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Kreis I, Lagerberg TV, Wold KF, Åsbø G, Simonsen C, Flaaten CB, Engen MJ, Lyngstad SH, Widing LH, Ueland T, Melle I. Behind the heterogeneity in the long-term course of first-episode psychosis: Different psychotic symptom trajectories are associated with different patterns of cannabis and stimulant use. Schizophr Res 2024; 271:91-99. [PMID: 39018985 DOI: 10.1016/j.schres.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Data-driven classification of long-term psychotic symptom trajectories and identification of associated risk factors could assist treatment planning and improve long-term outcomes in psychosis. However, few studies have used this approach, and knowledge about underlying mechanisms is limited. Here, we identify long-term psychotic symptom trajectories and investigate the role of illness-concurrent cannabis and stimulant use. METHODS 192 participants with first-episode psychosis were followed up after 10 years. Psychotic symptom trajectories were estimated using growth mixture modeling and tested for associations with baseline characteristics and cannabis and stimulant use during the follow-up (FU) period. RESULTS Four trajectories emerged: (1) Stable Psychotic Remission (54.2 %), (2) Delayed Psychotic Remission (15.6 %), (3) Psychotic Relapse (7.8 %), (4) Persistent Psychotic Symptoms (22.4 %). At baseline, all unfavorable trajectories (2-4) were characterized by more schizophrenia diagnoses, higher symptom severity, and longer duration of untreated psychosis. Compared to the Stable Psychotic Remission trajectory, unstable trajectories (2,3) showed distinct associations with cannabis/stimulant use during the FU-period, with dose-dependent effects for cannabis but not stimulants (Delayed Psychotic Remission: higher rates of frequent cannabis and stimulant use during the first 5 FU-years; Psychotic Relapse: higher rates of sporadic stimulant use throughout the entire FU-period). The Persistent Psychosis trajectory was less clearly linked to substance use during the FU-period. CONCLUSIONS The risk for an adverse long-term course could be mitigated by treatment of substance use, where particular attention should be devoted to preventing the use of stimulants while the use reduction of cannabis may already yield positive effects.
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Affiliation(s)
- Isabel Kreis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Trine Vik Lagerberg
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kristin Fjelnseth Wold
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gina Åsbø
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Camilla Bärthel Flaaten
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; Drammen District Psychiatric Center, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen District Psychiatric Center, Oslo University Hospital, Oslo, Norway
| | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen District Psychiatric Center, Oslo University Hospital, Oslo, Norway
| | - Line Hustad Widing
- Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Child and Adolescent Psychiatry, Division of Mental Health and Substance Use, Diakonhjemmet Hospital, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Section for Clinical Psychosis Research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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2
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Bassalov H, Yakirevich-Amir N, Reuveni I, Monk C, Florentin S, Bonne O, Matok I. Prenatal cannabis exposure and the risk for neuropsychiatric anomalies in the offspring: a systematic review and meta-analysis. Am J Obstet Gynecol 2024:S0002-9378(24)00682-3. [PMID: 38908654 DOI: 10.1016/j.ajog.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE To evaluate the association between cannabis use during pregnancy and the risk for long-term neuropsychiatric pathology in the offspring. DATA SOURCES MEDLINE, EMBASE, and Cochrane library databases were systematically searched until January 22, 2024, with no language or date restrictions. STUDY ELIGIBILITY CRITERIA Studies were eligible for inclusion if they reported quantitative data on any long-term neuropsychiatric outcome in offspring whose mothers used cannabis during pregnancy for medical or recreational use, by any route and at any trimester, in comparison to offspring of women who abstained from cannabis use during pregnancy. All observational study designs were included in the analysis. STUDY APPRAISAL AND SYNTHESIS METHODS A systematic review and meta-analysis were performed according to the PRISMA and MOOSE guidelines. The data was extracted independently by 2 reviewers. The following offspring outcomes were of interest: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, anxiety, psychotic disorders, as well as cannabis and other substance use. Odds ratios (OR) and 95% confidence intervals (CI) were pooled for each neuropsychiatric outcome in the offspring of women exposed to cannabis during pregnancy compared with nonexposed. Data were pooled using random-effects models. RESULTS Eighteen eligible observational studies were included in the systematic review, and 17 were included in the final quantitative analysis, representing 534,445 participants. After adjusting for confounders, the pooled OR for ADHD was 1.13 (95% CI 1.01-1.26); for ASD, the pooled OR was 1.04 (95% CI 0.74-1.46); for psychotic symptoms, the pooled OR was 1.29 (95% CI 0.97-1.72); for anxiety, the pooled OR was 1.34 (95% CI 0.79-2.29); for depression, the pooled OR was 0.72 (95% CI 0.11-4.57); and for offspring's cannabis use, the pooled OR was 1.20 (95% CI 1.01-1.42). CONCLUSION Prenatal cannabis exposure is not associated with an increased risk of ASD, psychotic symptoms, anxiety, or depression in offspring. However, it may slightly elevate the risk of ADHD and predispose offspring to cannabis consumption. Despite these findings, caution is warranted regarding cannabis use during pregnancy. Further research is imperative, especially given the increasing potency of cannabis in recent years.
