from two first episode of psychosis (FEP) cohort studies. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses. RESULTS The age at onset was determined for 555 individuals with a FEP and the median age at onset was 27.3years. Individuals with a history of cannabis abuse had an earlier age at onset by nearly six years. There was a trend for a history of obstetric complications to be associated with a younger age at onset by 2.7years and this was significant in the subgroup with a family history of psychosis. Social class at birth, migration status, place of birth and season of birth were not associated with the age at onset. Exposure to a higher number of environmental factors was associated with an earlier age at onset. CONCLUSIONS Cannabis and obstetric complications are associated with an earlier age at onset and there appears to be a cumulative effect of exposure to multiple environmental factors.
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Affiliation(s)
- Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.
| | - John Lyne
- DETECT Early Intervention for Psychosis Service, Avila House, Blackrock Business Park, Dublin 4, Ireland; University College Dublin, Belfield, Dublin 4, Ireland.
| | - Kevin Madigan
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Institute of Leadership, Royal College of Surgeons, Ireland.
| | - Abbie Lane
- University College Dublin, Belfield, Dublin 4, Ireland.
| | - Niall Turner
- DETECT Early Intervention for Psychosis Service, Avila House, Blackrock Business Park, Dublin 4, Ireland.
| | - Eadbhard O'Callaghan
- DETECT Early Intervention for Psychosis Service, Avila House, Blackrock Business Park, Dublin 4, Ireland; University College Dublin, Belfield, Dublin 4, Ireland
| | - Mary Clarke
- DETECT Early Intervention for Psychosis Service, Avila House, Blackrock Business Park, Dublin 4, Ireland; University College Dublin, Belfield, Dublin 4, Ireland.
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30
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van der Doef TF, Doorduin J, van Berckel BNM, Cervenka S. Assessing brain immune activation in psychiatric disorders: clinical and preclinical PET imaging studies of the 18-kDa translocator protein. Clin Transl Imaging 2015; 3:449-460. [PMID: 28781965 PMCID: PMC5496979 DOI: 10.1007/s40336-015-0140-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/26/2015] [Indexed: 01/24/2023]
Abstract
Accumulating evidence from different lines of research suggests an involvement of the immune system in the pathophysiology of several psychiatric disorders. During recent years, a series of positron emission tomography (PET) studies have been published using radioligands for the translocator protein (TSPO) to study microglia activation in schizophrenia, bipolar I disorder, major depression, autism spectrum disorder, and drug abuse. The results have been somewhat conflicting, which could be due to differences both in patient sample characteristics and in PET methods. In particular, further work is needed to address both methodological and biological sources of variability in TSPO levels, a process in which the use of animal models and small animal PET systems can be a valuable tool. Given this development, PET studies of immune activation have the potential to further increase our understanding of disease mechanisms in psychiatric disorders, which is a requisite in the search for new treatment approaches. Furthermore, molecular imaging could become an important clinical tool for identifying specific subgroups of patients or disease stages that would benefit from treatment targeting the immune system.
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Affiliation(s)
- Thalia F van der Doef
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Janine Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart N M van Berckel
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Simon Cervenka
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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31
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Bui QM, Simpson S, Nordstrom K. Psychiatric and medical management of marijuana intoxication in the emergency department. West J Emerg Med 2015; 16:414-7. [PMID: 25987916 PMCID: PMC4427213 DOI: 10.5811/westjem.2015.3.25284] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/01/2015] [Accepted: 03/29/2015] [Indexed: 11/24/2022] Open
Abstract
We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient's psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care.
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Affiliation(s)
- Quan M. Bui
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado. University of Colorado School of Medicine, Denver Health Medical Center, Department of Psychiatry, Denver, Colorado
| | - Scott Simpson
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado. University of Colorado School of Medicine, Denver Health Medical Center, Department of Psychiatry, Denver, Colorado
| | - Kimberly Nordstrom
- University of Colorado School of Medicine, Department of Psychiatry, Aurora, Colorado. University of Colorado School of Medicine, Denver Health Medical Center, Department of Psychiatry, Denver, Colorado
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32
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The impact of mood symptomatology on pattern of substance use among homeless. J Affect Disord 2015; 176:164-70. [PMID: 25723559 DOI: 10.1016/j.jad.2015.01.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested. METHODS Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques. RESULTS No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003). LIMITATIONS Data collected are self-reported and no urinalyses were performed. CONCLUSIONS The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population.
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33
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Severe manic episode associated with tramadol in a patient with recurrent depressive disorder. J Clin Psychopharmacol 2015; 35:203-4. [PMID: 25627074 DOI: 10.1097/jcp.0000000000000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Pettorruso M, De Risio L, Di Nicola M, Martinotti G, Conte G, Janiri L. Allostasis as a conceptual framework linking bipolar disorder and addiction. Front Psychiatry 2014; 5:173. [PMID: 25520673 PMCID: PMC4253530 DOI: 10.3389/fpsyt.2014.00173] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 11/16/2014] [Indexed: 12/28/2022] Open
Abstract
Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.
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Affiliation(s)
- Mauro Pettorruso
- Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy
| | - Luisa De Risio
- Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy
| | - Marco Di Nicola
- Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy
| | - Giovanni Martinotti
- Department of Neuroscience and Imaging, Institute of Psychiatry, "G. d'Annunzio" University of Chieti-Pescara , Chieti , Italy
| | - Gianluigi Conte
- Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy
| | - Luigi Janiri
- Department of Neuroscience, Institute of Psychiatry and Clinical Psychology, Catholic University of Sacred Heart , Rome , Italy
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