Substance misuse and early psychosis

Profiles and factors associated with schizophrenia in eastern Ethiopia: A matched case-control study

Background

Despite its strong hereditary and genetic connections, there are other factors reported to be linked to schizophrenia, but not well studied in eastern Ethiopia.

Objective

This study was aimed to investigating the potential profiles and factors associated with schizophrenia in eastern Ethiopia.

Materials and methods

A matched case-control study was conducted in two public hospitals from December 1, 2021, to January 30, 2022. Cases were patients with schizophrenia who visited the hospitals, and controls were healthy individuals without any mental illness who visited the same hospitals. A questionnaire was used to collect the data. Cases and controls were matched using age and sex. STATA-14 was used for analysis. A conditional logistic regression with an adjusted odds ratio (AOR) and a 95% confidence interval (CI) was applied to identify the determinants. P-values of <0.05 were used to build the final model as a measure of statistical significance.

Results

The mean age of the study participants group was 28.6 (±8.44) years, mean age for cases was 28.7(±8.5) ranging from 18 to 56 years and the mean age for the controls was 28.4 (±8.5), ranging from 18 to 60 years. About 181 (83.03%) of the participants were male. The odds of having schizophrenia was about 12.2 times higher among participants with family history of mental illness (AOR: 12.21; 95% CI: 4.83-30.00). The odds of having schizophrenia was 4.5 times higher among polysubstance users (AOR: 4.45; 95% CI: 1.28-5.45) and 2.8 times higher among khat consumers (AOR: 2.82; 95% CI: 1.23-6.45) compared to their counterparts.

Conclusion

Our findings show that genetic risk factors as well as some modifiable behaviors are associated to schizophrenia in eastern Ethiopia. At all levels, special attention should be given to those who are at risk.

The Relationships Between Childhood Abuse and Neglect, Sub-clinical Symptoms of Psychosis and Self-harm in a Non-clinical Community Sample

There is now substantial evidence that childhood adverse events are a significant risk factor for symptoms of psychosis in both clinical and community samples. Both childhood trauma and positive symptoms of psychosis are associated with an increased risk of self-harming behaviours. Therefore the current study aimed to consider the relationship between retrospective reports of childhood adversity, sub-clinical positive symptoms of psychosis and self-harm in a non-clinical community sample. The study employed a cross-sectional survey design, distributed online. Participants were asked to complete psychometric assessments relating to: demographic characteristics including past-year substance misuse; childhood adversity; sub-clinical symptoms of psychosis (delusions and hallucinations) and self-harming behaviours. The results found that, after controlling for substance misuse, childhood adversity predicted significant variance in sub-clinical delusions and hallucinations in the general population. Both symptoms of psychosis and childhood adversity increased the risk of self-harming behaviours. Positive symptoms partially mediated the relationship between early adversity and self-harming behaviours. For some people, the sequelae of early adversity including sub-clinical delusions and hallucinations may increase the risk of self-harming behaviours. Future research would benefit from considering the role of dissociation in these relationships and the affective impact of pseudo-psychotic experiences. Practitioners should consider the impact of childhood adversity, unusual perceptual experiences and distorted beliefs when working with people who self-harm. The current research was limited by the cross-sectional survey design and non-random sampling methodology.

Psychological interventions for psychosis in adolescents

BACKGROUND

Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis.

OBJECTIVES

To assess the effects of various psychological interventions for adolescents with psychosis.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019).

SELECTION CRITERIA

All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data.

DATA COLLECTION AND ANALYSIS

We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE.

MAIN RESULTS

The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty).

AUTHORS' CONCLUSIONS

Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.

Metaphor Processing Dysfunctions in Schizophrenia Patients With and Without Substance Use Disorders

BACKGROUND

Patients with schizophrenia have difficulties comprehending metaphors, which significantly impedes communication. However, this topic has not been thoroughly studied in people with a dual diagnosis. On this basis, we formulated two research aims: a) to compare the ability to comprehend metaphors in schizophrenia patients without (SZ) and with substance use disorder (SZ-SUD) and b) to determine the relationship between the processing of metaphorical content and the severity of psychopathological symptoms in both clinical groups.

METHODS

A total of 40 individuals with SZ and 40 individuals with SZ-SUD took part in the study. The control group was composed of 40 individuals without a psychiatric or neurological diagnosis. Four subtests from the Right Hemisphere Language Battery (Picture Metaphor Test, Written Metaphor Test, Picture Metaphor Explanation Test, Written Metaphor Explanation Test) were used to measure the ability to understand and explain metaphors.

