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Sheitman A, Bello I, Montague E, Scodes J, Dambreville R, Wall M, Nossel I, Dixon L. Observed Trajectories of Cannabis Use and Concurrent Longitudinal Outcomes in Youth and Young Adults Receiving Coordinated Specialty Care for Early Psychosis. Schizophr Res 2024; 267:313-321. [PMID: 38608418 DOI: 10.1016/j.schres.2024.04.005] [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: 09/27/2023] [Revised: 01/31/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
Cannabis use is present and persistent in young adults with early psychosis receiving Coordinated Specialty Care (CSC) in the United States. While CSC programs are effective in improving quality of life, helping individuals reach goals, and promoting recovery, cannabis use may limit the extent of these improvements. This study extended upon previous findings to examine trajectories of cannabis use among individuals with early psychosis. The sample consisted of 1325 CSC participants enrolled for more than one year at OnTrackNY and followed up to two years, categorized into three groups: no use, reduced use, and persistent use. Baseline demographic and clinical differences were compared across groups and associations between clinical and psychosocial outcomes at 12 months and 24 months were examined across groups. Of the sample, 40 % remained persistent users over two years while 12.8 % reduced their use. At baseline, persistent users were younger (p = 0.011), more likely to be male (p < 0.001), had lower education levels (p = 0.019), and were more likely to have had past legal issues prior to admission (p < 0.001) than non-users. At 2 years, persistent users had significantly worse symptom scores than non-users (p = 0.0003) and reduced users (p = 0.0004). These findings highlight the presence of persistent cannabis use being common in this population and the need to improve substance use treatment offered to allow more CSC participants to achieve improved outcomes.
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Affiliation(s)
- A Sheitman
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA.
| | - I Bello
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - E Montague
- Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Queens, NY 11004, USA
| | - J Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - R Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - M Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - I Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - L Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
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Llorca-Bofí V, Madero S, Amoretti S, Cuesta MJ, Moreno C, González-Pinto A, Bergé D, Rodriguez-Jimenez R, Roldán A, García-León MÁ, Ibáñez A, Usall J, Contreras F, Mezquida G, García-Rizo C, Berrocoso E, Bernardo M, Bioque M. Inflammatory blood cells and ratios at remission for psychosis relapse prediction: A three-year follow-up of a cohort of first episodes of schizophrenia. Schizophr Res 2024; 267:24-31. [PMID: 38513331 DOI: 10.1016/j.schres.2024.03.011] [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: 03/15/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND The clinical course following a first episode of schizophrenia (FES) is often characterized by recurrent relapses, resulting in unfavorable clinical and functional outcomes. Inflammatory dysregulation has been implicated in relapse risk; however, the predictive value of inflammatory blood cells in clinically remitted patients after a FES has not been previously explored. METHODS In this study, we closely monitored 111 patients in remission after a FES until relapse or a three-year follow-up endpoint. The participants were recruited from the multicenter 2EPS Project. Data on inflammatory blood cells and ratios were collected at baseline and at the time of relapse or after three years of follow-up. RESULTS Monocyte counts (OR = 1.91; 95 % CI = 1.07-3.18; p = 0.009) and basophil counts (OR = 1.09; 95 % CI = 1.01-1.12; p = 0.005) at baseline were associated with an increased risk of relapse, while the platelet-lymphocyte ratio (OR = 0.98; 95 % CI = 0.97-0.99; p = 0.019) was identified as a protective factor. However, after adjusting for cannabis and tobacco use during the follow-up, only monocyte counts (OR = 1.73; 95 % CI = 1.03-2.29; p = 0.027) and basophil counts (OR = 1.08; 95 % CI = 1.01-1.14; p = 0.008) remained statistically significant. ROC curve analysis indicated that the optimal cut-off values for discriminating relapsers were 0.52 × 10^9/L (AUC: 0.66) for monocytes and 0.025 × 10^9/L (AUC: 0.75) for basophils. When considering baseline inflammatory levels, no significant differences were observed in the inflammatory biomarkers at the endpoint between relapsers and non-relapsers. CONCLUSION This study provides evidence that higher monocyte and basophil counts measured at remission after a FES are associated with an increased risk of relapse during a three-year follow-up period.
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Affiliation(s)
- Vicent Llorca-Bofí
- Department of Medicine, University of Barcelona, Barcelona, Spain; Department of Psychiatry, Santa Maria University Hospital Lleida, Lleida, Spain; Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Santiago Madero
- Department of Medicine, University of Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Silvia Amoretti
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Spain; Bipolar and Depressive Disorder Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Spain; University of Barcelona, Spain.
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Ana González-Pinto
- Bioaraba, Alava University Hospital, UPV/EHU, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Dani Bergé
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Roberto Rodriguez-Jimenez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Alexandra Roldán
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, IIB-SANT PAU, Barcelona, Spain; CIBERSAM, ISCIII, Spain.
| | - María Ángeles García-León
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
| | - Angela Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), ISCIII, Madrid, Spain
| | - Judith Usall
- Research Institute Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
| | - Fernando Contreras
- Psychiatric Service, Bellvitge Universitari Hospital, IDIBELL, CIBERSAM, Spain.
| | - Gisela Mezquida
- University of Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic of Barcelona, Neuroscience Institute, Spain; Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Instituto de Salud Carlos III, Spain.
| | - Clemente García-Rizo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.
| | - Esther Berrocoso
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain.
| | - Miquel Bioque
- Department of Medicine, University of Barcelona, Barcelona, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Instituto de Salud Carlos III (ISCIII), Spain.
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3
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Denissoff A, Taipale H, Tiihonen J, Di Forti M, Mittendorfer-Rutz E, Tanskanen A, Mustonen A, Niemelä S. Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study. Schizophr Bull 2024:sbae034. [PMID: 38534050 DOI: 10.1093/schbul/sbae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND HYPOTHESIS There is a paucity of research on treatment outcomes of patients with psychosis and cannabis use disorder (CUD). We aimed to compare the effectiveness of antipsychotics in reducing the risk of hospitalization in patients with first-episode psychosis (FEP) and co-occurring CUD. STUDY DESIGN We utilized a nationwide Swedish cohort of patients with longitudinal register data from the year 2006 to 2021. Participants were patients with FEP and co-occurring CUD (n = 1820, 84.73% men, mean age 26.80 years, SD 8.25 years). The main outcome was hospitalization due to psychotic relapse. Hospitalization due to any psychiatric disorder or substance use disorder (SUD) were examined as secondary outcomes. Within-individual Cox regression models were used to study these associations. STUDY RESULTS Use of any antipsychotic was associated with a 33% risk reduction of psychotic relapse (aHR = 0.67; 95% CI 0.60-0.75). Clozapine (0.43; 0.29-0.64), long-acting injectable (LAI) formulations of risperidone (0.40; 0.22-0.71), aripiprazole (0.42; 0.27-0.65), and paliperidone (0.46; 0.30-0.69) were associated with the lowest risk of relapse. The association between the LAI formulation of olanzapine and hospitalization due to psychosis was statistically non-significant (0.61; 0.35-1.05). Clozapine was associated with an 86% risk reduction of hospitalization due to SUD (0.14; 0.05-0.44). Of oral non-clozapine antipsychotics, aripiprazole was associated with the lowest risk of hospitalization due to psychotic relapse (0.61; 0.45-0.83). CONCLUSIONS These findings support the use of clozapine, LAI formulations of second-generation antipsychotics other than olanzapine, or oral aripiprazole to prevent hospitalization in FEP and co-occurring CUD.
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Affiliation(s)
- Alexander Denissoff
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marta Di Forti
- Department of Social Genetics and Developmental Psychiatry, IoPPN, King's College London, London, England
| | | | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Antti Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Solja Niemelä
- Department of Psychiatry, Faculty of Medicine, University of Turku, Turku, Finland
- Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, The Wellbeing Services County of Southwest Finland, Turku, Finland
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4
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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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5
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Wilson M, Harris M, Pereira M, Buckle J, Forshall E, Murphy T, Thompson A, Kavanagh G, Whale R. Predictors of hospitalisation and recovery following full antipsychotic discontinuation in first episode psychosis. A naturalistic retrospective cohort study. Schizophr Res 2023; 261:269-274. [PMID: 37862826 DOI: 10.1016/j.schres.2023.10.004] [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] [Received: 10/18/2022] [Revised: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Whilst antipsychotic medication reduces risk of relapse following a first episode of psychosis (FEP), some individuals can discontinue medication and remain relapse free. We aimed to identify patient and service-specific factors which influence clinical outcome following antipsychotic discontinuation. The outcomes 'admission to hospital' and 'remaining free from psychotic symptoms', both within one year from discontinuation, were explored retrospectively in an established naturalistic cohort of 354 patients with FEP. Logistic regression analysis was used to explore influence of routinely available baseline and treatment course variables on these outcomes. Seventy-seven individuals (22 %) fully discontinued antipsychotic treatment within a year, at mean 102 days from initiation. Only antipsychotic type had significant association with discontinuation; aripiprazole was discontinued more than olanzapine (p = 0.028). Seventeen individuals required admission to hospital; significantly associated with prior admission at first illness onset (p = 0.004), and prior legal detention to hospital (p = 0.001). Admission was less likely in those discontinuing aripiprazole vs olanzapine (p = 0.044). Twenty-four patients remained psychosis symptom free and were most significantly likely to have received clinician support in discontinuation; this group had no association with either initial duration of untreated psychosis or prior duration of antipsychotic treatment. Future studies exploring outcomes following antipsychotic discontinuation require consistency of choice of outcome measures and sample stratification by vulnerability factors including severity of first illness episode, whether remaining symptom free after first episode, which medication switched from and baseline functioning. The impact and nature of clinician support to discontinue requires further exploration alongside its association with abruptness of discontinuation.
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Affiliation(s)
| | | | - Marco Pereira
- University of Coimbra, Faculty of Psychology and Educational Sciences, Portugal
| | | | | | | | | | | | - Richard Whale
- Brighton and Sussex Medical School, UK; Sussex Partnership NHS Foundation Trust, UK.
