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Cavalcante DA, Noto M, Cerqueira RDO, Costa GO, Coutinho L, Malinovski F, Fonseca AO, Santoro ML, Ota V, Cordeiro Q, Bressan RA, Belangero S, Gadelha A, Noto C. GAPi: A description of the initiative for early psychosis intervention in Latin America and the short- to medium-term outcomes in early psychosis patients. Asian J Psychiatr 2024; 98:104104. [PMID: 38878447 DOI: 10.1016/j.ajp.2024.104104] [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: 12/31/2023] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 08/03/2024]
Abstract
INTRODUCTION Schizophrenia is a debilitating disorder that affects a significant proportion of the population and leads to impaired functionality and long-term challenges. The first episode of psychosis (FEP) is a critical intervention stage for improving long-term outcomes. The GAPi program was established in São Paulo, Brazil to provide early intervention services and evaluate biomarkers in individuals with FEP. This article delineates the objectives of the GAPi program, detailing its innovative research protocol, examining the clinical outcomes achieved, and discussing the operational challenges encountered during its initial decade of operation. METHODS The study comprised a prospective cohort of antipsychotic-naïve individuals with first-episode psychosis aged between 16 and 35 years. Participants were recruited from a public psychiatric facility in São Paulo. Emphasizing the initiative's commitment to early intervention, clinical assessments were systematically conducted at baseline and at two months, one year, two years, and five years of treatment to capture both short- and medium-term outcomes. Various assessment tools were utilized, including structured interviews, symptom scales, the Addiction Severity Index, and functional assessments. RESULTS A total of 232 patients were enrolled in the cohort. Among them, 65.95 % completed the 2-month follow-up. Most patients presented with schizophrenia spectrum disorders, followed by bipolar disorder and major depressive disorder with psychotic features. Treatment response rates and remission rates were evaluated at different time points, with promising outcomes observed. The program also assessed socio-demographic factors, substance use, family history, and genetic and biomarker profiles, providing valuable data for research. DISCUSSION The GAPi program has emerged as the largest ongoing cohort of antipsychotic-naïve first-episode psychosis in Latin America, contributing to the understanding of early psychosis in low- and middle-income countries. Despite operational challenges, the program has demonstrated efficacy in reducing the duration of untreated psychosis and in improving clinical outcomes. A multidisciplinary approach, including pharmacological treatment, psychosocial interventions, and family involvement, has been instrumental in enhancing treatment adherence and long-term prognosis. CONCLUSION The GAPi program represents a valuable model for early intervention in first-episode psychosis and provides insights into the pathophysiology, treatment, and long-term outcomes of individuals with schizophrenia and related disorders. Continued research and resource allocation are essential for addressing operational challenges and expanding early intervention services in low- and middle-income countries.
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Affiliation(s)
- Daniel A Cavalcante
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Mariane Noto
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Raphael de O Cerqueira
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Giovany Oliveira Costa
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil; Genetic Division, Department of Morphology and Genetics, UNIFESP, Brazil
| | - Luccas Coutinho
- Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Fernando Malinovski
- Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Ana Olívia Fonseca
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil
| | - Marcos Leite Santoro
- Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil; Genetic Division, Department of Morphology and Genetics, UNIFESP, Brazil
| | - Vanessa Ota
- Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil; Genetic Division, Department of Morphology and Genetics, UNIFESP, Brazil
| | - Quirino Cordeiro
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil
| | - Rodrigo A Bressan
- Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil; Instituto Ame Sua Mente, Brazil
| | - Sintia Belangero
- Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil; Genetic Division, Department of Morphology and Genetics, UNIFESP, Brazil
| | - Ary Gadelha
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil
| | - Cristiano Noto
- Grupo de Atenção às Psicose Iniciais (GAPi), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Centro de Pesquisa e Inovação em Prevenção de Transtornos Mentais e Uso de Álcool e Outras Drogas (CEPIPREV), Health Ministry, Brazil; Programa de Esquizofrenia (PROESQ), UNIFESP, Brazil; Laboratório de Neurociências Integrativas (LINC), UNIFESP, Brazil.
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Hjorthøj C, Stürup A, Karlsen M, Speyer H, Osler M, Ongur D, Nordentoft M. Use of antipsychotic medication, benzodiazepines, and psychiatric hospitalization in cannabis-related versus cannabis-unrelated schizophrenia - a nationwide, register-based cohort study. Psychol Med 2024:1-10. [PMID: 38571303 DOI: 10.1017/s0033291724000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Evidence suggests that cannabis may be a causal factor for development of schizophrenia. We aimed to investigate whether use of antipsychotic medication, benzodiazepines, and psychiatric service use differs among patients with schizophrenia depending on whether psychosis was precipitated by a diagnosis of cannabis use disorder (CUD). METHODS We utilized the nationwide Danish registries to identify all individuals with an incident diagnosis of schizophrenia from 1995 to 2016. We also collected information on whether first CUD diagnosis preceded schizophrenia and thus defined a group of potentially cannabis-related schizophrenia. We compared the cannabis-related schizophrenia group both with all non-cannabis-related patients with schizophrenia and with non-cannabis-related patients with schizophrenia that were propensity-score matched to cases using a range of potentially confounding variables. RESULTS We included 35 714 people with incident schizophrenia, including 4116 (11.5%) that were cannabis-related. In the unmatched-comparison analyses, there were no clear differences over time in use of antipsychotics and benzodiazepines related to whether the diagnosis of schizophrenia was cannabis-related. After propensity-score matching, use of antipsychotics and benzodiazepines was significantly lower among cannabis-related cases of schizophrenia. In the unmatched comparison, the cannabis-related group had significantly more days admitted than the non-cannabis-related group. This was markedly attenuated after propensity-score matching. CONCLUSIONS Our findings indicate the importance of considering cannabis-related cases of schizophrenia as a potentially distinct disorder in terms of prognosis. It is unclear, however, if these differences are due to different biological types of schizophrenia being compared or if they rather indicate behavioral differences such as reduced adherence and treatment-seeking.
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Affiliation(s)
- Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Section of Epidemiology, Copenhagen, Denmark
| | - Anne Stürup
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
| | - Mette Karlsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
| | - Helene Speyer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Section of Epidemiology, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
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Murta JCD, Easpaig BNG, Hazell-Raine K, Byrne MK, Lertwatthanawilat W, Kritkitrat P, Bressington D. Recreational cannabis policy reform-What mental health nurses need to know about minimising harm and contributing to the reform debate. J Psychiatr Ment Health Nurs 2024; 31:270-282. [PMID: 37767750 DOI: 10.1111/jpm.12984] [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: 04/04/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
The recently rapidly evolving legal status of recreational cannabis in various countries has triggered international debate, particularly around measures required to minimise resulting harms. The present article argues that mental health nurses should have a key role in promoting safe and appropriate use of recreational cannabis, and minimising harm based on the extant evidence. The article summarises the factors driving legalisation, outlines the evident medicinal benefits of cannabis, and appraises the evidence on the negative mental health impacts associated with use. We go on to discuss research findings on the potentially deleterious mental health effects resulting from legalising recreational cannabis and strategies to minimise these harms, including directions for future research and evaluation. Further, we consider the importance of the implementation of harm minimisation measures that are context-specific, using Thailand as an example. Finally, we present the key health promotion messages that mental health nurses should aim to convey to people who use or consider using recreational cannabis. Ultimately, we aim to provide a summary of the existing evidence that mental health nurses can draw upon to promote mental health and engage with the policy reform debate.
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Affiliation(s)
| | | | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mitchell K Byrne
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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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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Sainz-Cort A, Jimenez-Garrido D, Muñoz-Marron E, Viejo-Sobera R, Heeroma J, Bouso JC. The Effects of Cannabidiol and δ-9-Tetrahydrocannabinol in Social Cognition: A Naturalistic Controlled Study. Cannabis Cannabinoid Res 2024; 9:230-240. [PMID: 35881851 DOI: 10.1089/can.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Social cognition abilities such as empathy and the Theory of Mind (ToM) have been shown to be impaired in neuropsychiatric conditions such as psychotic, autistic, and bipolar disorders. The endocannabinoid system (ECS) seems to play a role in social behavior and emotional processing while it also seems to play a role in those neuropsychiatric conditions showing social cognition impairments. Main plant cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) modulate the ECS and, due to their opposite effects, have been proposed as both cause and treatment for neuropsychiatric-related disorders such as schizophrenia, anxiety, or post-traumatic stress disorder (PTSD). The aim of this study was to test the effects of THC and CBD on social cognition abilities in chronic cannabis users. Method: Eighteen members from a cannabis social club were tested for social cognition effects under the effects of different full spectrum cannabis extracts containing either THC, CBD, THC+CBD, or placebo in a naturalistic randomized double-blind crossover placebo-controlled study. Results: Results showed that participants under the effects of THC showed lower cognitive empathy when compared with the effects of CBD but not when those were compared with THC+CBD or placebo. Also, participants showed higher cognitive ToM under the effects of CBD when compared with the effects of placebo, but not when those were compared with THC or THC+CBD. However, we did not find differences on the emotional scales for empathy or ToM. Conclusions: This study provides evidence for the interaction between the effects of THC and CBD and social cognition abilities in a naturalistic environment, which can be of special interest for the clinical practice of medical cannabis on neuropsychiatric disorders. We show for the first time that CBD can improve ToM abilities in chronic cannabis users. Our results might help to understand the role of the ECS in social cognition, and their association with psychiatric and neurodevelopmental disorders such as schizophrenia or autism. Finally, we demonstrate how reliable methodologies can be implemented in naturalistic environments to collect valid ecological evidence outside classic laboratory settings.