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Affiliation(s)
- Hely Bassalov
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Sharon Florentin
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel
| | - Ilan Matok
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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3
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Treves N, Yakirevich-Amir N, Abu Ahmad W, Bonne O, Davidson E, Keeling K, Hall B, Dautrich T, Matok I. Characterization of Cannabis users and products and the experience of negative mental emotions following Cannabis use. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01812-0. [PMID: 38861239 DOI: 10.1007/s00406-024-01812-0] [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: 07/17/2023] [Accepted: 04/19/2024] [Indexed: 06/12/2024]
Abstract
There is a potential link between cannabis and mental disorders. Cannabis exposure involves in many cases negative mental emotions, which are unpleasant sensations or thoughts. Whereas mild cases of negative mental emotions inflict patient's quality of life, more severe cases lead to therapy discontinuations, or even hospitalizations and death. This study characterizes cannabis users who experienced negative mental emotions after cannabis exposure. The Releaf App database was utilized to evaluate the association between personal and cannabis use characteristics on reporting a negative mental emotion during cannabis exposure. This global mobile lets individuals track real-time cannabis experience use with cannabinoid-based products, containing data points such as gender, age, reasons for use, product type, cannabis composition, and feelings and emotions experienced after cannabis use. Multivariable logistic regression models were constructed, adjusting for potential confounders such as gender and previous experience with cannabis use. The study population comprised 4,435 users, and 34,279 sessions were collected from various countries, mainly from North America, and included in the primary analysis. Reporting on negative mental emotions was associated with users in the age group of 18-30 years. Using cannabis for a mental purpose was associated with a small increase in reporting on negative mental emotions (OR = 1.10, 95%CI [1.03-1.19]). Oral products were associated with reporting on negative mental emotions. THC-dominant products were associated with reporting negative mental emotions compared to balanced products (OR = 1.21, 95%CI [1.06-1.38]). This study suggests that some characteristics of cannabis use, such as young age and oral consumption are associated with negative mental emotions. Further studies should examine the interface between cannabis consumption, characteristics of consumers, and negative emotional experience or even long-term mental disorders.
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Affiliation(s)
- Nir Treves
- Division of Clinical Pharmacy, School of Pharmacy, The Hebrew University, Jerusalem, Israel.
| | - Noa Yakirevich-Amir
- Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Hebrew University, Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Elyad Davidson
- Department of Anesthesia CCM and Pain Management, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Branden Hall
- MoreBetter, Ltd. (dba Releaf App), Hyattsville, MD, USA
| | | | - Ilan Matok
- Division of Clinical Pharmacy, School of Pharmacy, The Hebrew University, Jerusalem, Israel
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4
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Dubois C, Lunghi C, Eurich DT, Dyck JRB, Hyshka E, Hanlon JG, Zongo A. Medical cannabis authorization and risk of emergency department visits and hospitalization due to psychotic disorders: A propensity score-matched cohort study. Schizophr Res 2024; 264:534-542. [PMID: 38330686 DOI: 10.1016/j.schres.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Despite evidence showing that recreational cannabis use is associated with a higher risk of psychotic disorders, this risk has not been well characterized for patients using medical cannabis. Therefore, this study assessed the risk of emergency department (ED) visits and hospitalization for psychotic disorders (the study outcome) among adult patients authorized to use medical cannabis. We performed a retrospective cohort study on patients authorized to use medical cannabis in a group of Ontario cannabis clinics between 2014 and 2019. Using clinical and health administrative data, each patient was matched by propensity scores to up to 3 population-based controls. Conditional Cox proportional hazards regressions were used to assess the risk. Among 54,006 cannabis patients matched to 161,265 controls, 39 % were aged ≤50 years, and 54 % were female. Incidence rates for psychotic disorders were 3.00/1000 person-years (95%CI: 2.72-3.32) in the cannabis group and 1.88/1000 person-years (1.75-2.03) in the control group. A significant association was observed, with an adjusted hazard ratio of 1.38 (95%CI: 1.19-1.60) in the total sample and 1.63 (1.40-1.91) in patients without previous psychotic disorders. The results suggest that cannabis authorization should include a benefit-risk assessment of psychotic disorders to minimize the risk of events requiring emergency attention.
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Affiliation(s)
- Cerina Dubois
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John G Hanlon
- St. Michael's Hospital Department of Anesthesia, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
| | - Arsene Zongo
- Population Health and Optimal Health Practices Research Unit, CHU de Québec, Université Laval Research Centre, Quebec City, Quebec, Canada; Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.
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5
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West ML, Sharif S. Cannabis and Psychosis. Psychiatr Clin North Am 2023; 46:703-717. [PMID: 37879833 DOI: 10.1016/j.psc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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6
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Fridman J, Bloemhof-Bris E, Weizman S, Kessler T, Porat D, Ivry A, Wolf A, Stryjer R, Shelef A. Inflammation Markers Among Schizophrenia Patients Who Use Cannabis. Clin Neuropharmacol 2023; Publish Ahead of Print:00002826-990000000-00053. [PMID: 37335845 DOI: 10.1097/wnf.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVES The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without. METHODS In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use. RESULTS No differences were found in the NLR and MPV values between the groups. CONCLUSION The results were contrary to our expectations. These results may be explained by the presentation of a "pseudo-balanced" picture created when multiple processes affect inflammatory indices.