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6
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Segura AG, Mané A, Prohens L, Rodriguez N, Mezquida G, Cuesta MJ, Vieta E, Amoretti S, Lobo A, González-Pinto A, Diaz-Caneja CM, Roldán-Bejarano A, Jimenez E, Baeza I, Legido T, Saiz-Ruiz J, Bernardo M, Mas S. Exploration of cannabis use and polygenic risk scores on the psychotic symptom progression of a FEP cohort. Psychiatry Res 2023; 325:115249. [PMID: 37178502 DOI: 10.1016/j.psychres.2023.115249] [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: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Cannabis use is highly prevalent in first-episode psychosis (FEP) and plays a critical role in its onset and prognosis, but the genetic underpinnings promoting both conditions are poorly understood. Current treatment strategies for cannabis cessation in FEP are clearly inefficacious. Here, we aimed to characterize the association between cannabis-related polygenic risk scores (PRS) on cannabis use and clinical course after a FEP. A cohort of 249 FEP individuals were evaluated during 12 months. Symptom severity was measured with the Positive and Negative Severity Scale and cannabis use with the EuropASI scale. Individual PRS for lifetime cannabis initiation (PRSCI) and cannabis use disorder (PRSCUD) were constructed. Current cannabis use was associated with increased positive symptoms. Cannabis initiation at younger ages conditioned the 12-month symptom progression. FEP patients with higher cannabis PRSCUD reported increased baseline cannabis use. PRSCI was associated with the course of negative and general symptomatology over follow-up. Cannabis use and symptom progression after a FEP were modulated by cannabis PRS, suggesting that lifetime initiation and use disorders may have partially independent genetic factors. These exploratory results may be the first step to identify those FEP patients more vulnerable to cannabis use and worse outcomes to ultimately develop tailored treatments.
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Affiliation(s)
- Alex G Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Llucia Prohens
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Natalia Rodriguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Gisela Mezquida
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Silvia Amoretti
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Bipolar and Depressive Disorder Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Hospital Universitario de Alava, Vitoria-Gasteiz, Spain; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain; University of the Basque Country, Vizcaya, Spain
| | - Covadonga M Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alexandra Roldán-Bejarano
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANTPAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Esther Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Immaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Teresa Legido
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Jeronimo Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Universidad de Alcala, Alcalá de Henares, Spain; Hospital Ramon y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
| | - Miguel Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.
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7
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Oscoz-Irurozqui M, Almodóvar-Payá C, Guardiola-Ripoll M, Guerrero-Pedraza A, Hostalet N, Salvador R, Carrión MI, Maristany T, Pomarol-Clotet E, Fatjó-Vilas M. Cannabis Use and Endocannabinoid Receptor Genes: A Pilot Study on Their Interaction on Brain Activity in First-Episode Psychosis. Int J Mol Sci 2023; 24:ijms24087501. [PMID: 37108689 PMCID: PMC10142622 DOI: 10.3390/ijms24087501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The role of both cannabis use and genetic background has been shown in the risk for psychosis. However, the effect of the interplay between cannabis and variability at the endocannabinoid receptor genes on the neurobiological underpinnings of psychosis remains inconclusive. Through a case-only design, including patients with a first-episode of psychosis (n = 40) classified as cannabis users (50%) and non-users (50%), we aimed to evaluate the interaction between cannabis use and common genetic variants at the endocannabinoid receptor genes on brain activity. Genetic variability was assessed by genotyping two Single Nucleotide Polymorphisms (SNP) at the cannabinoid receptor type 1 gene (CNR1; rs1049353) and cannabinoid receptor type 2 gene (CNR2; rs2501431). Functional Magnetic Resonance Imaging (fMRI) data were obtained while performing the n-back task. Gene × cannabis interaction models evidenced a combined effect of CNR1 and CNR2 genotypes and cannabis use on brain activity in different brain areas, such as the caudate nucleus, the cingulate cortex and the orbitofrontal cortex. These findings suggest a joint role of cannabis use and cannabinoid receptor genetic background on brain function in first-episode psychosis, possibly through the impact on brain areas relevant to the reward circuit.
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Affiliation(s)
- Maitane Oscoz-Irurozqui
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Salud Mental Errenteria-Osakidetza, Av Galtzaraborda 69-75, 20100 Errenteria, Guipúzcoa, Spain
| | - Carmen Almodóvar-Payá
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Maria Guardiola-Ripoll
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Amalia Guerrero-Pedraza
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Hospital Benito Menni CASM, C/Doctor Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Noemí Hostalet
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | | | - Teresa Maristany
- Diagnostic Imaging Department, Hospital Sant Joan de Déu Research Foundation, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Mar Fatjó-Vilas
- FIDMAG Germanes Hospitalàries Research Foundation, Av Jordà 8, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Av Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Avinguda Diagonal, 643, 08028 Barcelona, Spain
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8
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Petros R, Walker DD, Pierce A, Monroe-DeVita M. Scoping Review of Cannabis-Reduction Psychosocial Interventions and Reasons for Use among Young Adults with Psychosis. J Dual Diagn 2023; 19:124-150. [PMID: 37391686 DOI: 10.1080/15504263.2023.2226024] [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: 07/02/2023]
Abstract
Objective: No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods: A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts (N = 3,216) and full-texts (n = 136) resulted in 46 articles. Results: YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions: Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.
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Affiliation(s)
- Ryan Petros
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Denise D Walker
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Adam Pierce
- Mental Health and Neurosciences Division, VA Portland Health Care System, Portland, Oregon, USA
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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9
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Gouse BM, Boliver EE, Oblath R, Camacho L, Brown HE. Cannabis use among patients presenting to the emergency department for psychosis: Associations with restraint use, medication administration, psychiatric hospitalization, and repeat visits. Psychiatry Res 2023; 323:115151. [PMID: 36934468 DOI: 10.1016/j.psychres.2023.115151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/21/2023]
Abstract
Cannabis use is associated with increased severity of psychotic symptoms and the risk of acute agitation and aggressive behavior in inpatient (IP) and outpatient settings. Whether or not cannabis use is associated with increased acuity of psychosis-related ED presentations and risk of repeat ED visits for psychosis is unclear. In this retrospective study of 2,134 ED visits for acute psychosis, we investigated the risk of physical restraint, parenteral medication administration, psychiatric hospitalization, and recurrent ED visits. We examined ED visits between March 1, 2019 and February 28, 2021 based on urinary Tetrahydrocannabinol (THC) screen status (positive vs negative vs no screen). The risk of physical restraint, parenteral antipsychotic, and benzodiazepine administration was significantly greater in ED visits with a positive THC screen compared to those with a negative or no THC screen. We did not find an association between a positive urinary THC screen and IP hospitalization or the risk of recurrent ED presentation for psychosis within 90 days. These findings suggest that positive urinary THC may predict acute agitation or acuity of symptoms in ED settings and underscores the importance of screening for THC during ED presentations for psychosis.
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Affiliation(s)
- Brittany M Gouse
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA.
| | - Elijah E Boliver
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Boston University School of Public Health, Boston, MA 02118, USA
| | - Rachel Oblath
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - Luisa Camacho
- Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - Hannah E Brown
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
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10
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Herman Y, Norouzian N, MacKenzie LE. An integrated substance use treatment model for young adults with first-episode psychosis: A naturalistic pilot evaluation. Early Interv Psychiatry 2023; 17:311-318. [PMID: 35932200 DOI: 10.1111/eip.13337] [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: 06/30/2021] [Revised: 05/04/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
AIM Approximately 50% of individuals with first-episode psychosis meet criteria for a substance use disorder and these concurrent disorders are associated with worse long-term outcomes. Psychosocial interventions, including motivational interviewing as well as cognitive and behavioural therapies, have shown some evidence for effective treatment in substance use disorders; however, there is a paucity of existing studies that have successfully examined these interventions in first-episode psychosis. METHODS Participants (n = 64) received the concurrent disorders intervention, which included individual support alongside participation in at least one of two groups: a 4-week Motivational Engagement group utilizing motivational interviewing (n = 59) and an 8-week Relapse Prevention Training group emphasizing skill acquisition, which some participants entered directly (n = 5) and some participants entered following completion of the Motivational Engagement group (n = 16). RESULTS Participants who completed the Motivational Engagement group (n = 59) demonstrated significantly increased motivation to change substance use (d = -.0.58; t = -3.02, p < .01) and significantly decreased substance use frequency (d = 0.65; t = 3.26, p < .01). For participants who completed the Relapse Prevention Training group (n = 21), substance use frequency significantly decreased (d = 0.92; t = 3.46, p < .01) and self-efficacy in one's ability to maintain substance use changes significantly increased (d = -0.85; t = -3.59, p < .01). CONCLUSIONS This pilot evaluation suggests that motivational interviewing and relapse prevention skills training are acceptable and feasible interventions in the treatment of substance use disorders in young adults with first-episode psychosis.
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Affiliation(s)
- Yarissa Herman
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nikoo Norouzian
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lynn E MacKenzie
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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11
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Waterreus A, Di Prinzio P, Ambrosi T, Morgan VA. Discontinuing cannabis use: Symptomatic and functional outcomes in people with an established psychotic disorder. Schizophr Res 2023; 254:118-124. [PMID: 36842223 DOI: 10.1016/j.schres.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
For people with psychotic disorders, the negative outcomes associated with continuing cannabis use would suggest that discontinuing such use may be beneficial for their symptomatic and functional recovery. However, existing evidence that discontinuation is associated with better clinical outcomes is inconsistent and it remains unclear whether discontinuing use is associated with improvements in outcomes for people with an established psychotic disorder. In this 3-5-year longitudinal study we examined baseline and follow-up symptomatic and functional profiles of 371 people with an established psychotic disorder, comparing those who continued to use cannabis with those who discontinued use after baseline assessment. At follow-up, one third (33.3 %) of baseline cannabis users had discontinued use. Discontinuation was associated with significantly lower odds of past-year hallucinations and a mean improvement in level of functioning (Personal and Social Performance Scale) compared to a decline in functioning in continuing users. No significant differences in severity of negative symptoms were observed. With few longitudinal studies examining symptomatic and functional outcomes for people with established psychotic disorders who continue to use cannabis compared to those who discontinue use, our findings that discontinuing cannabis was associated with significant clinical improvements fill gaps in the evidence-base.