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Affiliation(s)
- Alberto Sainz-Cort
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- International Center of Ethnobotanic Education, Research and Service (ICEERS), Barcelona, Spain
- GH Medical, Amsterdam, The Netherlands
| | - Daniel Jimenez-Garrido
- International Center of Ethnobotanic Education, Research and Service (ICEERS), Barcelona, Spain
| | - Elena Muñoz-Marron
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Raquel Viejo-Sobera
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | | | - Jose Carlos Bouso
- International Center of Ethnobotanic Education, Research and Service (ICEERS), Barcelona, Spain
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Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Anderson KK, Rodrigues R, Le B, Mamun M, Archie S, Edwards J, Elton-Marshall T, Gilliland J, Myran DT, Palaniyappan L, Perlman CM, Seabrook JA, Murray RM, Shariff SZ. Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104285. [PMID: 38071933 DOI: 10.1016/j.drugpo.2023.104285] [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: 03/14/2023] [Revised: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. METHODS We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. RESULTS We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014-2020). CONCLUSION Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | | | - Maliha Mamun
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Jordan Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Tara Elton-Marshall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa ON Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Canada; Dalla Lana School of Public Health, University of Toronto, Toronto ON Canada
| | - Jason Gilliland
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Geography and Environment, Western University, London ON Canada
| | - Daniel Thomas Myran
- Department of Family Medicine, University of Ottawa, Ottawa ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON Canada; ICES uOttawa, Ottawa Hospital Research Institute, Ottawa ON Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal ON Canada
| | | | - Jamie A Seabrook
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Food and Nutritional Sciences, Brescia University College, London ON Canada
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada
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8
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Groening JM, Denton E, Parvaiz R, Brunet DL, Von Daniken A, Shi Y, Bhattacharyya S. A systematic evidence map of the association between cannabis use and psychosis-related outcomes across the psychosis continuum: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res 2024; 331:115626. [PMID: 38096722 DOI: 10.1016/j.psychres.2023.115626] [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: 07/12/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 01/02/2024]
Abstract
While the legal status and public perception of cannabis are currently changing in many countries, one of the important considerations from a public health viewpoint is its potential association with adverse health outcomes such as the development of psychosis. We conducted an umbrella review of systematic reviews and meta-analyses using the AMSTAR-2 to assess the quality of included reviews. We further created an evidence map to visualize and facilitate the overview of the published evidence synthesis on the association between cannabis use and all psychosis-related outcomes and risk moderators in healthy, high-risk, and clinical populations. Overall, we found 32 systematic reviews and meta-analyses. Based on a synthesis of current evidence, cannabis use is associated with subclinical psychosis states (psychotic-like experiences) and traits (schizotypal personality) in the healthy population, as well as earlier onset and development of psychosis. An association with the clinical-high-risk state for psychosis, attenuated psychosis symptoms and transition to psychosis in this population could not be confirmed. An association between cannabis use and psychosis outcomes in patients with psychotic disorder could solely be confirmed regarding relapse. Whether causal effects underlie those associations has not sufficiently been addressed in the evidence synthesis to date.
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Affiliation(s)
- Johanna Manja Groening
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Emma Denton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Rimsha Parvaiz
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - David Losada Brunet
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Aisha Von Daniken
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Yiling Shi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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Ghelani A. Perspectives toward cannabidiol (CBD) among youth in Early Psychosis Intervention programs: A qualitative study. Early Interv Psychiatry 2024; 18:10-17. [PMID: 37038248 DOI: 10.1111/eip.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/30/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
AIM Cannabis is used by one third of youth in Early Psychosis Intervention (EPI) programs and high dose consumption of the primary constituent Δ-9 tetrahydrocannabinol (THC) is associated with higher risk for relapse in this group. Cannabidiol (CBD) is a secondary cannabis constituent that may have antipsychotic properties, though its health risks are only beginning to be understood. Little is known about the views of youth in EPI programs toward CBD, including their reasons for use and perceptions of risk. METHODS This qualitative study used Interpretive Phenomenological Analysis to investigate the perspectives of a sample (n = 15) of cannabis-consuming youth in EPI programs toward CBD. RESULTS Those who used CBD (n = 13) did so for pain relief, THC substitution, relaxation, social reasons, and sleep enhancement. CBD was perceived to be beneficial for health and wellness, though many consumers were disappointed with its effects. Most believed there were no risks associated with its use or were unaware of any risks, and all believed CBD could be used safely. CONCLUSION Clinicians should assess THC and CBD consumption patterns, motives for use, and perceptions of risk separately to tailor interventions accordingly. Youth in EPI programs would benefit from education related to the known health risks and benefits associated with this drug. Clinicians in regions where cannabis is regulated should be open to discussing CBD as a safer substitute for THC. The potential for CBD to serve as viable treatment for psychosis requires further study.
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Affiliation(s)
- Amar Ghelani
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
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de Medeiros MW, Andrade JC, Haddad NM, Mendonça M, de Jesus LP, Fekih-Romdhane F, van de Bilt MT, Gattaz WF, Loch AA. Cannabis use influences disorganized symptoms severity but not transition in a cohort of non-help-seeking individuals at-risk for psychosis from São Paulo, Brazil. Psychiatry Res 2024; 331:115665. [PMID: 38113810 DOI: 10.1016/j.psychres.2023.115665] [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] [Received: 07/21/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Cannabis use is associated with an increased risk of developing a psychotic disorder. However, in individuals with at-risk mental states for psychosis (ARMS) this association is not clear, as well as the impact of cannabis use on symptom severity. The objective of this study was to evaluate the association of cannabis use patterns and ARMS risk status, transition to psychotic and psychiatric disorders, and psychopathology. METHOD A sample of 109 ARMS and 197 control individuals was drawn from the general population. Lifetime, maximum and current amount of cannabis use were assessed with the South Westminster modified questionnaire. Participants were followed-up for a mean of 2.5 years and reassessed for transition to any psychiatric disorder. RESULTS There were no differences between ARMS and controls regarding lifetime use, current amount of use, or maximum amount of cannabis use. There were also no differences between those who transitioned to a psychiatric disorder and those who did not regarding cannabis use variables. In ARMS individuals, cannabis use was significantly related to disorganization symptoms. CONCLUSION The results of this study suggest that cannabis plays a role in the psychopathology of ARMS individuals, leading to more severe symptomatology.
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Affiliation(s)
- Matheus Wanderley de Medeiros
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Julio Cesar Andrade
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Mansur Haddad
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Melina Mendonça
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leonardo Peroni de Jesus
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010 Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Martinus Theodorus van de Bilt
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Wagner Farid Gattaz
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.
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Merola GP, Boy OB, Fascina I, Pecoraro V, Falone A, Patti A, Santarelli G, Cicero DC, Ballerini A, Ricca V. Aberrant Salience Inventory: A meta-analysis to investigate its psychometric properties and identify screening cutoff scores. Scand J Psychol 2023; 64:734-745. [PMID: 37243361 DOI: 10.1111/sjop.12931] [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: 02/18/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The Aberrant Salience Inventory (ASI) is a useful tool to measure salience abnormalities among the general population. There is strong clinical and scientific evidence that salience alteration is linked to psychosis. To the present day, no meta-analysis evaluating ASI's psychometric properties and screening potential has been published. MATERIALS AND METHODS PubMed, Google Scholar, Scopus, and Embase were searched using terms including "psychosis," "schizophrenia," and "Aberrant Salience Inventory." Observational and experimental studies employing ASI on populations of non-psychotic controls and patients with psychosis were included. ASI scores and other demographic measures (age, gender, ethnicity) were extracted as outcomes. Individual patients' data (IPD) were collected. Exploratory factor analysis (EFA) was performed on the IPD. RESULTS Eight articles were finally included in the meta-analysis. ASI scores differ significantly between psychotic and non-psychotic populations; a novel three-factor model is proposed regarding subscales structure. Theoretical positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and presented together with different cutoff points depending on preselected specific populations of interest. DISCUSSION PPV and NPV values reached levels adequate for ASI to be considered a viable screening tool for psychosis. The factor analysis highlights the presence of a novel subscale that was named "Unveiling experiences." Implications regarding the meaning of the new factor structure are discussed, as well as ASI's potential as a screening tool.
