1
|
Hodgins S. What do we know now about evidence-based treatment for psychosis and aggressive behaviour or criminality that we did not know when community care was implemented? Nord J Psychiatry 2024:1-10. [PMID: 39331403 DOI: 10.1080/08039488.2024.2403586] [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: 06/14/2024] [Revised: 08/02/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE Community care replaced institutional care for people with psychosis without guidance about what constituted effective treatment. In a Swedish birth cohort, many of those who developed schizophrenia or bipolar disorder as community care was being implemented were subsequently convicted of violent and non-violent crimes. Studies from other countries that were implementing community care at this time also reported elevated proportions of patients acquiring criminal convictions. Since community care was first implemented, much has been learned about factors that promote and treatments that limit aggressive/antisocial behaviour/criminality (AABC) among people with psychosis. Without the benefit of this knowledge, did mental health policy and practices that were in place as the asylums were closed inadvertently contribute to criminality? MATERIAL AND METHODS This article provides a narrative review of current evidence of effective treatments and management strategies to reduce AABC among patients with psychosis. RESULTS Reductions in AABC are associated with stable contact with psychiatric services, second-generation antipsychotic medication, clozapine for patients with schizophrenia and elevated levels of hostility and/or a history of childhood conduct disorder, abstinence from substances, avoidance of trauma, and constant monitoring of both illness symptoms and AABC. CONCLUSIONS Failure to adopt evidence-based practices allows the problem of AABC to persist, prevents patients from experiencing independent, safe, community tenure, and puts those around them at risk. Many challenges remain, including implementing effective assessment and interventions at first-episode and convincing patients with antisocial attitudes and behaviours to participate in treatment programs to reduce AABC and to learn prosocial behaviours.
Collapse
Affiliation(s)
- Sheilagh Hodgins
- Département de psychiatrie et addictologie, Université de Montréal, and Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
| |
Collapse
|
2
|
Bortolato M, Braccagni G, Pederson CA, Floris G, Fite PJ. "Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression. AGGRESSION AND VIOLENT BEHAVIOR 2024; 78:101948. [PMID: 38828012 PMCID: PMC11141739 DOI: 10.1016/j.avb.2024.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Recent shifts in societal attitudes towards cannabis have led to a dramatic increase in consumption rates in many Western countries, particularly among young people. This trend has shed light on a significant link between cannabis use disorder (CUD) and pathological reactive aggression, a condition involving disproportionate aggressive and violent reactions to minor provocations. The discourse on the connection between cannabis use and aggression is frequently enmeshed in political and legal discussions, leading to a polarized understanding of the causative relationship between cannabis use and aggression. However, integrative analyses from both human and animal research indicate a complex, bidirectional interplay between cannabis misuse and pathological aggression. On the one hand, emerging research reveals a shared genetic and environmental predisposition for both cannabis use and aggression, suggesting a common underlying biological mechanism. On the other hand, there is evidence that cannabis consumption can lead to violent behaviors while also being used as a self-medication strategy to mitigate the negative emotions associated with pathological reactive aggression. This suggests that the coexistence of pathological aggression and CUD may result from overlapping vulnerabilities, potentially creating a self-perpetuating cycle where each condition exacerbates the other, escalating into externalizing and violent behaviors. This article aims to synthesize existing research on the intricate connections between these issues and propose a theoretical model to explain the neurobiological mechanisms underpinning this complex relationship.
Collapse
Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, Lawrence, KS, USA
| | - Giulia Braccagni
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Casey A. Pederson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gabriele Floris
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Center for Substance Abuse Research, Temple University, Philadelphia, PA, USA
- Department of Neural Sciences, Temple University, Philadelphia, PA, USA
| | - Paula J. Fite
- Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, Lawrence, KS, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| |
Collapse
|
3
|
Dugré JR, Giguère CÉ, Potvin S. The company you keep: The neglected role of affiliating with delinquent friends in the development of the cannabis-violence link. Addict Behav 2024; 151:107939. [PMID: 38141319 DOI: 10.1016/j.addbeh.2023.107939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
A growing body of research suggests a potential role of cannabis use on aggressive behaviors. In literature on adolescents, the lack of consideration of important confounders, such as adolescent's affiliation with delinquent peers, limits the possibility to determine whether there might be a direct or indirect link between cannabis use and aggression. Therefore, we sought to examine the effect of delinquent peers on the association between cannabis use and violence. We re-analyzed data from 850 ninth graders who were followed from mid-adolescence to early adulthood. Generalized Estimations Equations (GEE) were conducted to examine whether affiliation with delinquent peers may mediate the relationship between cannabis use and violence. Cross-Lagged Panel Models were also conducted to estimate the directionality of these relationships over time. We additionally tested whether similar relationships may be identifiable when examining rule-breaking behaviors and/or alcohol use. GEE models revealed that both cannabis use and affiliation with delinquent peers were statistically associated with aggressive behaviors. Cannabis use, alcohol use and delinquent peers also predicted rule-breaking behaviors. More precisely, cross-lagged models showed that affiliation with delinquent peers played a partially mediating role in the cannabis-aggression link, and that similar cross-lagged estimates were observed when examining rule-breaking behaviors instead of aggression. Our results indicate that cannabis use may be associated with aggression as well as rule-breaking behaviors, suggesting a broader effect on conduct problems. More importantly, our study highlights the non-negligible role of affiliating with delinquent peers during adolescence.