RESULTS

Both groups of individuals with schizophrenia (SZ and SZ-SUD) scored lower than individuals from the control group on all tests of metaphor processing. However, no differences were observed between the two clinical groups. SZ-SUD patients had better results for Picture Metaphor Explanation than for Written Metaphor Explanation. Negative symptoms were found to be significant predictors of difficulties with understanding and explaining metaphors.

CONCLUSION

Individuals with schizophrenia, regardless of their substance use disorder (SUD) status, exhibit impaired metaphorical content processing. SUD in schizophrenia is not associated with significant impairments in understanding and explaining metaphorical content. Moreover, impairments in processing metaphorical content are associated with more severe negative symptoms of schizophrenia.

A case of Capgras syndrome and folie à duex in monozygotic twins

Both Capgras syndrome and folie à deux (insanity of two) are rare and fascinating psychopathological syndromes. Their etiology and the nosological position remain unclear. We present a case of substance-induced Capgras syndrome emerging as folie à deux (insanity of two) in monozygotic twins with strongly overlapping life histories. Then, we discuss the etiology and the nosological position of these two conditions as well as their significance for understanding the concept of psychosis.

Risk of transition to schizophrenia following first admission with substance-induced psychotic disorder: a population-based longitudinal cohort study

BACKGROUND

The potential for drugs of abuse to induce acute psychotic symptoms is well recognised. However, the likelihood of transition from initial substance-induced psychotic disorder (SIPD) to chronic psychosis is much less well understood. This study investigated the rate of SIPD transition to schizophrenia (F20), the time to conversion and other possible related factors.

METHODS

Using data from the Scottish Morbidity Record, we examined all patients (n = 3486) since their first admission to psychiatric hospital with a diagnosis of SIPD [International Classification of Diseases, Tenth Revision (ICD-10) codes F10-F19, with third digit five] from January 1997 to July 2012. Patients were followed until first episode of schizophrenia (ICD-10 code F20, with any third digit) or July 2012. Any change in diagnosis was noted in the follow-up period, which ranged from 1 day to 15.5 years across the groups.

RESULTS

The 15.5-year cumulative hazard rate was 17.3% (s.e. = 0.007) for a diagnosis of schizophrenia. Cannabis, stimulant, opiate and multiple drug-induced psychotic disorder were all associated with similar hazard rates. The mean time to transition to a diagnosis of schizophrenia was around 13 years, although over 50% did so within 2 years and over 80% of cases presented within 5 years of SIPD diagnosis. Risk factors included male gender, younger age and longer first admission.

CONCLUSIONS

SIPD episodes requiring hospital admission for more than 2 weeks are more likely to be associated with later diagnosis of schizophrenia. Follow-up periods of more than 2 years are needed to detect the majority of those individuals who will ultimately develop schizophrenia.

Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder

Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are limited. Thus, individuals at earlier stages of illness are often not identified. The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen is a self-report questionnaire originally developed to identify clinical risk for developing bipolar or psychotic disorders. The goal of the current study was to investigate the utility of the WERCAP Screen and two complementary questionnaires, the WERC Stress Screen and the WERC Substance Screen, in identifying individuals with established SCZ or BPD. Participants consisted of 35 BPD and 34 SCZ patients, as well as 32 controls (CON), aged 18-30 years. Univariate analyses were used to test for score differences between groups. Logistic regression and receiver operating characteristic (ROC) curves were used to identify diagnostic predictors. Significant group differences were found for the psychosis section of the WERCAP (pWERCAP; p < 0.001), affective section of the WERCAP (aWERCAP; p = 0.001), and stress severity (p = 0.027). No significant group differences were found in the rates of substance use as measured by the WERC Substance Screen (p = 0.267). Only the aWERCAP and pWERCAP scores were useful predictors of diagnostic category. ROC curve analysis showed the optimal cut point on the aWERCAP to identify BPD among our participant groups was a score of >20 [area under the curve (AUC): 0.87; sensitivity: 0.91; specificity: 0.71], while that for the pWERCAP to identify SCZ was a score of >13 (AUC: 0.89; sensitivity: 0.88; specificity: 0.82). These results indicate that the WERCAP Screen may be useful in screening individuals for BPD and SCZ and that identifying stress and substance-use severity can be rapidly done using self-report questionnaires. Larger studies in undiagnosed individuals will be needed to test the WERCAP Screen's ability to identify mania or psychosis in the community.