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Affiliation(s)
| | - Ottone Baccaredda Boy
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Isotta Fascina
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo Pecoraro
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Falone
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Patti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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12
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Myran DT, Pugliese M, Roberts RL, Solmi M, Perlman CM, Fiedorowicz J, Tanuseputro P, Anderson KK. Association between non-medical cannabis legalization and emergency department visits for cannabis-induced psychosis. Mol Psychiatry 2023; 28:4251-4260. [PMID: 37500826 DOI: 10.1038/s41380-023-02185-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
A major public health concern of cannabis legalization is that it may result in an increase in psychotic disorders. We examined changes in emergency department (ED) visits for cannabis-induced psychosis following the legalization and subsequent commercialization (removal of restrictions on retail stores and product types) of non-medical cannabis in Ontario, Canada (population of 14.3 million). We used health administrative data containing the cause of all ED visits to examine changes over three periods; 1) pre-legalization (January 2014-September 2018); 2) legalization with restrictions (October 2018 - February 2020); and 3) commercialization (March 2020 - September 2021). We considered subgroups stratified by age and sex and examined cocaine- and methamphetamine-induced psychosis ED visits as controls. During our study, there were 6300 ED visits for cannabis-induced psychosis. The restricted legalization period was not associated with changes in rates of ED visits for cannabis-induced psychosis relative to pre-legalization. The commercialization period was associated with an immediate increase in rates of ED visits for cannabis-induced psychosis (IRR 1.30, 95% CI 1.02-1.66) and no gradual monthly change; immediate increases were seen only for youth above (IRR 1.63, 1.27-2.08, ages 19-24) but not below (IRR 0.73 95%CI 0.42-1.28 ages, 15-18) the legal age of purchase, and similar for men and women. Commercialization was not associated with changes in rates of ED visits for cocaine- or methamphetamine-induced psychosis. This suggests that legalization with store and product restrictions does not increase ED visits for cannabis-induced psychosis. In contrast, cannabis commercialization may increase cannabis-induced psychosis presentations highlighting the importance of preventive measures in regions considering legalization.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rhiannon L Roberts
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marco Solmi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | - Jess Fiedorowicz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Neurosciences, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kelly K Anderson
- Departments of Epidemiology & Biostatistics and Psychiatry, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
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Argote M, Sescousse G, Brunelin J, Baudin G, Schaub MP, Rabin R, Schnell T, Ringen PA, Andreassen OA, Addington JM, Brambilla P, Delvecchio G, Bechdolf A, Wobrock T, Schneider-Axmann T, Herzig D, Mohr C, Vila-Badia R, Rodie JU, Mallet J, Ricci V, Martinotti G, Knížková K, Rodriguez M, Cookey J, Tibbo P, Scheffler F, Asmal L, Garcia-Rizo C, Amoretti S, Huber C, Thibeau H, Kline E, Fakra E, Jardri R, Nourredine M, Rolland B. Association between cannabis use and symptom dimensions in schizophrenia spectrum disorders: an individual participant data meta-analysis on 3053 individuals. EClinicalMedicine 2023; 64:102199. [PMID: 37731936 PMCID: PMC10507201 DOI: 10.1016/j.eclinm.2023.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Background The association between cannabis use and positive symptoms in schizophrenia spectrum disorders is well documented, especially via meta-analyses. Yet, findings are inconsistent regarding negative symptoms, while other dimensions such as disorganization, depression, and excitement, have not been investigated. In addition, meta-analyses use aggregated data discarding important confounding variables which is a source of bias. Methods PubMed, ScienceDirect and PsycINFO were used to search for publications from inception to September 27, 2022. We contacted the authors of relevant studies to extract raw datasets and perform an Individual Participant Data meta-analysis (IPDMA). Inclusion criteria were: psychopathology of individuals with schizophrenia spectrum disorders assessed by the Positive and Negative Syndrome Scale (PANSS); cannabis-users had to either have a diagnosis of cannabis use disorder or use cannabis at least twice a week. The main outcomes were the PANSS subscores extracted via the 3-factor (positive, negative and general) and 5-factor (positive, negative, disorganization, depression, excitement) structures. Preregistration is accessible via Prospero: ID CRD42022329172. Findings Among the 1149 identified studies, 65 were eligible and 21 datasets were shared, totaling 3677 IPD and 3053 complete cases. The adjusted multivariate analysis revealed that relative to non-use, cannabis use was associated with higher severity of positive dimension (3-factor: Adjusted Mean Difference, aMD = 0.34, 95% Confidence Interval, CI = [0.03; 0.66]; 5-factor: aMD = 0.38, 95% CI = [0.08; 0.63]), lower severity of negative dimension (3-factor: aMD = -0.49, 95% CI [-0.90; -0.09]; 5-factor: aMD = -0.50, 95% CI = [-0.91; -0.08]), higher severity of excitement dimension (aMD = 0.16, 95% CI = [0.03; 0.28]). No association was found between cannabis use and disorganization (aMD = -0.13, 95% CI = [-0.42; 0.17]) or depression (aMD = -0.14, 95% CI = [-0.34; 0.06]). Interpretation No causal relationship can be inferred from the current results. The findings could be in favor of both a detrimental and beneficial effect of cannabis on positive and negative symptoms, respectively. Longitudinal designs are needed to understand the role of cannabis is this association. The reported effect sizes are small and CIs are wide, the interpretation of findings should be taken with caution. Funding This research did not receive any specific grant or funding. Primary financial support for authors was provided by Le Vinatier Psychiatric Hospital.
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Affiliation(s)
- Mathilde Argote
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Guillaume Sescousse
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Jérôme Brunelin
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Grégoire Baudin
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, F-92100, France
| | - Michael Patrick Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland
| | - Rachel Rabin
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Petter Andreas Ringen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy und Psychosomatic, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, CCM, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Wobrock
- Centre for Mental Health, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
- Department of Psychiatry and Psychotherapy, Georg-August University Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University Munich, Munich, Germany
| | - Daniela Herzig
- Clienia Littenheid AG, Psychiatrische Tagesklinik Frauenfeld, 8500, Frauenfeld, Switzerland
- Department of Experimental Psychology, University of Bristol, Bristol, UK
- Université de Lausanne, Institute of Psychology (IP), Lausanne, Switzerland
| | - Christine Mohr
- Department of Experimental Psychology, University of Bristol, Bristol, UK
- Université de Lausanne, Institute of Psychology (IP), Lausanne, Switzerland
| | - Regina Vila-Badia
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Institut de Recerca Sant Joan de Déu, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Judith Usall Rodie
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Institut de Recerca Sant Joan de Déu, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jasmina Mallet
- Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris France, France
- AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Valerio Ricci
- Department of Neuroscience, San Luigi Gonzaga University Hospital, 10043, Orbassano, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University of Chieti-Pescara, Italy
| | - Karolína Knížková
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital in Prague, Czech Republic
| | - Mabel Rodriguez
- National Institute of Mental Health, Klecany, Czech Republic
| | - Jacob Cookey
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
| | - Philip Tibbo
- Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Silvia Amoretti
- Psychiatric Genetics Unit, Vall d’Hebron Research Institute (VHIR), Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Christian Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Universität Basel, Wilhelm Klein-Str. 27, 4002 Basel, Switzerland
| | - Heather Thibeau
- Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
| | - Emily Kline
- Boston Medical Center, Department of Psychiatry, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
- Department of Psychiatry, Boston University School of Medicine, 801 Massachusetts Avenue, 4th Floor, Boston, MA, 02118, United States of America
| | - Eric Fakra
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Pôle Universitaire de Psychiatrie, CHU Saint-Etienne, Saint-Etienne, France
| | - Renaud Jardri
- Lille University, Inserm U1172-LilNcog-Lille Neuroscience & Cognition, Plasticity and Subjectivity Team, F-59000, Lille, France
- CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Department & CURE Research Platform, Lille, France
| | - Mikail Nourredine
- Université Claude Bernard Lyon 1, Lyon, France
- Service de biostatistique, Hospices Civils de Lyon, Lyon, France
- Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Rolland
- PSYR, CNRL, INSERM U1028, CNRS UMR5292, UCBL1, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Hospitalier Le Vinatier, Bron, France
- Service Universitaire d’Addictologie de Lyon (SUAL), HCL, CH Le Vinatier, Lyon, France
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Yeap ZJS, Marsault J, George TP, Mizrahi R, Rabin RA. Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders? Am J Addict 2023; 32:367-375. [PMID: 36815595 DOI: 10.1111/ajad.13394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of cannabis use disorder (CUD) are higher in people with schizophrenia than in the general population. Irrespective of psychiatric diagnosis, tobacco co-use is prevalent in those with CUD and leads to poor cannabis cessation outcomes. The cannabis withdrawal syndrome is well-established and increases cannabis relapse risk. We investigated whether cannabis withdrawal severity differed as a function of high versus no/low tobacco dependence and psychiatric diagnosis in individuals with CUD. METHOD Men with CUD (N = 55) were parsed into four groups according to schizophrenia diagnosis and tobacco dependence severity using the Fagerstrom Test for Nicotine Dependence (FTND): men with schizophrenia with high tobacco dependence (SCT+, n = 13; FTND ≥ 5) and no/low tobacco dependence (SCT-, n = 22; FTND ≤ 4), and nonpsychiatric controls with high (CCT+, n = 7; FTND ≥ 5) and no/low (CCT-, n = 13; FTND ≤ 4) tobacco dependence. Participants completed the Marijuana Withdrawal Checklist following 12-h of cannabis abstinence. RESULTS There was a significant main effect of tobacco dependence on cannabis withdrawal severity (p < .001). Individuals with high tobacco dependence had significantly greater cannabis withdrawal severity (M = 13.85 [6.8]) compared to individuals with no/low tobacco dependence (M = 6.49, [4.9]). Psychiatric diagnosis and the interaction effects were not significant. Lastly, cannabis withdrawal severity positively correlated with FTND (r = .41, p = .002). CONCLUSION AND SCIENTIFIC SIGNIFICANCE Among individuals with CUD and high tobacco dependence, cannabis withdrawal severity was elevated twofold, irrespective of diagnosis, relative to individuals with CUD and no/low tobacco dependence. Findings from this study emphasize the importance of addressing tobacco co-use when treating CUD.