Collapse
Affiliation(s)
- Jules R Dugré
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
| | - Charles-Édouard Giguère
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, Canada.
| |
Collapse
|
4
|
Migliaro M, Ruiz-Contreras AE, Herrera-Solís A, Méndez-Díaz M, Prospéro-García OE. Endocannabinoid system and aggression across animal species. Neurosci Biobehav Rev 2023; 153:105375. [PMID: 37643683 DOI: 10.1016/j.neubiorev.2023.105375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
This narrative review article summarizes the current state of knowledge regarding the relationship between the endocannabinoid system (ECS) and aggression across multiple vertebrate species. Experimental evidence indicates that acute administration of phytocannabinoids, synthetic cannabinoids, and the pharmacological enhancement of endocannabinoid signaling decreases aggressive behavior in several animal models. However, research on the chronic effects of cannabinoids on animal aggression has yielded inconsistent findings, indicating a need for further investigation. Cannabinoid receptors, particularly cannabinoid receptor type 1, appear to be an important part of the endogenous mechanism involved in the dampening of aggressive behavior. Overall, this review underscores the importance of the ECS in regulating aggressive behavior and provides a foundation for future research in this area.
Collapse
Affiliation(s)
- Martin Migliaro
- Grupo de Neurociencias: Laboratorio de Cannabinoides, Departamento de Fisiología, Facultad de Medicina, UNAM, Mexico.
| | - Alejandra E Ruiz-Contreras
- Grupo de Neurociencias: Laboratorio de Neurogenómica Cognitiva, Unidad de Investigación en Psicobiología y Neurociencias, Coordinación de Psicobiología y Neurociencias, Facultad de Psicología, UNAM, Mexico
| | - Andrea Herrera-Solís
- Grupo de Neurociencias: Laboratorio de Efectos Terapéuticos de los Cannabinoides, Hospital General Dr. Manuel Gea González, Secretaría de Salud, Mexico
| | - Mónica Méndez-Díaz
- Grupo de Neurociencias: Laboratorio de Cannabinoides, Departamento de Fisiología, Facultad de Medicina, UNAM, Mexico
| | - Oscar E Prospéro-García
- Grupo de Neurociencias: Laboratorio de Cannabinoides, Departamento de Fisiología, Facultad de Medicina, UNAM, Mexico
| |
Collapse
|
5
|
Giguère S, Potvin S, Beaudoin M, Dellazizzo L, Giguère CÉ, Furtos A, Gilbert K, Phraxayavong K, Dumais A. Avatar Intervention for Cannabis Use Disorder in Individuals with Severe Mental Disorders: A Pilot Study. J Pers Med 2023; 13:jpm13050766. [PMID: 37240936 DOI: 10.3390/jpm13050766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Cannabis use disorder (CUD) is a complex issue, even more so when it is comorbid with a severe mental disorder (SMD). Available interventions are at best slightly effective, and their effects are not maintained over time. Therefore, the integration of virtual reality (VR) may increase efficacy; however, it has not yet been investigated in the treatment of CUD. A novel approach, avatar intervention for CUD, uses existing therapeutic techniques from other recommended therapies (e.g., cognitive behavioral methods, motivational interviewing) and allows participants to practice them in real-time. During immersive sessions, participants are invited to interact with an avatar representing a significant person related to their drug use. This pilot clinical trial aimed to evaluate the short-term efficacity of avatar intervention for CUD on 19 participants with a dual diagnosis of SMD and CUD. Results showed a significant moderate reduction in the quantity of cannabis use (Cohen's d = 0.611, p = 0.004), which was confirmed via urinary quantification of cannabis use. Overall, this unique intervention shows promising results. Longer-term results, as well as comparison with classical interventions in a larger sample, are warranted through a future single-blind randomized controlled trial.
Collapse
Affiliation(s)
- Sabrina Giguère
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Mélissa Beaudoin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | - Laura Dellazizzo
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Charles-Édouard Giguère
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Alexandra Furtos
- Department of Chemistry, University of Montreal, Montreal, QC H2V 0B3, Canada
| | - Karine Gilbert
- Department of Chemistry, University of Montreal, Montreal, QC H2V 0B3, Canada
| | - Kingsada Phraxayavong
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
| |
Collapse
|