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Coronado-Montoya S, Abdel-Baki A, Crockford D, Côté J, Dubreucq S, Dyachenko A, Fischer B, Lecomte T, L’Heureux S, Ouellet-Plamondon C, Roy MA, Tibbo P, Villeneuve M, Jutras-Aswad D. Preferences of Young Adults With Psychosis for Cannabis-Focused Harm Reduction Interventions: A Cross-Sectional Study: Préférences des jeunes adultes souffrant de psychose pour les interventions de réduction des méfaits axées sur le cannabis : une étude transversale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:524-535. [PMID: 38571478 PMCID: PMC11168346 DOI: 10.1177/07067437241242395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Cannabis use is common in people with early-phase psychosis (EP) and is associated with worse treatment outcomes. Few targeted interventions for cannabis use behaviour in this population exist, most focusing on abstinence, none focusing on harm reduction. Many people with EP will not seek treatment for their cannabis use with current therapeutic options. Understanding preferences for cannabis-focused harm reduction interventions may be key to improving outcomes. This study aimed to determine preferences of young adults with EP who use cannabis for cannabis-focused harm reduction interventions. METHODS Eighty-nine young adults across Canada with EP interested in reducing cannabis-related harms were recruited. An online questionnaire combining conventional survey methodology and two unique discrete choice experiments (DCEs) was administered. One DCE focused on attributes of core harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analysed these using mixed ranked-ordered logistic regression models. Preference questions using conventional survey methodology were analysed using summary statistics. RESULTS Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions (60 min vs. 10 min, odds ratio (OR): 0.72; P < 0.001); less frequent sessions (daily vs. monthly, OR: 0.68; P < 0.001); shorter interventions (3 months vs. 1 month, OR: 0.80; P < 0.01); technology-based interventions (vs. in-person, OR: 1.17; P < 0.05). Preferences for post-intervention boosters (DCE 2) included opting into boosters (vs. opting out, OR: 3.53; P < 0.001) and having shorter boosters (3 months vs. 1 month, OR: 0.79; P < 0.01). Nearly half of the participants preferred to reduce cannabis use as a principal intervention goal (vs. using in less harmful ways or avoiding risky situations). CONCLUSIONS Further research is required to see if technology-based harm reduction interventions for cannabis featuring these preferences translate into greater engagement and improved outcomes in EP patients.
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Affiliation(s)
- Stephanie Coronado-Montoya
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - José Côté
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Simon Dubreucq
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Alina Dyachenko
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Addiction and Mental Health, Simon Fraser University, Vancouver, Canada
- Research & Graduate Studies Division, University of the Fraser Valley, Abbotsford, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- School of Population Health, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Tania Lecomte
- Department of Psychology, University of Montréal, Montréal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Sophie L’Heureux
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, Canada
- Department of Psychiatry and Neurosciences, Laval University, Québec, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Québec, Canada
- Centre de Recherche CERVO, Québec, Canada
| | - Philip Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- University Institute on Addictions, Montréal, Canada
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Besana F, Civardi SC, Mazzoni F, Carnevale Miacca G, Arienti V, Rocchetti M, Politi P, Martiadis V, Brondino N, Olivola M. Predictors of Readmission in Young Adults with First-Episode Psychosis: A Multicentric Retrospective Study with a 12-Month Follow-Up. Clin Pract 2024; 14:1234-1244. [PMID: 39051293 PMCID: PMC11270315 DOI: 10.3390/clinpract14040099] [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: 04/06/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND A significant number of young individuals are readmitted one or more times shortly after their first episode of psychosis. Readmission may represent a marker of psychopathological vulnerability. Our primary aim was to evaluate the impact of clinical and socio-demographic variables on readmission at 12-month follow-up. Secondly, our goal was to determine whether the use of Long-Acting Injection (LAI) antipsychotics provides notable benefits compared to oral medications in preventing subsequent readmissions. SUBJECTS AND METHODS 80 patients hospitalised for the first time with a diagnosis of psychotic disorder (ICD-10 criteria) were retrospectively assessed through clinical records. The mean age was 21.7 years. Patients were predominantly male (n = 62, 77.5%), and 55 subjects had at least 8 years of education. 50% of the sample was "NEET" (not in education, employment, or training). RESULTS 35 patients (43.8%) were discharged with a LAI antipsychotic, while 45 (56.2%) recieved oral antipsychotic therapy. Substance use (p = 0.04) and oral antipsychotics at discharge (p = 0.003) were significantly associated with readmission at 1 year. We did not find any significant predictors of being discharged with LAI therapy. CONCLUSION Our findings underlined the importance of identifying patients at risk of readmission in order to prevent future rehospitalization and promote appropriate prevention strategies. LAIs should be considered as a first-choice treatment for patients hospitalised for FEP since they proved to be effective in preventing relapse.
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Affiliation(s)
- Filippo Besana
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
| | - Serena Chiara Civardi
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
| | - Filippo Mazzoni
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
| | - Giovanni Carnevale Miacca
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
| | - Vincenzo Arienti
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
| | - Matteo Rocchetti
- Department of Mental Health and Addiction, ASST Pavia, 27100 Pavia, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
- Department of Mental Health and Addiction, ASST Pavia, 27100 Pavia, Italy;
| | | | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
- Department of Mental Health and Addiction, ASST Pavia, 27100 Pavia, Italy;
| | - Miriam Olivola
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy; (S.C.C.); (F.M.); (G.C.M.); (V.A.); (P.P.); (N.B.); (M.O.)