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7
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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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8
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West ML, Sharif S. Cannabis and Psychosis. Child Adolesc Psychiatr Clin N Am 2023; 32:69-83. [PMID: 36410907 DOI: 10.1016/j.chc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psychosis and cannabis use may overlap in multiple ways in young people. Research suggests that cannabis use increases risk for having psychotic symptoms, both attenuated (subthreshold) and acute. Cannabis use may also exacerbate psychosis symptoms among young people with underlying psychosis risk and psychotic disorders. Although there are suggestions for treating co-occurring psychosis and cannabis use in young people (e.g., incorporating cannabis use assessment and treatment strategies into specialized early psychosis care), there are many gaps in clinical trial research to support evidence-based treatment of these overlapping concerns.
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Affiliation(s)
- Michelle L West
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA.
| | - Shadi Sharif
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Health Sciences Building, 1890 N Revere Court, Mailstop F443, Aurora, CO 80045, USA
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9
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Rault O, Romeo B, Butlen-Ducuing F, Rari E, Benyamina A, Martelli C. Impact of cannabis use and its cessation on the dosage and the efficacy of antipsychotic drugs in in- and outpatients with schizophrenia taking medication: A systematic review and meta-analysis. J Psychiatr Res 2022; 156:713-721. [PMID: 36410310 DOI: 10.1016/j.jpsychires.2022.11.012] [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: 05/22/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Compared with the general population, there are more cannabis users among patients suffering from schizophrenia and this consumption seems to impact the course and the treatment of their pathology. The aim of this meta-analysis and systematic review was to assess the impact of cannabis use on the efficacy of treatments, more particularly regarding the antipsychotic dosage, symptoms evolution, therapeutic resistance and the risk of relapse in patients with schizophrenia taking medication. We performed a systematic search of keywords on multiple databases up to August 2020 to identify all studies meeting the following criteria: comparison between cannabis smokers and non-cannabis users in patients with schizophrenia, assessment of antipsychotics doses, information about their efficacy or resistance to treatment and control of the compliance. Standardized mean differences were calculated for antipsychotic dosage and symptoms evolution at discharge, and a systematic review was performed for other outcomes. Twelve studies were included. Cannabis use did not seem to be associated with higher doses of antipsychotics at seven days and at the end of the studies, nor with poorer symptoms evolution, and nor with higher rate of antipsychotic resistance. However, cannabis use seems to be associated with a higher risk of relapse. This meta-analysis provides evidence that previous cannabis use, or occasional use, in patients with schizophrenia taking medication does not impact antipsychotic efficacy as described by antipsychotic dosage or PANSS score.
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Affiliation(s)
- Ophélie Rault
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France.
| | - Bruno Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Florence Butlen-Ducuing
- Office of Therapies for Neurological and Psychiatric Disorders, European Medicines Agency, Amsterdam, the Netherlands
| | - Eirini Rari
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Amine Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France
| | - Catherine Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche PSYCOMADD 4872, Université Paris Sud - AP-HP, Université Paris Saclay, France; INSERM U A1299 "Trajectoires développementales en Psychiatrie", Université Paris-Saclay, Ecole Normale Supérieure Paris-Saclay, CNRS 9010, Centre Borelli, Digiteo-Labs, Bâtiment 660 Claude Shannon, Avenue des Sciences, 91190, Gif-sur-Yvette, France
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10
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Schüler M, Moritz S, Schnell T. Development and initial validation of a reliable German self-report measure to assess acute cannabis intoxication-effects (CanTox-17). Int J Methods Psychiatr Res 2022; 31:e1925. [PMID: 35708959 PMCID: PMC9464325 DOI: 10.1002/mpr.1925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/30/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Both positive and negative including psychotic-like cannabis intoxication effects are well-established. Yet, consequences for consumption patterns, addictive behavior or psychotic developments are poorly researched in general, in Germany not at all. Thus, objective was to develop the first German-language questionnaire operationalizing acute cannabis intoxication effects, based on the original "Cannabis Experience Questionnaire" (CEQ). METHODS After expert translation of the CEQ, items related to acute intoxication effects were presented to a sample of 537 cannabis users. Four- and five-factorial solutions of explorative factor analysis with a randomly split sub-sample 1 were cross-validated by confirmatory factor analysis on sub-sample 2. RESULTS After content review of factors and analysis of external validity, a 17 item four-factorial model was approved. Factors are (1) "paranoia/dysphoria", (2) "confusion/disorientation", (3) "euphoria/creativity", (4) "psychosis-like/loss of reality". Model fit is satisfactory (RMSEA = 0.058, SRMR = 0.065, CFI = 0.929, TLI = 0.914). Correlations with corresponding external measures support construct validity. CONCLUSIONS The present questionnaire is a time-efficient, valid and reliable instrument. Thus, predictors of different cannabis intoxication effects can be analysed for the first time in German-speaking area, as well as their significance for substance use or psychosis risk.