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Affiliation(s)
- A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - P Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - T Ambrosi
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, Australia
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12
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Ihler HM, Lyngstad SH, Gardsjord ES, Widing LH, Flaaten CB, Åsbø G, Wold KF, Engen MJ, Simonsen C, Ueland T, Lagerberg TV, Melle I, Romm KL. The trajectory of two negative symptom dimensions in first-episode psychosis and the role of cannabis use: A 10-year follow-up study. Schizophr Res 2023; 252:317-325. [PMID: 36706477 DOI: 10.1016/j.schres.2023.01.024] [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: 08/31/2022] [Revised: 11/21/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms. METHODS 351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories. RESULTS The severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression. CONCLUSION Both cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.
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Affiliation(s)
- Henrik Myhre Ihler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
| | - Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Erlend Strand Gardsjord
- Unit for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, P. O. box 4956 Nydalen, 0424 Oslo, Norway
| | - Line Hustad Widing
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Camilla Bärthel Flaaten
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Gina Åsbø
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristin Fjelnseth Wold
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Magnus Johan Engen
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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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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Casanovas F, Fonseca F, Mané A. Substance use Specificities in Women with Psychosis: A Critical Review. Curr Neuropharmacol 2023; 21:1953-1963. [PMID: 36453494 PMCID: PMC10514534 DOI: 10.2174/1570159x21666221129113942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years. METHODS We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia. RESULTS Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis. CONCLUSION Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.
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Affiliation(s)
- Francesc Casanovas
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Mané
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
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15
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Patterson VC, Tibbo PG, Stewart SH, Town J, Crocker CE, Ursuliak Z, Lee S, Morrison J, Abidi S, Dempster K, Alexiadis M, Henderson N, Pencer A. A multiple baseline trial of adapted prolonged exposure psychotherapy for individuals with early phase psychosis, comorbid substance misuse, and a history of adversity: A study protocol. Front Psychol 2022; 13:1012776. [PMID: 36578677 PMCID: PMC9791093 DOI: 10.3389/fpsyg.2022.1012776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background Adversity is prevalent among people with psychotic disorders, especially those within the first 5 years of a psychotic disorder, called early phase psychosis. Although adversity can lead to many negative outcomes (e.g., posttraumatic stress symptoms), very few treatments for adversity-related sequelae have been tested with individuals with psychotic disorders, and even fewer studies have specifically tested interventions for people in early phase psychosis. Furthermore, people who misuse substances are commonly excluded from adversity treatment trials, which is problematic given that individuals with early phase psychosis have high rates of substance misuse. For the first time, this trial will examine the outcomes of an adapted 15-session prolonged exposure protocol (i.e., PE+) to observe whether reductions in adversity-related psychopathology occurs among people with early phase psychosis and comorbid substance misuse. Methods This study will use a multiple-baseline design with randomization of participants to treatment start time. Participants will complete baseline appointments prior to therapy, engage in assessments between each of the five therapy modules, and complete a series of follow-up appointments 2 months after the completion of therapy. Primary hypothesized outcomes include clinically significant reductions in (1) negative psychotic symptoms measured using the Positive and Negative Syndrome Scale, (2) adversity-related sequelae measured using the Trauma Symptom Checklist-40, and (3) substance use frequency and overall risk score measured with the Alcohol, Smoking, and Substance Involvement Screening Test. We also anticipate that clinically significant reductions in hopelessness and experiential avoidance, measured with the Beck Hopelessness Scale and Brief Experiential Avoidance Questionnaire, the theorized mechanisms of change of PE+, will also be observed. A secondary outcome is a hypothesized improvement in functioning, measured using the Clinical Global Impression and Social and Occupational Functioning Assessment scales. Discussion The results of this treatment trial will contribute to the advancement of treatment research for individuals in early phase psychosis who have current substance misuse and a history of adversity, and the findings may provide evidence supporting the use of hopelessness and experiential avoidance as mechanisms of change for this treatment. Clinical trial registration Clinicaltrials.gov, NCT04546178; registered August 28, 2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1.
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Affiliation(s)
- Victoria C. Patterson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Philip G. Tibbo
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada,Mental Health and Addictions, IWK Health, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Joel Town
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Zenovia Ursuliak
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Siranda Lee
- Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Jason Morrison
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Sabina Abidi
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, IWK Health, Halifax, NS, Canada
| | - Kara Dempster
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Maria Alexiadis
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Neal Henderson
- Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada
| | - Alissa Pencer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada,Department of Psychiatry, Dalhousie University, Halifax, NS, Canada,Mental Health and Addictions, Nova Scotia Health, Halifax, NS, Canada,Mental Health and Addictions, IWK Health, Halifax, NS, Canada,*Correspondence: Alissa Pencer,
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16
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González-Ortega I, Echeburúa E, Alberich S, Bernardo M, Vieta E, de Pablo GS, González-Pinto A. Cognitive Behavioral Therapy Program for Cannabis Use Cessation in First-Episode Psychosis Patients: A 1-Year Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127325. [PMID: 35742573 PMCID: PMC9224093 DOI: 10.3390/ijerph19127325] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023]
Abstract
Despite the negative influence of cannabis use on the development and prognosis of first-episode psychosis (FEP), there is little evidence on effective specific interventions for cannabis use cessation in FEP. The aim of this study was to compare the efficacy of a specific cognitive behavioral therapy (CBT) for cannabis cessation (CBT-CC) with treatment as usual (TAU) in FEP cannabis users. In this single-blind, 1-year randomized controlled trial, 65 participants were randomly assigned to CBT-CC or TAU. The primary outcome was the reduction in cannabis use severity. The CBT-CC group had a greater decrease in cannabis use severity and positive psychotic symptoms over time, and a greater improvement in functioning at post-treatment than TAU. The treatment response was also faster in the CBT-CC group, reducing cannabis use, anxiety, positive and general psychotic symptoms, and improving functioning earlier than TAU in the follow-up. Moreover, patients who stopped and/or reduced cannabis use during the follow-up, decreased psychotic symptoms and increased awareness of disease compared to those who continued using cannabis. Early intervention based on a specific CBT for cannabis cessation, may be effective in reducing cannabis use severity, in addition to improving clinical and functional outcomes of FEP cannabis users.
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Affiliation(s)
- Itxaso González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Bioaraba Research Institute, Department of Psychiatry, Araba University Hospital, 01004 Vitoria, Spain
- Department of Personality, Assessment and Psychological Treatment, National University of Distance Education (UNED), 01008 Vitoria, Spain
- Correspondence:
| | - Enrique Echeburúa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Department of Personality, Assessment and Psychological Treatment, University of the Basque Country, Biodonostia, 20018 San Sebastian, Spain
| | - Susana Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Bioaraba Research Institute, Department of Psychiatry, Araba University Hospital, 01004 Vitoria, Spain
- Department of Fundamental Mathematics, National University of Distance Education (UNED), 01008 Vitoria, Spain
| | - Miguel Bernardo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Department of Psychiatry, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Eduard Vieta
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Department of Psychiatry, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK
- Child and Adolescent Mental Health Services, South London & Maudsley NHS Trust, London SE11 6JJ, UK
| | - Ana González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), 28029 Madrid, Spain; (E.E.); (S.A.); (M.B.); (E.V.); (A.G.-P.)
- Bioaraba Research Institute, Department of Psychiatry, Araba University Hospital, 01004 Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, 48940 Leioa, Spain
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17
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Safont G, Garriga M, Amoretti S, Cuesta MJ, Parellada M, González-Pinto A, Bergé D, Rodriguez-Jimenez R, Bejarano AR, Sarró S, Ibáñez Á, Usall J, Gutiérrez M, Vieta E, Arranz B, Berrocoso E, Verdolini N, Bernardo M. Sex and substance use in first episode psychosis: impact on clinical symptoms, psychosocial functioning and cognitive performance. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022. [DOI: 10.1016/j.rpsm.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Amoretti S, Verdolini N, Varo C, Mezquida G, Sánchez-Torres AM, Vieta E, Garcia-Rizo C, Lobo A, González-Pinto A, Abregú-Crespo R, Corripio I, Serra M, de la Serna E, Mané A, Ramos-Quiroga JA, Ribases M, Cuesta MJ, Bernardo M. Is the effect of cognitive reserve in longitudinal outcomes in first-episode psychoses dependent on the use of cannabis? J Affect Disord 2022; 302:83-93. [PMID: 35066012 DOI: 10.1016/j.jad.2022.01.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive reserve (CR) is a protective factor against cognitive and functional impairment in first-episode psychosis (FEP). The aim of this study was to evaluate the differences in clinical presentation according to the use of cannabis (cannabis users vs non-users) among patients presenting a FEP (non-affective vs affective psychosis), to investigate the impact of CR and cannabis use on several outcomes and to explore the potentially mediatory role played by CR in the relationship between cognitive domains or clinical status and functionality, depending on the use of cannabis. METHODS Linear regression analysis models were carried out to assess the predictive value of CR on clinical, functional and cognitive variables at baseline and at two-year follow-up. The mediation analyzes were performed according to the principles of Baron and Kenny. RESULTS CR was associated with better cognitive performance, regardless of cannabis consumption or diagnosis. In both diagnoses, CR was associated with better clinical and functional outcomes in those patients who did not use cannabis. In terms of mediation procedure, CR mediates the relationship between some cognitive domains and functioning at follow-up only in patients without cannabis use. LIMITATIONS The small sample size of the affective group. CONCLUSIONS CR plays a differential role in the outcome of psychoses according to whether patients are cannabis users or not. Both in affective and non-affective groups CR exerted a greater effect in patients without cannabis use. Our results suggest that the deleterious effect of cannabis use on functioning in FEP surpasses the protective effect of CR.
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Affiliation(s)
- Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain
| | - Norma Verdolini
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Cristina Varo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Eduard Vieta
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain.
