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Vilar-Ribó L, Cabana-Domínguez J, Alemany S, Llonga N, Arribas L, Grau-López L, Daigre C, Cormand B, Fernàndez-Castillo N, Ramos-Quiroga JA, Soler Artigas M, Ribasés M. Disentangling heterogeneity in substance use disorder: Insights from genome-wide polygenic scores. Transl Psychiatry 2024; 14:221. [PMID: 38811559 PMCID: PMC11137038 DOI: 10.1038/s41398-024-02923-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Substance use disorder (SUD) is a global health problem with a significant impact on individuals and society. The presentation of SUD is diverse, involving various substances, ages at onset, comorbid conditions, and disease trajectories. Current treatments for SUD struggle to address this heterogeneity, resulting in high relapse rates. SUD often co-occurs with other psychiatric and mental health-related conditions that contribute to the heterogeneity of the disorder and predispose to adverse disease trajectories. Family and genetic studies highlight the role of genetic and environmental factors in the course of SUD, and point to a shared genetic liability between SUDs and comorbid psychopathology. In this study, we aimed to disentangle SUD heterogeneity using a deeply phenotyped SUD cohort and polygenic scores (PGSs) for psychiatric disorders and related traits. We explored associations between PGSs and various SUD-related phenotypes, as well as PGS-environment interactions using information on lifetime emotional, physical, and/or sexual abuse. Our results identify clusters of individuals who exhibit differences in their phenotypic profile and reveal different patterns of associations between SUD-related phenotypes and the genetic liability for mental health-related traits, which may help explain part of the heterogeneity observed in SUD. In our SUD sample, we found associations linking the genetic liability for attention-deficit hyperactivity disorder (ADHD) with lower educational attainment, the genetic liability for post-traumatic stress disorder (PTSD) with higher rates of unemployment, the genetic liability for educational attainment with lower rates of criminal records and unemployment, and the genetic liability for well-being with lower rates of outpatient treatments and fewer problems related to family and social relationships. We also found evidence of PGS-environment interactions showing that genetic liability for suicide attempts worsened the psychiatric status in SUD individuals with a history of emotional physical and/or sexual abuse. Collectively, these data contribute to a better understanding of the role of genetic liability for mental health-related conditions and adverse life experiences in SUD heterogeneity.
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Grants
- Instituto de Salud Carlos III: CP22/00128 Ministry of Science, Innovation and Universities: IJC2018-035346-I
- Instituto de Salud Carlos III: FI18/00285
- Ministry of Science, Innovation and Universities: RYC2021-031324-I Network Center for Biomedical Research (CIBER)
- Instituto de Salud Carlos III: CP22/00026
- Ministry of Science, Innovation and Universities: PID2021-1277760B-I100
- Ministry of Science, Innovation and Universities: PID2021-1277760B-I100 Ministry of Health, Social Services and Equality:PNSD-2020I042
- Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR, 2017SGR-1461, 2021SGR-00840 and 2021-SGR-01093)., European Regional Development Fund (ERDF), the European Union H2020 Programme (H2020/2014-2020) under grant agreements no. 848228 (DISCOvERIE) and no. 2020604 (TIMESPAN), the ECNP Network ‘ADHD across the Lifespan’,“La Marató de TV3” (202228-30 and 202228-31) and ICREA Academia 2021
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Affiliation(s)
- Laura Vilar-Ribó
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Judit Cabana-Domínguez
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Alemany
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Llonga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Lorena Arribas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Lara Grau-López
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Constanza Daigre
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Catalonia, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
| | - Noèlia Fernàndez-Castillo
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Catalonia, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Addiction and Dual Diagnosis Unit, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - María Soler Artigas
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain.
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Catalonia, Spain.
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Turan S, Ermiş Ç, Eray Ş, Ağaç N, Karakuş OB, Sağlam Y, Bandırma A, Güler D, Tunçtürk M, Çıray RO, Karaçetin G, İnal N, Üçok A. Illness-related outcomes of illicit substance use disorder in adolescents with early onset schizophrenia: a multicenter study. J Addict Dis 2024:1-5. [PMID: 38566305 DOI: 10.1080/10550887.2024.2332512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Lifetime co-occurring substance use disorders are common at the time of presentation for the treatment of primary psychosis. Our aim was to investigate the clinical characteristics of adolescents with early-onset schizophrenia/schizoaffective disorder (EOS), categorized as either with (EOS + SUD) or without SUD (non-SUD/EOS), in a multi-center sample. METHODS Between 2016 and 2022, 255 patients were evaluated across three tertiary-care inpatient units. Diagnoses were confirmed by the treating physician according to the DSM-5 during the hospital stay. The severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS The EOS + SUD group exhibited a higher illness onset, fewer years of education, longer duration of untreated psychosis (DUP), a higher frequency of male gender, more frequent hospitalizations, increased use of clozapine and zuclopenthixol LAI, along with higher rates of post-traumatic stress disorder and conduct disorder. Notably, differences in DUP, clozapine use, and the number of hospitalizations did not persist in the multivariate logistic regression model. CONCLUSIONS Our findings support the notion of SUD playing a role in modifying the course of illness in EOS. Future studies should emphasize exploring treatment responses to medications and interventions among youth with dual diagnoses.
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Affiliation(s)
- Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | | | - Şafak Eray
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Nilay Ağaç
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Oğuz Bilal Karakuş
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yeşim Sağlam
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Aylin Bandırma
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, Bursa, Turkey
| | - Duru Güler
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Neslihan İnal
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Alp Üçok
- Department of Psychiatry, Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul, Turkey
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Miller AP, Baranger DAA, Paul SE, Garavan H, Mackey S, Tapert SF, LeBlanc KH, Agrawal A, Bogdan R. Neuroanatomical variability associated with early substance use initiation: Results from the ABCD Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.06.24303876. [PMID: 38496425 PMCID: PMC10942495 DOI: 10.1101/2024.03.06.24303876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The extent to which neuroanatomical variability associated with substance involvement reflects pre-existing risk and/or consequences of substance exposure remains poorly understood. In the Adolescent Brain Cognitive DevelopmentSM (ABCD®) Study, we identify associations between global and regional differences in brain structure and early substance use initiation (i.e., occurring <15 years of age; nsanalytic=6,556-9,804), with evidence that associations precede initiation. Neurodevelopmental variability in brain structure may confer risk for substance involvement.
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Affiliation(s)
- Alex P. Miller
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - David A. A. Baranger
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah E. Paul
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont Lamer College of Medicine, Burlington, VT, United States
| | - Scott Mackey
- Department of Psychiatry, University of Vermont Lamer College of Medicine, Burlington, VT, United States
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Kimberly H. LeBlanc
- Division of Extramural Research, National Institute on Drug Abuse, Bethesda, MA, United States
| | - Arpana Agrawal
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States
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Hinckley J, Bhatia D, Ellingson J, Molinero K, Hopfer C. The impact of recreational cannabis legalization on youth: the Colorado experience. Eur Child Adolesc Psychiatry 2024; 33:637-650. [PMID: 35428897 PMCID: PMC10097013 DOI: 10.1007/s00787-022-01981-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Over the past two decades, cannabis policies have liberalized in the United States, culminating in the legalization of recreational cannabis in Colorado and Washington state in 2012. This review will focus on the impact of recreational cannabis legalization in Colorado. While the prevalence of past-year and past-month cannabis use has remained relatively steady among adolescents post-legalization, the prevalence of young adult use has continued to rise. Cannabis products with increased potency have become more prevalent and widely used. There are concerns that the use of products with increased potency will increase risk for cannabis use and comorbid mental health disorders, particularly cannabis-induced psychosis and suicidal behavior, although more research is needed to fully understand the impact of high-potency products. Since the legalization of recreational cannabis, numerous additional public health concerns have emerged: unintentional overdoses requiring acute care visits, electronic vaping-associated lung injury, increased motor vehicle collisions related to cannabis consumption, and higher rates of cannabis use during pregnancy. Lessons learned from the first decade of cannabis legalization emphasize the need for research efforts to provide evidence-based guidelines, inform prevention strategies, and implement selective interventions for at-risk populations including youth, individuals with comorbid mental health disorders, and individuals who are pregnant.
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Affiliation(s)
- Jesse Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Devika Bhatia
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jarrod Ellingson
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karla Molinero
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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Beaudoin M, Dellazizzo L, Giguère S, Guay JP, Giguère CE, Potvin S, Dumais A. Is There a Dose-Response Relationship Between Cannabis Use and Violence? A Longitudinal Study in Individuals with Severe Mental Disorders. Cannabis Cannabinoid Res 2024; 9:241-251. [PMID: 36787482 DOI: 10.1089/can.2022.0038] [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] [Indexed: 02/16/2023] Open
Abstract
Introduction: Recent longitudinal studies point toward the existence of a positive relationship between cannabis use and violence in people with severe mental disorders (SMD). However, the existence of a dose-response relationship between the frequency/severity of cannabis use and violence has seldom been investigated. Therefore, this study aims to determine if such a relationship exists in a psychiatric population. Methods: To do so, a total of 98 outpatients (81 males and 17 females, all over 18 years of age) with SMD were recruited at the Institut universitaire de santé mentale de Montréal (Montréal, Canada) and included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (nonusers, occasional, regular, and frequent users) and violence was investigated, as well as the association between the severity of cannabis use and violent behaviors. Results: It was found that cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, diagnoses, impulsivity, and use of alcohol and stimulants, odds ratios were of 1.91 (p<0.001) between each frequency profile and 1.040 (p<0.001) for each increase of one point of the severity of cannabis use score (ranging from 0 to 79). Conclusions: Despite the high attrition rate, these findings may have important implications for clinicians as cannabis use may have serious consequences in psychiatric populations. Nevertheless, the mechanisms underlying this association remain unclear.