- Department of Mental Health and Addiction, ASST Pavia, 27100 Pavia, Italy;
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3
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Romeo B, Lestra V, Martelli C, Amirouche A, Benyamina A, Hamdani N. Increased markers of inflammation after cannabis cessation and their association with psychotic symptoms. Acta Neuropsychiatr 2024; 36:118-127. [PMID: 37114467 DOI: 10.1017/neu.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION A dysbalance of the immune system in psychotic disorders has been well investigated. However, despite a higher prevalence of cannabis (THC) consumption in patients with psychosis, few studies have investigated the impact of this use on inflammatory markers. METHODS One hundred and two inpatients were included in this retrospective study. Leukocytic formula, hsCRP, fibrinogen levels and urinary THC were measured, and comparisons were performed at baseline and after 4 weeks of cannabis cessation between cannabis users (THC+) and non-users (THC-). RESULTS After cannabis cessation, we found a greater increase in leucocyte level (p < 0.01), monocyte level (p = 0.05) and a statistical trend to a highest increase of lymphocyte level (p = 0.06) between baseline and 4 weeks in the THC+ group as compared to the THC- group. At 4 weeks, highest leucocyte (p = 0.03), lymphocyte (p = 0.04) and monocyte (p < 0.01) counts were found in the THC+ group, whereas at baseline no difference was found. A positive correlation was found between monocyte count at 4 weeks and baseline Positive and Negative Syndrome Scale (PANSS) negative subscore (p = 0.045) and between the variation of monocyte count between baseline and 4 weeks and the PANSS total score at 4 weeks (p = 0.05). CONCLUSION THC cessation is associated with an increase in inflammatory markers, including white blood cell, lymphocyte and monocyte levels, which correlates with symptomatology of patients with psychosis.
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Affiliation(s)
- Bruno Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
- Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France
| | - Valentine Lestra
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
| | - Catherine Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
- Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1299, Research Unit, NeuroImaging and Psychiatry, Paris Sud University- Paris Saclay University, Paris Descartes University, Digiteo Labs, Bâtiment 660, Gif-sur-Yvette, France
| | - Ammar Amirouche
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
- Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France
| | - Amine Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
- Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France
| | - Nora Hamdani
- Unité de recherche UR Psychiatrie-Comorbidités-Addictions PSYCOMADD Université Paris Saclay, Paris, France
- Cédiapsy, 87 rue d'Assas, 75006 Paris, France
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Denissoff A, Taipale H, Tiihonen J, Di Forti M, Mittendorfer-Rutz E, Tanskanen A, Mustonen A, Niemelä S. Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study. Schizophr Bull 2024:sbae034. [PMID: 38534050 DOI: 10.1093/schbul/sbae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND HYPOTHESIS There is a paucity of research on treatment outcomes of patients with psychosis and cannabis use disorder (CUD). We aimed to compare the effectiveness of antipsychotics in reducing the risk of hospitalization in patients with first-episode psychosis (FEP) and co-occurring CUD. STUDY DESIGN We utilized a nationwide Swedish cohort of patients with longitudinal register data from the year 2006 to 2021. Participants were patients with FEP and co-occurring CUD (n = 1820, 84.73% men, mean age 26.80 years, SD 8.25 years). The main outcome was hospitalization due to psychotic relapse. Hospitalization due to any psychiatric disorder or substance use disorder (SUD) were examined as secondary outcomes. Within-individual Cox regression models were used to study these associations. STUDY RESULTS Use of any antipsychotic was associated with a 33% risk reduction of psychotic relapse (aHR = 0.67; 95% CI 0.60-0.75). Clozapine (0.43; 0.29-0.64), long-acting injectable (LAI) formulations of risperidone (0.40; 0.22-0.71), aripiprazole (0.42; 0.27-0.65), and paliperidone (0.46; 0.30-0.69) were associated with the lowest risk of relapse. The association between the LAI formulation of olanzapine and hospitalization due to psychosis was statistically non-significant (0.61; 0.35-1.05). Clozapine was associated with an 86% risk reduction of hospitalization due to SUD (0.14; 0.05-0.44). Of oral non-clozapine antipsychotics, aripiprazole was associated with the lowest risk of hospitalization due to psychotic relapse (0.61; 0.45-0.83). CONCLUSIONS These findings support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring CUD.