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.
| | - Antonio Lobo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Medicine and Psychiatry, Zaragoza University. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Araba University Hospital, Bioaraba Research Institute, Spain; University of the Basque Country (UPV-EHU), Spain
| | - Renzo Abregú-Crespo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria Serra
- Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Villarroel, 170, Catalonia, Barcelona 08036, Spain
| | - Elena de la Serna
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR2017881, Institut Clinic de Neurociències, Hospital Clínic Universitari, CIBERSAM, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital del Mar Medical research Institute (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - J Antoni Ramos-Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Catalonia, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Barcelona, Spain
| | - Marta Ribases
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Catalonia, Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, SGR2017881, Institut Clinic de Neurociències, Hospital Clínic Universitari, CIBERSAM, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
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19
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Archie S, Palaniyappan L, Olagunju AT, Johnson N, Kozloff N, Sadeh E, Bardell A, Baines A, Anderson KK, Ayonrinde O, Ferrari M. Insights about Cannabis and Psychosis Using Video Games for Young People with a First Episode of Psychosis, particularly those from Black Racialized Backgrounds: Study Design. JMIR Res Protoc 2022; 11:e36758. [PMID: 35389874 PMCID: PMC9166641 DOI: 10.2196/36758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cannabis use disorder among young people with a first episode of psychosis contributes to relapse, hospitalization, and impaired functioning. However, few studies have examined what young people with early phase psychosis, particularly those from Black racialized communities, understand or appreciate about this relationship, even though they may be at risk. There are no formally tested knowledge translation strategies that disseminate these research findings for young people with emerging psychosis from Black racialized communities. Objective This study aims to conceptualize what young people with early phase psychosis/cannabis use disorder understand about the relationship between cannabis and psychosis, focusing on people from racialized backgrounds. This study also aims to assess whether the knowledge translation product, the “Back to Reality Series,” increases awareness of the impact of cannabis use on psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Methods Qualitative analysis will reveal themes from qualitative interviews about cannabis and psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Perceptions before and after exposure to the Back to Reality Series will be qualitatively analyzed. A control game will be used for comparison, and scores on a quiz after playing the Back to Reality Series will be quantitatively analyzed to establish whether the Back to Reality Series raises awareness of the effects of cannabis on psychosis. An advisory council involving young people from Black communities, family members, and clinicians will bring community perspectives to this research. Results We began recruiting participants for this study in September 2021. We will complete data collection on demographic and clinical factors, qualitative interviews, and quantitative assessments of the Back to Reality Series. Conclusions The voices of young people from racialized backgrounds will generate preliminary data to inform early psychosis programs, addressing cannabis use in this population. The findings may advance the use of a new knowledge translation product that deals with gaps in knowledge about cannabis use for people experiencing early phase psychosis, particularly those from racialized communities. International Registered Report Identifier (IRRID) DERR1-10.2196/36758
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Affiliation(s)
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, CA.,Robarts Research Institute, Western University, London, CA.,Lawson Health Research Institute, London, CA
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, CA.,Discipline of Psychiatry, The University of Adelaide, Adelaide, AU
| | | | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, CA.,Department of Psychiatry, University of Toronto, Toronto, CA
| | - Elham Sadeh
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA
| | - Andrea Bardell
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA.,Canadian Consortium for Early Psychosis Intervention, Ottawa, CA.,Department of Psychiatry, University of British Columbia, Vancouver, CA.,Ottawa Hospital Research Institute, Ottawa, CA.,Department of Psychiatry, University of Ottawa, Ottawa, CA
| | - Alexandra Baines
- On Track, Champlain District Regional First Episode Psychosis Program, The Ottawa Hospital, Ottawa, CA.,Department of Psychiatry, University of Ottawa, Ottawa, CA.,Ottawa Hospital Research Institute, Ottawa, CA.,Integrated Schizophrenia and Recovery Program, The Royal Ottawa Hospital, Ottawa, CA
| | - Kelly K Anderson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, CA
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20
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Mielau J, Reiche S, Moon DU, Groß E, Gutwinski S, Betzler F, Romanello A, Masah DJ, Scicchitano M, Marek R, Brandt L, Evens R, Mick IM, Majić T, Montag C. Cannabis use during the early COVID-19 pandemic: Use patterns, predictors, and subjective experiences. Front Psychiatry 2022; 13:1037451. [PMID: 36704748 PMCID: PMC9872100 DOI: 10.3389/fpsyt.2022.1037451] [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: 09/05/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Even in the early stages, global crises such as the COVID-19 pandemic lead to serious dislocations of social life, secondary adjustment reactions to external restrictions and individual concerns. Coping mechanisms may also include dysfunctional strategies like an increase of drug use. Considering the wide-spread use of cannabis, the aim of this study was to elucidate the interplay of social restrictions, psychopathology, concerns related to the pandemic in addition to the users' experiences, motivations and consumption quantities during the early COVID-19 pandemic. It was presumed that cannabis intake would increase during the early phase of the crisis and that consumption quantities would be related to corona-related restrictions, concerns as well as subjective substance effects and psychopathology. MATERIALS AND METHODS As part of an international, cross-sectional, internet-based survey (N = 5,049) available in five languages, consumption quantities and patterns of cannabis use in the early phase of the pandemic from April to August 2020 were examined. Participants retrospectively rated restrictions and concerns related to the pandemic, motives of cannabis use prior to and during 1 month the pandemic, and subjective consumption effects. RESULTS Cannabis use behavior showed no significant differences when consumption quantities prior and during 1 month after the COVID-19 outbreak were compared. Higher quantities of cannabis intake prior and during 1 month of the pandemic as well as more corona-related concern were associated with an increased perception of positive effects of cannabis during the pandemic. Predictors of its use during 1 month of pandemic were higher pre-pandemic consumption quantity, older age, quarantinization, a lesser degree of being affected by negative effects of the pandemic and a stronger subjective experience of corona-related positive effects of cannabis. Comparisons of the motives for cannabis intake in the pre-pandemic versus the pandemic period showed that all rationales for consumption were reported less frequently, except boredom. CONCLUSION Frequencies of cannabis intake remained relatively stable in the early pandemic phase. Risk factors for increased use seem related to habitual consumption patterns that become more prominent under quarantinization. The use of cannabis as a dysfunctional coping strategy might not be amenable via self-report and should therefore receive special attention in clinical contexts.
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Affiliation(s)
- Juliane Mielau
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simon Reiche
- Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Daa Un Moon
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elisa Groß
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Felix Betzler
- Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Amy Romanello
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Dario Jalilzadeh Masah
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matteo Scicchitano
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roman Marek
- Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany.,Interdisciplinary Research Group "The Future of Medicine: Good Health for All," Berlin-Brandenburg Academy of Sciences and Humanities, Berlin, Germany.,German Sepsis Foundation, Berlin, Germany
| | - Lasse Brandt
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Inge Maria Mick
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Tomislav Majić
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Research Group Psychotropic Substances, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Psychiatric University Clinic at Hospital St. Hedwig, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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21
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Ricci V, Ceci F, Di Carlo F, Lalli A, Ciavoni L, Mosca A, Sepede G, Salone A, Quattrone D, Fraticelli S, Maina G, Martinotti G. Cannabis use disorder and dissociation: A report from a prospective first-episode psychosis study. Drug Alcohol Depend 2021; 229:109118. [PMID: 34688166 DOI: 10.1016/j.drugalcdep.2021.109118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated. AIMS To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis. METHODS Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected. RESULTS FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it. DISCUSSION Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.
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Affiliation(s)
- V Ricci
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy
| | - F Ceci
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy.
| | - F Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Lalli
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - L Ciavoni
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Mosca
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - G Sepede
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Salone
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - D Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Ln, London SE5 8AF, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159 Mannheim, Germany
| | - S Fraticelli
- DSM PIPSM ASL ROMA 1, Via Plinio, 31, 00193 Roma
| | - G Maina
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy; Rita Levi Montalcini Department of Neurosciences, University of Turin, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy; Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
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22
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Barbeito S, Vega P, Sánchez-Gutiérrez T, Becerra JA, González-Pinto A, Calvo A. A systematic review of suicide and suicide attempts in adolescents with psychotic disorders. Schizophr Res 2021; 235:80-90. [PMID: 34332428 DOI: 10.1016/j.schres.2021.07.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicide is the main cause of premature death in patients with psychosis. Therefore, the goal of the present study was to review suicide in adolescents with psychotic disorders by evaluating factors associated with suicidal acts. Ours is the first systematic review of suicide in this population. METHOD We performed a systematic review of suicide in adolescents (10 to 19 years) with psychotic disorder. RESULTS We identified 10 studies, only 2 of which were randomized clinical trials. The results revealed high rates of suicidal behaviour in this population: the times of higher risk were the time before admission and the period immediately following discharge. The factors most associated with suicide attempts were depression, distress with psychotic symptoms, fewer negative symptoms at baseline, positive symptoms, and anxiety disorders. Associated factors included previous psychiatric history or psychiatric admissions, female sex, prior suicidal behaviour, family history of completed suicide, and nicotine dependence. LIMITATIONS Clinical and methodological diversity of the studies. CONCLUSIONS Adolescents with psychotic disorders had a major risk of suicidal behaviour, and specific factors were associated with the act. Early detection of adolescents with psychosis is vital, since it has been found that early intervention can prevent suicidal acts in young people. However, it is necessary to perform more studies, particularly randomized controlled trials, on suicide and suicide attempts, particularly in adolescents.
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Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM) (G10), Vitoria, Spain.
| | - Patricia Vega
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain; Bask Country University, Leioa, Bizkaia, Spain; University Hospital of Álava, BIOARABA, Spain.
| | | | - Juan Antonio Becerra
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM) (G10), Vitoria, Spain; Bask Country University, Leioa, Bizkaia, Spain; University Hospital of Álava, BIOARABA, Spain
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
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23
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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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Athanassiou M, Dumais A, Gnanhoue G, Abdel-Baki A, Jutras-Aswad D, Potvin S. A systematic review of longitudinal studies investigating the impact of cannabis use in patients with psychotic disorders. Expert Rev Neurother 2021; 21:779-791. [PMID: 34120548 DOI: 10.1080/14737175.2021.1942845] [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] [Indexed: 10/21/2022]
Abstract
Introduction: Research has established a link between cannabis use and adverse psychotic outcomes in psychosis patients. However, we have yet to determine if this relationship is maintained when controlling for important confounding variables. The following systematic review aims to investigate if the association between cannabis use and psychotic outcomes is preserved when accounting for important confounders, and if discontinued use mitigates any potential negative impacts.Areas covered: The authors conducted an exhaustive search of the MEDLINE database and Google Scholar to identify articles pertaining to the systematic review. Thirty-three articles were retained for meeting the eligibility criteria.Expert opinion: The evidence confirms an overarching pattern of negative psychotic outcomes of cannabis intake in psychosis populations, even when accounting for crucial confounders. Psychosis patients should be informed with evidence-based health information regarding the effects of cannabis use. Clinicians should systematically evaluate cannabis intake patterns in psychosis patients and offer intervention services geared toward reducing problematic consumption. Researchers should record confounding factors in a more systematic manner in future longitudinal investigations while paying careful attention to the potency and dose-response effects of the ingested cannabis. Deciders will need to investigate the impact of cannabis regulations on psychosis populations.