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Affiliation(s)
- Merle Schüler
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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11
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Xu H, Li D, Yin B. Aberrant hippocampal shape development in young adults with heavy cannabis use: Evidence from a longitudinal study. J Psychiatr Res 2022; 152:343-351. [PMID: 35785577 DOI: 10.1016/j.jpsychires.2022.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/26/2022]
Abstract
Cannabis is one of the most commonly used illicit drugs globally. Mounting evidence indicates that cannabis use, particularly consumption during young adulthood, is related to adverse mental and behavioral outcomes and an increased risk of the onset and relapse of psychosis. However, the neuromechanism underpinnings of heavy cannabis use (HCU) in young adults remain largely unknown, and no study has yet investigated the development of hippocampal shape in young adults with HCU. Twenty young adults with HCU and 22 matched non-cannabis-use healthy controls (HCs) were enrolled. Neuroimaging scanning and clinical assessments for all participants were performed at baseline (BL) and 3-year follow-up (FU). The vertex-wise shape analysis was conducted to investigate aberrant hippocampal shape development in young adults with HCU. Aberrant shape development pattern of the hippocampus was observed in young adults with HCU. There was no significant difference in hippocampal shape between the groups at BL, but young adults with HCU at FU exhibited significant shape atrophy of the right dorsal anterior hippocampus related to HCs. In addition, there was a significantly lower growth rate of the right hippocampal shape. Furthermore, there were significant associations of heavy cannabis use, as indicated by the age at onset first and frequent cannabis use, with the growth rate of hippocampal shape in young adults with HCU. The aberrant hippocampal shape development may reflect the effect of heavy cannabis use on young adults and it may be a potential target for heavy cannabis use treatment for young adults.
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Affiliation(s)
- Hui Xu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
| | - Dandong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
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12
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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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13
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Ahmed S, Roth RM, Stanciu CN, Brunette MF. The Impact of THC and CBD in Schizophrenia: A Systematic Review. Front Psychiatry 2021; 12:694394. [PMID: 34366924 PMCID: PMC8343183 DOI: 10.3389/fpsyt.2021.694394] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: People with schizophrenia are more likely to develop cannabis use disorder (CUD) and experience worse outcomes with use. Yet as cannabis is legalized for medical and recreational use, there is interest in its therapeutic potential. Objectives: To conduct a systematic review summarizing the design and results of controlled trials using defined doses of THC and CBD in schizophrenia. Method: A keyword search of eight online literature databases identified 11 eligible reports. Results: One placebo controlled trial (13 stable patients without CUD) found that intravenous THC increased psychosis and worsened learning/recall. Two reports of a functional magnetic resonance (fMRI) study of smoked or oral THC in 12 abstinent patients with schizophrenia and CUD found no change in symptoms and cognition, and an amelioration of impaired resting state brain function in areas implicated in reward function and the default mode network. One 4 week trial in acutely psychotic inpatients without CUD (mean age 30 y) found 800 mg CBD to be similarly efficacious to amisupride in improving psychosis and cognition. Two 6 week studies of CBD augmentation of antipsychotics in stable outpatients reported mixed results: CBD 600 mg was not more effective than placebo; CBD 1,000 mg reduced symptoms in a sample that did not exclude cannabis use and CUD. A brain fMRI and proton magnetic resonance spectroscopy study of single dose CBD in a sample that did not exclude CUD and cannabis use found that CBD improved symptoms and brain function during a learning/recall task and was associated with increased hippocampal glutamate. Discussion: There is substantial heterogeneity across studies in dose, method of drug delivery, length of treatment, patient age, whether patients with cannabis use/CUD were included or excluded, and whether patients were using antipsychotic medication. Conclusion: There is insufficient evidence for an effect of THC or CBD on symptoms, cognition, and neuroimaging measures of brain function in schizophrenia. At this time, research does not support recommending medical cannabis (THC or CBD) for treating patients with schizophrenia. Further research should examine THC and CBD in schizophrenia with and without comorbid CUD and consider the role of CBD in mitigating symptom exacerbation from THC.