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Affiliation(s)
- Mélissa Beaudoin
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Laura Dellazizzo
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Jean-Pierre Guay
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
- Faculty of Arts and Sciences, Criminology School, University of Montreal, Montreal, Canada
- Centre International de Criminologie Comparée, Montreal, Canada
| | | | - Stéphane Potvin
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
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Zhao Y, Potenza MN, Tapert SF, Paulus MP. Neural correlates of negative life events and their relationships with alcohol and cannabis use initiation. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:112-121. [PMID: 37916739 PMCID: PMC10623894 DOI: 10.1080/19585969.2023.2252437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Negative life events (NLEs), e.g., poor academic performance (controllable) or being the victim of a crime (uncontrollable), can profoundly affect the trajectory of one's life. Yet, their impact on how the brain develops is still not well understood. This investigation examined the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) dataset for the impact of NLEs on the initiation of alcohol and cannabis use, as well as underlying neural mechanisms. METHODS This study evaluated the impact of controllable and uncontrollable NLEs on substance use initiation in 207 youth who initiated alcohol use, 168 who initiated cannabis use, and compared it to 128 youth who remained substance-naïve, using generalised linear regression models. Mediation analyses were conducted to determine neural pathways of NLE impacting substance use trajectories. RESULTS Dose-response relationships between controllable NLEs and substance use initiation were observed. Having one controllable NLE increased the odds of alcohol initiation by 50% (95%CI [1.18, 1.93]) and cannabis initiation by 73% (95%CI [1.36, 2.24]), respectively. Greater cortical thickness in left banks of the superior temporal sulcus mediated effects of controllable NLEs on alcohol and cannabis initiations. Greater left caudate gray-matter volumes mediated effects of controllable NLEs on cannabis initiation. CONCLUSIONS Controllable but not uncontrollable NLEs increased the odds of alcohol and cannabis initiation. Moreover, those individuals with less mature brain structures at the time of the NLEs experienced a greater impact of NLEs on subsequent initiation of alcohol or cannabis use. Targeting youth experiencing controllable NLEs may help mitigate alcohol and cannabis initiation.
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Affiliation(s)
- Yihong Zhao
- Columbia University School of Nursing, New York, NY, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Department of Psychiatry, Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Martin P. Paulus
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Laureate Institute for Brain Research, Tulsa, OK, USA
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7
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West ML, Sharif S. Cannabis and Psychosis. Psychiatr Clin North Am 2023; 46:703-717. [PMID: 37879833 DOI: 10.1016/j.psc.2023.03.006] [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: 10/27/2023]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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Muñoz-Galán R, Lana-Lander I, Coronado M, Segura L, Colom J. Association between Cannabis Use Disorder and Mental Health Disorders in the Adolescent Population: A Cohort Study. Eur Addict Res 2023; 29:344-352. [PMID: 37586355 PMCID: PMC10614238 DOI: 10.1159/000530331] [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] [Received: 08/03/2022] [Accepted: 03/16/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION According to the literature, early initiation to cannabis use and a dependent pattern of use are important risk factors for the development of mental health disorders. However, there are few cohort studies which look at the development of mental health disorders associated with cannabis use among young people with cannabis use disorder (CUD). The aim of the study was to determine the cumulative incidence of mental health disorders and the risk of developing mental health disorders among minors who commenced treatment for CUD in Catalonia during 2015-2019. METHODS This was a retrospective fixed cohort study, matched for confounding variables, based on data from the Catalan Health Surveillance System. The exposed cohort comprised young people who entered treatment for CUD during 2015-2019 (n = 948) and who were minors on the date of commencing treatment. Matching was done with a paired cohort (n = 4,737), according to confounding variables. Individuals with a diagnosis of a mental health disorder prior to the study period were excluded. The cumulative incidence was calculated for mental health disorders for the exposed and the paired cohorts and stratified by type of mental disorder. Incidence rate ratios were estimated using the conditional Poisson model with robust variance, stratified by sex. RESULTS The cumulative incidence for development of a mental health disorder was 19.6% in the exposed cohort and 3.1% in the paired cohort; with higher incidence among females (females 32.7%; males 15.8%). The exposed cohort had an 8.7 times increased risk of developing a mental health disorder than the paired cohort. The most frequent diagnoses were reaction to severe stress, adjustment disorder, and personality disorders. CONCLUSION This study confirmed that the exposed cohort was at increased risk of developing mental health disorders compared to the paired cohort. To date, few studies have analyzed the association between cannabis use and the development of mental health disorders, considering cannabis dependence. Further studies should be undertaken considering CUD. In addition, more studies are needed to understand the factors that determine the development of CUD. Further research in these areas would contribute to the design of prevention strategies aimed at those young individuals with a higher risk of developing cannabis dependence and suffering its consequences.
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Affiliation(s)
- Regina Muñoz-Galán
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Addictions, HIV, STI and Viral Hepatitis, Barcelona, Spain
| | - Irene Lana-Lander
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Addictions, HIV, STI and Viral Hepatitis, Barcelona, Spain
| | - Marta Coronado
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Addictions, HIV, STI and Viral Hepatitis, Barcelona, Spain
| | - Lidia Segura
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Addictions, HIV, STI and Viral Hepatitis, Barcelona, Spain
| | - Joan Colom
- Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Programme on Addictions, HIV, STI and Viral Hepatitis, Barcelona, Spain
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Jeste DV, Malaspina D, Bagot K, Barch DM, Cole S, Dickerson F, Dilmore A, Ford CL, Karcher NR, Luby J, Rajji T, Pinto-Tomas AA, Young LJ. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: III. Biology. Schizophr Bull 2023; 49:867-880. [PMID: 37023360 PMCID: PMC10318888 DOI: 10.1093/schbul/sbad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Social determinants of health (SDoHs) are nonmedical factors that significantly impact health and longevity. We found no published reviews on the biology of SDoHs in schizophrenia-spectrum psychotic disorders (SSPD). STUDY DESIGN We present an overview of pathophysiological mechanisms and neurobiological processes plausibly involved in the effects of major SDoHs on clinical outcomes in SSPD. STUDY RESULTS This review of the biology of SDoHs focuses on early-life adversities, poverty, social disconnection, discrimination including racism, migration, disadvantaged neighborhoods, and food insecurity. These factors interact with psychological and biological factors to increase the risk and worsen the course and prognosis of schizophrenia. Published studies on the topic are limited by cross-sectional design, variable clinical and biomarker assessments, heterogeneous methods, and a lack of control for confounding variables. Drawing on preclinical and clinical studies, we propose a biological framework to consider the likely pathogenesis. Putative systemic pathophysiological processes include epigenetics, allostatic load, accelerated aging with inflammation (inflammaging), and the microbiome. These processes affect neural structures, brain function, neurochemistry, and neuroplasticity, impacting the development of psychosis, quality of life, cognitive impairment, physical comorbidities, and premature mortality. Our model provides a framework for research that could lead to developing specific strategies for prevention and treatment of the risk factors and biological processes, thereby improving the quality of life and increasing the longevity of people with SSPD. CONCLUSIONS Biology of SDoHs in SSPD is an exciting area of research that points to innovative multidisciplinary team science for improving the course and prognosis of these serious psychiatric disorders.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego (Retired), CA, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience and Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kara Bagot
- Department of Psychiatry, Addiction Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deanna M Barch
- Departments of Psychological and Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Steve Cole
- Departments of Psychiatry and Biobehavioral Sciences, and Medicine, University of California, Los Angeles, CA, USA
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, USA
| | - Amanda Dilmore
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Charles L Ford
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Nicole R Karcher
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Joan Luby
- Department of Psychiatry (Child), Washington University in St. Louis, St. Louis, MO, USA
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adrián A Pinto-Tomas
- Biochemistry Department, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Larry J Young
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
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10
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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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11
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Pintori N, Caria F, De Luca MA, Miliano C. THC and CBD: Villain versus Hero? Insights into Adolescent Exposure. Int J Mol Sci 2023; 24:ijms24065251. [PMID: 36982327 PMCID: PMC10048857 DOI: 10.3390/ijms24065251] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
Cannabis is the most used drug of abuse worldwide. It is well established that the most abundant phytocannabinoids in this plant are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). These two compounds have remarkably similar chemical structures yet vastly different effects in the brain. By binding to the same receptors, THC is psychoactive, while CBD has anxiolytic and antipsychotic properties. Lately, a variety of hemp-based products, including CBD and THC, have become widely available in the food and health industry, and medical and recreational use of cannabis has been legalized in many states/countries. As a result, people, including youths, are consuming CBD because it is considered “safe”. An extensive literature exists evaluating the harmful effects of THC in both adults and adolescents, but little is known about the long-term effects of CBD exposure, especially in adolescence. The aim of this review is to collect preclinical and clinical evidence about the effects of cannabidiol.
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Affiliation(s)
- Nicholas Pintori
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Francesca Caria
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Maria Antonietta De Luca
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-6758633
| | - Cristina Miliano
- School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
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12
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Scheyer AF, Laviolette SR, Pelissier AL, Manzoni OJ. Cannabis in Adolescence: Lasting Cognitive Alterations and Underlying Mechanisms. Cannabis Cannabinoid Res 2023; 8:12-23. [PMID: 36301550 PMCID: PMC9940816 DOI: 10.1089/can.2022.0183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cannabis consumption during adolescence is an area of particular concern, owing to changes in the social and political perception of the drug, and presents a scientific, medical, and economic challenge. Major social and economic interests continue to push toward cannabis legalization as well as pharmaceutical development. As a result, shifting perceptions of both legal and illicit cannabis use across the population have changed the collective evaluation of the potential dangers of the product. The wave of cannabis legalization therefore comes with new responsibility to educate the public on potential risks and known dangers associated with both recreational and medical cannabis. Among these is the risk of long-term cognitive and psychological consequences, particularly following early-life initiation of use, compounded by high-potency and/or synthetic cannabis, and heavy/frequent use of the drug. Underlying these cognitive and psychiatric consequences are lasting aberrations in the development of synaptic function, often secondary to epigenetic changes. Additional factors such as genetic risk and environmental influences or nondrug toxic insults during development are also profound contributors to these long-term functional alterations following adolescent cannabis use. Preclinical studies indicate that exposure to cannabinoids during specific windows of vulnerability (e.g., adolescence) impacts neurodevelopmental processes and behavior by durably changing dendritic structure and synaptic functions, including those normally mediated by endogenous cannabinoids and neuronal circuits.