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Affiliation(s)
- Alexander Denissoff
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marta Di Forti
- Department of Social Genetics and Developmental Psychiatry, IoPPN, King's College London, London, England
| | | | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Solja Niemelä
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
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Fischer B, Hall W, Fidalgo TM, Hoch E, Foll BL, Medina-Mora ME, Reimer J, Tibbo PG, Jutras-Aswad D. Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review. J Dual Diagn 2023; 19:71-96. [PMID: 37450645 DOI: 10.1080/15504263.2023.2226588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Objective: Cannabis use is increasingly normalized; psychosis is a major adverse health outcome. We reviewed evidence on cannabis use-related risk factors for psychosis outcomes at different stages toward recommendations for risk reduction by individuals involved in cannabis use. Methods: We searched primary databases for pertinent literature/data 2016 onward, principally relying on reviews and high-quality studies which were narratively summarized and quality-graded; recommendations were developed by international expert consensus. Results: Genetic risks, and mental health/substance use problem histories elevate the risks for cannabis-related psychosis. Early age-of-use-onset, frequency-of-use, product composition (i.e., THC potency), use mode and other substance co-use all influence psychosis risks; the protective effects of CBD are uncertain. Continuous cannabis use may adversely affect psychosis-related treatment and medication effects. Risk factor combinations further amplify the odds of adverse psychosis outcomes. Conclusions: Reductions in the identified cannabis-related risks factors-short of abstinence-may decrease risks of related adverse psychosis outcomes, and thereby protect cannabis users' health.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Research and Graduate Studies Division, University of the Fraser Valley, Abbotsford, Canada
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Thiago M Fidalgo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilian-University, Munich, Germany
- Institut für Therapieforschung (IFT), Munich, Germany
| | - Bernard Le Foll
- Translational Addiction Research Laboratory and Campbell Family Mental Health Research Institute and Acute Care Program, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology and Dalla Lana School of Public Health and Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Maria-Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jens Reimer
- Departments of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Center for Psychosocial Medicine, Academic Teaching Hospital Itzehoe, Itzehoe, Germany
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Édouard Montpetit Boulevard, Montreal, Canada
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Gouse BM, Boliver EE, Oblath R, Camacho L, Brown HE. Cannabis use among patients presenting to the emergency department for psychosis: Associations with restraint use, medication administration, psychiatric hospitalization, and repeat visits. Psychiatry Res 2023; 323:115151. [PMID: 36934468 DOI: 10.1016/j.psychres.2023.115151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
Cannabis use is associated with increased severity of psychotic symptoms and the risk of acute agitation and aggressive behavior in inpatient (IP) and outpatient settings. Whether or not cannabis use is associated with increased acuity of psychosis-related ED presentations and risk of repeat ED visits for psychosis is unclear. In this retrospective study of 2,134 ED visits for acute psychosis, we investigated the risk of physical restraint, parenteral medication administration, psychiatric hospitalization, and recurrent ED visits. We examined ED visits between March 1, 2019 and February 28, 2021 based on urinary Tetrahydrocannabinol (THC) screen status (positive vs negative vs no screen). The risk of physical restraint, parenteral antipsychotic, and benzodiazepine administration was significantly greater in ED visits with a positive THC screen compared to those with a negative or no THC screen. We did not find an association between a positive urinary THC screen and IP hospitalization or the risk of recurrent ED presentation for psychosis within 90 days. These findings suggest that positive urinary THC may predict acute agitation or acuity of symptoms in ED settings and underscores the importance of screening for THC during ED presentations for psychosis.
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Affiliation(s)
- Brittany M Gouse
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA.
| | - Elijah E Boliver
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Boston University School of Public Health, Boston, MA 02118, USA
| | - Rachel Oblath
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - Luisa Camacho
- Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - Hannah E Brown
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
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Waterreus A, Di Prinzio P, Ambrosi T, Morgan VA. Discontinuing cannabis use: Symptomatic and functional outcomes in people with an established psychotic disorder. Schizophr Res 2023; 254:118-124. [PMID: 36842223 DOI: 10.1016/j.schres.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
For people with psychotic disorders, the negative outcomes associated with continuing cannabis use would suggest that discontinuing such use may be beneficial for their symptomatic and functional recovery. However, existing evidence that discontinuation is associated with better clinical outcomes is inconsistent and it remains unclear whether discontinuing use is associated with improvements in outcomes for people with an established psychotic disorder. In this 3-5-year longitudinal study we examined baseline and follow-up symptomatic and functional profiles of 371 people with an established psychotic disorder, comparing those who continued to use cannabis with those who discontinued use after baseline assessment. At follow-up, one third (33.3 %) of baseline cannabis users had discontinued use. Discontinuation was associated with significantly lower odds of past-year hallucinations and a mean improvement in level of functioning (Personal and Social Performance Scale) compared to a decline in functioning in continuing users. No significant differences in severity of negative symptoms were observed. With few longitudinal studies examining symptomatic and functional outcomes for people with established psychotic disorders who continue to use cannabis compared to those who discontinue use, our findings that discontinuing cannabis was associated with significant clinical improvements fill gaps in the evidence-base.
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Affiliation(s)
- A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - P Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - T Ambrosi
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
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8
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Psychotic relapses from the perspective of patients and family members. Arch Psychiatr Nurs 2022; 41:300-305. [PMID: 36428064 DOI: 10.1016/j.apnu.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic.
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Rault O, Romeo B, Butlen-Ducuing F, Rari E, Benyamina A, Martelli C. Impact of cannabis use and its cessation on the dosage and the efficacy of antipsychotic drugs in in- and outpatients with schizophrenia taking medication: A systematic review and meta-analysis. J Psychiatr Res 2022; 156:713-721. [PMID: 36410310 DOI: 10.1016/j.jpsychires.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Compared with the general population, there are more cannabis users among patients suffering from schizophrenia and this consumption seems to impact the course and the treatment of their pathology. The aim of this meta-analysis and systematic review was to assess the impact of cannabis use on the efficacy of treatments, more particularly regarding the antipsychotic dosage, symptoms evolution, therapeutic resistance and the risk of relapse in patients with schizophrenia taking medication. We performed a systematic search of keywords on multiple databases up to August 2020 to identify all studies meeting the following criteria: comparison between cannabis smokers and non-cannabis users in patients with schizophrenia, assessment of antipsychotics doses, information about their efficacy or resistance to treatment and control of the compliance. Standardized mean differences were calculated for antipsychotic dosage and symptoms evolution at discharge, and a systematic review was performed for other outcomes. Twelve studies were included. Cannabis use did not seem to be associated with higher doses of antipsychotics at seven days and at the end of the studies, nor with poorer symptoms evolution, and nor with higher rate of antipsychotic resistance. However, cannabis use seems to be associated with a higher risk of relapse. This meta-analysis provides evidence that previous cannabis use, or occasional use, in patients with schizophrenia taking medication does not impact antipsychotic efficacy as described by antipsychotic dosage or PANSS score.