Effect of Abstinence on Depression, Anxiety, and Quality of Life in Chronic Methamphetamine Users in a Therapeutic Community

Background:

During withdrawal, patients experience different symptoms. These symptoms are associated with relapse. Understanding different outcomes of methamphetamine abstinence is useful for finding better treatments for dependence.

Objectives:

This study aimed to show the effects of abstinence on depression, anxiety, and quality of life in methamphetamine users.

Patients and Methods:

A prospective quasi-experimental (before and after study) method was used to show the effect of 3 weeks abstinence on depression, anxiety, and quality of life. A convenient sample of addicted people entered into the study and 34 people completed the study. Beck Depression Scale, Cattell Anxiety Inventory and Short Form Health Survey (SF-36) (for assessing quality of life), were used for outcome assessments.

Results:

The mean depression score after abstinence decreased significantly (P < 0.001). Both hidden and obvious anxiety and total anxiety had a high level at admission and after 3 weeks of abstinence, the mean level of anxiety did not change significantly (P < 0.096). However, the quality of life increased after 3 weeks of abstinence (P < 0.001).

Conclusions:

Depression and anxiety are prevalent in methamphetamine users. Short-term abstinence improves depression and quality of life but does not improve anxiety in methamphetamine abusers. During follow up of these patients, addressing depression and anxiety is important to achieve better results.

Cannabis use and family history in adolescent first episode psychosis in Durban, South Africa

OBJECTIVES

To investigate the clinical correlates of cannabis use in adolescents with first episode psychosis (FEP).

METHODS

Inpatient psychiatric records provided demographic, lifetime cannabis use, family history of mental illness, and clinical data on 45 FEP adolescents, aged 12-18 years, admitted to a psychiatric unit in Durban, KwaZulu-Natal, South Africa, over a 2-year period.

RESULTS

Thirty-one (68.8%) of the 45 FEP adolescents reported a history of lifetime cannabis use. The age of FEP presentation and pre-diagnosis symptom duration was not significantly different in cannabis users versus non cannabis users. Of the 15/43 (34.8%) FEP patients with family history of mental illness, 10 had a history of cannabis use. The 26 (57.8%) schizophrenia spectrum disorder patients did not differ significantly from the 19 (42.2%) with other psychoses in terms of cannabis use and family history of mental illness. They were, however, significantly younger at age of presentation and had a significantly longer duration of pre-diagnosis symptoms.

CONCLUSIONS

These preliminary findings suggest a high prevalence of cannabis use in adolescents with FEP and highlight the public health concern of addressing substance abuse in the adolescent population.

First-episode psychosis in the criminal justice system: identifying a critical intercept for early intervention

LEARNING OBJECTIVE

After participating in this activity, learners should be better able to:Evaluate emerging concepts of identification, treatment and discharge planning for individuals who are experiencing a first psychotic episode while detained in the criminal justice system.

ABSTRACT

The United States incarcerates more people than any other nation in the world. The system of jails and prisons that holds those individuals has become the largest provider of mental health care in the country, with rates of psychotic illness many times higher than in the community. A subset of this population includes individuals experiencing their first episode of psychosis who are untreated and are new to the rules of institutional settings. Retrospective and anecdotal reports indicate that many individuals in the criminal justice system have first-episode psychosis, yet no published information is available about the actual rates. For these patients, behavior associated with psychotic symptoms may have led to their arrest, but correctional facilities are poorly equipped to identify their needs and to provide the type of comprehensive treatment needed to improve functional status, quality of life, and illness recovery. Even as first-episode programs are flourishing in community settings, we know little about how to identify, engage, possibly divert, and treat these patients in settings designed as punishment. Efforts should be made both to reduce the number of these individuals inappropriately prosecuted within the criminal justice system and to begin in-jail efforts to engage them in treatment, in anticipation of their eventual return to the community.

Clinical features of methamphetamine-induced paranoia and preliminary genetic association with DBH-1021C→T in a Thai treatment cohort

AIMS

To explore the clinical features of methamphetamine-induced paranoia (MIP) and associations between MIP and a genetic polymorphism in dopamine β-hydroxylase (DBH-1021C→T).