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Affiliation(s)
- Andrew F. Scheyer
- INMED, INSERM U1249, Marseille, France
- Aix-Marseille University, Marseille, France
| | - Steven R. Laviolette
- Addiction Research Group, University of Western Ontario, London, Ontario, Canada
- Department of Anatomy & Cell Biology and Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Anne-Laure Pelissier
- INMED, INSERM U1249, Marseille, France
- APHM, CHU Timone Adultes, Service de Médecine Légale, Marseille, France
| | - Olivier J.J. Manzoni
- INMED, INSERM U1249, Marseille, France
- Aix-Marseille University, Marseille, France
- Address correspondence to: Olivier J.J. Manzoni, PhD, INMED, INSERM U1249, Parc Scientifique de Luminy - BP 13 - 13273 MARSEILLE Cedex 09, France,
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13
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West ML, Sharif S. Cannabis and Psychosis. Child Adolesc Psychiatr Clin N Am 2023; 32:69-83. [PMID: 36410907 DOI: 10.1016/j.chc.2022.07.004] [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: 11/20/2022]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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14
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Matheson SL, Laurie M, Laurens KR. Substance use and psychotic-like experiences in young people: a systematic review and meta-analysis. Psychol Med 2023; 53:305-319. [PMID: 36377500 PMCID: PMC9899577 DOI: 10.1017/s0033291722003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to systematically review and synthesise the available evidence on the prevalence and associations between psychotic-like experiences (PLEs) and substance use in children and adolescents aged ⩽17 years, prior to the typical age of development of prodromal symptoms of psychosis. As substance use has been associated with earlier age of psychosis onset and more severe illness, identifying risk processes in the premorbid phase of the illness may offer opportunities to prevent the development of prodromal symptoms and psychotic illness. MEDLINE, PsycINFO, and CINAHL databases were searched for chart review, case-control, cohort, twin, and cross-sectional studies. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, and pooled evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Searches identified 55 studies that met inclusion criteria. Around two-in-five substance users reported PLEs [rate = 0.41, 95% confidence interval (CI) 0.32-0.51; low quality evidence], and one-in-five with PLEs reported using substances (rate = 0.19, 95% CI 0.12-0.28; moderate-to-high quality evidence). Substance users were nearly twice as likely to report PLEs than non-users [odds ratio (OR) 1.77, 95% CI 1.55-2.02; moderate quality evidence], and those with PLEs were twice as likely to use substances than those not reporting PLEs (OR 1.93, 95% CI 1.55-2.41; very low quality evidence). Younger age was associated with greater odds of PLEs in substance users compared to non-users. Young substance users may represent a subclinical at-risk group for psychosis. Developing early detection and intervention for both substance use and PLEs may reduce long-term adverse outcomes.
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Affiliation(s)
- Sandra L. Matheson
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW), Sydney, Australia
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- National Drug and Alcohol Research Centre (NDARC), Sydney, Australia
| | - Mallory Laurie
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Kristin R. Laurens
- Discipline of Psychiatry and Mental Health, University of New South Wales (UNSW), Sydney, Australia
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
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15
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Pedrazzi JFC, Ferreira FR, Silva-Amaral D, Lima DA, Hallak JEC, Zuardi AW, Del-Bel EA, Guimarães FS, Costa KCM, Campos AC, Crippa ACS, Crippa JAS. Cannabidiol for the treatment of autism spectrum disorder: hope or hype? Psychopharmacology (Berl) 2022; 239:2713-2734. [PMID: 35904579 DOI: 10.1007/s00213-022-06196-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE Autism spectrum disorder (ASD) is defined as a group of neurodevelopmental disorders whose symptoms include impaired communication and social interaction, restricted and repetitive patterns of behavior, and varying levels of intellectual disability. ASD is observed in early childhood and is one of the most severe chronic childhood disorders in prevalence, morbidity, and impact on society. It is usually accompanied by attention deficit hyperactivity disorder, anxiety, depression, sleep disorders, and epilepsy. The treatment of ASD has low efficacy, possibly because it has a heterogeneous nature, and its neurobiological basis is not clearly understood. Drugs such as risperidone and aripiprazole are the only two drugs available that are recognized by the Food and Drug Administration, primarily for treating the behavioral symptoms of this disorder. These drugs have limited efficacy and a high potential for inducing undesirable effects, compromising treatment adherence. Therefore, there is great interest in exploring the endocannabinoid system, which modulates the activity of other neurotransmitters, has actions in social behavior and seems to be altered in patients with ASD. Thus, cannabidiol (CBD) emerges as a possible strategy for treating ASD symptoms since it has relevant pharmacological actions on the endocannabinoid system and shows promising results in studies related to disorders in the central nervous system. OBJECTIVES Review the preclinical and clinical data supporting CBD's potential as a treatment for the symptoms and comorbidities associated with ASD, as well as discuss and provide information with the purpose of not trivializing the use of this drug.
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Affiliation(s)
- João F C Pedrazzi
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Frederico R Ferreira
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-900, Brazil
| | - Danyelle Silva-Amaral
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel A Lima
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaime E C Hallak
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antônio W Zuardi
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elaine A Del-Bel
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Morphology, Physiology, and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco S Guimarães
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karla C M Costa
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alline C Campos
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana C S Crippa
- Graduate Program in Child and Adolescent Health, Neuropediatric Center of the Hospital of Clinics (CENEP), Federal University of Paraná, Curitiba, Paraná, Brazil
| | - José A S Crippa
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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16
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Cannabis Use in Autism: Reasons for Concern about Risk for Psychosis. Healthcare (Basel) 2022; 10:healthcare10081553. [PMID: 36011210 PMCID: PMC9407973 DOI: 10.3390/healthcare10081553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 01/09/2023] Open
Abstract
Being particularly vulnerable to the pro-psychotic effects of cannabinoid exposure, autism spectrum individuals present with an increased risk of psychosis, which may be passed on to their own children. More specifically, cannabis exposure among autism spectrum individuals seems to exert disruptive epigenetic effects that can be intergenerationally inherited in brain areas which play a critical role in schizophrenia pathophysiology. Additionally, because of such cannabinoid-induced epigenetic effects, autism candidate genes present with bivalent chromatin markings which make them more vulnerable to subsequent disruption, possibly leading to psychosis onset later in life. Thus, findings support a developmental trajectory between autism and psychosis, as per endocannabinoid system modulation. However, such evidence has not received the attention it deserves.
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17
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Dellazizzo L, Potvin S, Giguère S, Dumais A. The Potential Paradoxical Neurocognitive Effects of Cannabis Use in Patients with Psychotic Disorders: A Critical Meta-Review of Meta-Analytical Evidence. Cannabis Cannabinoid Res 2022. [PMID: 35666226 DOI: 10.1089/can.2021.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The association between cannabis and cognitive functions has been thoroughly studied in psychotic disorders, but conflictual/paradoxical results have emerged. This critical meta-review examined the magnitude of effects of cannabis on neurocognitive functions in patients with psychotic disorders provided by meta-analyses and evaluated the quality of evidence. Methods: A systematic search of meta-analyses was performed in PubMed, PsycINFO, Web of Science, and Google Scholar. Results: The search retrieved six meta-analyses. Quality of evidence varied from very low to moderate quality. No neurocognitive difference was observed between cannabis users and nonusers in first episode of psychosis samples. Limited evidence showed no significant difference in language, psychomotor functioning, and verbal/visual learning/memory, apart from improvements in verbal and visual memory (recognition). Findings showed better neurocognitive performances in cannabis-using patients for planning/reasoning and working memory. There were tendencies toward significance for processing speed and attention. Most effect sizes showed small to moderate degrees of outperformances in cannabis users. Individuals with lifetime use appeared to show better neurocognitive functions. Conclusion: Evidence indicated nonuniform effects of cannabis use across cognitive domains, with some areas suggesting better cognitive performances in cannabis users, entitled the paradoxical effect of the dually diagnosed. Clinical significance of these findings should be interpreted cautiously.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université 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, Université de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
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18
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Duan Z, Wang Y, Weaver SR, Spears CA, Zheng P, Self-Brown SR, Eriksen MP, Huang J. Effect modification of legalizing recreational cannabis use on the association between e-cigarette use and future cannabis use among US adolescents. Drug Alcohol Depend 2022; 233:109260. [PMID: 35152099 PMCID: PMC8957562 DOI: 10.1016/j.drugalcdep.2021.109260] [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: 08/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many states have legalized recreational cannabis use for adults. However, no study has examined how this policy may interact with youth vaping to influence cannabis use among US adolescents. This study investigates whether the association between baseline e-cigarette use and subsequent cannabis use differs by state recreational cannabis legalization status. METHODS This study analyzed data from the first four waves (2013-2018) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal survey. The study sample included adolescents (aged 12-17) who reported never used cannabis at baseline. Generalized estimating equations were used to analyze the effect modification of state recreational cannabis law on the association between baseline e-cigarette use and cannabis use at 12-month follow-up, controlling for individual characteristics. RESULTS Among adolescents who have never used cannabis at baseline, baseline past-30-day e-cigarette use was significantly associated with past-30-day cannabis use at 12-month follow-up (aOR=5.92, 95% CI: 3.52-9.95). This association was different by state recreational cannabis legalization status, as indicated by the significant interaction term. Subgroup analysis showed that the aOR was 18.39 (95% CI: 4.25-79.68) for adolescents living in states that legalized adult recreational cannabis use and 5.09 (95% CI: 2.86-9.07) for adolescents living in states without such laws. CONCLUSIONS E-cigarette use is associated with cannabis initiation among youth. This association is stronger among those living in states that legalized adult recreational cannabis use. Further examination of the impact of e-cigarette use on cannabis initiation in relation to state cannabis laws is warranted.
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Affiliation(s)
- Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yu Wang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Scott R. Weaver
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Claire A. Spears
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai 200433, China
| | | | - Michael P. Eriksen
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA.