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Affiliation(s)
- Ophélie Rault
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France.
| | - Bruno Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Florence Butlen-Ducuing
- Office of Therapies for Neurological and Psychiatric Disorders, European Medicines Agency, Amsterdam, the Netherlands
| | - Eirini Rari
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Amine Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Catherine Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France; INSERM U A1299 "Trajectoires développementales en Psychiatrie", Université Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS 9010, Centre Borelli, Digiteo-Labs, Bâtiment 660 Claude Shannon, Avenue des Sciences, 91190, Gif-sur-Yvette, France
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10
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Harm reduction interventions as a potential solution to managing cannabis use in people with psychosis: A call for a paradigm shift. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103814. [PMID: 35926338 DOI: 10.1016/j.drugpo.2022.103814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022]
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11
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Martín-Muñoz JC, Acuña MJ, Carrión-Mellado N, Blanco-Venzalá M, Mantrana-Ridruejo L, Rico-Villademoros F, Rosado-Tejero L, Utrera-Caballero E. A naturalistic study on the effectiveness of long-acting antipsychotics in an early intervention program for patients with recent-onset psychosis. Early Interv Psychiatry 2022; 17:378-384. [PMID: 35716056 DOI: 10.1111/eip.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/20/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the impact of long-acting injectable antipsychotics (LAIs) on the risk of hospitalization and the length of hospitalization in the setting of an early intervention program for patients with recent-onset psychosis. METHODS Observational, retrospective study conducted under routine clinical practice conditions. We included all patients admitted from July 2015 to April 2020 to the Early Intervention Program in Psychosis. We analysed the incidence of hospitalization and hospitalization days before and after treatment with LAIs and calculated the incidence rate ratio (IRR). We also compared the outcomes of patients treated with LAIs with those of the patients maintained on oral antipsychotics using a binomial negative regression analysis. RESULTS A total of 170 patients were included in the program. Of them, 34 (20%) received LAIs (aripiprazole [n = 22], and paliperidone/risperidone [n = 12]). There was an 89% reduction in the incidence of hospitalizations after treatment with LAIs (IRR 0.11, 95%CI 0.05-0.21; p < .0001). The IRR for LAIs vs. oral antipsychotics was 0.87 (95%CI, 0.24-3.18; p = .829). The presence of a substance use disorder significantly increased the rate of hospitalizations by 123% (IRR 2.23, 95%CI 1.31-3.78). Analyses of hospitalization days showed similar results. CONCLUSIONS Our results suggest that LAIs are useful for the management of patients with recent-onset psychosis who fail treatment with oral antipsychotics. Whether LAIs are superior to oral antipsychotics as first-line treatment of patients with early psychosis and/or could play a special role in managing patients with early psychosis and comorbid substance use disorders should be further evaluated.
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Affiliation(s)
- Joaquín-Carlos Martín-Muñoz
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - María-José Acuña
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Natividad Carrión-Mellado
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Matilde Blanco-Venzalá
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Laura Mantrana-Ridruejo
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Luisa Rosado-Tejero
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Eva Utrera-Caballero
- Mental Health Clinical Unit of the Southern Health Area of Sevilla, Andalusian Health Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
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12
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Colizzi M, Bortoletto R, Costa R, Bhattacharyya S, Balestrieri M. The Autism-Psychosis Continuum Conundrum: Exploring the Role of the Endocannabinoid System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5616. [PMID: 35565034 PMCID: PMC9105053 DOI: 10.3390/ijerph19095616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
Evidence indicates shared physiopathological mechanisms between autism and psychosis. In this regard, the endocannabinoid system has been suggested to modulate neural circuits during the early stage of neurodevelopment, with implications for both autism and psychosis. Nevertheless, such potential common markers of disease have been investigated in both autism and psychosis spectrum disorders, without considering the conundrum of differentiating the two groups of conditions in terms of diagnosis and treatment. Here, we systematically review all human and animal studies examining the endocannabinoid system and its biobehavioral correlates in the association between autism and psychosis. Studies indicate overlapping biobehavioral aberrancies between autism and schizophrenia, subject to correction by modulation of the endocannabinoid system. In addition, common cannabinoid-based pharmacological strategies have been identified, exerting epigenetic effects across genes controlling neural mechanisms shared between autism and schizophrenia. Interestingly, a developmental and transgenerational trajectory between autism and schizophrenia is supported by evidence that exogenous alteration of the endocannabinoid system promotes progression to inheritable psychosis phenotypes in the context of biobehavioral autism vulnerability. However, evidence for a diametral association between autism and psychosis is scant. Several clinical implications follow from evidence of a developmental continuum between autism and psychosis as a function of the endocannabinoid system dysregulation.
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Affiliation(s)
- Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Riccardo Bortoletto
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Rosalia Costa
- Community Mental Health Team, Friuli Centrale University Health Service (ASUFC), 33057 Palmanova, Italy;
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
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13
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Romeo B, Lestra V, Martelli C, Benyamina A, Hamdani N. Cannabis Cessation, Inflammatory Markers and Schizophrenia. J Dual Diagn 2022; 18:33-41. [PMID: 34985404 DOI: 10.1080/15504263.2021.2013697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective A dysbalance of the immune system in schizophrenia has been largely described but few studies have investigated the impact of cannabis use on inflammatory markers in patients with schizophrenia. The objective of our study was to investigate the impact of cannabis use on high-sensitivity C-reactive protein (hsCRP), fibrinogen levels and leucocytic formula in patients with schizophrenia. Methods: Thirty-eight acutely ill inpatients with schizophrenia were included. Patient hsCRP, fibrinogen levels, leukocytic formula and urinary cannabis were measured at baseline and after four weeks of treatment. Results: After four weeks of cannabis cessation (as confirmed by urinary tests), we found an increase of hsCRP level (p = .016) and lymphocytes (p = .03) in consumers patients whereas no difference was observed in non-consumers patients. As compared to non-consumers patients with schizophrenia, consumers had lower levels of hsCRP (p = .045). Finally, a negative correlation was found between the PANSS score evolution (between baseline and 4 weeks) and baseline hsCRP level. Conclusions: In our study, cannabis cessation raises inflammatory markers though improving clinical symptoms. The investigation and the understanding of interactions between cannabis use and inflammatory markers in patients with schizophrenia is of importance and could in the future be a new target for treatment of psychiatric symptoms linked to inflammation.