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Affiliation(s)
- Maria Athanassiou
- Centre De Recherche De l'Institut Universitaire En Santé Mentale De Montréal, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Alexandre Dumais
- Centre De Recherche De l'Institut Universitaire En Santé Mentale De Montréal, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada.,Philippe-Pinel National Institute of Legal Psychiatry, Montreal, Canada
| | - Gismonde Gnanhoue
- Centre De Recherche De l'Institut Universitaire En Santé Mentale De Montréal, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada.,Centre De Recherche Du Centre Hospitalier De l'Université De Montréal, Montreal, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada.,Centre De Recherche Du Centre Hospitalier De l'Université De Montréal, Montreal, Canada
| | - Stéphane Potvin
- Centre De Recherche De l'Institut Universitaire En Santé Mentale De Montréal, Montreal, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, Canada
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Muzaffar A, Ullah S, Subhan F, Nazar Z, Hussain SM, Khuda F, Khan A, Khusro A, Sahibzada MUK, Albogami S, El-Shehawi AM, Emran TB, Javed B, Ali J. Clinical Investigation on the Impact of Cannabis Abuse on Thyroid Hormones and Associated Psychiatric Manifestations in the Male Population. Front Psychiatry 2021; 12:730388. [PMID: 34925083 PMCID: PMC8678041 DOI: 10.3389/fpsyt.2021.730388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Cannabis abuse is a common public health issue and may lead to considerable adverse effects. Along with other effects, the dependence on cannabis consumption is a serious problem which has significant consequences on biochemical and clinical symptoms. This study intends to evaluate the harmful effects of the use of cannabis on thyroid hormonal levels, cardiovascular indicators, and psychotic symptoms in the included patients. This prospective multicenter study was conducted on cannabis-dependent patients with psychotic symptoms (n = 40) vs. healthy control subjects (n = 40). All participants were evaluated for psychiatric, biochemical, and cardiovascular physiological effects. Patients were selected through Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria and urine samples, exclusively for the evaluation of cannabis presence. Serum thyroid stimulating hormone (TSH), T3, and T4 levels were measured using the immunoassay technique. Patients were assessed for severity of depressive, schizophrenic, and manic symptoms using international ranking scales. Various quantifiable factors were also measured for the development of tolerance by cannabis. Among the patients of cannabis abuse, 47.5% were found with schizophrenia, 20% with schizoaffective symptoms, 10% with manic symptoms, and 22.5% with both manic and psychotic symptoms. In the group-group and within-group statistical analysis, the results of thyroid hormones and cardiovascular parameters were non-significant. The psychiatric assessment has shown highly significant (p < 0.001) difference of positive, negative, general psychopathology, and total scores [through Positive and Negative Syndrome Scale (PANSS) rating scales] in patients vs. the healthy control subjects. The study revealed that cannabis abuse did not significantly alter thyroid hormones and cardiovascular parameters due to the development of tolerance. However, the cannabis abuse might have a significant contributing role in the positive, negative, and manic symptoms in different psychiatric disorders.
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Affiliation(s)
- Anum Muzaffar
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Sami Ullah
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Fazal Subhan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Zahid Nazar
- Department of Psychiatry, Lady Reading Hospital MTI Peshawar, Peshawar, Pakistan
| | | | - Fazli Khuda
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Abuzar Khan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Ameer Khusro
- Research Department of Plant Biology and Biotechnology, Loyola College, Chennai, India
| | | | - Sarah Albogami
- Department of Biotechnology, College of Science, Taif University, Taif, Saudi Arabia
| | - Ahmed M El-Shehawi
- Department of Biotechnology, College of Science, Taif University, Taif, Saudi Arabia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Binish Javed
- Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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26
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Arranz S, Mané A, Bergé D, Monserrat C, Cabezas A, Vilella E, Sanchez-Gistau V. The impact of sex and cannabis on clinical features in first-admitted patients with psychosis. Eur Neuropsychopharmacol 2020; 36:235-243. [PMID: 32291209 DOI: 10.1016/j.euroneuro.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/22/2022]
Abstract
There is a scarcity of studies investigating the effect of sex on the clinical and treatment characteristics of first-admitted patients with first-episode psychosis (FEP). The reasons for using cannabis and the effect of cannabis on clinical features have not received enough attention either. We aim therefore, to investigate sex differences in the reasons for cannabis use and to determine the effects of sex, cannabis use and their interaction on clinical variables at admission and at discharge from the inpatient unit. 204 first-admitted FEPs in two inpatient units in Spain were included. The reasons for using cannabis were determined using the Dixon questionnaire. Clinical variables were compared between sexes and between cannabis users and non-users. Cannabis use was more frequent in males, but females were more likely to smoke cannabis to "feel relaxed". There was a main effect of sex on positive psychotic symptoms and antipsychotics dose and an interaction effect of cannabis and sex on global functioning at discharge .Our findings show sex differences in the reasons for cannabis use and in some clinical and treatment characteristics among FEP patients. More studies focusing on gender perspectives are needed to develop more individualized treatments.
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Affiliation(s)
- Sara Arranz
- Parc Sanitari Sant Joan de Dèu, Sant Boi de Llobregat, Barcelona, Spain; Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Dani Bergé
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Clara Monserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain
| | - Angel Cabezas
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Vanessa Sanchez-Gistau
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain.
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27
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Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes. Eur Psychiatry 2020; 29:424-30. [DOI: 10.1016/j.eurpsy.2013.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/24/2013] [Accepted: 07/27/2013] [Indexed: 11/23/2022] Open
Abstract
AbstractObjectiveTo examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.MethodAffective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.ResultsManic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.ConclusionThe activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.
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28
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Ferraro L, La Cascia C, Quattrone D, Sideli L, Matranga D, Capuccio V, Tripoli G, Gayer-Anderson C, Morgan C, Sami MB, Sham P, de Haan L, Velthorst E, Jongsma HE, Kirkbride JB, Rutten BPF, Richards AL, Roldan L, Arango C, Bernardo M, Bobes J, Sanjuan J, Santos JL, Arrojo M, Tarricone I, Tortelli A, Szöke A, Del-Ben CM, Selten JP, Lynskey M, Jones PB, Van Os J, La Barbera D, Murray RM, Di Forti M. Premorbid Adjustment and IQ in Patients With First-Episode Psychosis: A Multisite Case-Control Study of Their Relationship With Cannabis Use. Schizophr Bull 2020; 46:517-529. [PMID: 31361020 PMCID: PMC7147569 DOI: 10.1093/schbul/sbz077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychotic patients with a lifetime history of cannabis use generally show better cognitive functioning than other psychotic patients. Some authors suggest that cannabis-using patients may have been less cognitively impaired and less socially withdrawn in their premorbid life. Using a dataset comprising 948 patients with first-episode psychosis (FEP) and 1313 population controls across 6 countries, we examined the extent to which IQ and both early academic (Academic Factor [AF]) and social adjustment (Social Factor [SF]) are related to the lifetime frequency of cannabis use in both patients and controls. We expected a higher IQ and a better premorbid social adjustment in psychotic patients who had ever used cannabis compared to patients without any history of use. We did not expect such differences in controls. In both patients and controls, IQ was 3 points higher among occasional-users than in never-users (mean difference [Mdiff] = 2.9, 95% CI = [1.2, 4.7]). Both cases and control daily-users had lower AF compared to occasional (Mdiff = -0.3, 95% CI = [-0.5; -0.2]) and never-users (Mdiff = -0.4, 95% CI = [-0.6; -0.2]). Finally, patient occasional (Mdiff = 0.3, 95% CI = [0.1; 0.5]) and daily-users (Mdiff = 0.4, 95% CI = [0.2; 0.6]) had better SF than their never-using counterparts. This difference was not present in controls (Fgroup*frequency(2, 2205) = 4.995, P = .007). Our findings suggest that the better premorbid social functioning of FEP with a history of cannabis use may have contributed to their likelihood to begin using cannabis, exposing them to its reported risk-increasing effects for Psychotic Disorders.
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Affiliation(s)
- Laura Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,To whom correspondence should be addressed; Via Gaetano La Loggia, 1, 90129 Palermo, Italy; tel: 091-6555175, fax: 091-6555164, e-mail:
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Lucia Sideli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Domenica Matranga
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
| | - Veronica Capuccio
- Department of Economic, Management and Statistical Sciences (DSEAS) University of Palermo, Palermo, Italy
| | - Giada Tripoli
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Musa B Sami
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Pak Sham
- Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,Psylife Group, Division of Psychiatry, University College London, London, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Laura Roldan
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Julio Sanjuan
- Department of Psychiatry, School of Medicine, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz,” Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris, France,INSERM, Créteil, France
| | | | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands,Rivierduinen Institute for Mental Health Care, Leiden, The Netherlands
| | - Michael Lynskey
- Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Cambridge, UK,CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jim Van Os
- 2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | | | - Robin M Murray
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,2Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Marta Di Forti
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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Wright A, Cather C, Gilman J, Evins AE. The Changing Legal Landscape of Cannabis Use and Its Role in Youth-onset Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:145-156. [PMID: 31708043 DOI: 10.1016/j.chc.2019.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rapidly changing landscape of cannabis in terms of availability, potency, and routes of administration, as well as the decrease in risk perception and changing norms, have contributed to an increase in the popularity of cannabis. Cannabis use is associated with a poorer recovery from a psychotic disorder, increasing the risk of relapse, rehospitalization, and lower social functioning. Data are mixed regarding cannabis use as a component cause of psychosis in people at risk for psychotic disorder. Care providers, parents, and schools must educate youth and adolescents about the risks of cannabis use.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA USA.