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19
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Curry JF, Kaminer Y, Goldston DB, Chan G, Wells KC, Burke RH, Inscoe AB, Meyer AE, Cheek SM. Adaptive Treatment for Youth With Substance Use and Depression: Early Depression Response and Short-term Outcomes. J Am Acad Child Adolesc Psychiatry 2022; 61:508-519. [PMID: 34371102 PMCID: PMC8818057 DOI: 10.1016/j.jaac.2021.07.807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/22/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach. METHOD At 2 sites, 95 youths (ages 14-21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU). RESULTS Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F1,82 = 11.09, η2 = 0.119, p = .001), heavy drinking (F1,82 = 19.91, η2 = 0.195, p < .0001), and cannabis use (F1,220 = 35.01, η2 = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F2,220 = 4.16, η2 = 0.036, p = .0169). Negative (clean) urine screens increased over time (F1,219 = 5.10, η2 = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F1,48 = 64.20, η2 = 0.572, p < .001), with no advantage for CBT-D. CONCLUSION Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.
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Affiliation(s)
- John F Curry
- Duke University School of Medicine, Durham, North Carolina.
| | - Yifrah Kaminer
- Alcohol Research Center, University of Connecticut, Farmington
| | | | - Grace Chan
- Alcohol Research Center, University of Connecticut, Farmington
| | - Karen C Wells
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Allison E Meyer
- At the time of the study, Duke University, Durham, North Carolina; University of Michigan, Ann Arbor, Michigan
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Duko B, Pereira G, Tait RJ, Betts K, Newnham J, Alati R. Prenatal alcohol and tobacco exposures and the risk of cannabis use in offspring: Findings from a population-based cohort study. Neurotoxicol Teratol 2022; 90:107064. [PMID: 35007727 DOI: 10.1016/j.ntt.2022.107064] [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: 10/08/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a paucity of prospective longitudinal studies examining the associations between maternal use of alcohol and tobacco during pregnancy and the risk of cannabis use in offspring. The aim of this study was to examine the association between prenatal alcohol and tobacco exposures and offspring cannabis use. METHODS Data were from the Raine Study, a longitudinal prospective birth cohort based in Western Australia. Cannabis use at 17 years of age was measured with a self-reported questionnaire developed to capture risky behaviors in adolescents. Associations between prenatal alcohol and tobacco exposures and the risk of cannabis use in offspring were examined using log-binomial regression models, computing relative risk (RR). We also computed the E-values (E) to estimate the extent of unmeasured confounding. RESULTS After adjusting for potential confounders, we observed increased risks of cannabis use in offspring exposed to first trimester prenatal alcohol use (RR = 1.38, 95% CI: 1.09-1.75; E = 2.10, CI:1.40) and tobacco use (RR = 1.42, 95% CI: 1.08-1.86; E = 2.19, CI:1.37) as well as third trimester prenatal alcohol use (RR = 1.39, 95% CI: 1.09-1.79; E = 2.13, CI:1.40) and tobacco use (RR = 1.39, 95% CI: 1.09-1.79; E = 2.21, CI:1.34]. We also noted dose-response associations in which risk estimates in offspring increased with the level of exposures to prenatal alcohol and tobacco use. CONCLUSION These findings provide epidemiological evidence for effects of prenatal alcohol and tobacco exposures on offspring cannabis use. Although these results should be confirmed by other studies, the present study adds to the mounting evidence suggesting that women should be encouraged to abstain from alcohol and tobacco during pregnancy.
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Affiliation(s)
- Bereket Duko
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia.
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place Building 609, Level 2 Technology Park, Bentley, WA 6102, Australia
| | - Kim Betts
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, 17 Monash Ave, Nedlands, WA 6009, Australia
| | - Rosa Alati
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland 4068, Australia
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21
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The Construct of Medical and Non-Medical Marijuana—Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052769. [PMID: 35270462 PMCID: PMC8910105 DOI: 10.3390/ijerph19052769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
The rising popularity of medical marijuana and its potential therapeutic uses has resulted in passionate discussions that have mainly focused on its possible benefits and applications. Although the concept itself seems promising, the multitude of presented information has noticeable ramifications—terminological chaos being one. This work aimed to synthesize and critically analyze scientific evidence on the therapeutic uses of cannabinoids in the field of psychiatry. Emphasis was placed on the anxiolytic effects of cannabis constituents and their effects on post-traumatic stress disorder, anxiety disorders, schizophrenia spectrum, and other psychotic disorders. The review was carried out from an addictological perspective. A database search of interchangeably combined keywords resulted in the identification of subject-related records. The data were then analyzed in terms of relevance, contents, methodologies, and cited papers. The results were clear in supporting one common conclusion: while most findings provide support for beneficial applications of medical marijuana in psychiatry, no certain conclusions can be drawn until larger-scaled, more methodologically rigorous, and (preferably) controlled randomized trials verify these discoveries.
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22
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Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations. Eur J Pediatr 2022; 181:453-462. [PMID: 34396473 PMCID: PMC8364775 DOI: 10.1007/s00431-021-04220-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/24/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, youth electronic cigarette use (vaping) has risen significantly over the past decade. This public health concern has spurred many high-quality studies characterizing country-specific prevalence, risk factors, physical and behavioral health complications, and optimal methods of assessment and counseling for youth vaping. Clinicians remain underexposed to this recent work, limiting translation of evidence into higher quality patient care. This review aims to provide pediatricians and other clinicians working with youth a clinically focused survey of key research findings and considerations based on recent evidence. This narrative review surveys emerging trends in EC use across different countries, reasons for youth vaping, characteristics of vaping materials that promote youth use, associations with combustible cigarette use, relation with cannabis and other illicit substances, physical and behavioral health risks associated with vaping, and methods of assessment, counseling, and intervention for problematic vaping in youth. Since vaping remains a relatively new phenomenon, long-term health consequences remain unknown.Conclusion: Youth vaping is an increasingly well-studied phenomenon with both physical and behavioral health risks. Pediatricians and other youth-focused clinicians can apply the lessons of recent research in work with youth and their families. What is Known: • Youth vaping is an increasingly prevalent public health concern. • Recent research demonstrates physical and behavioral health risks associated with vaping as well as methods for assessment, counseling, and intervention. What is New: • The current review summarizes the latest evidence in a clinically focused framework to facilitate translation of emerging knowledge to practice.
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Kumari R, Ranjan JK, Verma S. Cannabis use, polysubstance use, and psychosis prodrome among first-degree relatives of patients with schizophrenia. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1989510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rajbala Kumari
- Department of Psychology, Banaras Hindu University, Varanasi, India
| | - Jay Kumar Ranjan
- Department of Psychology, Banaras Hindu University, Varanasi, India
| | - Saroj Verma
- Department of Psychology, Banaras Hindu University, Varanasi, India
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Merrin GJ, Leadbeater BJ, Sturgess CMB, Ames ME, Thompson K. Predictors of Early-Onset Cannabis Use in Adolescence and Risks for Substance Use Disorder Symptoms in Young Adulthood. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211049356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early detection of risks for substance use disorders is essential to lifelong health and well-being for some youth. Very early-onset use is proposed as an indicator of risk for substance use disorders, but risk and protective factors related to early-onset use have not been identified. The current study compared risk and protective factors that distinguish early- and late-onset cannabis users from abstainers using data collected from a large community sample. The study also examined onset-group differences in participants’ reports of substance use disorder symptoms a decade later. Heavy episodic drinking (early-onset: OR = 7.29 CI = [1.60, 33.19]) and engagement with peers involved in deviant behaviors (early-onset: OR = 2.50 CI = [1.50, 4.13]) are risk factors for early-onset cannabis use. Protective factors, including parent monitoring (early-onset: OR = 0.73 CI = [0.58, 0.93]), engagement with peers involved in positive behaviors (early-onset: OR = 0.54 CI = [0.39, 0.76]), school engagement (early-onset: OR = 0.83 CI = [0.72, 0.96]), and academic grades (early-onset: OR = 0.37 CI = [0.21, 0.65]) also predicted early versus later onset-group differences. Early age of onset may be distinctly related to risk and protective factors previously associated with risks for substance use in all adolescents.
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Affiliation(s)
- Gabriel J. Merrin
- Department of Human Development and Family Science, Syracuse University, NY, USA
| | | | | | - Megan E. Ames
- Department of Psychology, University of Victoria, British Columbia, Canada
| | - Kara Thompson
- Department of Psychology, St Francis Xavier University, Antigonish, Nova Scotia, Canada
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25
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Pardo M, Matalí JL, Sivoli J, Regina VB, Butjosa A, Dolz M, Sánchez B, Barajas A, Del Cacho N, Baños I, Ochoa S, Usall J. Early onset psychosis and cannabis use: Prevalence, clinical presentation and influence of daily use. Asian J Psychiatr 2021; 62:102714. [PMID: 34090251 DOI: 10.1016/j.ajp.2021.102714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 05/21/2021] [Indexed: 01/16/2023]
Abstract
Most of the studies examining the impact of cannabis use in first episode psychosis (FEP) have been carried out in samples with adult-onset FEP. Data in persons with early onset psychosis (EOP) is scarce. The aims of the study were: To describe the prevalence of lifetime cannabis use, current use, and daily use in patients with EOP compared to healthy controls. To study the differences in clinical presentation between cannabis users and non-users. To examine the risk of presenting an EOP associated with cannabis use and the effect of doses and age of onset of use. An observational cross-sectional study was performed in 90 EOP cases and 62 healthy controls, aged between 7 and 17 years. Our results show a higher prevalence of lifetime use (p = 0002), current use (p < 0.001), and daily use (p < 0.001) in EOP cases in comparison with healthy controls. Regarding clinical presentation, we did not find significant differences in any subscale of the Positive and Negative Syndrome Scale (PANSS). Non-user patients presented more severe depressive symptoms (p = 0002) and worse social functioning than cannabis users (p = 0026). Compared with subjects who never used cannabis, the risk of an EOP was significantly higher for those with a lifetime use (OR = 2.88, p = 0.002)current use (O.R = 6.09, p < 0001), and especially in those with daily use (O.R = 42.77, p = <0001). We found a higher risk of EOP in patients that have used cannabis before 15 years of age. In conclusion, it is necessary to develop early- detection and specific treatment programs for adolescents with cannabis use.