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Affiliation(s)
- Bruno Romeo
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France.,Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche 4872 PSYCOMADD Université Paris Sud - AP-HP - Université Paris Saclay, Villejuif, France
| | - Valentine Lestra
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France
| | - Catherine Martelli
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France.,Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche 4872 PSYCOMADD Université Paris Sud - AP-HP - Université Paris Saclay, Villejuif, France.,Institut National de la Santé et de la Recherche Médicale U1299, Research unit, NeuroImaging and Psychiatry, Paris Sud University- Paris Saclay University, Paris Descartes University, Digiteo Labs, Gif-sur- Yvette, France
| | - Amine Benyamina
- Department of Psychiatry and Addictology, APHP, Paul Brousse Hospital, Villejuif, France.,Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche 4872 PSYCOMADD Université Paris Sud - AP-HP - Université Paris Saclay, Villejuif, France
| | - Nora Hamdani
- Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche 4872 PSYCOMADD Université Paris Sud - AP-HP - Université Paris Saclay, Villejuif, France.,Cédiapsy, Paris, France
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14
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Abstract
BACKGROUND Evidence suggests that an overlap exists between the neurobiology of psychotic disorders and the effects of cannabinoids on neurocognitive and neurochemical substrates involved in reward processing. AIMS We investigate whether the psychotomimetic effects of delta-9-tetrahydrocannabinol (THC) and the antipsychotic potential of cannabidiol (CBD) are underpinned by their effects on the reward system and dopamine. METHODS This narrative review focuses on the overlap between altered dopamine signalling and reward processing induced by cannabinoids, pre-clinically and in humans. A systematic search was conducted of acute cannabinoid drug-challenge studies using neuroimaging in healthy subjects and those with psychosis RESULTS: There is evidence of increased striatal presynaptic dopamine synthesis and release in psychosis, as well as abnormal engagement of the striatum during reward processing. Although, acute THC challenges have elicited a modest effect on striatal dopamine, cannabis users generally indicate impaired presynaptic dopaminergic function. Functional MRI studies have identified that a single dose of THC may modulate regions involved in reward and salience processing such as the striatum, midbrain, insular, and anterior cingulate, with some effects correlating with the severity of THC-induced psychotic symptoms. CBD may modulate brain regions involved in reward/salience processing in an opposite direction to that of THC. CONCLUSIONS There is evidence to suggest modulation of reward processing and its neural substrates by THC and CBD. Whether such effects underlie the psychotomimetic/antipsychotic effects of these cannabinoids remains unclear. Future research should address these unanswered questions to understand the relationship between endocannabinoid dysfunction, reward processing abnormalities, and psychosis.
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15
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Coronado-Montoya S, Morissette F, Abdel-Baki A, Fischer B, Côté J, Ouellet-Plamondon C, Tremblay L, Jutras-Aswad D. Preventive interventions targeting cannabis use and related harms in people with psychosis: A systematic review. Early Interv Psychiatry 2021; 15:1439-1453. [PMID: 33283448 DOI: 10.1111/eip.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 10/06/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
AIM While most users will not experience severe adverse health outcomes from cannabis, it can be associated with negative outcomes in people with psychosis. People with psychosis who use cannabis have more severe psychiatric symptoms, higher rates of hospitalization, and diminished psychosocial functioning compared to those who do not use cannabis. Most studies of people with psychotic disorders have focused on cannabis use treatments and only a few on preventive interventions for cannabis. This systematic review aims to evaluate the effectiveness of preventive interventions focusing on cannabis use for people with psychosis. METHODS We searched CINAHL Plus, EBM reviews, EMBASE, MEDLINE, PsycInfo and PubMed databases for controlled studies assessing the effects of preventive interventions on cannabis use and related harms in people with psychosis. We conducted the search using a combination of the following concepts: cannabis, psychosis, intervention and prevention. Risk of bias was assessed. RESULTS The search yielded 11 460 unique studies. Of these, five studies met our eligibility criteria. None of the studies demonstrated clear efficacy of prevention interventions in reducing cannabis use, and none measured cannabis-related harms. All studies had high risk of bias. CONCLUSION The small number of studies and the considerable risk of bias made it difficult to conclude whether any of the existing interventions were promising. With increased acceptance and accessibility of cannabis due to liberalizing cannabis policies, it is imperative to improve the evidence base for preventive interventions, in particular their effectiveness in decreasing the risk of cannabis-related harms in people with psychosis.