DESIGN

Retrospective analysis of clinical presentation and genetic association by χ(2) test and logistic regression analysis.

SETTING

A Thai substance abuse treatment center.

PARTICIPANTS

A total of 727 methamphetamine-dependent (MD) individuals.

MEASUREMENTS

Clinical: Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) and the Methamphetamine Experience Questionnaire (MEQ). Genetic: DBH-1021C→T.

FINDINGS

Forty per cent of individuals (289 of 727; 39.8%) with MD had MIP. Within-binge latency to MIP onset occurred more rapidly in the most recent compared with initial MIP episode (P = 0.02), despite unchanging intake (P = 0.89). Individuals with MIP were significantly less likely to carry lower (TT/CT) compared with higher (CC) activity genotypes (34.3 versus 43.3%; χ(2) 1  = 5, P = 0.03). DBH effects were confirmed [odds ratio (OR) = 0.7, P = 0.04] after controlling for associated clinical variables (MD severity, OR = 3.4, P < 0.001; antisocial personality disorder, OR = 2.2, P < 0.001; alcohol dependence, OR = 1.4, P = 0.05; and nicotine dependence, OR = 1.4, P = 0.06). TT/CT carriers were more likely to initiate cigarette smoking (OR = 3.9, P = 0.003) and probably less likely to be dependent on alcohol (OR = 0.6, P = 0.05).

CONCLUSIONS

Among methamphetamine-dependent individuals, paranoia appears to occur increasingly rapidly in the course of a session of methamphetamine use. Severity of methamphetamine dependence and antisocial personality disorder predicts methamphetamine-induced paranoia. The genetic polymorphism in dopamine β-hydroxylase is associated with methamphetamine-induced paranoia and influences smoking initiation.

Substance abuse and psychosis

This article reviews the literature for the most pressing diagnostic and treatment challenges faced in working with adolescents. Diagnosing the treatment interventions required for this population involve psychoeducation, engagement of the patient and family in the treatment process, and use of antipsychotic medications. Cannabis may be a causal risk factor in psychotic illness, and data support recommendations to reduce or cease cannabis use in this population. Treatment strategies are discussed that are effective in adult patients and that may be efficacious for youth to abstain from substances after the resolution of psychotic symptoms.

Substance use in young persons in Ireland, a systematic review

Adolescence is a time of physical and mental development when small changes can impact on the rest of a person's life. Substance use in this crucial period can have long-lasting consequences for the individual and for society. The prevalence of substance use in young people is an area of concern for policy makers and health workers. This systematic review looked at prevalence for four substances: alcohol, tobacco, cannabis, and benzodiazepines, across the Republic of Ireland for persons between the ages of 13 and 24, and compared usage between 2000 and 2012. Eighteen articles were included in the review. It was seen that tobacco, alcohol, and cannabis use has fallen in the lifetime and previous month use. The level of benzodiazepine use has remained similar in the period of study. Future work should redress the imbalance in substance use research that sees the majority of researchers looking at a few substances while little work is done on the others.

Pharmacotherapy challenges in patients with first-episode psychosis

The first episode of a psychotic disorder typically occurs in late adolescence or young adulthood, a critical time of development with respect to personality, social role, education, and vocation. The first few years of psychosis appear to be a critical period during which intervention needs to be initiated before the consequences of psychosis become more severe. Early intervention is therefore crucial in maximizing outcomes. Although response rates to antipsychotic medication in first-episode psychosis (FEP) are good, there is a relatively high risk of relapse. The greatest challenges that physicians face in treating FEP and preventing relapse are engaging patients in treatment and preventing non-adherence to therapy. Overall rates of non-adherence to antipsychotic medications for FEP patients are estimated to be at or higher than 50% within the first year of treatment, suggesting that malleable factors linked to non-adherence need to be targeted in interventions provided. Factors influencing adherence can be categorized into four groups: (1) environment-related, (2) patient-related, (3) medication-related, and (4) illness-related. This paper will review the factors associated with adherence and discuss solutions to optimize engagement, adherence to medication, and treatment in order to prevent relapse. Factors like social and family support, therapeutic alliance, attitudes and beliefs toward illness and medication, insight, substance use disorders, medication efficacy, tolerability, and accessibility will be discussed. Solutions, such as early psychosis specialized services integrating psychosocial therapies and careful selection of appropriate antipsychotic medication, will be proposed.