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Affiliation(s)
- Marta Pardo
- Hospital Sant Joan de Déu, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain.
| | - Jose L Matalí
- Hospital Sant Joan de Déu, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain
| | | | - Vila-Badia Regina
- Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain
| | - Anna Butjosa
- Hospital Sant Joan de Déu, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain
| | - Montse Dolz
- Hospital Sant Joan de Déu, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Ana Barajas
- Serra Húnter Fellow, Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain; Research Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Edifici Sant Rafael, 1a planta, 08330, Barcelona, Sant Boi de Llobregat, Spain
| | - Nuria Del Cacho
- Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain
| | - Iris Baños
- Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain
| | - Susana Ochoa
- Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain; Research Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Edifici Sant Rafael, 1a planta, 08330, Barcelona, Sant Boi de Llobregat, Spain
| | - Judith Usall
- Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain
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Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis. Neuropsychopharmacology 2021; 46:1484-1493. [PMID: 33658653 PMCID: PMC8209059 DOI: 10.1038/s41386-021-00977-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/04/2022]
Abstract
Cannabis use during adolescence is associated with an increased risk of developing psychosis. According to a current hypothesis, this results from detrimental effects of early cannabis use on brain maturation during this vulnerable period. However, studies investigating the interaction between early cannabis use and brain structural alterations hitherto reported inconclusive findings. We investigated effects of age of cannabis initiation on psychosis using data from the multicentric Personalized Prognostic Tools for Early Psychosis Management (PRONIA) and the Cannabis Induced Psychosis (CIP) studies, yielding a total sample of 102 clinically-relevant cannabis users with recent onset psychosis. GM covariance underlies shared maturational processes. Therefore, we performed source-based morphometry analysis with spatial constraints on structural brain networks showing significant alterations in schizophrenia in a previous multisite study, thus testing associations of these networks with the age of cannabis initiation and with confounding factors. Earlier cannabis initiation was associated with more severe positive symptoms in our cohort. Greater gray matter volume (GMV) in the previously identified cerebellar schizophrenia-related network had a significant association with early cannabis use, independent of several possibly confounding factors. Moreover, GMV in the cerebellar network was associated with lower volume in another network previously associated with schizophrenia, comprising the insula, superior temporal, and inferior frontal gyrus. These findings are in line with previous investigations in healthy cannabis users, and suggest that early initiation of cannabis perturbs the developmental trajectory of certain structural brain networks in a manner imparting risk for psychosis later in life.
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27
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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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Cannabis, schizophrenia genetic risk, and psychotic experiences: a cross-sectional study of 109,308 participants from the UK Biobank. Transl Psychiatry 2021; 11:211. [PMID: 33837184 PMCID: PMC8035271 DOI: 10.1038/s41398-021-01330-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Cannabis is known to produce acute, transient psychotic-like experiences. However, it is unclear whether cannabis disproportionately increases the risk of specific types of psychotic experiences and whether genetic predisposition influences the relationship between cannabis use and psychotic experiences. In this cross-sectional study of 109,308 UK Biobank participants, we examined how schizophrenia polygenic risk modulates the association between self-reported cannabis use and four types of self-reported psychotic experiences (auditory hallucinations, visual hallucinations, persecutory delusions, and delusions of reference). Cohort-wide, we found a strong, dose-dependent relationship between cannabis use and all four types of psychotic experiences, especially persecutory delusions. Cannabis users' psychotic experiences tended to be earlier-onset and cause greater distress than non-users', but were not more likely to lead to help-seeking. Participants with high schizophrenia polygenic risk scores showed stronger associations between cannabis use and auditory hallucinations, visual hallucinations, and delusions of reference, as well as psychotic experiences overall. For instance, cannabis ever-use was associated with 67% greater adjusted odds of delusions of reference among individuals in the top fifth of polygenic risk, but only 7% greater adjusted odds among the bottom fifth. Our results suggest that cannabis use is a predictive risk factor for psychotic experiences, including early-onset and distressing experiences. Individuals genetically predisposed to schizophrenia may be especially vulnerable to psychotic experiences as a result of using cannabis, supporting a long-postulated hypothesis. This study exemplifies the utility of population-scale biobanks for elucidating gene-by-environment interactions relating substance use to neuropsychiatric outcomes and points to the translational potential of using polygenic risk scores to inform personalized harm reduction interventions.
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Mota P. "I have no disease and weed just relaxes me!": The therapeutic challenge in young patients with psychosis and cannabis abuse. Psychiatry Res 2021; 297:113741. [PMID: 33517143 DOI: 10.1016/j.psychres.2021.113741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Pedro Mota
- Psychiatry and Mental Health Department, Tâmega e Sousa Hospital Center - Avenida do Hospital Padre Américo 210, Guilhufe, 4564-007, Portugal.
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Poulia N, Delis F, Brakatselos C, Polissidis A, Koutmani Y, Kokras N, Dalla C, Politis PK, Antoniou K. Detrimental effects of adolescent escalating low-dose Δ 9 -tetrahydrocannabinol leads to a specific bio-behavioural profile in adult male rats. Br J Pharmacol 2021; 178:1722-1736. [PMID: 33496341 DOI: 10.1111/bph.15394] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Adolescent cannabis use is associated with adult psychopathology. When Δ9 -tetrahydrocannabinol (THC), mainly in high doses, is administered to adolescence rats there are also long lasting effects in adults. This study aims to determine the specific adult bio-behavioural profile after adolescent low-dose THC, which better mirrors adolescent recreational cannabis use. EXPERIMENTAL APPROACH Adolescent male Sprague-Dawley rats were treated with escalating low-dose of THC. In adulthood, they were evaluated for their spontaneous locomotion, sensorimotor gating, higher order and spatial cognitive functions. Dopaminergic activity and cannabinoid receptor expression were measured in distinct brain regions. Hippocampal neurogenic activity of neural stem cells was determined and protein levels of neuroplasticity-related biomarkers were quantified. Adolescent low-dose THC exposure increased spontaneous open-field activity, without affecting prepulse inhibition and attentional set-shifting performance. Region-specific dopaminergic alterations and CB1 receptor up-regulation in the prefrontal cortex were observed. Impaired spatial memory, as assessed with the object location task and Morris water maze test, was associated with significantly decreased proliferative activity (SOX2-positive cells), neurogenic potential (decreased doublecortin-positive cells) in the adult hippocampus and defective neuroplasticity, including reduced BDNF expression in the hippocampus and prefrontal cortex. KEY RESULTS Our findings reveal the adverse impact of adolescent low-dose THC on the psychomotor profile, dopaminergic neurotransmission, compensatory cannabinoid receptor response, cognition-related neurobiological and behavioural functions. CONCLUSION AND IMPLICATIONS Our adolescent low-dose THC animal model does not induce tangible psychotic-like effects, such as those reported in high-dose THC studies, but it impairs cognitive functions and points to hippocampal vulnerability and disrupted neurogenesis.
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Affiliation(s)
- Nafsika Poulia
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Foteini Delis
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Charalampos Brakatselos
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexia Polissidis
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Yassemi Koutmani
- Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,Center of Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Nikolaos Kokras
- Department of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First Department of Psychiatry, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Dalla
- Department of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis K Politis
- Center of Basic Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Katerina Antoniou
- Department of Pharmacology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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31
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Kiburi SK, Molebatsi K, Ntlantsana V, Lynskey MT. Cannabis use in adolescence and risk of psychosis: Are there factors that moderate this relationship? A systematic review and meta-analysis. Subst Abus 2021; 42:527-542. [DOI: 10.1080/08897077.2021.1876200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah Kanana Kiburi
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Mbagathi Hospital, Nairobi, Kenya
| | - Keneilwe Molebatsi
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Psychiatry, Nelson Mandela School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Vuyokazi Ntlantsana
- Department of Psychiatry, Nelson Mandela School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Michael T. Lynskey
- Addiction Department, Institute of Psychiatry, Psychology and Neuroscience, Kings college London, London, UK
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Komaryk A, Elbe D, Burgess L. Retrospective Review of Clozapine Use in Children and Adolescents. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:36-48. [PMID: 33552171 PMCID: PMC7837516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Literature describing use of clozapine by children and adolescents is limited. The primary study objective was to assess the patterns of clozapine use in an inpatient child and adolescent population. METHODS A retrospective review of child and adolescent inpatients receiving clozapine at a Canadian children's hospital from January 2000 through December 2014 was conducted. Interdisciplinary comprehensive data collection was conducted by experienced clinicians. Baseline population characteristics and psychiatric illness risk factors were captured. Illness symptoms and severity were assessed retrospectively using validated measures including the Brief Psychiatric Rating Scale (BPRS), Children's Global Assessment Scale (CGAS) and Clinical Global Impressions (CGI) scales. Estimated clozapine dosing requirements for each patient to achieve a serum level associated with response was calculated. Clozapine-related adverse events were captured. RESULTS Twenty-eight inpatients (64% female) receiving clozapine during the study period were identified. Mean age at clozapine initiation was 15.8 years. Twenty-three patients (82%) were taking clozapine at discharge, and of these, 22 patients (96%) experienced at least minimal improvement in BPRS and CGAS scores. Patients took a mean of 33.1 days from clozapine start to reach their maximum clozapine dosage, a mean maximum of 57% of their estimated clozapine dose requirement. Mean length of stay following clozapine initiation was 60.7 days. We observed a high rate of benign hematological adverse events, but no episodes of severe neutropenia. The majority of patients were of ethnicity associated with high risk for metabolic adverse events. CONCLUSION Most hospitalized, treatment-refractory children requiring clozapine clinically improve despite experiencing high, but largely manageable, adverse event rates.