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Affiliation(s)
- Zac J S Yeap
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Justine Marsault
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
| | - Tony P George
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Complex Interventions and Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Romina Mizrahi
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rachel A Rabin
- Douglas Mental Health University Institute, Verdun, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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15
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O'Donoghue B, Allott K, Harrigan S, Scalzo F, Ward J, Mallawaarachchi S, Whitson S, Baldwin L, Graham J, Mullen E, MacNeil C, Alexander D, Wood SJ, Berk M, Alvarez‐Jimenez M, Thompson A, Fornito A, Yuen HP, Nelson B, Francey SM, McGorry P. Isolating the impact of antipsychotic medication on metabolic health: Secondary analysis of a randomized controlled trial of antipsychotic medication versus placebo in antipsychotic medication naïve first-episode psychosis (the STAGES study). Early Interv Psychiatry 2023; 17:597-607. [PMID: 36196478 PMCID: PMC10947230 DOI: 10.1111/eip.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular and metabolic diseases are the leading contributors to the early mortality associated with psychotic disorders. To date, it has not been possible to disentangle the effect of medication and non-medication factors on the physical health of people with a first episode of psychosis (FEP). This study aimed to isolate the effects of antipsychotic medication on anthropometric measurements, fasting glucose and lipids. METHODS This study utilized data from a triple-blind randomized placebo-controlled trial comparing two groups of antipsychotic-naïve young people with a FEP who were randomized to receive a second-generation antipsychotic medication (FEP-medication group) or placebo (FEP-placebo group) for 6 months. Twenty-seven control participants were also recruited. RESULTS Eighty-one participants commenced the trial; 69.1% completed at least 3 months of the intervention and 33.3% completed the full 6 months. The FEP-placebo group gained a mean of 2.4 kg (±4.9) compared to 1.1 kg (±4.9) in the control participants (t = 0.76, p = .45). After controlling for multiple analyses, there was no difference in blood pressure, waist circumference or heart rate between the FEP-placebo group and controls. After 6 months, the FEP medication group had gained 4.1 kg (±4.5), higher than those receiving placebo but not statistically significant (t = 0.8, p = .44). There were no differences in fasting glucose or lipids between the FEP groups after 3 months. CONCLUSIONS While limited by small numbers and high attrition, these findings indicate that some of the metabolic complications observed in psychotic disorders could be attributable to factors other than medication. This emphasizes the need to deliver physical health interventions early in the course of FEP.
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Allebeck P, Gunnarsson T, Lundin A, Löfving S, Dal H, Zammit S. Does a history of cannabis use influence onset and course of schizophrenia? Acta Psychiatr Scand 2023; 147:614-622. [PMID: 37094811 DOI: 10.1111/acps.13562] [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] [Received: 12/11/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION While evidence strongly supports a causal effect of cannabis on psychosis, it is less clear whether the symptom pattern, clinical course, and outcomes differ in cases of schizophrenia with and without a background of cannabis use. METHODS Analysis of medical records from a longitudinal follow-up of Swedish conscripts with data on cannabis use in adolescence and subsequent incidence of schizophrenia. One hundred sixty patients with schizophrenia were assessed using the OPCRIT protocol. Cases were validated for diagnosis schizophrenia according to OPCRIT. RESULTS Patients with a cannabis history (n = 32), compared to those without (n = 128), had an earlier age at onset, a higher number of hospital admissions and a higher total number of hospital days. There was no significant difference in type of onset and clinical symptom profiles between the groups. CONCLUSION Our findings indicate that the disease burden of schizophrenia is greater in individuals who use cannabis during adolescence. Strengthening evidence on causality and teasing out long-term effects of pre-illness cannabis use from continued post-illness has clinical implications for improving schizophrenia outcomes.
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Affiliation(s)
- Peter Allebeck
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tove Gunnarsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Löfving
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Dal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Center for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Fischer B, Hall W, Fidalgo TM, Hoch E, Foll BL, Medina-Mora ME, Reimer J, Tibbo PG, Jutras-Aswad D. Recommendations for Reducing the Risk of Cannabis Use-Related Adverse Psychosis Outcomes: A Public Mental Health-Oriented Evidence Review. J Dual Diagn 2023; 19:71-96. [PMID: 37450645 DOI: 10.1080/15504263.2023.2226588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Objective: Cannabis use is increasingly normalized; psychosis is a major adverse health outcome. We reviewed evidence on cannabis use-related risk factors for psychosis outcomes at different stages toward recommendations for risk reduction by individuals involved in cannabis use. Methods: We searched primary databases for pertinent literature/data 2016 onward, principally relying on reviews and high-quality studies which were narratively summarized and quality-graded; recommendations were developed by international expert consensus. Results: Genetic risks, and mental health/substance use problem histories elevate the risks for cannabis-related psychosis. Early age-of-use-onset, frequency-of-use, product composition (i.e., THC potency), use mode and other substance co-use all influence psychosis risks; the protective effects of CBD are uncertain. Continuous cannabis use may adversely affect psychosis-related treatment and medication effects. Risk factor combinations further amplify the odds of adverse psychosis outcomes. Conclusions: Reductions in the identified cannabis-related risks factors-short of abstinence-may decrease risks of related adverse psychosis outcomes, and thereby protect cannabis users' health.
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Affiliation(s)
- Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Research and Graduate Studies Division, University of the Fraser Valley, Abbotsford, Canada
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Australia
| | - Thiago M Fidalgo
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilian-University, Munich, Germany
- Institut für Therapieforschung (IFT), Munich, Germany
| | - Bernard Le Foll
- Translational Addiction Research Laboratory and Campbell Family Mental Health Research Institute and Acute Care Program, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology and Toxicology and Dalla Lana School of Public Health and Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| | - Maria-Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jens Reimer
- Departments of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Center for Psychosocial Medicine, Academic Teaching Hospital Itzehoe, Itzehoe, Germany
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Édouard Montpetit Boulevard, Montreal, Canada
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18
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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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19
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Al-Gburi K, Abd Alridha AM, Abbood SK, Ali AB, Salih AT. Tobacco smoking and substance use among medical undergraduates in Najaf, Iraq: prevalence and associated factors. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2173093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Karrar Al-Gburi
- Department of Clinical Pharmacy, University of Kufa, Najaf, Iraq
| | | | | | - Ahmed Basim Ali
- Department of Clinical Pharmacy, University of Kufa, Najaf, Iraq
| | - Ali Talib Salih
- Department of Clinical Pharmacy, University of Kufa, Najaf, Iraq
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20
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[Cannabis use and impulsivity in violent behaviour]. L'ENCEPHALE 2023; 49:97-99. [PMID: 35738924 DOI: 10.1016/j.encep.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023]
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21
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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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22
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D'Souza DC, DiForti M, Ganesh S, George TP, Hall W, Hjorthøj C, Howes O, Keshavan M, Murray RM, Nguyen TB, Pearlson GD, Ranganathan M, Selloni A, Solowij N, Spinazzola E. Consensus paper of the WFSBP task force on cannabis, cannabinoids and psychosis. World J Biol Psychiatry 2022; 23:719-742. [PMID: 35315315 DOI: 10.1080/15622975.2022.2038797] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The liberalisation of cannabis laws, the increasing availability and potency of cannabis has renewed concern about the risk of psychosis with cannabis. METHODS The objective of the WFSBP task force was to review the literature about this relationship. RESULTS Converging lines of evidence suggest that exposure to cannabis increases the risk for psychoses ranging from transient psychotic states to chronic recurrent psychosis. The greater the dose, and the earlier the age of exposure, the greater the risk. For some psychosis outcomes, the evidence supports some of the criteria of causality. However, alternate explanations including reverse causality and confounders cannot be conclusively excluded. Furthermore, cannabis is neither necessary nor sufficient to cause psychosis. More likely it is one of the multiple causal components. In those with established psychosis, cannabis has a negative impact on the course and expression of the illness. Emerging evidence also suggests alterations in the endocannabinoid system in psychotic disorders. CONCLUSIONS Given that exposure to cannabis and cannabinoids is modifiable, delaying or eliminating exposure to cannabis or cannabinoids, could potentially impact the rates of psychosis related to cannabis, especially in those who are at high risk for developing the disorder.