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Affiliation(s)
- Stephanie Coronado-Montoya
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Benedikt Fischer
- Schools of Population Health & Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Universidade Federal de (Federal University of) São Paulo (UNIFESP), Sao Paulo, Brazil
| | - José Côté
- Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Laurence Tremblay
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.,University Institute on Addictions, Montreal, Canada
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16
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Soler S, Montout C, Pepin B, Abbar M, Mura T, Lopez-Castroman J. Impact of cannabis use on outcomes of patients admitted to an involuntary psychiatric unit: A retrospective cohort study. J Psychiatr Res 2021; 138:507-513. [PMID: 33975067 DOI: 10.1016/j.jpsychires.2021.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cannabis is associated with an increased risk of mental disorders, including the onset or adverse evolution of schizophrenia, bipolar disorder and depression. The aim of our study was to examine how cannabis use influences length of stay and readmissions in a unit of involuntary care. METHOD All patients admitted to one secure adult psychiatry unit in France in 2016 were included (n = 370). Patients were assigned to one of two groups according to detection of urinary tetrahydrocannabinol (THC + or -). Clinical outcomes, such as length of stay and readmissions, were compared between the groups in multivariate analyses. RESULTS We identified 130 THC + patients and 240 THC- patients. THC + patients were often young men. In adjusted analyses, THC + status was significantly associated with one-year readmissions (OR = 2.29, p = .0082) and more prescriptions of benzodiazepines (OR = 1.93, p = .02), but not antipsychotics, at discharge. CONCLUSIONS Cannabis users seem to have a particular profile in secure units, and are associated with specific diagnoses and treatments, and a higher risk of readmissions. Adapted management strategies might be warranted for these patients.
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Affiliation(s)
- Stephan Soler
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France.
| | - Christine Montout
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France; INSERM et Université de Montpellier, Montpellier, France; Department of Biostatistics, CHU Nimes, Univ Montpellier, Nimes, France
| | - Berengere Pepin
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France
| | - Mocrane Abbar
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France
| | - Thibault Mura
- INSERM et Université de Montpellier, Montpellier, France; Department of Biostatistics, CHU Nimes, Univ Montpellier, Nimes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nimes, Univ Montpellier, Nimes, France; INSERM et Université de Montpellier, Montpellier, France; CIBERSAM, Spain.
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17
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Bartoli F, Cavaleri D, Moretti F, Bachi B, Calabrese A, Callovini T, Cioni RM, Riboldi I, Nacinovich R, Crocamo C, Carrà G. Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study. MEDICINA-LITHUANIA 2020; 56:medicina56110613. [PMID: 33203127 PMCID: PMC7696058 DOI: 10.3390/medicina56110613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: Readmissions of youths hospitalized for a severe mental disorder are common events and bear a remarkable human, social, and economic burden. The current study aimed at evaluating predictors of 1-year rehospitalization in a sample of adolescents and young adults with severe mental disorders. Materials and Methods: Data for ≤25-year-old inpatients with a severe mental disorder and consecutively admitted between 1 January 2016 and 30 June 2019 were collected. Subjects were retrospectively assessed over a follow-up period of one year after the index discharge to track readmissions—i.e., the primary outcome variable. Standard descriptive statistics were used. The association between variables and 1-year rehospitalization was estimated using the univariate Cox proportional hazards regression model. We then carried out a multivariable Cox regression model, also estimating the covariate-adjusted survivor function. Hazard ratios (HRs) with related 95% confidence intervals (95% CIs) were provided. Results: The final sample included 125 individuals. The multivariable Cox regression model estimated that co-occurring substance use disorders (HR = 2.14; 95% CI: 1.08 to 4.26; p = 0.029) and being admitted for a suicide attempt (HR = 2.49; 95% CI: 1.13 to 5.49; p = 0.024) were both significant predictors of 1-year rehospitalization. Conclusions: Our study showed that comorbid substance use disorders and being admitted for a suicide attempt were predictors of early readmission in youths with severe mental disorders. Although their generalizability is limited, our findings could contribute to improve the quality of young patients’ mental health care by identifying vulnerable subjects who may benefit from tailored interventions to prevent rehospitalizations.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Correspondence: ; Tel.: +39-02-5799-8353
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Riccardo M. Cioni
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Renata Nacinovich
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
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18
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Blest‐Hopley G, O'Neill A, Wilson R, Giampietro V, Lythgoe D, Egerton A, Bhattacharyya S. Adolescent-onset heavy cannabis use associated with significantly reduced glial but not neuronal markers and glutamate levels in the hippocampus. Addict Biol 2020; 25:e12827. [PMID: 31478302 DOI: 10.1111/adb.12827] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
Cannabis use has been associated with adverse mental health outcomes, the neurochemical underpinnings of which are poorly understood. Although preclinical evidence suggests glutamatergic dysfunction following cannabis exposure in several brain regions including the hippocampus, evidence from human studies have been inconsistent. We investigated the effect of persistent cannabis use on the brain levels of N-acetyl aspartate (NAA) and myoinositol, the metabolite markers of neurons and glia, the site of the main central cannabinoid CB1 receptor, and the levels of glutamate, the neurotransmitter directly affected by CB1 modulation. We investigated cannabis users (CUs) who started using during adolescence, the period of greatest vulnerability to cannabis effects and focused on the hippocampus, where type 1 cannabinoid receptors (CBR1) are expressed in high density and have been linked to altered glutamatergic neurotransmission. Twenty-two adolescent-onset CUs and 21 nonusing controls (NU), completed proton magnetic resonance spectroscopy, to measure hippocampal metabolite concentrations. Glutamate, NAA, and myoinositol levels were compared between CU and NU using separate analyses of covariance. CU had significantly lower myoinositol but not glutamate or NAA levels in the hippocampus compared with NU. Myoinositol levels in CU positively correlated with glutamate levels, whereas this association was absent in NU. Altered myoinositol levels may be a marker of glia dysfunction and is consistent with experimental preclinical evidence that cannabinoid-induced glial dysfunction may underlie cannabinoid-induced memory impairments. Future studies using appropriate imaging techniques such as positron emission tomography should investigate whether glial dysfunction associated with cannabis use underlies hippocampal dysfunction and memory impairment in CUs.