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Affiliation(s)
- Ardelle Komaryk
- Family Nurse Practitioner; Healthy Minds Centre, BC Children's Hospital, Vancouver, British Columbia
| | - Dean Elbe
- Clinical Pharmacy Specialist, Child & Adolescent Mental Health; Healthy Minds Centre, BC Children's Hospital, Vancouver, British Columbia; Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia; Associate Member, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Leah Burgess
- Registered Psychologist; Healthy Minds Centre, BC Children's Hospital, Vancouver, British Columbia
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Hempel BJ, Crissman ME, Imanalieva A, Melkumyan M, Winston CA, Riley AL. Cross-generational THC Exposure Weakly Attenuates Cocaine's Rewarding Effects in Adult Male Offspring. Physiol Behav 2020; 227:113164. [PMID: 32891609 DOI: 10.1016/j.physbeh.2020.113164] [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: 07/15/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Adolescents represent a large demographic of marijuana consumers. Regrettably, use during this developmental period has been associated with above average health risks. A growing body of evidence suggests that adolescent drug use in the lifetime of a parent can modify behavior and neurochemistry in descendants without direct exposure. The current study was designed to evaluate the effects of pre-conception THC during adolescence on vulnerability to cocaine in adult male offspring. Male and female rats were given an intermittent THC (0 or 1.5 mg/kg) exposure regimen during the adolescent window and mated with drug group conspecifics in adulthood. F1-THC and F1-Veh pups were cross fostered to drug naïve control dams. In Experiment 1, adult offspring underwent cocaine (0 or 15 mg/kg) locomotor sensitization procedures and showed no effect of parental THC exposure on locomotor activity. In Experiment 2, intravenous catheters were implanted and subjects were tested under a number of reinforcement schedules with cocaine (FR1, FR5, FR10, PR, dose-response, extinction, cue + stress induced reinstatement). F1-THC subjects exhibited a slight decrease in cocaine responding during acquisition and a more rapid extinction, but they failed to produce significant differences on any other measure. These findings indicate that adolescent cannabis use likely has minimal effects on cocaine abuse liability in the next generation.
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Affiliation(s)
- Briana J Hempel
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA.
| | - Madeline E Crissman
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA
| | - Aikerim Imanalieva
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA
| | - Mariam Melkumyan
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA
| | - Chloe A Winston
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA
| | - Anthony L Riley
- Psychopharmacology Laboratory, Department of Neuroscience, Center for Behavioral Neuroscience, American University, 4400 Massachusetts Ave NW, Washington, D.C. 20016, USA.
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Hung CC, Liu YH, Huang CC, Chou CY, Chen CM, Duann JR, Li CSR, Lee TSH, Lin CP. Effects of early ketamine exposure on cerebral gray matter volume and functional connectivity. Sci Rep 2020; 10:15488. [PMID: 32968108 PMCID: PMC7512006 DOI: 10.1038/s41598-020-72320-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/27/2020] [Indexed: 01/14/2023] Open
Abstract
Ketamine has been used for medical purposes, most typically as an anesthetic, and recent studies support its use in the treatment of depression. However, ketamine tends to be abused by adolescents and young adults. In the current study, we examined the effects of early ketamine exposure on brain structure and function. We employed MRI to assess the effects of ketamine abuse on cerebral gray matter volume (GMV) and functional connectivity (FC) in 34 users and 19 non-users, employing covariates. Ketamine users were categorized as adolescent-onset and adult-onset based on when they were first exposed to ketamine. Imaging data were processed by published routines in SPM and AFNI. The results revealed lower GMV in the left precuneus in ketamine users, with a larger decrease in the adolescent-onset group. The results from a seed-based correlation analysis show that both ketamine groups had higher functional connectivity between left precuneus (seed) and right precuneus than the control group. Compared to controls, ketamine users showed decreased GMV in the right insula, left inferior parietal lobule, left dorsolateral prefrontal cortex/superior frontal gyrus, and left medial orbitofrontal cortex. These preliminary results characterize the effects of ketamine misuse on brain structure and function and highlight the influence of earlier exposure to ketamine on the development of the brain. The precuneus, a structure of central importance to cerebral functional organization, may be particularly vulnerable to the influences of early ketamine exposure. How these structural and functional brain changes may relate to the cognitive and affective deficits remains to be determined with a large cohort of participants.
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Affiliation(s)
- Chia-Chun Hung
- Institute of Brain Science, National Yang Ming University, Taipei, Taiwan.,Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yi-Hsuan Liu
- Institute of Neuroscience, National Yang Ming University, No.155, Sec.2, Li-nong Street, Taipei, Taiwan
| | - Chu-Chung Huang
- Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, Taiwan
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Chun-Ming Chen
- Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan.,Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University, New Haven, CT, USA.,Departemnt of Neuroscience, Yale University, New Haven, CT, USA
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162 Section One, He-Ping East Road, Taipei, Taiwan. .,CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, Taipei, Taiwan.
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming University, No.155, Sec.2, Li-nong Street, Taipei, Taiwan.
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The Impact of Treatment Orders for Residential Treatment of Comorbid Severe Substance Use Disorders for Youth Suffering from Early Psychosis: a Case Series. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00317-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Cannabinoid exposure in rat adolescence reprograms the initial behavioral, molecular, and epigenetic response to cocaine. Proc Natl Acad Sci U S A 2020; 117:9991-10002. [PMID: 32312805 PMCID: PMC7211986 DOI: 10.1073/pnas.1920866117] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The endocannabinoid system has a modulatory role in brain reward and cognitive processes. It has been hypothesized that repeated interference with endocannabinoid signaling (e.g., through abuse of cannabis or synthetic cannabinoids) can remodel the adolescent brain and make it respond differently to more addictive substances, such as cocaine. In the present study, we demonstrate that a history of synthetic cannabinoid exposure in adolescent animals results in distinct molecular and epigenetic changes following initial exposure to cocaine. These changes were pronounced in the prefrontal cortex and associated with an enhanced response to cocaine’s stimulatory effects. The prefrontal cortex is a brain region that still undergoes maturation in adolescence and its dysfunction contributes to the development of addictions. The initial response to an addictive substance can facilitate repeated use: That is, individuals experiencing more positive effects are more likely to use that drug again. Increasing evidence suggests that psychoactive cannabinoid use in adolescence enhances the behavioral effects of cocaine. However, despite the behavioral data, there is no neurobiological evidence demonstrating that cannabinoids can also alter the brain’s initial molecular and epigenetic response to cocaine. Here, we utilized a multiomics approach (epigenomics, transcriptomics, proteomics, and phosphoproteomics) to characterize how the rat brain responds to its first encounter with cocaine, with or without preexposure to the synthetic cannabinoid WIN 55,212-2 (WIN). We find that in adolescent (but not in adult) rats, preexposure to WIN results in cross-sensitization to cocaine, which correlates with histone hyperacetylation and decreased levels of HDAC6 in the prefrontal cortex (PFC). In the PFC, we also find that WIN preexposure blunts the typical mRNA response to cocaine and instead results in alternative splicing and chromatin accessibility events, involving genes such as Npas2. Moreover, preexposure to WIN enhances the effects of cocaine on protein phosphorylation, including ERK/MAPK-targets like gephyrin, and modulates the synaptic AMPAR/GluR composition both in the PFC and the nucleus accumbens (NAcc). PFC–NAcc gene network topological analyses, following cocaine exposure, reveal distinct top nodes in the WIN preexposed group, which include PACAP/ADCYAP1. These preclinical data demonstrate that adolescent cannabinoid exposure reprograms the initial behavioral, molecular, and epigenetic response to cocaine.
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Sternberg A, Hill ML, Suk HW, Meier M, Chassin L. Exploring Cannabis-Specific Parenting as a Mechanism of the Intergenerational Transmission of Cannabis Use and Cannabis Use Disorder. J Stud Alcohol Drugs 2020. [PMID: 30807272 DOI: 10.15288/jsad.2019.80.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Parental cannabis use disorder (CUD) is a known risk factor in the development of adolescent cannabis use. One potential mechanism is parenting behaviors. This study considered cannabis-specific parenting strategies as a mechanism of the relation between parental CUD and adolescent cannabis use. METHOD Pathways were examined using multilevel longitudinal mediation models (N = 363, mean age = 16.3 years) comparing adolescent offspring of parents who never used cannabis, parents who used cannabis without CUD, and parents with CUD. RESULTS Parental cannabis use history did not significantly predict parental sharing of negative experiences with cannabis or parental strategies to prevent cannabis use. Cannabis-specific strategies did not successfully deter adolescent use. Parental sharing of negative experiences with cannabis use in fact predicted increased adolescent cannabis use. CONCLUSIONS Cannabis-specific parenting did not reduce adolescent cannabis use, and sharing negative experiences was detrimental. Future studies should consider alternative mechanisms underlying the intergenerational transmission of cannabis use.
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Affiliation(s)
- Ariel Sternberg
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Melanie L Hill
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Hye Won Suk
- Department of Psychology, Sogang University, Seoul, Korea
| | - Madeline Meier
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Laurie Chassin
- Department of Psychology, Arizona State University, Tempe, Arizona
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Cash MC, Cunnane K, Fan C, Romero-Sandoval EA. Mapping cannabis potency in medical and recreational programs in the United States. PLoS One 2020; 15:e0230167. [PMID: 32214334 PMCID: PMC7098613 DOI: 10.1371/journal.pone.0230167] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023] Open
Abstract
Cannabis related online searches are associated with positive attitudes toward medical cannabis, particularly when information is obtained from dispensaries. Since pain is the main reason for medicinal cannabis use, information from dispensary websites has the potential to shape the attitude of pain patients towards cannabis. This is relevant because cannabis has demonstrated efficacy in neuropathic pain with low tetrahydrocannabinol (THC) concentrations (< 5-10%), in contrast to potent cannabis (>15% THC), which is highly rewarded in the recreational realm. The role of CBD in pain is not clear, however it has gained popularity. Thus, we hypothesize that the potency of medical cannabis that is advertised online is similar to the cannabis advertised for recreational purposes, which would potentially create a misconception towards medical cannabis. The current lack of knowledge surrounding advertised potencies in the legal cannabis market limits the ability to generate clear policies regarding online advertising to protect patients that are willing to use cannabis for their condition. Thus, we evaluated the advertised THC and CBD content of cannabis products offered online in dispensaries in the United States to determine products' suitability to medicinal use and compare the strength of products offered in legal medical and recreational programs. We recorded THC and CBD concentrations for all herb cannabis products provided by dispensary websites and compared them between or within states. Four Western states (CA, CO, NM, WA) and five Northeastern states (ME, MA, NH, RI, VT) were included. A total of 8,505 cannabis products across 653 dispensaries were sampled. Despite the clear differences between medicinal and recreational uses of cannabis, the average THC concentration advertised online in medicinal programs was similar (19.2% ±6.2) to recreational programs (21.5% ±6.0) when compared between states with different programs, or between medicinal and recreational programs within the same states (CO or WA). Lower CBD concentrations accompanied higher THC products. The majority of products, regardless of medicinal or recreational programs, were advertised to have >15% THC (70.3% - 91.4% of products). These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain. This data is consistent with reports in which THC and CBD in products from legal dispensaries or in nationwide products from the illegal market were actually measured, which indicates that patients consuming these products may be at risk of acute intoxication or long-term side effects. Our study offers grounds to develop policies that help prevent misconceptions toward cannabis and reduce risks in pain patients.