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Affiliation(s)
- Deepak Cyril D'Souza
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marta DiForti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Suhas Ganesh
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tony P George
- Addictions Division and Centre for Complex Interventions, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wayne Hall
- The National Centre for Youth Substance Use Research, University of Queensland, Brisbane, Australia
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy B Nguyen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.,Institute for Clinical Sciences, Imperial College London, London, UK
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Olin Neuropsychiatry Ctr. Institute of Living, Hartford, CT, USA
| | - Mohini Ranganathan
- Psychiatry Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alex Selloni
- Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE), New Lambton Heights, NSW, Australia
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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23
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Chesney E, Lamper D, Lloyd M, Oliver D, Hird E, McGuire P. Acceptability of cannabidiol in patients with psychosis. Ther Adv Psychopharmacol 2022; 12:20451253221128445. [PMID: 36312845 PMCID: PMC9608242 DOI: 10.1177/20451253221128445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cannabidiol (CBD) is a promising novel candidate treatment for psychosis. It has a more benign side effect profile than antipsychotic medications, and being treated with CBD is not perceived as being stigmatising. These observations suggest that patients with psychosis would find CBD to be a relatively acceptable treatment. Objective This study tested the above hypothesis by assessing the views of a sample of patients. Methods Patients with a psychotic disorder were invited to complete a survey exploring their expectations about the efficacy and side effects of CBD. Results Seventy patients completed the survey. The majority (86%) were willing to try CBD as a treatment. Most patients believed that CBD would improve their psychotic symptoms (69%) and that it would have fewer side effects than their current medication (64%; mainly antipsychotics). A minority of patients (10%) were concerned that CBD might exacerbate their psychotic symptoms. This, however, appeared to reflect confusion between the effects of CBD and those of cannabis. Conclusion Most patients with psychosis regard CBD as an acceptable treatment. Although CBD has not yet been approved as a treatment for psychosis, many patients are aware of it through the presence of CBD in cannabis and in health supplements. When added to the emerging evidence of its efficacy and the low risk of side effects, the high acceptability of CBD underlines its therapeutic potential.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Doga Lamper
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Millie Lloyd
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic Oliver
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emily Hird
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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24
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Zeraatkar D, Cooper MA, Agarwal A, Vernooij RWM, Leung G, Loniewski K, Dookie JE, Ahmed MM, Hong BY, Hong C, Hong P, Couban R, Agoritsas T, Busse JW. Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: a systematic review of non-randomised studies. BMJ Open 2022; 12:e054282. [PMID: 35926992 PMCID: PMC9358949 DOI: 10.1136/bmjopen-2021-054282] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To establish the prevalence of long-term and serious harms of medical cannabis for chronic pain. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CENTRAL from inception to 1 April 2020. STUDY SELECTION Non-randomised studies reporting on harms of medical cannabis or cannabinoids in adults or children living with chronic pain with ≥4 weeks of follow-up. DATA EXTRACTION AND SYNTHESIS A parallel guideline panel provided input on the design and interpretation of the systematic review, including selection of adverse events for consideration. Two reviewers, working independently and in duplicate, screened the search results, extracted data and assessed risk of bias. We used random-effects models for all meta-analyses and the Grades of Recommendations, Assessment, Development and Evaluation approach to evaluate the certainty of evidence. RESULTS We identified 39 eligible studies that enrolled 12 143 adult patients with chronic pain. Very low certainty evidence suggests that adverse events are common (prevalence: 26.0%; 95% CI 13.2% to 41.2%) among users of medical cannabis for chronic pain, particularly any psychiatric adverse events (prevalence: 13.5%; 95% CI 2.6% to 30.6%). Very low certainty evidence, however, indicates serious adverse events, adverse events leading to discontinuation, cognitive adverse events, accidents and injuries, and dependence and withdrawal syndrome are less common and each typically occur in fewer than 1 in 20 patients. We compared studies with <24 weeks and ≥24 weeks of cannabis use and found more adverse events reported among studies with longer follow-up (test for interaction p<0.01). Palmitoylethanolamide was usually associated with few to no adverse events. We found insufficient evidence addressing the harms of medical cannabis compared with other pain management options, such as opioids. CONCLUSIONS There is very low certainty evidence that adverse events are common among people living with chronic pain who use medical cannabis or cannabinoids, but that few patients experience serious adverse events.
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Affiliation(s)
- Dena Zeraatkar
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Adam Cooper
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robin W M Vernooij
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Gareth Leung
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kevin Loniewski
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Jared E Dookie
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Muhammad Muneeb Ahmed
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Brian Y Hong
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Hong
- Health Research Methods, Evidence, and Impact, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Patrick Hong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Epidemiology, University Hospitals Geneva, Geneve, Switzerland
| | - Jason W Busse
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
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25
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Wright AC, Browne J, Cather C, Meyer-Kalos P, Mueser KT. Relationship between patterns of cannabis use and functional and symptomatic trajectories in first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01441-5. [PMID: 35900474 DOI: 10.1007/s00406-022-01441-5] [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: 05/27/2021] [Accepted: 05/29/2022] [Indexed: 02/04/2023]
Abstract
Cannabis use is common in first-episode psychosis (FEP) but evidence is mixed about the extent to which cannabis use predicts symptoms and functional outcomes among those who seek treatment. This study sought to characterize cannabis use patterns and examine the relationship with clinical outcomes, including interactions with early intervention services (EIS). Data were drawn from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study including FEP individuals receiving treatment at sites randomized to provide either EIS (NAVIGATE) or community care (CC). Cannabis use was assessed monthly and symptom and functioning data were collected at baseline, 6, 12, 18, and 24 months. Among the 404 participants enrolled, 334 were classified into four cannabis use groups (consistent, sporadic, stopped, and never users) based on their use during the first year. Consistent and sporadic cannabis users were younger, whereas those who had stopped using were older. Sporadic users had the highest depression and the lowest functioning at baseline and improved less during treatment in negative emotions and intrapsychic foundations (e.g., motivation and sense of purpose) than non-users. However, sporadic users who received NAVIGATE improved more in overall symptoms and functioning than those who received CC. Consistent users did not tend to differ in their trajectories from non-users. Individuals with FEP who use cannabis sporadically showed less clinical improvement than non-users. However, EIS treatment reduced the negative effects of sporadic cannabis use on clinical outcomes. Those who use cannabis sporadically may have unique needs that require attention in EIS.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Piper Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
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26
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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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de Haan L. It might be a wonderful opportunity when patients with a psychotic disorder use cannabis. Psychol Med 2022; 52:601-602. [PMID: 35074041 PMCID: PMC8961333 DOI: 10.1017/s0033291721003561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022]
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Kline ER, Ferrara M, Li F, Cyril D’Souza D, Keshavan M, Srihari VH. Timing of cannabis exposure relative to prodrome and psychosis onset in a community-based first episode psychosis sample. J Psychiatr Res 2022; 147:248-253. [PMID: 35066293 PMCID: PMC8882157 DOI: 10.1016/j.jpsychires.2022.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Cannabis has been implicated as both a potential cause and adverse prognostic factor in psychotic disorders. Investigating the contributory role of cannabis toward the overall burden of psychotic illnesses may represent an important step toward psychosis prevention and treatment. The current study samples consecutive admissions (N = 246) to two community based first-episode psychosis services to characterize timing of cannabis use relative to psychosis and attenuated symptom onset, differences between those with and without cannabis exposure, and the association of age at first cannabis exposure with clinical and demographic variables. Both cannabis exposure (78%) and cannabis use disorders (47%) were highly prevalent at admission. In 94% of participants, cannabis use preceded the onset of both attenuated and full-threshold psychosis symptoms by several years. Earlier age at first exposure to cannabis was associated with younger age at prodrome and psychosis onset, worse premorbid functioning, and greater severity of cannabis use disorder at admission. The timing of first exposure to cannabis may have individual prognostic as well as public health significance. Documenting the prevalence and impact of cannabis use in early psychosis samples, as well as the overall incidence of psychotic disorders, will be of vital public health significance as the United States enacts cannabis legalization and cannabis products become more widely available.
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Affiliation(s)
- Emily R. Kline
- Harvard Medical School, Department of Psychiatry,Beth Israel Deaconess Medical Center, Department of Psychiatry,Boston University School of Medicine, Department of Psychiatry,Boston Medical Center
| | - Maria Ferrara
- Yale University School of Medicine, Department of Psychiatry
| | - Fangyong Li
- Yale University School of Medicine, Department of Psychiatry
| | | | - Matcheri Keshavan
- Harvard Medical School, Department of Psychiatry,Beth Israel Deaconess Medical Center, Department of Psychiatry
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Hodgins S, Moulin V. Le nouveau défi des services destinés aux personnes présentant un premier épisode de psychose : intégrer des interventions pour prévenir et réduire les agressions physiques. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094146ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hodgins S. Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime? Front Psychiatry 2022; 13:821760. [PMID: 35242064 PMCID: PMC8885584 DOI: 10.3389/fpsyt.2022.821760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Some persons developing, or presenting, schizophrenia engage in aggressive behaviour (AB) and/or criminal offending. Most of these individuals display AB prior to a first episode of psychosis (FEP). In fact, approximately one-third of FEP patients have a history of AB, some additionally display other antisocial behaviours (A+AB). The large majority of these individuals have presented conduct problems since childhood, benefit from clozapine, have extensive treatment needs, and are unlikely to comply with treatment. A smaller sub-group begin to engage in AB as illness onsets. A+AB persists, often for many years in spite of treatment-as-usual, until a victim is seriously harmed. This article proposes providing multi-component treatment programs at FEP in order to prevent aggressive and antisocial behaviours of persons with schizophrenia. METHOD Non-systematic reviews of epidemiological studies of AB among persons with schizophrenia, of the defining characteristics of sub-types of persons with schizophrenia who engage in AB and their responses to treatment, and of FEP service outcomes. RESULTS Studies have shown that mental health services that simultaneously target schizophrenia and aggressive behaviour are most effective both in reducing psychotic symptoms and aggressive behaviour. Evidence, although not abundant, suggests that a multi-component treatment program that would include the components recommended to treat schizophrenia and cognitive-behavioural interventions to reduce A+AB, and the other factors promoting A+AB such as substance misuse, victimisation, and poor recognition of emotions in the faces of others has the potential to effectively treat schizophrenia and reduce A+AB. Patients with a recent onset of AB would require few components of treatment, while those with prior conduct disorder would require all. Such a program of treatment would be long and intense. CONCLUSIONS Trials are needed to test the effectiveness of multi-component treatment programs targeting schizophrenia and A+AB at FEP. Studies are also necessary to determine whether providing such programs in hospitals and/or prisons, with long-term community after-care, and in some cases with court orders to participate in treatment, would enhance effectiveness. Whether investing at FEP would be cost-effective requires investigation.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal et Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Haina Institute of Forensic Psychiatry, Haina, Germany
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31
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Mervis JE, Fischer J, Cooper SE, Deckert AC, Lysaker PH, MacDonald AW, Meyer-Kalos P. Introspective accuracy for substance use across a year of treatment for first episode psychosis. Schizophr Res Cogn 2021; 26:100200. [PMID: 34136362 PMCID: PMC8176356 DOI: 10.1016/j.scog.2021.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
Substance use exacerbates psychosis, mania, depression, and poor functioning in people with first episodes of psychosis (FEP) and is associated with poor treatment outcomes, even when it does not reach the level of a formal disorder. Impaired insight and substance use are common issues that may interfere with treatment outcomes among people experiencing FEP, yet both are treatable. Improvements in these domains are associated with better outcomes. Low insight could increase risk for substance use by impairing the ability to self-appraise and assess consequences. Introspective accuracy (IA) is understudied in this area and is one way of considering self-appraisal. This study is an archival review using data collected from NAVIGATE, a coordinated specialty care program treating people with FEP. IA was operationalized as the difference between clinician and client ratings of substance use. We tested whether IA changed over one year of treatment and whether those changes occurred alongside changes in symptoms and illness self-management. No changes in IA were detected in relation to illness self-management. Changes in IA for substance use occurred midway through treatment-individuals with greater symptom remission had more overconfident IA. Prior research on insight has shown a paradox where greater insight accompanies more symptoms. However, past research has also shown a relationship between IA and functional outcomes, like illness self-management, and that overconfidence in one domain can positively bias clinician ratings in another. Our findings suggest either a positive bias for ratings associated with overconfident IA or an insight paradox type effect.