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA USA
| | - Jodie Gilman
- Harvard Medical School, Boston, MA USA; Massachusetts General Hospital, Center for Addiction Medicine, 101 Merrimac Street, Boston, MA 02114, USA
| | - Anne Eden Evins
- Harvard Medical School, Boston, MA USA; Massachusetts General Hospital, Center for Addiction Medicine, 101 Merrimac Street, Boston, MA 02114, USA
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30
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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Thungana Y, Zingela Z, van Wyk S. First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit. S Afr J Psychiatr 2019; 25:1372. [PMID: 31745443 PMCID: PMC6851873 DOI: 10.4102/sajpsychiatry.v25i0.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Use of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA). Aim The study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC. Setting Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis. Methods Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis. Results A total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18–60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%). Conclusion In keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province.
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Affiliation(s)
- Yanga Thungana
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Acute Mental Health Care Unit, Dora Nginza Hospital, Bethelsdorp, South Africa
| | - Zukiswa Zingela
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Stephan van Wyk
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
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32
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Reid S, Bhattacharyya S. Antipsychotic treatment failure in patients with psychosis and co-morbid cannabis use: A systematic review. Psychiatry Res 2019; 280:112523. [PMID: 31450032 DOI: 10.1016/j.psychres.2019.112523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/23/2023]
Abstract
Whilst the effects of cannabis preceding psychosis onset are well established, an effect post-onset is less clear. Emerging evidence suggests that cannabis use is associated with increased relapse outcomes possibly because of determinants, antipsychotic treatment failure and medication adherence, that are not mutually exclusive. Due to the paucity of literature on antipsychotic treatment failure an association with cannabis remains conjectural. This review sought to summarise current evidence regarding the effect of cannabis use on antipsychotic treatment failure among users and non-users with psychosis. Ovid databases (Embase, Journals@Ovid Full Text, OvidMEDLINE® In-Process and Other Non-Indexed Citations and PsycINFO) were searched to identify relevant articles. Seven articles met eligibility criteria. Cannabis use was associated with the following deleterious outcomes increased: odds of non-remission, prescription of unique antipsychotic medications, cumulative prescription of Clozapine and poor treatment trajectories. One study reported similar life-time, but lower past-year, rates of cannabis use in those prescribed Clozapine. Another study reported differences between groups for chlorpromazine equivalent doses for long-term Olanzapine prescription. Improved methodologies are warranted due to a lack of well-designed prospective studies and heterogeneity of key variables. There remains, despite research paucity, the need to encourage early cannabis cessation and higher-quality research to inform clinical practice.
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Affiliation(s)
- Sam Reid
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
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33
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Setién-Suero E, Neergaard K, Ortiz-García de la Foz V, Suárez-Pinilla P, Martínez-García O, Crespo-Facorro B, Ayesa-Arriola R. Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatr Scand 2019; 140:349-359. [PMID: 31381129 DOI: 10.1111/acps.13081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2 = 15.583, P ≤ 0.001; SAPS: x2 = 12.386, P = 0.002) and poorer functionality (DAS: x2 = 6.067, P = 0.048; GAF: x2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.
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Affiliation(s)
- E Setién-Suero
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - K Neergaard
- Department of Laboratoire Parole et Langage, Aix-Marseille Université, Marseille, France
| | - V Ortiz-García de la Foz
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - P Suárez-Pinilla
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - O Martínez-García
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.,Hospital Universitario Virgen del Rocio, IBiS, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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34
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Weibell MA, Johannessen JO, Auestad B, Bramness J, Brønnick K, Haahr U, Joa I, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Stain H, Friis S, Hegelstad WTV. Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients. Front Psychiatry 2019; 10:495. [PMID: 31354551 PMCID: PMC6640174 DOI: 10.3389/fpsyt.2019.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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Affiliation(s)
- Melissa A Weibell
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innland Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kolbjørn Brønnick
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Ulrik Haahr
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Helen Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
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Sanada K, de Azúa SR, Nakajima S, Alberich S, Ugarte A, Zugasti J, Vega P, Martínez-Cengotitabengoa M, González-Pinto A. Correlates of neurocognitive functions in individuals at ultra-high risk for psychosis - A 6-month follow-up study. Psychiatry Res 2018; 268:1-7. [PMID: 29986171 DOI: 10.1016/j.psychres.2018.06.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 01/30/2023]
Abstract
Cognitive deficits are evident at the prodromal phase of psychosis. It has been noted that brain-derived neurotrophic factor (BDNF) is correlated with cognition in both preclinical and clinical studies. However, to our knowledge, no study has evaluated blood BDNF levels and their association with cognitive impairment in individuals at ultra-high risk for psychosis (UHR). We included 13 individuals at UHR and 30 healthy controls (HC) matched by sex, age, and educational level. Plasma BDNF levels were measured at baseline and 6 months. Neurocognitive functions (executive functions, speed of processing, verbal learning and memory, working memory) were examined at 6 months. Regression analyses were conducted to examine the relationship between BDNF levels and cognitive performance. BDNF levels were lower in UHR group than in HC group both at baseline and at 6 months (P = 0.001, and P = 0.007, respectively). There were no associations between plasma BDNF levels and all of the cognitive domains in both groups. Our findings showed that peripheral BDNF levels were not related to cognitive deficits in UHR and HC groups while the lower BDNF level in the former persisted up to 6 months. Further research is needed in a large sample.
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Affiliation(s)
- Kenji Sanada
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
| | - Sonia Ruiz de Azúa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Susana Alberich
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Amaia Ugarte
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Jone Zugasti
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Patricia Vega
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Mónica Martínez-Cengotitabengoa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country; National Distance Education University (UNED), Spain
| | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country.
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36
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Hunt GE, Large MM, Cleary M, Lai HMX, Saunders JB. Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis. Drug Alcohol Depend 2018; 191:234-258. [PMID: 30153606 DOI: 10.1016/j.drugalcdep.2018.07.011] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs) and schizophrenia. This systematic review and meta-analysis estimated prevalence rates of SUDs in epidemiological and treatment-seeking patients diagnosed with schizophrenia or first episode psychosis. METHODS A literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to 2017 inclusive. Prevalence of co-morbid SUDs and schizophrenia were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. Combining like studies was dictated how authors reported substance use. RESULTS There were 123 included articles with a total sample size of 165,811 subjects that yielded six epidemiological studies, 11 national or state case-registry studies, 20 large cohort studies and 86 clinical studies using in- or out-patient samples. The prevalence of any SUD was 41.7%, followed by illicit drugs (27.5%), cannabis (26.2%), alcohol (24.3%) and stimulant use (7.3%). Meta-analysis showed the pooled variance of any SUD in males was 48% which was significantly higher than that for females with schizophrenia (22.1%, OR 3.43, 95% CI 3.01, 3.92). Patients with SUD had an earlier age of onset of schizophrenia. Meta-regression showed prevalence increased over time for illicit drugs but not for other substances, including alcohol. CONCLUSIONS The meta-analysis revealed that SUDs in schizophrenia is highly prevalent and rates have not changed over time. This indicates SUD are difficult to treat in this patient population and there is an urgent need for more informative studies to help develop better prevention, detection and treatment of SUDs in persons with schizophrenia and co-morbid disorders.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry and Addiction Medicine, Concord Clinical School, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
| | - Matthew M Large
- School of Psychiatry, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Lilyfield, NSW, 2040, Australia.
| | - Harry Man Xiong Lai
- Discipline of Psychiatry, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
| | - John B Saunders
- Discipline of Psychiatry and Addiction Medicine, Concord Clinical School, University of Sydney, Hospital Rd, Concord, NSW, 2139, Australia.
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37
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Hadden KL, LeDrew K, Hogan K, Thomas B. Impact of comorbid cannabis use on outcome in first episode psychosis. Early Interv Psychiatry 2018; 12:848-855. [PMID: 27592556 DOI: 10.1111/eip.12377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/26/2016] [Accepted: 06/12/2016] [Indexed: 11/29/2022]
Abstract
AIM Comorbid cannabis abuse is common in patients with early psychosis. Little is known about the effect of stopping cannabis use on positive, negative and depressive symptoms. Few studies have controlled for multiple substance use that may mask the specific role that cannabis plays in symptom outcomes. The aim of this study was to investigate whether course and level of cannabis use negatively impacted early psychosis patient symptom profiles (positive, negative and depressive symptoms) over 24 months. METHODS One hundred and ninety-two patients admitted to an early psychosis intervention programme in a naturalistic setting were followed across three time periods: initial presentation, 12 and 24 months. Patients' clinical characteristics (substance use, positive/negative symptoms and depressive symptoms) were assessed at each time period. RESULTS There were no significant associations found between cannabis abuse and positive and negative symptoms. Continuation and discontinuation of cannabis use were not significant for cannabis or any other substance when compared to positive and negative symptoms. There was a significant interaction between cannabis and alcohol for depressive symptoms, where depressive symptoms were significantly higher in patients who abused cannabis without co-occurring alcohol abuse when compared to non-cannabis using patients. CONCLUSION The current study findings indicate a complex interaction between cannabis and alcohol use in a sample of early psychosis patients across 24 months. More research is needed into the association between ceasing cannabis use and long-term outcome for early psychosis patients. Of particular importance is the interaction between level of cannabis and alcohol use as it is related to symptom outcome in early psychosis patients.