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Affiliation(s)
- Grace Blest‐Hopley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Aisling O'Neill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Robin Wilson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - David Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- South London and Maudsley NHS Foundation Trust London UK
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19
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Madero S, Oliveras C, Pons MT, Sague M, López-Pelayo H, Gual A, Balcells M. Cannabis use the week before admission to psychiatric in-patient service as a marker of severity. J Psychiatr Res 2020; 129:40-46. [PMID: 32563776 DOI: 10.1016/j.jpsychires.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. METHODS Cross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJU and symptoms severity through the Brief Psychiatric Rating Scale (BPRS). Secondary outcomes (e.g. length of stay) were also assessed. Bivariate analyses and multivariate analyses were performed to determine the effect of SJU consumed before admission on measures of clinical severity. RESULTS Point prevalence of cannabis use before admission was 25.5%. Mean BPRS score was 55.8 (SD = 16.1); and 62.9 (SD = 11.1) among cannabis users. A low degree positive correlation between SJU consumed the week before admission and BPRS score (rs = 0.28, p = 0.03) was found. In the multivariate analyses both main diagnostic group, Schizophrenia and other psychotic disorders vs. others (Bipolar and Unipolar Affective Disorders and Addictive disorders) (B = 8.327; 95% CI 4.976-11.677) and need of PRN ("pre re nata" or when necessary) administration of antipsychotics and benzodiazepines (B = 12.13; 95% CI 6.868-17.393) were significant predictors, both increasing BPRS score. CONCLUSIONS The study did not find a correlation between SJU consumed last week and psychiatric severity. On the other hand, individuals with psychotic disorders reported a higher prevalence of cannabis use the week before admission and displayed higher BPRS scores, which points to the need for the development of tailored interventions for high-risk groups. The SJU is a useful quantification tool suitable for further clinical research.
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Affiliation(s)
- S Madero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
| | - C Oliveras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M T Pons
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - M Sague
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - H López-Pelayo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - A Gual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M Balcells
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
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20
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Moulin V, Alameda L, Framorando D, Baumann PS, Gholam M, Gasser J, Do Cuenod KQ, Conus P. Early onset of cannabis use and violent behavior in psychosis. Eur Psychiatry 2020; 63:e78. [PMID: 32669157 PMCID: PMC7503178 DOI: 10.1192/j.eurpsy.2020.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients. METHOD Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18-35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB. RESULTS Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13-20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB. CONCLUSIONS Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.
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Affiliation(s)
- Valerie Moulin
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
| | - David Framorando
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp-S Baumann
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jacques Gasser
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kim-Q Do Cuenod
- Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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21
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Sami M, Worker A, Colizzi M, Annibale L, Das D, Kelbrick M, Eranti S, Collier T, Onyejiaka C, O'Neill A, Lythgoe D, McGuire P, Williams SCR, Kempton MJ, Bhattacharyya S. Association of cannabis with glutamatergic levels in patients with early psychosis: Evidence for altered volume striatal glutamate relationships in patients with a history of cannabis use in early psychosis. Transl Psychiatry 2020; 10:111. [PMID: 32317625 PMCID: PMC7174331 DOI: 10.1038/s41398-020-0790-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023] Open
Abstract
The associative striatum, an established substrate in psychosis, receives widespread glutamatergic projections. We sought to see if glutamatergic indices are altered between early psychosis patients with and without a history of cannabis use and characterise the relationship to grey matter. 92 participants were scanned: Early Psychosis with a history of cannabis use (EPC = 29); Early Psychosis with minimal cannabis use (EPMC = 25); Controls with a history of cannabis use (HCC = 16) and Controls with minimal use (HCMC = 22). Whole brain T1 weighted MR images and localised proton MR spectra were acquired from head of caudate, anterior cingulate and hippocampus. We examined relationships in regions with known high cannabinoid 1 receptor (CB1R) expression (grey matter, cortex, hippocampus, amygdala) and low expression (white matter, ventricles, brainstem) to caudate Glutamine+Glutamate (Glx). Patients were well matched in symptoms, function and medication. There was no significant group difference in Glx in any region. In EPC grey matter volume explained 31.9% of the variance of caudate Glx (p = 0.003) and amygdala volume explained 36.9% (p = 0.001) of caudate Glx. There was no significant relationship in EPMC. The EPC vs EPMC interaction was significant (p = 0.042). There was no such relationship in control regions. These results are the first to demonstrate association of grey matter volume and striatal glutamate in the EPC group. This may suggest a history of cannabis use leads to a conformational change in distal CB1 rich grey matter regions to influence striatal glutamatergic levels or that such connectivity predisposes to heavy cannabis use.
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Affiliation(s)
- Musa Sami
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
- Institute of Mental Health, Nottingham University, Nottingham, UK.