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Affiliation(s)
- Joshua E. Mervis
- University of Minnesota, Department of Psychology, United States of America
| | - Jamie Fischer
- University of Minnesota, School of Social Work, United States of America
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Samuel E. Cooper
- University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Andrew C. Deckert
- University of Minnesota, Department of Psychology, United States of America
| | - Paul H. Lysaker
- Richard L. Roudebush VA Medical Center, United States of America
- Indiana University School of Medicine, Department of Psychiatry, United States of America
| | - Angus W. MacDonald
- University of Minnesota, Department of Psychology, United States of America
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Piper Meyer-Kalos
- University of Minnesota Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America
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Vila-Badia R, Del Cacho N, Butjosa A, Ochoa S, Serra-Arumí C, Esteban-Sanjusto M, Pardo M, Dolz M, Casado-Ortega A, Coromina M, Usall J. Cognitive functioning in first episode psychosis. Gender differences and relation with clinical variables. Early Interv Psychiatry 2021; 15:1667-1676. [PMID: 33369161 DOI: 10.1111/eip.13110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
AIMS to study the differences in cognitive functioning in patients and controls. In addition, study the influence of symptoms, cannabis consumption, chlorpromazine doses, DUP and IQ in cognitive performance in patients, both in the total sample and divided by gender. METHODS 70 first episode psychosis patients and 63 healthy controls (HC) participated in the study and were assessed with the MATRICS battery and the Vocabulary subtest of WAIS-IV. Symptoms in FEP patients were evaluated with the Emsley factors of the PANSS scale. RESULTS patients showed lower scores than controls in all cognitive domains studied. There were no significant differences between FEP men and FEP women, but we found gender differences in favour of women in processing speed, working memory and composite total scored domains in the HC group. Finally, symptoms and Chlorpromazine doses showed an influence on cognitive performance in the total FEP sample. When splitting the sample by gender, positive symptoms may be more detrimental to women's cognitive functioning, while disorganized symptoms may play the most important role in cognitive performance in men. CONCLUSIONS patients showed worse cognitive performance in all cognitive domains compared to healthy controls. In our FEP sample, gender does not seem to influence cognitive performance measured with the MATRICS. Severity of symptoms influences positively in cognitive performance. The dose of Chlorpromazine and symptoms are influential variables to be taken into account in cognition rehabilitation programs.
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Affiliation(s)
- Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Anna Butjosa
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Clara Serra-Arumí
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Marina Esteban-Sanjusto
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Marta Pardo
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Ariadna Casado-Ortega
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Marta Coromina
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
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- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
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Sami M, Quattrone D, Ferraro L, Tripoli G, Cascia EL, Gayer-Anderson C, Selten JP, Arango C, Bernardo M, Tarricone I, Tortelli A, Gatto G, Del Peschio S, Del-Ben CM, Rutten BP, Jones PB, van Os J, de Haan L, Morgan C, Lewis C, Bhattacharyya S, Freeman TP, Lynskey M, Murray RM, Forti MD. Association of extent of cannabis use and psychotic like intoxication experiences in a multi-national sample of first episode psychosis patients and controls. Psychol Med 2021; 51:2074-2082. [PMID: 32340643 DOI: 10.1017/s0033291720000847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND First episode psychosis (FEP) patients who use cannabis experience more frequent psychotic and euphoric intoxication experiences compared to controls. It is not clear whether this is consequent to patients being more vulnerable to the effects of cannabis use or to their heavier pattern of use. We aimed to determine whether extent of use predicted psychotic-like and euphoric intoxication experiences in patients and controls and whether this differs between groups. METHODS We analysed data on patients who had ever used cannabis (n = 655) and controls who had ever used cannabis (n = 654) across 15 sites from six countries in the EU-GEI study (2010-2015). We used multiple regression to model predictors of cannabis-induced experiences and to determine if there was an interaction between caseness and extent of use. RESULTS Caseness, frequency of cannabis use and money spent on cannabis predicted psychotic-like and euphoric experiences (p ⩽ 0.001). For psychotic-like experiences (PEs) there was a significant interaction for caseness × frequency of use (p < 0.001) and caseness × money spent on cannabis (p = 0.001) such that FEP patients had increased experiences at increased levels of use compared to controls. There was no significant interaction for euphoric experiences (p > 0.5). CONCLUSIONS FEP patients are particularly sensitive to increased psychotic-like, but not euphoric experiences, at higher levels of cannabis use compared to controls. This suggests a specific psychotomimetic response in FEP patients related to heavy cannabis use. Clinicians should enquire regarding cannabis related PEs and advise that lower levels of cannabis use are associated with less frequent PEs.
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Affiliation(s)
- Musa Sami
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Institute of Mental Health, Jubilee Campus, University of Nottingham, Nottingham, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 9012 9Palermo, Italy
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Erika La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 9012 9Palermo, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZLeiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM (CIBERSAM), C/Doctor Esquerdo 46, 28007Madrid, Spain
| | - Miguel Bernardo
- Department of Medicine, Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris, 75020, France
| | - Giusy Gatto
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Simona Del Peschio
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Bart P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
- Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZAmsterdam, The Netherlands
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Cathryn Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Tom P Freeman
- Department of Psychology, Addiciton and Mental Health Group (AIM), University of Bath, BA2 7AY, UK
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, LondonSE5 8BB, UK
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, LondonSE5 8BB, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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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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35
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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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Sami MB, Annibale L, O'Neill A, Collier T, Onyejiaka C, Eranti S, Das D, Kelbrick M, McGuire P, Williams SCR, Rana A, Ettinger U, Bhattacharyya S. Eye movements in patients in early psychosis with and without a history of cannabis use. NPJ SCHIZOPHRENIA 2021; 7:24. [PMID: 33980870 PMCID: PMC8115050 DOI: 10.1038/s41537-021-00155-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/09/2021] [Indexed: 11/20/2022]
Abstract
It is unclear whether early psychosis in the context of cannabis use is different from psychosis without cannabis. We investigated this issue by examining whether abnormalities in oculomotor control differ between patients with psychosis with and without a history of cannabis use. We studied four groups: patients in the early phase of psychosis with a history of cannabis use (EPC; n = 28); patients in the early phase of psychosis without (EPNC; n = 25); controls with a history of cannabis use (HCC; n = 16); and controls without (HCNC; n = 22). We studied smooth pursuit eye movements using a stimulus with sinusoidal waveform at three target frequencies (0.2, 0.4 and 0.6 Hz). Participants also performed 40 antisaccade trials. There were no differences between the EPC and EPNC groups in diagnosis, symptom severity or level of functioning. We found evidence for a cannabis effect (χ2 = 23.14, p < 0.001), patient effect (χ2 = 4.84, p = 0.028) and patient × cannabis effect (χ2 = 4.20, p = 0.04) for smooth pursuit velocity gain. There was a large difference between EPC and EPNC (g = 0.76-0.86) with impairment in the non cannabis using group. We found no significant effect for antisaccade error whereas patients had fewer valid trials compared to controls. These data indicate that impairment of smooth pursuit in psychosis is more severe in patients without a history of cannabis use. This is consistent with the notion that the severity of neurobiological alterations in psychosis is lower in patients whose illness developed in the context of cannabis use.