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Affiliation(s)
- Kellie L Hadden
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Kellie LeDrew
- Eastern Health Authority of Newfoundland, Waterford Hospital, PIER Program, St. John's, Newfoundland and Labrador, Canada.,Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
| | - Kevin Hogan
- Eastern Health Authority of Newfoundland, Waterford Hospital, PIER Program, St. John's, Newfoundland and Labrador, Canada
| | - Barbara Thomas
- Eastern Health Authority of Newfoundland, Waterford Hospital, PIER Program, St. John's, Newfoundland and Labrador, Canada.,School of Pharmacy, Memorial University of Newfoundland, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
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38
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Rømer Thomsen K, Thylstrup B, Pedersen MM, Pedersen MU, Simonsen E, Hesse M. Drug-related predictors of readmission for schizophrenia among patients admitted to treatment for drug use disorders. Schizophr Res 2018; 195:495-500. [PMID: 28965780 DOI: 10.1016/j.schres.2017.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with schizophrenia and comorbid drug use disorders (DUD) have a severe course of illness. Despite strong evidence that drug use can exacerbate psychotic symptoms, we have limited knowledge of how specific drugs may increase risk of schizophrenia readmission in this group. This study aimed to assess drug-related predictors of readmission for schizophrenia among a national cohort of patients with a history of schizophrenia admitted to DUD treatment. METHODS A record-linkage study was used to assess drug-related factors associated with readmission to mental health treatment for schizophrenia, using a consecutive cohort of 634 patients admitted to DUD treatment between 2000 and 2006 in Danish treatment services and tracked until February 2013 or death, controlling for baseline psychiatric treatment variables. RESULTS The majority of patients were males (79.8%) and the mean age was 34.7years. Of all patients, 78.7% were readmitted for schizophrenia during follow-up, and 6.8% died without having been readmitted. We found a robust association between use of amphetamine at baseline and elevated risk of readmission, a less robust association between use of cannabis and elevated risk of readmission, and no association with cocaine, opioids, alcohol, benzodiazepines, and MDMA. Furthermore, one or more psychiatric inpatients visit in the year prior to DUD admission was robustly associated with elevated risk of schizophrenia readmission. CONCLUSIONS Use of amphetamine and cannabis are risk markers for schizophrenia readmission among patients with a history of schizophrenia and DUD. Psychiatric history is a predictor of schizophrenia readmission in this patient group.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Michael Mulbjerg Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Mads Uffe Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Toftebakken 9, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark.
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Rabin RA, Kozak K, Zakzanis KK, Remington G, George TP. Effects of extended cannabis abstinence on clinical symptoms in cannabis dependent schizophrenia patients versus non-psychiatric controls. Schizophr Res 2018; 194:55-61. [PMID: 28285022 DOI: 10.1016/j.schres.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rates of cannabis use among patients with schizophrenia are high, however little is understood about clinical effects of continued cannabis use and cessation after illness onset. Therefore, we investigated the effects of 28-days of cannabis abstinence on psychotic and depressive symptomatology in cannabis dependent patients with schizophrenia. METHOD Males with cannabis dependence and co-morbid schizophrenia (n=19) and non-psychiatric controls (n=20) underwent 28-days of monitored cannabis abstinence. Clinical symptoms were assessed at baseline and then weekly. Abstinence was encouraged using weekly therapy sessions and contingency reinforcement, confirmed by twice-weekly urine assays. RESULTS Forty-two percent (8/19) of patients and 55% (11/20) of controls achieved 28-days of sustained cannabis abstinence. In patients, PANSS subscores did not change over time irrespective of abstinence status. In contrast, patient abstainers demonstrated a more pronounced reduction in depression scores compared to non-abstainers, however, the Abstinence Status x Time interaction was non-significant. DISCUSSION Short-term (28-days) cannabis abstinence is not associated with improvement in psychotic symptoms, but may be associated with improvement in depressive symptomatology in patients with schizophrenia. Future studies employing larger samples as well as a continuous cannabis-using group may help to better characterize the causal effects of cannabis on symptom outcomes in this disorder.
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
| | - Karolina Kozak
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Gary Remington
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- The Institute of Medical Sciences (IMS), University of Toronto, Toronto, Ontario, Canada; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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40
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Crocker CE, Tibbo PG. The interaction of gender and cannabis in early phase psychosis. Schizophr Res 2018; 194:18-25. [PMID: 28506705 DOI: 10.1016/j.schres.2017.04.046] [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: 12/28/2016] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
Cannabis is the third most common recreational drug used world-wide after tobacco and alcohol. Globally, cannabis legalization is becoming more common. In light of its known link to psychosis development, it is imperative that we are well-informed regarding the impact of cannabis on the course of psychosis, in both males and females. However, the majority of the work to date on the role of cannabis in psychosis outcomes has not had a gender focus, important when considering patient specific treatments. This review examines what is currently known, from gender focused studies, about the interaction of gender, cannabis use and psychotic disorders.
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Affiliation(s)
- Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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41
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Ouellet-Plamondon C, Abdel-Baki A, Salvat É, Potvin S. Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychol Med 2017; 47:2461-2471. [PMID: 28424105 DOI: 10.1017/s0033291717000976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances. METHODS This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP. RESULTS Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization). CONCLUSION The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.
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Affiliation(s)
- C Ouellet-Plamondon
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - A Abdel-Baki
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - É Salvat
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - S Potvin
- Department of Psychiatry, Faculty of Medicine,Université de Montréal,Montreal, Quebec,Canada
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42
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Miller CL. The disconnect between the science on cannabis and public health campaigns. Addiction 2017; 112:1882-1883. [PMID: 28762233 DOI: 10.1111/add.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 05/23/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
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43
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Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, Murray R, Bhattacharyya S. Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis. Lancet Psychiatry 2017; 4:627-633. [PMID: 28705600 PMCID: PMC5522816 DOI: 10.1016/s2215-0366(17)30233-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND Cannabis use following the onset of first-episode psychosis has been linked to both increased risk of relapse and non-adherence with antipsychotic medication. Whether poor outcome associated with cannabis use is mediated through an adverse effect of cannabis on medication adherence is unclear. METHODS In a prospective analysis of data acquired from four different adult inpatient and outpatient units of the South London and Maudsley Mental Health National Health Service Foundation Trust in London, UK, 245 patients were followed up for 2 years from the onset of first-episode psychosis. Cannabis use after onset of psychosis was assessed by self-reports in face-to-face follow-up interviews. Relapse data were collected from clinical notes using the WHO Life Chart Schedule. This measure was also used to assess medication adherence on the basis of both face-to-face interviews and clinical notes. Patients were included if they had a diagnosis of first-episode non-organic or affective psychosis according to ICD-10 criteria, and were aged between 18 and 65 years when referred to local psychiatric services. We used structural equation modelling analysis to estimate whether medication adherence partly mediated the effects of continued cannabis use on risk of relapse. The primary outcome variable was relapse, defined as admission to a psychiatric inpatient unit after exacerbation of symptoms within 2 years of first presentation to psychiatric services. Information on cannabis use over the first 2 years after onset of psychosis was investigated as a predictor variable for relapse. Medication adherence was assessed as a mediator variable on the basis of clinical records and self-report data. Study researchers (TS, NP, EK, and EF) rated the adherence. FINDINGS 397 patients who presented with their first episode of psychosis between April 12, 2002, and July 26, 2013 had a follow-up assessment until September, 2015. Of the 397 patients approached for followed up, 133 refused to take part in this study and 19 could not be included because of missing data. 91 (37%) of 245 patients with first-episode psychosis had a relapse over the 2 years of follow-up. Continued cannabis use predicted poor outcome, including risk of relapse, number of relapses, length of relapse, and care intensity at follow-up. In controlled structural equation modelling analyses, medication adherence partly mediated the effect of continued cannabis use on outcome, including risk of relapse (proportion mediated=26%, βindirect effects=0·08, 95% CI 0·004 to 0·16), number of relapses (36%, βindirect effects=0·07, 0·003 to 0·14), time until relapse (28%, βindirect effects=-0·26, -0·53 to 0·001) and care intensity (20%, βindirect effects=0·06, 0·004 to 0·11) but not length of relapse (6%, βindirect effects=0·03, -0·03 to 0·09). The adjusted models explained moderate amounts of variance for outcomes defined as risk of relapse (R2=0·25), number of relapses (R2=0·21), length of relapse (R2=0·07), time until relapse (R2=0·08), and care intensity index (R2=0·15). INTERPRETATION Between 20% and 36% of the adverse effects of continued cannabis use on outcome in psychosis might be mediated through the effects of cannabis use on medication adherence. Interventions directed at medication adherence could partly help mitigate the harm from cannabis use in psychosis. FUNDING This study is funded by the National Institute of Health Research (NIHR) Clinician Scientist award.
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Affiliation(s)
- Tabea Schoeler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewa Klamerus
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Enrico Foglia
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Engh JA, Bramness JG. Psychosis relapse, medication non-adherence, and cannabis. Lancet Psychiatry 2017; 4:578-579. [PMID: 28705599 DOI: 10.1016/s2215-0366(17)30254-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 05/29/2017] [Accepted: 06/02/2017] [Indexed: 01/13/2023]
Affiliation(s)
- John A Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
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Weibell MA, Hegelstad WTV, Auestad B, Bramness J, Evensen J, Haahr U, Joa I, Johannessen JO, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, McGorry P, Friis S. The Effect of Substance Use on 10-Year Outcome in First-Episode Psychosis. Schizophr Bull 2017; 43:843-851. [PMID: 28199703 PMCID: PMC5472130 DOI: 10.1093/schbul/sbw179] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Substance use is common in first-episode psychosis (FEP) and has been linked to poorer outcomes with more severe psychopathology and higher relapse rates. Early substance discontinuation appears to improve symptoms and function. However, studies vary widely in their methodology, and few have examined patients longitudinally, making it difficult to draw conclusions for practice and treatment. We aimed to investigate the relationship between substance use and early abstinence and the long-term course of illness in a representative sample of FEP patients. Out of 301 included patients, 266 could be divided into 4 groups based on substance use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users and nonusers. Differences in clinical and functional measures during the follow-up period were assessed using linear mixed effects models for the analysis of repeated measures data. Patients who stopped using substances within the first 2 years after diagnosis had outcomes similar to those who had never used with fewer symptoms than episodic or persistent users. Both episodic and persistent users had lower rates of symptom remission than nonusers, and persistent users also had more negative symptoms than those who stopped using. Our findings emerge from one of very few long-term longitudinal studies examining substance use cessation in FEP with 10-year follow-up. The results convey hope that the detrimental effects of substance abuse on mental health may be significantly reversed if one stops the abuse in time. This can help patients who struggle with addiction with their motivation to embrace abstinence.