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Affiliation(s)
- Saeed Ahmed
- Department of Psychiatry, Rutland Regional Medical Center, Rutland, VT, United States
- Vermont Hub-and-Spoke System of Care, West Ridge Center at Rutland Regional Medical Center, Rutland, VT, United States
| | - Robert M. Roth
- New Hampshire Hospital, Concord, NH, United States
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Corneliu N. Stanciu
- New Hampshire Hospital, Concord, NH, United States
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mary F. Brunette
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Bureau of Mental Health Services, Concord, NH, United States
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14
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Fish S, Christidi F, Karavasilis E, Velonakis G, Kelekis N, Klein C, Stefanis NC, Smyrnis N. Interaction of schizophrenia and chronic cannabis use on reward anticipation sensitivity. NPJ SCHIZOPHRENIA 2021; 7:33. [PMID: 34135344 PMCID: PMC8209034 DOI: 10.1038/s41537-021-00163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
Chronic cannabis use and schizophrenia are both thought to affect reward processing. While behavioural and neural effects on reward processing have been investigated in both conditions, their interaction has not been studied, although chronic cannabis use is common among these patients. In the present study eighty-nine participants divided into four groups (control chronic cannabis users and non-users; schizophrenia patient cannabis users and non-users) performed a two-choice decision task, preceded by monetary cues (high/low reward/punishment or neutral), while being scanned using functional magnetic resonance imaging. Reward and punishment anticipation resulted in activation of regions of interest including the thalamus, striatum, amygdala and insula. Chronic cannabis use and schizophrenia had opposing effects on reward anticipation sensitivity. More specifically control users and patient non-users showed faster behavioural responses and increased activity in anterior/posterior insula for high magnitude cues compared to control non-users and patient users. The same interaction pattern was observed in the activation of the right thalamus for reward versus punishment cues. This study provided evidence for interaction of chronic cannabis use and schizophrenia on reward processing and highlights the need for future research addressing the significance of this interaction for the pathophysiology of these conditions and its clinical consequences.
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Affiliation(s)
- Simon Fish
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece.,1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Foteini Christidi
- Department of Medical Physics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece
| | - Christoph Klein
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece.,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Freiburg, Freiburg, Germany.,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicholas C Stefanis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", Athens, Greece. .,2nd Department of Psychiatry, National and Kapodistrian University of Athens, School of Medicine, University General Hospital "ATTIKON", Athens, Greece.
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15
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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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16
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Blest-Hopley G, O'Neill A, Wilson R, Giampietro V, Bhattacharyya S. Disrupted parahippocampal and midbrain function underlie slower verbal learning in adolescent-onset regular cannabis use. Psychopharmacology (Berl) 2021; 238:1315-1331. [PMID: 31814047 PMCID: PMC8062355 DOI: 10.1007/s00213-019-05407-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022]
Abstract
RATIONALE Prolonged use of cannabis, the most widely used illicit drug worldwide, has been consistently associated with impairment in memory and verbal learning. Although the neurophysiological underpinnings of these impairments have been investigated previously using functional magnetic resonance imaging (fMRI), while performing memory tasks, the results of these studies have been inconsistent and no clear picture has emerged yet. Furthermore, no previous studies have investigated trial-by-trial learning. OBJECTIVES We aimed to investigate the neural underpinnings of impaired verbal learning in cannabis users as estimated over repeated learning trials. METHODS We studied 21 adolescent-onset regular cannabis users and 21 non-users using fMRI performed at least 12 h after last cannabis use, while they performed a paired associate verbal learning task that allowed us to examine trial-by-trial learning. Brain activation during repeated verbal encoding and recall conditions of the task was indexed using the blood oxygen level-dependent haemodynamic response fMRI signal. RESULTS There was a significant improvement in recall score over repeated trials indicating learning occurring across the two groups of participants. However, learning was significantly slower in cannabis users compared to non-users (p = 0.032, partial eta-squared = 0.108). While learning verbal stimuli over repeated encoding blocks, non-users displayed progressive increase in recruitment of the midbrain, parahippocampal gyrus and thalamus (p = 0.00939, partial eta-squared = 0.180). In contrast, cannabis users displayed a greater but disrupted activation pattern in these regions, which showed a stronger correlation with new word-pairs learnt over the same blocks in cannabis users than in non-users. CONCLUSIONS These results suggest that disrupted medial temporal and midbrain function underlie slower learning in adolescent-onset cannabis users.
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Affiliation(s)
- Grace Blest-Hopley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Aisling O'Neill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Robin Wilson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK.
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17
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Sharma P, Riehm KE, Young AS, Reynolds MD, Tarter RE, Horner MS, Hammond CJ. Do the Transmissible Liability Index (TLI) and Adolescent Cannabis Use Predict Paranoid and Schizotypal Symptoms at Young Adulthood? Subst Use Misuse 2021; 56:2026-2034. [PMID: 34402373 DOI: 10.1080/10826084.2021.1964086] [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: 10/20/2022]
Abstract
Background: Adolescent cannabis use is an established risk factor for the development of psychosis, but the premorbid vulnerability factors and specificity versus generality of the psychotic symptom domains affected in cannabis-psychosis relationships remain incompletely understood. To improve our understanding of these relationships, we used longitudinal data to examine the individual and interactive effects of preadolescent transmissible liability to substance use disorders (SUD), measured via the transmissible liability index (TLI), and adolescent cannabis use on the development of two distinct psychotic symptom domains, paranoid and schizotypal personality traits in young adulthood. Methods: We performed secondary analysis of data from the Center for Education and Drug Abuse (CEDAR) study, which longitudinally assessed offspring of men with (N = 211) and without (N = 237) lifetime history of SUD at ages 10-12, and across adolescence as they transitioned to young adulthood. TLI scores were calculated at age 10-12, self-reported cannabis use was assessed at age 16, and paranoid and schizotypal symptoms were assessed at age 19. Results: Cannabis use at age 16 and family history of SUD were significantly associated with paranoid and schizotypal symptoms at age 19, but TLI scores were not. The interactive effect of TLI x cannabis use was also not significant. Paranoid and schizotypal symptoms showed different dose-dependent sensitivities to cannabis exposure at age 16. Conclusions: These findings indicate that adolescent cannabis use and family history of SUD differentially contribute to the development of paranoid and schizotypal personality traits through mechanisms that do not include behavioral disinhibition.