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Affiliation(s)
- Musa Basseer Sami
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK.
- Institute of Mental Health, Nottingham University, Nottingham, England.
| | - Luciano Annibale
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
| | - Aisling O'Neill
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
| | - Tracy Collier
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
| | - Chidimma Onyejiaka
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
| | | | - Debasis Das
- Leicestershire Partnership NHS Trust, Leicester, UK
| | | | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
| | | | - Anas Rana
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | | | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neurosciences King's College London, London, UK
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Scheffler F, Du Plessis S, Asmal L, Kilian S, Phahladira L, Luckhoff HK, Emsley R. Cannabis use and hippocampal subfield volumes in males with a first episode of a schizophrenia spectrum disorder and healthy controls. Schizophr Res 2021; 231:13-21. [PMID: 33740561 DOI: 10.1016/j.schres.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/25/2021] [Accepted: 02/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Both schizophrenia and cannabis use are associated with structural brain changes. The hippocampus is a region of particular interest due to its role in memory and select cognitive functions, impairment of which is a core feature of schizophrenia and has also been observed in substance abuse. This study aimed to explore the effects of recent/current cannabis use on hippocampal subfield volumes in male patients with first-episode schizophrenia spectrum disorders and matched controls. METHODS This cross-sectional, case-control study included 63 patients and 58 controls scanned on 3T MRI scanners, with hippocampal segmentation performed using recently validated Freesurfer v6.0 software. Cannabis use status was determined by self and carer report together with urine toxicology screening, and patients were categorised as recent/current users or non-users. We used multivariate analysis of covariance (MANCOVA) with age, scan sequence, scan quality, and total intracranial volume as covariates, with subsequent analysis of variance (ANOVA) to test the effects of diagnosis and cannabis use status on individual hippocampal subfields. RESULTS We found a group (patient/control) by cannabis use interaction effect in the subiculum, with decreased volumes observed in the cannabis non-using patients compared to the cannabis using patients, and decreased volumes in the cannabis using controls compared to the cannabis non-using controls. CONCLUSION The increased subiculum volume in cannabis using patients compared to cannabis non-using patients raises important questions regarding the pathophysiology of schizophrenia and the role of cannabis use therein.
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Affiliation(s)
- F Scheffler
- Department of Psychiatry, Stellenbosch University, South Africa.
| | - S Du Plessis
- Department of Psychiatry, Stellenbosch University, South Africa
| | - L Asmal
- Department of Psychiatry, Stellenbosch University, South Africa
| | - S Kilian
- Department of Psychiatry, Stellenbosch University, South Africa
| | - L Phahladira
- Department of Psychiatry, Stellenbosch University, South Africa
| | - H K Luckhoff
- Department of Psychiatry, Stellenbosch University, South Africa
| | - R Emsley
- Department of Psychiatry, Stellenbosch University, South Africa
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38
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Are we any closer to identifying a causal relationship between cannabis and psychosis? Curr Opin Psychol 2021; 38:56-60. [DOI: 10.1016/j.copsyc.2020.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
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Bartoli F, Riboldi I, Bachi B, Calabrese A, Moretti F, Crocamo C, Carrà G. Efficacy of Cannabidiol for Δ-9-Tetrahydrocannabinol-Induced Psychotic Symptoms, Schizophrenia, and Cannabis Use Disorders: A Narrative Review. J Clin Med 2021; 10:jcm10061303. [PMID: 33810033 PMCID: PMC8005219 DOI: 10.3390/jcm10061303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/17/2023] Open
Abstract
Although cannabis’ major psychoactive component, Δ-9-tetrahydrocannabinol (THC), has been linked to both earlier onset and poorer outcomes of psychotic disorders, Cannabidiol (CBD) seems to have different pharmacological mechanisms and potential therapeutic properties. However, no clinical study has investigated CBD for the treatment of co-occurring psychotic and cannabis use disorders so far, even though its utility seems grounded in a plausible biological basis. The aim of this work is thus to provide an overview of available clinical studies evaluating the efficacy of CBD for psychotic symptoms induced by THC, schizophrenia, and cannabis use disorders. After searching for relevant studies in PubMed, Cochrane Library, and ClinicalTrials.gov, we included 10 clinical studies. Available evidence suggests that CBD may attenuate both psychotic-like symptoms induced by THC in healthy volunteers and positive symptoms in individuals with schizophrenia. In addition, preliminary data on the efficacy of CBD for cannabis use disorders show mixed findings. Evidence from ongoing clinical studies will provide insight into the possible role of CBD for treating psychotic and cannabis use disorders.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
- Correspondence: (F.B.); (G.C.); Tel.: +39-025-799-8644 (F.B.); +39-025-799-8645 (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (I.R.); (B.B.); (A.C.); (F.M.); (C.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
- Correspondence: (F.B.); (G.C.); Tel.: +39-025-799-8644 (F.B.); +39-025-799-8645 (G.C.)
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40
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Lees R, Hines LA, D'Souza DC, Stothart G, Di Forti M, Hoch E, Freeman TP. Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: a narrative review. Psychol Med 2021; 51:353-364. [PMID: 33536109 DOI: 10.1017/s0033291720005449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.
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Affiliation(s)
- Rachel Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Lindsey A Hines
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Deepak Cyril D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
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41
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Crocker CE, Carter AJE, Emsley JG, Magee K, Atkinson P, Tibbo PG. When Cannabis Use Goes Wrong: Mental Health Side Effects of Cannabis Use That Present to Emergency Services. Front Psychiatry 2021; 12:640222. [PMID: 33658953 PMCID: PMC7917124 DOI: 10.3389/fpsyt.2021.640222] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25-30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.
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Affiliation(s)
- Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services, Halifax, NS, Canada
| | - Jason G Emsley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Horizon Health Network, Saint John, NB, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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42
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Garel N, Greenway K, Joober R. The antipsychotic potential of cannabidiol: clinical implications for patients with psychosis and comorbid cannabis use disorder. J Psychiatry Neurosci 2021; 46:E164-E165. [PMID: 33464779 PMCID: PMC7955839 DOI: 10.1503/jpn.200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nicolas Garel
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
| | - Kyle Greenway
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
| | - Ridha Joober
- From McGill University, Psychiatry residency program (Garel, Greenway); and McGill University, Douglas Mental Health University Institute, (Joober), Montreal, Que., Canada
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43
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Marino L, Scodes J, Richkin T, Alves-Bradford JM, Nossel I, Wall M, Dixon L. Persistent cannabis use among young adults with early psychosis receiving coordinated specialty care in the United States. Schizophr Res 2020; 222:274-282. [PMID: 32473930 PMCID: PMC8237378 DOI: 10.1016/j.schres.2020.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
Persistent cannabis use among young adults with first episode psychosis (FEP), even those receiving early intervention services, has been associated with poor outcomes. In the United States (US), Coordinated Specialty Care (CSC) has been shown to be more effective at reducing symptoms, improving quality of life and increasing involvement in work or school, compared to typical care for FEP. However, little is known about the prevalence, course and outcomes for cannabis use in this real-world, clinical setting. This study examined the prevalence, course and outcomes of cannabis use categorized into three groups: no use, reduced use, and persistent use, among a sample of 938 CSC participants enrolled for at least 1 year. Prevalence of cannabis use was 38.8% at admission and 32.8% of the sample had persistent cannabis use at 1 year. At baseline, persistent cannabis users were more likely to be male (p < .001), white, non-Hispanic and black non-Hispanic (p = .001), have worse symptoms as measured by the GAF (p < .001), increased suicidality (p = .024), violent ideation (p = .008), and legal trouble (p = .006) compared with non-users. At 1 year, persistent users maintained worse symptoms compared with non-users (p = .021) while those who reduced use had significant improvement in symptoms compared with persistent users (p = .008). This study suggests that cannabis use is common among young adults enrolled in a CSC program in the US and that persistent cannabis users may have worse outcomes while reducing cannabis use may improve outcomes. These findings highlight the potential impact of secondary prevention in this population through reduction in cannabis use.
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Affiliation(s)
- Leslie Marino
- 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, USA 10032.
| | - Jennifer Scodes
- 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, USA 10032
| | - Talia Richkin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - Jean-Marie Alves-Bradford
- 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, USA 10032
| | - Ilana 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, USA 10032
| | - Melanie 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, USA 10032
| | - Lisa 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, USA 10032
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44
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Moulin V, Alameda L, Framorando D, Baumann PS, Gholam M, Gasser J, Do Cuenod KQ, Conus P. Early onset of cannabis use and violent behavior in psychosis. Eur Psychiatry 2020; 63:e78. [PMID: 32669157 PMCID: PMC7503178 DOI: 10.1192/j.eurpsy.2020.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients. METHOD Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18-35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB. RESULTS Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13-20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB. CONCLUSIONS Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.