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Affiliation(s)
- Melissa A. Weibell
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway;,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- SERAF, Norwegian Centre for Addiction Research, Oslo, Norway;,Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Julie Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Inge Joa
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Regional Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway;,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway;,Vestre Viken Hospital Trust, Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Zealand Region, Psychiatry East and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark;,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Per Vaglum
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia;,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Svein Friis
- Institute of Psychiatry, Faculty of Medicine, University of Oslo, Oslo, Norway;,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Symptomatic and functional outcomes of substance use disorder persistence 2 years after admission to a first-episode psychosis program. Psychiatry Res 2017; 247:113-119. [PMID: 27888680 DOI: 10.1016/j.psychres.2016.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/23/2022]
Abstract
Substance use disorders (SUD) in first-episode psychosis (FEP) are highly prevalent and linked with poor outcomes. However, most longitudinal studies investigating their impacts in FEP have not reported proportions of patients who ceased SUD. Our aim was to examine the influence of SUD course on functional and symptomatic outcomes as well as service use in FEP. We performed a 2-year longitudinal study of 212 FEP patients, aged between 18 and 30 years, admitted to 2 early psychosis services in Montréal, Québec, Canada. We observed that cannabis was the first substance abused (42.9% at baseline), followed by alcohol (19.3%). The SUD rate decreased by approximately 30% during the first year. Patients with persistent SUD had worse functional outcomes (Quality of Life Scale, Social and Occupational Functioning Assessment Scale, employment), more symptoms (Positive and Negative Symptoms Scale) and heavier service use (emergency and hospitalization). SUD persistence was associated with illness severity, homelessness and cluster-B personality. Those living with their parents and financially supported by them were more likely to cease SUD. Our results indicate that SUD course was more significant than having SUD at admission; persistent SUD was associated with worse outcomes. SUD decreased during a general early psychosis intervention program (with no specialized SUD treatment). An integrated, specialized approach targeting FEP patients with predictive factors of SUD persistence during the first years of treatment might increase SUD cessation and possibly improve outcomes.
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Pieterse D, Temmingh H, Vogel W. Factors associated with readmission in South African adolescents discharged from two inpatient psychosocial rehabilitation units. J Child Adolesc Ment Health 2016; 28:199-212. [PMID: 27998264 DOI: 10.2989/17280583.2016.1259165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to describe the socio-demographic and clinical factors associated with readmission in an adolescent population discharged from two inpatient psychosocial rehabilitation (PSR) units in Cape Town, South Africa. METHOD Data were obtained from 97 consecutive patients discharged from two adolescent psychiatric PSR units over a period of one year. Patients were followed up for readmission to hospitals offering specialised psychiatric care in the Western Cape Province over a period of 18 months. RESULTS 35 patients (36%) were readmitted during the study period. Multivariable analysis showed that previous admission increased readmission rate (Incidence Rate Ratio (IRR): 8.01, p < 0.001). Adolescents who were still schooling (IRR: 0.29, p < 0.001) or had a higher level of education (IRR: 0.45, p = 0.001) were less likely to be readmitted. No association was seen with type of diagnosis and readmission, although 51 adolescents (53%) were diagnosed on the schizophrenia spectrum of disorders. CONCLUSION Study findings highlight the need for increased collaboration between the Departments of Health and Education. Furthermore, the study illustrates the need for specific post-discharge community follow-up for adolescents. Prospective research in this particular population group is needed to contribute to the literature on factors associated with readmission in South African adolescent patients.
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Affiliation(s)
- Deirdre Pieterse
- a Department of Psychiatry and Mental Health , University of Cape Town , South Africa
| | - Henk Temmingh
- a Department of Psychiatry and Mental Health , University of Cape Town , South Africa
| | - Wendy Vogel
- a Department of Psychiatry and Mental Health , University of Cape Town , South Africa
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Schoeler T, Petros N, Di Forti M, Klamerus E, Foglia E, Ajnakina O, Gayer-Anderson C, Colizzi M, Quattrone D, Behlke I, Shetty S, McGuire P, David AS, Murray R, Bhattacharyya S. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study. Lancet Psychiatry 2016; 3:947-953. [PMID: 27567467 DOI: 10.1016/s2215-0366(16)30188-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although cannabis use after a first episode of psychosis has been associated with relapse, little is known about the determinants of this most preventable risk factor for relapse of psychosis. Here we aimed to study whether the effects on outcome vary depending on the type of cannabis consumed and usage pattern. METHODS In this observational study, we prospectively recruited and followed up patients aged 18-65 years who presented with their first episode of psychosis to psychiatric services in south London, London, UK. Relapse of psychosis within 2 years after onset of psychosis was defined as risk of subsequent admission to hospital. We classified patients into different patterns of cannabis use based on continuity of use after onset of psychosis, potency of cannabis consumed, and frequency of use after the onset of their illness. We used multiple regression analyses (logistic or binominal) to compare the different cannabis use groups and propensity score analysis to validate the results. FINDINGS Between April 12, 2002, and July 26, 2013, 256 patients presented with a first episode of psychosis. We did follow-up assessments for these patients until September, 2015. Simple analyses showed that former regular users of cannabis who stopped after the onset of psychosis had the most favourable illness course with regards to relapse. In multiple analysis, continued high-frequency users (ie, daily use in all 24 months) of high-potency (skunk-like) cannabis had the worst outcome, indexed as an increased risk for a subsequent relapse (odds ratio [OR] 3·28; 95% CI 1·22-9·18), more relapses (incidence rate ratio 1·77; 95% CI 0·96-3·25), fewer months until a relapse occurred (b -0·22; 95% CI -0·40 to -0·04), and more intense psychiatric care (OR 3·16; 95% CI 1·26-8·09) after the onset of psychosis. INTERPRETATION Adverse effects associated with continued use of cannabis after the onset of a first episode of psychosis depend on the specific patterns of use. Possible interventions could focus on persuading cannabis-using patients with psychosis to reduce use or shift to less potent forms of cannabis. FUNDING National Institute for Health Research (NIHR).
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Affiliation(s)
- Tabea Schoeler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Natalia Petros
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ewa Klamerus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Enrico Foglia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olesya Ajnakina
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Marco Colizzi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Diego Quattrone
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Irena Behlke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sachin Shetty
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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49
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González-Pinto A, González-Ortega I, Alberich S, Ruiz de Azúa S, Bernardo M, Bioque M, Cabrera B, Corripio I, Arango C, Lobo A, Sánchez-Torres AM, Cuesta MJ. Opposite Cannabis-Cognition Associations in Psychotic Patients Depending on Family History. PLoS One 2016; 11:e0160949. [PMID: 27513670 PMCID: PMC4981356 DOI: 10.1371/journal.pone.0160949] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022] Open
Abstract
The objective of this study is to investigate cognitive performance in a first-episode psychosis sample, when stratifying the interaction by cannabis use and familial or non-familial psychosis. Hierarchical-regression models were used to analyse this association in a sample of 268 first-episode psychosis patients and 237 controls. We found that cannabis use was associated with worse working memory, regardless of family history. However, cannabis use was clearly associated with worse cognitive performance in patients with no family history of psychosis, in cognitive domains including verbal memory, executive function and global cognitive index, whereas cannabis users with a family history of psychosis performed better in these domains. The main finding of the study is that there is an interaction between cannabis use and a family history of psychosis in the areas of verbal memory, executive function and global cognition: that is, cannabis use is associated with a better performance in patients with a family history of psychosis and a worse performance in those with no family history of psychosis. In order to confirm this hypothesis, future research should explore the actual expression of the endocannabinoid system in patients with and without a family history of psychosis.
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Affiliation(s)
- Ana González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country, Vitoria, Spain
| | - Itxaso González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country, Vitoria, Spain
| | - Susana Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country, Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country, Vitoria, Spain
| | - Miguel Bernardo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Miquel Bioque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Bibiana Cabrera
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Iluminada Corripio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Celso Arango
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department. Gregorio Marañón General University Hospital. School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Antonio Lobo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- University of Zaragoza, Zaragoza, Spain
- Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - Ana M. Sánchez-Torres
- Department of Psychiatry, Navarre Hospital Complex, Pamplona, Spain. IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - Manuel J. Cuesta
- Department of Psychiatry, Navarre Hospital Complex, Pamplona, Spain. IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
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González-Ortega I, Echeburúa E, García-Alocén A, Vega P, González-Pinto A. Cognitive behavioral therapy program for cannabis use cessation in first-episode psychosis patients: study protocol for a randomized controlled trial. Trials 2016; 17:372. [PMID: 27473688 PMCID: PMC4966873 DOI: 10.1186/s13063-016-1507-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 07/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The high rate of cannabis use among patients with first-episode psychosis (FEP), as well as the associated negative impact on illness course and treatment outcomes, underlines the need for effective interventions in these populations. However, to date, there have been few clinical treatment trials (of pharmacological or psychological interventions) that have specifically focused on addressing comorbid cannabis use among these patients. The aim of this paper is to describe the design of a study protocol for a randomized controlled trial in which the objective is to assess the efficacy of a specific cognitive behavioral therapy program for cannabis cessation in patients with FEP compared to standard treatment (psychoeducation). METHODS/DESIGN This is a single-blind randomized study with 1 year of follow-up. Patients are to be randomly assigned to one of two treatments: (1) specific cognitive behavioral therapy for cannabis cessation composed of 1-hour sessions once a week for 16 weeks, in addition to pharmacological treatment scheduled by the psychiatrist, or (2) a control group (psychoeducation + pharmacological treatment) following the same format as the experimental group. Participants in both groups will be evaluated at baseline (pre-treatment), at 16 weeks (post-treatment), and at 3 and 6 months and 1 year of follow-up. The primary outcome will be that patients in the experimental group will have greater cannabis cessation than patients in the control group at post-treatment. The secondary outcome will be that the experimental group will have better clinical and functional outcomes than the control group. DISCUSSION This study provides the description of a clinical trial design based on specific cognitive behavioral therapy for cannabis cessation in FEP patients, aiming to improve clinical and functional outcome, as well as tackling the addictive disorder. TRIAL REGISTRATION NCT02319746 ClinicalTrials.gov Identifier. ClinicalTrials.gov Protocol and Results Registration System (PRS) Receipt Release Date: 15 December 2014.
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Affiliation(s)
- Itxaso González-Ortega
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain. .,Department of Psychiatry, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain. .,School of Psychology, University of the Basque Country, San Sebastián, Spain.
| | - Enrique Echeburúa
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain.,School of Psychology, University of the Basque Country, San Sebastián, Spain
| | - Adriana García-Alocén
- Department of Psychiatry, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain
| | - Patricia Vega
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain
| | - Ana González-Pinto
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,School of Medicine, University of the Basque Country, Vitoria, Spain
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