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Affiliation(s)
- Mary Catherine Cash
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America
| | - Katharine Cunnane
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Chuyin Fan
- The University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America
| | - E. Alfonso Romero-Sandoval
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- * E-mail:
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Drobinin V, Van Gestel H, Zwicker A, MacKenzie L, Cumby J, Patterson VC, Vallis EH, Campbell N, Hajek T, Helmick CA, Schmidt MH, Alda M, Bowen CV, Uher R. Psychotic symptoms are associated with lower cortical folding in youth at risk for mental illness. J Psychiatry Neurosci 2020; 45:125-133. [PMID: 31674733 PMCID: PMC7828904 DOI: 10.1503/jpn.180144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cortical folding is essential for healthy brain development. Previous studies have found regional reductions in cortical folding in adult patients with psychotic illness. It is unknown whether these neuroanatomical markers are present in youth with subclinical psychotic symptoms. METHODS We collected MRIs and examined the local gyrification index in a sample of 110 youth (mean age ± standard deviation 14.0 ± 3.7 yr; range 9–25 yr) with a family history of severe mental illness: 48 with psychotic symptoms and 62 without. Images were processed using the Human Connectome Pipeline and FreeSurfer. We tested for group differences in local gyrification index using mixed-effects generalized linear models controlling for age, sex and familial clustering. Sensitivity analysis further controlled for intracranial volume, IQ, and stimulant and cannabis use. RESULTS Youth with psychotic symptoms displayed an overall trend toward lower cortical folding across all brain regions. After adjusting for multiple comparisons and confounders, regional reductions were localized to the frontal and occipital lobes. Specifically, the medial (B = –0.42, pFDR = 0.04) and lateral (B = –0.39, pFDR = 0.04) orbitofrontal cortices as well as the cuneus (B = –0.47, pFDR = 0.03) and the pericalcarine (B = –0.45, pFDR = 0.03) and lingual (B = –0.38, pFDR = 0.04) gyri. LIMITATIONS Inference about developmental trajectories was limited by the cross-sectional data. CONCLUSION Psychotic symptoms in youth are associated with cortical folding deficits, even in the absence of psychotic illness. The current study helps clarify the neurodevelopmental basis of psychosis at an early stage, before medication, drug use and other confounds have had a persistent effect on the brain.
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Affiliation(s)
- Vladislav Drobinin
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Holly Van Gestel
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Alyson Zwicker
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Lynn MacKenzie
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Jill Cumby
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Victoria C. Patterson
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Emily Howes Vallis
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Niamh Campbell
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Tomas Hajek
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Carl A. Helmick
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Matthias H. Schmidt
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Martin Alda
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Chris V. Bowen
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
| | - Rudolf Uher
- From the Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada (Drobinin, Schmidt, Uher); the Nova Scotia Health Authority, Halifax, NS (Drobinin, van Gestel, Zwicker, MacKenzie, Cumby, Patterson, Vallis, Campbell, Helmick, Alda, Bowen, Uher); the Department of Pathology, Dalhousie University, Halifax, NS (Zwicker, Uher); the Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS (MacKenzie, Patterson, Uher); the Department of Psychiatry, Dalhousie University, Halifax, NS (Vallis, Helmick, Alda, Uher); the Department of Medicine, Dalhousie University, Halifax, NS (Campbell); and the Department of Diagnostic Radiology, Dalhousie University, Halifax, NS (Bowen)
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Sánchez-Gutiérrez T, Fernandez-Castilla B, Barbeito S, González-Pinto A, Becerra-García JA, Calvo A. Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning. Eur Psychiatry 2020; 63:e6. [PMID: 32093788 PMCID: PMC8057396 DOI: 10.1192/j.eurpsy.2019.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP. METHODS Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age. RESULTS Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (β = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (β = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (β = 0.266, t = 2.06, p = 0.043). CONCLUSIONS This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.
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Affiliation(s)
| | - Belén Fernandez-Castilla
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Leuven. Belgium
| | - Sara Barbeito
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana González-Pinto
- Hospital Universitario de Alava, Servicio de Psiquiatría, BIOARABA, CIBERSAM, Universidad del País Vasco, Leioa, Spain
| | | | - Ana Calvo
- Faculty of Health Science, Universidad Internacional de La Rioja (UNIR), Madrid, Spain
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Bozzola E, Spina G, Ruggiero M, Vecchio D, Caruso C, Bozzola M, Staiano AM, Agostiniani R, Del Vecchio A, Banderali G, Peroni D, Chiara A, Memo L, Turra R, Corsello G, Villani A. Media use during adolescence: the recommendations of the Italian Pediatric Society. Ital J Pediatr 2019; 45:149. [PMID: 31775828 PMCID: PMC6880642 DOI: 10.1186/s13052-019-0725-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background The use of media device, such as smartphone and tablet, is currently increasing, especially among the youngest. Adolescents spend more and more time with their smartphones consulting social media, mainly Facebook, Instagram and Twitter because. Adolescents often feel the necessity to use a media device as a means to construct a social identity and express themselves. For some children, smartphone ownership starts even sooner as young as 7 yrs, according to internet safety experts. Material and methods We analyzed the evidence on media use and its consequences in adolescence. Results In literature, smartphones and tablets use may negatively influences the psychophysical development of the adolescent, such as learning, sleep and sigh. Moreover, obesity, distraction, addiction, cyberbullism and Hikikomori phenomena are described in adolescents who use media device too frequently. The Italian Pediatric Society provide action-oriented recommendations for families and clinicians to avoid negative outcomes. Conclusions Both parents and clinicians should be aware of the widespread phenomenon of media device use among adolescents and try to avoid psychophysical consequences on the youngest.
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Chadi N, Schroeder R, Jensen JW, Levy S. Association Between Electronic Cigarette Use and Marijuana Use Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:e192574. [PMID: 31403684 PMCID: PMC6692686 DOI: 10.1001/jamapediatrics.2019.2574] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Use of electronic cigarettes (often called e-cigarettes) has increased considerably among young people in the past 5 years. Use of e-cigarettes has been associated with higher rates of marijuana use, which is associated with several adverse health outcomes in youth. OBJECTIVE To characterize and quantify the association between e-cigarette and marijuana use among youth using a meta-analysis. DATA SOURCES PubMed, Embase, and Web of Science & ProQuest Dissertations and Theses were searched from inception to October 2018. A gray-literature search was also conducted on conference abstracts, government reports, and other sources. STUDY SELECTION Included studies compared rates of marijuana use among youth aged 10 to 24 years who had used e-cigarettes vs those who had not used e-cigarettes. Two reviewers independently assessed studies for inclusion; disagreements were discussed with a third reviewer and resolved by consensus. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers following Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines and pooled using a random-effects analysis. The Newcastle-Ottawa Scale was used to assess data quality and validity of individual studies. MAIN OUTCOMES AND MEASURES Adjusted odds ratios (AORs) of self-reported past or current marijuana use by youth with vs without past or current e-cigarette use. RESULTS Twenty-one of 835 initially identified studies (2.5%) met selection criteria. The meta-analysis included 3 longitudinal and 18 cross-sectional studies that included 128 227 participants. Odds of marijuana use were higher in youth who had an e-cigarette use history vs those who did not (AOR, 3.47 [95% CI, 2.63-4.59]; I2, 94%). Odds of marijuana use were significantly increased in youth who used e-cigarettes in both longitudinal studies (3 studies; AOR, 2.43 [95% CI, 1.51-3.90]; I2, 74%) and cross-sectional studies (18 studies; AOR, 3.70 [95% CI, 2.76-4.96]; I2, 94%). Odds of using marijuana in youth with e-cigarette use were higher in adolescents aged 12 to 17 years (AOR, 4.29 [95% CI, 3.14-5.87]; I2, 94%) than young adults aged 18 to 24 years (AOR, 2.30 [95% CI, 1.40-3.79]; I2, 91%). CONCLUSIONS AND RELEVANCE This meta-analysis found a significant increase in the odds of past or current and subsequent marijuana use in adolescents and young adults who used e-cigarettes. These findings highlight the importance of addressing the rapid increases in e-cigarette use among youths as a means to help limit marijuana use in this population.
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Affiliation(s)
- Nicholas Chadi
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Harvard Chan School of Public Health, Boston, Massachusetts
| | | | - Jens Winther Jensen
- Harvard Chan School of Public Health, Boston, Massachusetts,Danish Clinical Quality Program, National Clinical Registries, Aarhus, Denmark
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Goulter N, McMahon RJ, Dodge KA. Does the Fast Track Intervention Prevent Later Psychosis Symptoms? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1255-1264. [PMID: 31422489 DOI: 10.1007/s11121-019-01041-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Fast Track (FT) intervention was a multimodal preventive intervention addressing antisocial development across 10 years of childhood and early adolescence. The intervention included parent management training, child social-cognitive skills training, peer coaching and mentoring, academic skills tutoring, and a classroom social-emotional learning program. While not specifically designed to target psychosis symptoms (e.g., social withdrawal, thought abnormalities), the present study aimed to examine whether the FT intervention prevented psychosis symptoms through childhood and adolescence and into adulthood. Participants included the FT intervention and high-risk control samples (N = 891; 69% male; M age = 6.58 years, SD = .48). Psychosis symptoms were assessed using the "thought problems" subscale of the parent-report Child Behavior Checklist during grades 1, 2, 4, 5, and 7, and the self-report Adult Behavior Checklist at age 25 years, in line with prior research using this measure. Growth models included the FT condition and covariates (i.e., initial risk screen score, cohort, socioeconomic status, rural/urban status, race, and sex) as predictors; and child, adolescent, and adult psychosis symptoms as outcomes. Intervention status was not significantly associated with the slope of psychosis symptoms; however, after controlling for concurrent cannabis use, intervention participants reported lower levels of psychosis symptoms over time. Findings suggest that interventions targeting antisocial behavior may prevent psychosis symptoms in the long term.