| | - Amanda Worker
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Marco Colizzi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luciano Annibale
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Debasis Das
- Leicestershire Partnership NHS Trust, Thurmaston, UK
| | | | | | - Tracy Collier
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Chidimma Onyejiaka
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Aisling O'Neill
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - David Lythgoe
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Steve C R Williams
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Matthew J Kempton
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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22
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Vakharia RM, Sodhi N, Anis HK, Ehiorobo JO, Mont MA, Roche MW. Patients Who Have Cannabis Use Disorder Have Higher Rates of Venous Thromboemboli, Readmission Rates, and Costs Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:997-1002. [PMID: 31973970 DOI: 10.1016/j.arth.2019.11.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studies have shown that cannabis can interfere with hematological parameters and platelet morphology. The purpose of this study is to investigate whether patients with cannabis use disorder undergoing primary total knee arthroplasty (TKA) have higher rates of (1) venous thromboemboli (VTEs); (2) readmissions; and (3) costs. METHODS Study group patients undergoing primary TKA were identified from a large, nationwide database. Patients who had a history of VTEs, deep vein thromboses (DVTs), pulmonary emboli (PEs), and coagulopathies before their TKA were excluded. Study group patients were matched to controls in a 1:4 ratio by age, sex, a comorbidity index, and medical comorbidities. The query yielded 18,388 patients (cannabis = 3680; controls = 14,708). Outcomes analyzed included rates of 90-day VTEs, DVTs, and PEs, in addition to 90-day readmissions and costs. A P value less than .01 was considered statistically significant. RESULTS Patients who have cannabis use disorder were found to have significantly higher incidence and odds (2.79% vs 1.78%; odds ratio [OR], 1.58; P < .0001) of VTEs, DVTs (2.41% vs 1.44%; OR, 1.68; P < .0001), and PEs (0.97% vs 0.62%; P = .01). Readmissions were significantly higher (27.03% vs 23.18%; OR, 1.22; P < .0001) in patients who have cannabis use disorder. Patients with cannabis use disorder have significantly higher day of surgery ($14,024.88 vs $12,127.49; P < .0001) and 90-day costs ($19,155.45 vs $16,315.00; P < .0001). CONCLUSION This study found that patients who have a cannabis use disorder have higher rates of thromboembolic complications, readmission rates, and costs following primary TKA compared to a matched cohort.
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Affiliation(s)
- Rushabh M Vakharia
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
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23
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Gonçalves-Pinho M, Bragança M, Freitas A. Psychotic disorders hospitalizations associated with cannabis abuse or dependence: A nationwide big data analysis. Int J Methods Psychiatr Res 2020; 29:e1813. [PMID: 31808250 PMCID: PMC7051837 DOI: 10.1002/mpr.1813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We aimed to describe and correlate the hospital panorama of psychotic disorders (PD) with cannabis use (CU) trends in all Portuguese public hospitals. METHODS We conducted a retrospective observational study that analysed all hospitalizations that occurred in Portuguese public hospitals from 2000 to 2015. Hospitalizations with a primary diagnosis of PD or schizophrenia were selected based on Clinical Classification Software diagnostic single-level 659. Episodes associated with CU were identified by the International Classification of Diseases Version 9, Clinical Modification code 304.3/305.2 that correspond to cannabis dependence/cannabis abuse. RESULTS The number of hospitalizations with a primary diagnosis of PD and schizophrenia associated with CU rose 29.4 times during the study period, from 20 to 588 hospitalizations yearly (2000 and 2015, respectively) with a total of 3,233 hospitalizations and an average episode cost of €3,500. Male patients represented 89.8% of all episodes, and the mean/median age at discharge were 30.66/29.00 years, respectively. From all hospitalizations with a primary diagnosis of PD or schizophrenia, the ones with a secondary diagnosis of CU rose from 0.87% in 2000 to 10.60% in 2015. CONCLUSIONS The increase on secondary diagnosis coding and the change on cannabis patterns of consumption in Portuguese population with an increasing frequency of moderate/high dosage cannabis consumers may explain the rise on PD hospitalizations.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Miguel Bragança
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,2D4H - Secondary Data for Healthcare Research, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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24
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Reid S, Bhattacharyya S. Antipsychotic treatment failure in patients with psychosis and co-morbid cannabis use: A systematic review. Psychiatry Res 2019; 280:112523. [PMID: 31450032 DOI: 10.1016/j.psychres.2019.112523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/23/2023]
Abstract
Whilst the effects of cannabis preceding psychosis onset are well established, an effect post-onset is less clear. Emerging evidence suggests that cannabis use is associated with increased relapse outcomes possibly because of determinants, antipsychotic treatment failure and medication adherence, that are not mutually exclusive. Due to the paucity of literature on antipsychotic treatment failure an association with cannabis remains conjectural. This review sought to summarise current evidence regarding the effect of cannabis use on antipsychotic treatment failure among users and non-users with psychosis. Ovid databases (Embase, Journals@Ovid Full Text, OvidMEDLINE® In-Process and Other Non-Indexed Citations and PsycINFO) were searched to identify relevant articles. Seven articles met eligibility criteria. Cannabis use was associated with the following deleterious outcomes increased: odds of non-remission, prescription of unique antipsychotic medications, cumulative prescription of Clozapine and poor treatment trajectories. One study reported similar life-time, but lower past-year, rates of cannabis use in those prescribed Clozapine. Another study reported differences between groups for chlorpromazine equivalent doses for long-term Olanzapine prescription. Improved methodologies are warranted due to a lack of well-designed prospective studies and heterogeneity of key variables. There remains, despite research paucity, the need to encourage early cannabis cessation and higher-quality research to inform clinical practice.
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Affiliation(s)
- Sam Reid
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
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25
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Setién-Suero E, Neergaard K, Ortiz-García de la Foz V, Suárez-Pinilla P, Martínez-García O, Crespo-Facorro B, Ayesa-Arriola R. Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatr Scand 2019; 140:349-359. [PMID: 31381129 DOI: 10.1111/acps.13081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2 = 15.583, P ≤ 0.001; SAPS: x2 = 12.386, P = 0.002) and poorer functionality (DAS: x2 = 6.067, P = 0.048; GAF: x2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.
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Affiliation(s)
- E Setién-Suero
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - K Neergaard
- Department of Laboratoire Parole et Langage, Aix-Marseille Université, Marseille, France
| | - V Ortiz-García de la Foz
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - P Suárez-Pinilla
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - O Martínez-García
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.,Hospital Universitario Virgen del Rocio, IBiS, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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