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Kira E Riehm
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea S Young
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Ralph E Tarter
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle S Horner
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Blest‐Hopley G, O'Neill A, Wilson R, Giampietro V, Lythgoe D, Egerton A, Bhattacharyya S. Adolescent-onset heavy cannabis use associated with significantly reduced glial but not neuronal markers and glutamate levels in the hippocampus. Addict Biol 2020; 25:e12827. [PMID: 31478302 DOI: 10.1111/adb.12827] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/18/2022]
Abstract
Cannabis use has been associated with adverse mental health outcomes, the neurochemical underpinnings of which are poorly understood. Although preclinical evidence suggests glutamatergic dysfunction following cannabis exposure in several brain regions including the hippocampus, evidence from human studies have been inconsistent. We investigated the effect of persistent cannabis use on the brain levels of N-acetyl aspartate (NAA) and myoinositol, the metabolite markers of neurons and glia, the site of the main central cannabinoid CB1 receptor, and the levels of glutamate, the neurotransmitter directly affected by CB1 modulation. We investigated cannabis users (CUs) who started using during adolescence, the period of greatest vulnerability to cannabis effects and focused on the hippocampus, where type 1 cannabinoid receptors (CBR1) are expressed in high density and have been linked to altered glutamatergic neurotransmission. Twenty-two adolescent-onset CUs and 21 nonusing controls (NU), completed proton magnetic resonance spectroscopy, to measure hippocampal metabolite concentrations. Glutamate, NAA, and myoinositol levels were compared between CU and NU using separate analyses of covariance. CU had significantly lower myoinositol but not glutamate or NAA levels in the hippocampus compared with NU. Myoinositol levels in CU positively correlated with glutamate levels, whereas this association was absent in NU. Altered myoinositol levels may be a marker of glia dysfunction and is consistent with experimental preclinical evidence that cannabinoid-induced glial dysfunction may underlie cannabinoid-induced memory impairments. Future studies using appropriate imaging techniques such as positron emission tomography should investigate whether glial dysfunction associated with cannabis use underlies hippocampal dysfunction and memory impairment in CUs.
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Affiliation(s)
- Grace Blest‐Hopley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Aisling O'Neill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Robin Wilson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - David Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- South London and Maudsley NHS Foundation Trust London UK
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19
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Sami M, Cole JH, Kempton MJ, Annibale L, Das D, Kelbrick M, Eranti S, Collier T, Onyejiaka C, O'Neill A, Lythgoe DJ, McGuire P, Williams SCR, Bhattacharyya S. Cannabis use in patients with early psychosis is associated with alterations in putamen and thalamic shape. Hum Brain Mapp 2020; 41:4386-4396. [PMID: 32687254 PMCID: PMC7502838 DOI: 10.1002/hbm.25131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 03/06/2020] [Accepted: 06/24/2020] [Indexed: 12/31/2022] Open
Abstract
Around half of patients with early psychosis have a history of cannabis use. We aimed to determine if there are neurobiological differences in these the subgroups of persons with psychosis with and without a history of cannabis use. We expected to see regional deflations in hippocampus as a neurotoxic effect and regional inflations in striatal regions implicated in addictive processes. Volumetric, T1w MRIs were acquired from people with a diagnosis psychosis with (PwP + C = 28) or without (PwP - C = 26) a history of cannabis use; and Controls with (C + C = 16) or without (C - C = 22) cannabis use. We undertook vertex-based shape analysis of the brainstem, amygdala, hippocampus, globus pallidus, nucleus accumbens, caudate, putamen, thalamus using FSL FIRST. Clusters were defined through Threshold Free Cluster Enhancement and Family Wise Error was set at p < .05. We adjusted analyses for age, sex, tobacco and alcohol use. The putamen (bilaterally) and the right thalamus showed regional enlargement in PwP + C versus PwP - C. There were no areas of regional deflation. There were no significant differences between C + C and C - C. Cannabis use in participants with psychosis is associated with morphological alterations in subcortical structures. Putamen and thalamic enlargement may be related to compulsivity in patients with a history of cannabis use.