Evaluation and treatment of children and adolescents with psychotic symptoms

In recent years, there have been increasing efforts to develop early detection and prevention strategies for patients at risk of the development of psychotic disorders. These efforts have led to improved recognition and characterization of psychotic symptoms in youth. This review focuses on the evaluation of children and adolescents with psychotic symptoms who are experiencing functional impairment but who do not meet current criteria for schizophrenia. For this article, emphasis is placed on the evaluation of symptoms, differential diagnosis, and consideration of potential interventions.

Associations between substance use, neuropsychological functioning and treatment response in psychosis

Relationships between substance use, severity of psychosis, and neuropsychological functioning were examined, together with their associations with treatment response and retention status. Participants included 477 people with psychosis (354 volunteers registered on a research database, and 123 enrolled in a treatment trial for substance misuse). Variables of primary interest included substance use history, course of psychotic disorder, and neuropsychological functioning on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Specific RBANS deficits were associated with a more chronic illness course. Compared to those with a stable or chronic course, younger people with a single episode of psychosis were more likely to have uncertain diagnoses, higher levels of substance use problems and variable neuropsychological functioning. History of substance use was not associated with additional overall neuropsychological deficits. Likewise, treatment retention and outcome were not associated with neuropsychological functioning. The findings suggest that, among people with co-existing psychotic and substance use disorders, response to cognitive-behaviour therapy is likely to be independent of neuropsychological functioning. Consideration should also be given to the potential use of neuropsychological assessments to assist differentiation of likely substance-associated psychosis from primary psychosis.

Abuso de cannabis em pacientes com transtornos psiquiátricos: atualização para uma antiga evidência

OBJETIVO: Realizar uma atualização sobre o abuso de cannabis em pacientes com transtornos psiquiátricos. MÉTODO: Busca de artigos nas bases de dados eletrônicas Medline, The Cochrane Library Database, Lilacs, PubMed e SciELO, utilizando os descritores "marijuana abuse", "cannabis abuse", "psychiatric disorders" AND "mental disorders"; incluindo artigos que avaliaram ambas as exposições para abuso e dependência de cannabis e qualquer outro transtorno psiquiátrico. Foi considerado o período até dezembro de 2009. RESULTADOS: Observou-se que o abuso frequente de cannabis pode aumentar o risco para o desenvolvimento de esquizofrenia e de sintomas psicóticos crônicos, embora estes achados ainda careçam de comprovação. A cannabis parece ser uma das drogas de escolha de portadores de transtorno afetivo bipolar, sendo que é descrito que estados maníacos podem ser induzidos pelo seu consumo. O abuso de maconha também frequentemente co-ocorre em indivíduos com transtornos ansiosos, sendo que a relação de cronicidade destas condições e o consumo de maconha ainda é incerta. Para depressão ainda não existem evidências claras que apontem que o consumo de cannabis ocorre como forma de automedicação. Em indivíduos com transtornos psiquiátricos, há relatos de que o uso da cannabis pode exacerbar sintomas positivos, somar efeitos negativos no curso do transtorno, contribuir para pior adesão ao tratamento e levar a maior número de hospitalizações. CONCLUSÃO: O abuso de cannabis em pacientes com transtornos psiquiátricos como esquizofrenia, transtornos do humor e ansiosos tem impacto negativo tanto na fase aguda quanto em fases mais avançadas destas condições, embora futuros estudos avaliando estas associações ainda sejam necessários.

Immunoactive effects of cannabinoids: considerations for the therapeutic use of cannabinoid receptor agonists and antagonists

The active constituents of Cannabis sativa have been used for centuries as recreational drugs and medicinal agents. Today, marijuana is the most prevalent drug of abuse in the United States and, conversely, therapeutic use of marijuana constituents are gaining mainstream clinical and political acceptance. Given the documented contributions of endocannabinoid signaling to a range of physiological systems, including cognitive function, and the control of eating behaviors, it is unsurprising that cannabinoid receptor agonists and antagonists are showing significant clinical potential. In addition to the neuroactive effects of cannabinoids, an emerging body of data suggests that both endogenous and exogenous cannabinoids are potently immunoactive. The central premise of this review article is that the immunological effects of cannabinoids should be considered in the context of each prescribing decision. We present evidence that the immunological effects of cannabinoid receptor agonists and antagonists are highly relevant to the spectrum of disorders for which cannabinoid therapeutics are currently offered.