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Affiliation(s)
- Natalie Goulter
- Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Kenneth A Dodge
- Stanford School of Public Policy, Duke University, Durham, NC, USA
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What Every Pediatric Gynecologist Should Know About Marijuana Use in Adolescents. J Pediatr Adolesc Gynecol 2019; 32:349-353. [PMID: 30923025 DOI: 10.1016/j.jpag.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022]
Abstract
Use of marijuana in adolescent girls is common and shows no sign of decreasing. With recent trends toward legalization of "recreational" and "medical" marijuana products, adolescents are increasingly faced with information and misinformation about the health effects of marijuana use. We review the current literature on the risks and potential benefits of marijuana use during adolescence with a specific focus on pediatric and adolescent gynecological conditions. Despite limited research on this topic, the many risks associated with marijuana use in adolescents, including negative effects on the developing brain and adverse reproductive, sexual health, and mental health outcomes, likely outweigh potential benefits in this population.
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Mustonen A, Niemelä S, McGrath JJ, Murray GK, Nordström T, Mäki P, Miettunen J, Scott JG. Adolescent inhalant use and psychosis risk - a prospective longitudinal study. Schizophr Res 2018; 201:360-366. [PMID: 29958751 DOI: 10.1016/j.schres.2018.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cross-sectional studies have suggested inhalant use is associated with psychosis. This association was examined in a longitudinal study accounting for other substance use and potential confounders. METHODS We used a prospective sample (N = 6542) from the Northern Finland Birth Cohort 1986. Self-report questionnaires on substance use and psychotic experiences were completed when the cohort members were 15-16 years old. Inhalant use was categorized into four groups (never, once, 2-4 times, 5 times or more). Subsequent psychosis diagnoses (ICD-10) until age 30 years were obtained from national registers. Cox regression analysis was used to examine the association between adolescent inhalant use and risk of psychosis. RESULTS During the observation period 124 individuals were diagnosed with incident psychosis. Overall, there were 225 (3.4%) subjects with any inhalant use, 18 (8.0%) of whom were diagnosed with psychosis during the follow up. Of non-inhalant users (n = 6317) 106 (1.7%) were diagnosed with psychosis. Compared to non-users, those using inhalants had increased risk of incident psychosis with most frequent inhalant use associated with the greatest risk (unadjusted HR = 9.46; 3.86-23.20). After adjusting for baseline psychotic experiences, other substance use, comorbid mental disorder and parental substance abuse, the increased risk of psychosis persisted (HR = 3.06; 1.05-8.95). Furthermore, a dose-response effect between inhalant use and risk of psychosis was identified (OR = 2.34; 1.83-2.99). CONCLUSIONS Inhalant use in adolescence was independently associated with incident psychosis. The adverse health outcomes associated with adolescent inhalant use provide compelling reasons for implementation of policies to reduce the use of volatile substances in adolescents.
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Affiliation(s)
- Antti Mustonen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Solja Niemelä
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland; Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland
| | - John J McGrath
- Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia; National Centre for Register-Based Research, Aarhus University, Business and Social Sciences, Aarhus, Denmark
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pirjo Mäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, the Northern Ostrobothnia Hospital District, Finland; Department of Psychiatry, Länsi-Pohja healthcare district, Finland; Department of Psychiatry, the Middle Ostrobothnia Central Hospital, Soite, Finland; Mental Health Services, Basic Health Care District of Kallio, Finland; Department of Psychiatry, Kainuu Central Hospital, Kainuu social and healthcare district, Kajaani, Finland; Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Sokol NA, Okechukwu CA, Chen JT, Subramanian SV, Rees VW. Maternal Cannabis Use During a Child's Lifetime Associated With Earlier Initiation. Am J Prev Med 2018; 55:592-602. [PMID: 30262151 PMCID: PMC6481668 DOI: 10.1016/j.amepre.2018.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/19/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Earlier cannabis initiation is associated with more severe neuropsychiatric and social consequences. The authors investigated whether mothers' cannabis use is associated with earlier cannabis initiation by their children. METHODS Mother and child data were from the National Longitudinal Survey of Youth 1979 (1980-1998 waves) and Child and Young Adults (1988-2014 waves) cohorts, respectively. Cox proportional hazard models assessed the effect of maternal cannabis use prior to a child's adolescence on the child's risk of subsequent cannabis initiation. Models were stratified by race and child's age category (6-16, 17-24, ≥25 years). Adjusted analyses controlled for sociodemographic variables. Analyses were conducted in 2017. RESULTS Median age of cannabis initiation for children of maternal ever users was age 16years compared with age 18years among children of maternal never users. Children of 1-year and multiple-year users were at increased risk of cannabis initiation between ages 6 and 16years (hazard ratio=1.38, p<0.001, and hazard ratio = 1.45, p<0.001, respectively). Effects were slightly stronger among non-Hispanic non-black children. CONCLUSIONS As cannabis legalization expands across the U.S., adult use may become increasingly normative. This study indicates that maternal cannabis use may be a risk factor for early initiation among their offspring. Preventive interventions should consider strategies to delay initiation among children of cannabis users.
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Affiliation(s)
- Natasha A Sokol
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island.
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Subramaniam P, Rogowska J, DiMuzio J, Lopez-Larson M, McGlade E, Yurgelun-Todd D. Orbitofrontal connectivity is associated with depression and anxiety in marijuana-using adolescents. J Affect Disord 2018; 239:234-241. [PMID: 30025312 DOI: 10.1016/j.jad.2018.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/17/2018] [Accepted: 07/01/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prevalence of marijuana (MJ) use among adolescents has been on the rise. MJ use has been reported to impact several brain regions, including frontal regions such as the orbitofrontal cortex (OFC). The OFC is involved in emotion regulation and processing and has been associated with symptoms of depression and anxiety. Therefore, we hypothesized that adolescent MJ users would show disruptions in OFC connectivity compared with healthy adolescents (HC) which would be associated with symptoms of mood and anxiety. METHODS 43 MJ-using and 31 HC adolescents completed clinical measures including the Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Resting-state functional magnetic resonance imaging data was also acquired for all participants. RESULTS In MJ users, increased depressive symptoms were associated with increased connectivity between the left OFC and left parietal regions. In contrast, lower ratings of anxiety were associated with increased connectivity between right and left OFC and right occipital and temporal regions. These findings indicate significant differences in OFC connectivity in MJ-using adolescents, which correlated with mood/anxiety. LIMITATIONS Future studies with an increased number of female participants is required to address potential sex differences in connectivity patterns related to symptoms of depression and anxiety. CONCLUSIONS This study highlights the association between OFC connectivity, MJ use, and symptoms of depression and anxiety in adolescents. These findings provide further insight into understanding the neural correlates that modulate the relationship between comorbid MJ use and mood disorders and could potentially help us better develop preventive and treatment measures.
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Affiliation(s)
- Punitha Subramaniam
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.
| | - Jadwiga Rogowska
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
| | - Jennifer DiMuzio
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
| | | | - Erin McGlade
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA; Department of Veteran Affairs, Rocky Mountain MIRECC, Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah, Salt Lake City, UT, USA; Department of Veteran Affairs, Rocky Mountain MIRECC, Salt Lake City, UT, USA
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Derouiche L, Massotte D. G protein-coupled receptor heteromers are key players in substance use disorder. Neurosci Biobehav Rev 2018; 106:73-90. [PMID: 30278192 DOI: 10.1016/j.neubiorev.2018.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/19/2022]
Abstract
G protein-coupled receptors (GPCR) represent the largest family of membrane proteins in the human genome. Physical association between two different GPCRs is linked to functional interactions which generates a novel entity, called heteromer, with specific ligand binding and signaling properties. Heteromerization is increasingly recognized to take place in the mesocorticolimbic pathway and to contribute to various aspects related to substance use disorder. This review focuses on heteromers identified in brain areas relevant to drug addiction. We report changes at the molecular and cellular levels that establish specific functional impact and highlight behavioral outcome in preclinical models. Finally, we briefly discuss selective targeting of native heteromers as an innovative therapeutic option.
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Affiliation(s)
- Lyes Derouiche
- Institut des Neurosciences Cellulaires et Integratives, UPR 3212, 5 rue Blaise Pascal, F-67000 Strasbourg, France
| | - Dominique Massotte
- Institut des Neurosciences Cellulaires et Integratives, UPR 3212, 5 rue Blaise Pascal, F-67000 Strasbourg, France.
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Kimmel HL, Lopez MF. Cannabis Use Disorder: Recent Findings and Future Directions. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0223-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Bagot KS, Matthews SA, Mason M, Squeglia LM, Fowler J, Gray K, Herting M, May A, Colrain I, Godino J, Tapert S, Brown S, Patrick K. Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci 2018; 32:121-129. [PMID: 29636283 PMCID: PMC6447367 DOI: 10.1016/j.dcn.2018.03.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 01/06/2023] Open
Abstract
Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.
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Affiliation(s)
- K S Bagot
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S A Matthews
- Penn State University, 507 Oswald Tower, University Park, PA, 16802, USA.
| | - M Mason
- University of Tennessee, Henson Hall, 213 Knoxville, Knoxville, TN, 37996-3332, USA.
| | - Lindsay M Squeglia
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - J Fowler
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - M Herting
- University of Southern California, 2011 N Soto St., Los Angeles, CA, 90032, USA.
| | - A May
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - I Colrain
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - J Godino
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Tapert
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Brown
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Patrick
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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