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Affiliation(s)
- Musa Sami
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - James H. Cole
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Matthew J. Kempton
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Luciano Annibale
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Debasis Das
- Leicestershire Partnership NHS TrustLondonUK
| | | | | | - Tracy Collier
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | | | - Aisling O'Neill
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - David J. Lythgoe
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Philip McGuire
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Steve C. R. Williams
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
| | - Sagnik Bhattacharyya
- Institute of PsychiatryPsychology and Neurosciences King's College LondonLondonUK
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20
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Appiah-Kusi E, Wilson R, Colizzi M, Foglia E, Klamerus E, Caldwell A, Bossong MG, McGuire P, Bhattacharyya S. Childhood trauma and being at-risk for psychosis are associated with higher peripheral endocannabinoids. Psychol Med 2020; 50:1862-1871. [PMID: 31422779 DOI: 10.1017/s0033291719001946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence has been accumulating regarding alterations in components of the endocannabinoid system in patients with psychosis. Of all the putative risk factors associated with psychosis, being at clinical high-risk for psychosis (CHR) has the strongest association with the onset of psychosis, and exposure to childhood trauma has been linked to an increased risk of development of psychotic disorder. We aimed to investigate whether being at-risk for psychosis and exposure to childhood trauma were associated with altered endocannabinoid levels. METHOD We compared 33 CHR participants with 58 healthy controls (HC) and collected information about previous exposure to childhood trauma as well as plasma samples to analyse endocannabinoid levels. RESULTS Individuals with both CHR and experience of childhood trauma had higher N-palmitoylethanolamine (p < 0.001) and anandamide (p < 0.001) levels in peripheral blood compared to HC and those with no childhood trauma. There was also a significant correlation between N-palmitoylethanolamine levels and symptoms as well as childhood trauma. CONCLUSIONS Our results suggest an association between CHR and/or childhood maltreatment and elevated endocannabinoid levels in peripheral blood, with a greater alteration in those with both CHR status and history of childhood maltreatment compared to those with either of those risks alone. Furthermore, endocannabinoid levels increased linearly with the number of risk factors and elevated endocannabinoid levels correlated with the severity of CHR symptoms and extent of childhood maltreatment. Further studies in larger cohorts, employing longitudinal designs are needed to confirm these findings and delineate the precise role of endocannabinoid alterations in the pathophysiology of psychosis.
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Affiliation(s)
- E Appiah-Kusi
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - R Wilson
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - M Colizzi
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Policlinico 'G. B. Rossi', P.le L.A. Scuro 10, 37134, Verona, Italy
| | - E Foglia
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - E Klamerus
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - A Caldwell
- King's College London, Mass Spectometry Facility, Franklin Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - M G Bossong
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - P McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - S Bhattacharyya
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 63, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
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21
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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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22
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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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23
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Pinto JV, Saraf G, Frysch C, Vigo D, Keramatian K, Chakrabarty T, Lam RW, Kauer-Sant'Anna M, Yatham LN. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:213-227. [PMID: 31830820 PMCID: PMC7385425 DOI: 10.1177/0706743719895195] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To review the current evidence for efficacy of cannabidiol in the treatment of mood disorders. Methods: We systematically searched PubMed, Embase, Web of Science, PsychInfo, Scielo, ClinicalTrials.gov, and The Cochrane Central Register of Controlled Trials for studies published up to July 31, 2019. The inclusion criteria were clinical trials, observational studies, or case reports evaluating the effect of pure cannabidiol or cannabidiol mixed with other cannabinoids on mood symptoms related to either mood disorders or other health conditions. The review was reported in accordance with guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Results: Of the 924 records initially yielded by the search, 16 were included in the final sample. Among them, six were clinical studies that used cannabidiol to treat other health conditions but assessed mood symptoms as an additional outcome. Similarly, four tested cannabidiol blended with Δ-9-tetrahydrocannabinol in the treatment of general health conditions and assessed affective symptoms as secondary outcomes. Two were case reports testing cannabidiol. Four studies were observational studies that evaluated the cannabidiol use and its clinical correlates. However, there were no clinical trials investigating the efficacy of cannabidiol, specifically in mood disorders or assessing affective symptoms as the primary outcome. Although some articles point in the direction of benefits of cannabidiol to treat depressive symptoms, the methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders. Conclusions: There is a lack of evidence to recommend cannabidiol as a treatment for mood disorders. However, considering the preclinical and clinical evidence related to other diseases, cannabidiol might have a role as a treatment for mood disorders. Therefore, there is an urgent need for well-designed clinical trials investigating the efficacy of cannabidiol in mood disorders.
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Affiliation(s)
- Jairo Vinícius Pinto
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gayatri Saraf
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Frysch
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Márcia Kauer-Sant'Anna
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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24
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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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25
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Blest-Hopley G, Colizzi M, Giampietro V, Bhattacharyya S. Is the Adolescent Brain at Greater Vulnerability to the Effects of Cannabis? A Narrative Review of the Evidence. Front Psychiatry 2020; 11:859. [PMID: 33005157 PMCID: PMC7479242 DOI: 10.3389/fpsyt.2020.00859] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/06/2020] [Indexed: 01/01/2023] Open
Abstract
Cannabis use during the critical neurodevelopmental period of adolescence, may lead to brain structural, functional, and histological alterations that may underpin some of the longer-term behavioral and psychological harms associated with it. The endocannabinoid system performs a key regulatory and homeostatic role, that undergoes developmental changes during adolescence making it potentially more susceptible to the effects of exposure to cannabis during adolescence. Here, we synthesize evidence from human studies of adolescent cannabis users showing alterations in cognitive performance as well as in brain structure and function with relevant preclinical evidence to summarize the current state of knowledge. We also focus on the limited evidence that speaks to the hypothesis that cannabis use during adolescence, may pose a greater risk than use during adulthood, identify gaps in current evidence and suggest directions for new research. Existing literature is consistent with the association of cannabis use during adolescence and neurological changes. Adolescence cannabis users show altered functional connectivity within known functional circuits, that may underlie inefficient recruitment of brain regions, as largely increased functional activation has been observed compared to controls. This disruption in some cases may contribute to the development of adverse mental health conditions; increasing the chances or accelerating the onset, of their development. Preclinical evidence, further supports disruption from cannabis use being specific to the developmental period. Future studies are required to better investigate adolescent cannabis use with more accuracy using better defined groups or longitudinal studies and examine the permanency of these changes following caseation of use. Furthermore, research is required to identify heritable risk factors to cannabis use. There is a need for caution when considering the therapeutic potential of cannabis for adolescence and particularly in public discourse leading to potential trivialization of possible harm from cannabis use in adolescence. Current evidence indicates that adolescence is a sensitive period during which cannabis use may result in adverse neurocognitive effects that appear to show a level of permanency into adulthood.