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Affiliation(s)
- Valerie Moulin
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
| | - David Framorando
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp-S Baumann
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jacques Gasser
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kim-Q Do Cuenod
- Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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45
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Cannabis use and psychosis: a review of reviews. Eur Arch Psychiatry Clin Neurosci 2020; 270:403-412. [PMID: 31563981 DOI: 10.1007/s00406-019-01068-z] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/18/2019] [Indexed: 12/22/2022]
Abstract
We conducted a systematic review of meta-analyses and systematic reviews to evaluate the impact of cannabis use on the onset and course of psychoses. Following a systematic literature search of five data bases (2005-2016) and consecutive structured evaluation, we were able to include 26 systematic reviews and meta-analyses. The methodological quality of the included publications were in the range of high and poor. The scientific literature indicates that psychotic illness arises more frequently in cannabis users compared to non-users, cannabis use is associated with a dose-dependent risk of developing psychotic illness, and cannabis users have an earlier onset of psychotic illness compared to non-users. Cannabis use was also associated with increased relapse rates, more hospitalizations and pronounced positive symptoms in psychotic patients. We make recommendations about the type of research that is required to better characterize the relationship between cannabis use and the development and outcomes of psychosis.
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46
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Sami M, Worker A, Colizzi M, Annibale L, Das D, Kelbrick M, Eranti S, Collier T, Onyejiaka C, O'Neill A, Lythgoe D, McGuire P, Williams SCR, Kempton MJ, Bhattacharyya S. Association of cannabis with glutamatergic levels in patients with early psychosis: Evidence for altered volume striatal glutamate relationships in patients with a history of cannabis use in early psychosis. Transl Psychiatry 2020; 10:111. [PMID: 32317625 PMCID: PMC7174331 DOI: 10.1038/s41398-020-0790-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/01/2023] Open
Abstract
The associative striatum, an established substrate in psychosis, receives widespread glutamatergic projections. We sought to see if glutamatergic indices are altered between early psychosis patients with and without a history of cannabis use and characterise the relationship to grey matter. 92 participants were scanned: Early Psychosis with a history of cannabis use (EPC = 29); Early Psychosis with minimal cannabis use (EPMC = 25); Controls with a history of cannabis use (HCC = 16) and Controls with minimal use (HCMC = 22). Whole brain T1 weighted MR images and localised proton MR spectra were acquired from head of caudate, anterior cingulate and hippocampus. We examined relationships in regions with known high cannabinoid 1 receptor (CB1R) expression (grey matter, cortex, hippocampus, amygdala) and low expression (white matter, ventricles, brainstem) to caudate Glutamine+Glutamate (Glx). Patients were well matched in symptoms, function and medication. There was no significant group difference in Glx in any region. In EPC grey matter volume explained 31.9% of the variance of caudate Glx (p = 0.003) and amygdala volume explained 36.9% (p = 0.001) of caudate Glx. There was no significant relationship in EPMC. The EPC vs EPMC interaction was significant (p = 0.042). There was no such relationship in control regions. These results are the first to demonstrate association of grey matter volume and striatal glutamate in the EPC group. This may suggest a history of cannabis use leads to a conformational change in distal CB1 rich grey matter regions to influence striatal glutamatergic levels or that such connectivity predisposes to heavy cannabis use.
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Affiliation(s)
- Musa Sami
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
- Institute of Mental Health, Nottingham University, Nottingham, UK.
| | - Amanda Worker
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Marco Colizzi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luciano Annibale
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Debasis Das
- Leicestershire Partnership NHS Trust, Thurmaston, UK
| | | | | | - Tracy Collier
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Chidimma Onyejiaka
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Aisling O'Neill
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - David Lythgoe
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Steve C R Williams
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Matthew J Kempton
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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47
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Sami MB, McCutcheon RA, Ettinger U, Williams S, Lythgoe D, McGuire P, Bhattacharyya S. Cannabis Use Linked to Altered Functional Connectivity of the Visual Attentional Connectivity in Patients With Psychosis and Controls. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Both chronic cannabis use and psychotic disorders are associated with abnormalities in visual attentional processing. Using functional magnetic resonance imaging (fMRI), we sought to determine whether there would be a difference in functional connectivity in patients and controls with and without a history of cannabis use in the visual and dorsal attention networks.
Methods
Resting-state fMRI data were acquired in patients with early psychosis with (EPC = 29) and without (EPNC = 25); and controls with (HCC = 16) and without (HCNC = 22) cannabis use.
Results
There was a patient effect in both Visual-Dorsal Attention Internetwork (F(1,87) = 5.326, P = .023) and the Visual Network (F(1,87) = 4.044, P = .047) and a cannabis effect in the Dorsal Attention Network (F(1,87) = 4.773, P = .032). These effects were specific to the networks examined with no evidence for significant patient or cannabis effects in other canonical networks. Patients with a history of cannabis use showed increased connectivity in the Dorsal Attention Network (134%, P = .019) and Visual Dorsal Attention Internetwork (285%, P = .036) compared to non-using controls. In the EPC group connectivity of the Visual Network (ρ = 0.379, P = .042) and Visual-Dorsal Attention Internetwork (ρ = 0.421, P = .023) correlated with visual hallucinations which were significantly different from EPNC (P = .011). Dorsal attention network strength correlated with severity of dependence for cannabis (ρ = 0.215, P = .04).
Conclusion
We demonstrate specific cannabis and patient effects in networks associated with visual attentional processing. There is a differential association with hallucinatory symptoms in patients with and without a history of cannabis use. This may indicate that dysconnectivity in these networks serves different roles in the context of cannabis use.
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Affiliation(s)
- Musa Basseer Sami
- Institute of Psychiatry, Psychology and Neurosciences King’s College London, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Robert A McCutcheon
- Institute of Psychiatry, Psychology and Neurosciences King’s College London, London, UK
| | | | - Steve Williams
- Centre for Neuroimaging Sciences, King’s College London, London, UK
| | - Dave Lythgoe
- Centre for Neuroimaging Sciences, King’s College London, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences King’s College London, London, UK
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neurosciences King’s College London, London, UK
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48
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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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49
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Frydecka D, Misiak B, Kotowicz K, Pionke R, Krężołek M, Cechnicki A, Gawęda Ł. The interplay between childhood trauma, cognitive biases, and cannabis use on the risk of psychosis in nonclinical young adults in Poland. Eur Psychiatry 2020; 63:e35. [PMID: 32200775 PMCID: PMC7355126 DOI: 10.1192/j.eurpsy.2020.31] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background. Childhood traumatic events are risk factors for psychotic-like experiences (PLEs). However, the mechanisms explaining how trauma may contribute to the development of PLEs are not fully understood. In our study, we investigated whether cannabis use and cognitive biases mediate the relationship between early trauma and PLEs. Methods. A total sample of 6,772 young adults (age 26.6 ± 4.7, 2,181 male and 3,433 female) was recruited from the general population to participate in an online survey. We excluded 1,158 individuals due to a self-reported lifetime diagnosis of any mental disorder. The online survey included selected items from the following questionnaires: Traumatic Experience Checklist (TEC, 3 items), Childhood Experience of Care and Abuse Questionnaire (CECA.Q, 3 items), Cannabis Problems Questionnaire (CPQ, 10 items), Davos Assessment of Cognitive Biases Scale (DACOBS-18, 9 items), and Prodromal Questionnaire-16 (PQ-16). Mediation analyses were performed with respect to different categories of traumatic experiences (emotional, physical and sexual abuse as well as emotional neglect). Results. Our results showed significant associations of any time of childhood trauma with higher scores of cannabis use (CPQ), cognitive biases (DACOBS), and PLEs (PQ-16) (p < 0.001). We found a direct effect of childhood trauma on PLEs as well as significant indirect effect mediated through cannabis use and cognitive biases. All models tested for the effects of specific childhood adversities revealed similar results. The percentage of variance in PQ-16 scores explained by serial mediation models varied between 32.8 and 34.2% depending on childhood trauma category. Conclusion. Cannabis use and cognitive biases play an important mediating role in the relationship between childhood traumatic events and the development of PLEs in a nonclinical young adult population.
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Affiliation(s)
- Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Martyna Krężołek
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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50
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Kroon E, Kuhns L, Hoch E, Cousijn J. Heavy cannabis use, dependence and the brain: a clinical perspective. Addiction 2020; 115:559-572. [PMID: 31408248 PMCID: PMC7027478 DOI: 10.1111/add.14776] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022]
Abstract
AIMS To summarize and evaluate our knowledge of the relationship between heavy cannabis use, cannabis use disorder (CUD) and the brain. METHODS Narrative review of relevant literature identified through existing systematic reviews, meta-analyses and a PubMed search. Epidemiology, clinical representations, potential causal mechanisms, assessments, treatment and prognosis are discussed. RESULTS Although causality is unclear, heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments that seem to recover after a period of abstinence. Evidence regarding other cognitive domains and neurological consequences, including cerebrovascular events, is limited and inconsistent. Abstinence after treatment is only achieved in a minority of cases; treatment targeted at reduction in use appears have some success. Potential moderators of the impact of CUD on the brain include age of onset, heaviness of use, CUD severity, the ratio of ∆9-tetrahydrocannabinol to cannabidiol and severity of comorbid disorders. CONCLUSIONS Current evidence of long-term effects of daily cannabis use and cannabis use disorder on brain-related outcomes is suggestive rather than conclusive, but use is associated with psychiatric morbidity and with cognitive impairments that recover after a period of abstinence.
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Affiliation(s)
- Emese Kroon
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Lauren Kuhns
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig Maximilan UniversityMunichGermany
- Division of Clinical Psychology and Psychological Treatment, Department of PsychologyLudwig Maximilian University MunichMunichGermany
| | - Janna Cousijn
- Neuroscience of Addiction Lab, Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
- The Amsterdam Brain and Cognition Center (ABC)University of AmsterdamAmsterdamthe Netherlands
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