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Affiliation(s)
- Grace Blest-Hopley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.,Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Vincent Giampietro
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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26
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Reid S, Bhattacharyya S. Antipsychotic treatment failure in patients with psychosis and co-morbid cannabis use: A systematic review. Psychiatry Res 2019; 280:112523. [PMID: 31450032 DOI: 10.1016/j.psychres.2019.112523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/23/2023]
Abstract
Whilst the effects of cannabis preceding psychosis onset are well established, an effect post-onset is less clear. Emerging evidence suggests that cannabis use is associated with increased relapse outcomes possibly because of determinants, antipsychotic treatment failure and medication adherence, that are not mutually exclusive. Due to the paucity of literature on antipsychotic treatment failure an association with cannabis remains conjectural. This review sought to summarise current evidence regarding the effect of cannabis use on antipsychotic treatment failure among users and non-users with psychosis. Ovid databases (Embase, Journals@Ovid Full Text, OvidMEDLINE® In-Process and Other Non-Indexed Citations and PsycINFO) were searched to identify relevant articles. Seven articles met eligibility criteria. Cannabis use was associated with the following deleterious outcomes increased: odds of non-remission, prescription of unique antipsychotic medications, cumulative prescription of Clozapine and poor treatment trajectories. One study reported similar life-time, but lower past-year, rates of cannabis use in those prescribed Clozapine. Another study reported differences between groups for chlorpromazine equivalent doses for long-term Olanzapine prescription. Improved methodologies are warranted due to a lack of well-designed prospective studies and heterogeneity of key variables. There remains, despite research paucity, the need to encourage early cannabis cessation and higher-quality research to inform clinical practice.
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Affiliation(s)
- Sam Reid
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
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27
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Zvonarev V, Fatuki TA, Tregubenko P. The Public Health Concerns of Marijuana Legalization: An Overview of Current Trends. Cureus 2019; 11:e5806. [PMID: 31723545 PMCID: PMC6837267 DOI: 10.7759/cureus.5806] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to conduct a review of the benefits and adverse effects of cannabis (or marijuana) legalization in various states across the US. The current study offers a preliminary evaluation of the problems concerning marijuana legalization in several states, with the primary goal being the assessment of the impact of laws and policies governing the legalization and use of marijuana for medical purposes. A comprehensive search on cannabis and its derivatives was performed using multiple resource databases: PubMed, MEDLINE, Embase, PsycINFO, CENTRAL (Cochrane Controlled Register of Trials), government web sources, and the Department of Public Health databases. A total of 47 reports that evaluated the effects of cannabis legalization were included in this review. All review stages were conducted independently by two reviewers. Data were extracted in standardized tables by one reviewer and adjusted by a second, which were verified by the third author. We examined the use of cannabis before and after the changes in policy and the impact of marijuana legalization on traffic safety, behavior and educational achievement in adolescents, public health, tax revenues, criminal justice expenditures, and financial outcomes. We analyzed the effects and consequences of marijuana use in states that have or have not legalized marijuana. This report also includes the responsiveness of the people in states where marijuana is legalized and its value in the healthcare system. Our study highlights the existing limitations of reviews that probe the effect of decriminalizing marijuana in some states of the country. Our analysis shows that detailed and precise evaluation of policy dynamics must be conducted, taking into account the heterogeneity in population sub-groups and policies. Accordingly, in states where marijuana is used for its medicinal value and recreational purposes, people have different views on the legalization of marijuana. The complete effect of legalizing and commercializing marijuana on consumers' mental health and their educational outcomes is expected to take a longer duration prior to its achievement; unfortunately, fewer merits are anticipated. Most of the reports evaluated in this article proved to be marred with inconsistencies. Many of the stated claims did not pass a methodical evaluation. Going forward, additional data from available sources will lead to stronger conclusions. We weighed the pros and cons of marijuana legalization. However, we are certain that consumers can make better decisions by weighing each opinion by its reliability and safety.
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Affiliation(s)
- Valeriy Zvonarev
- Psychiatry, School of Behavioral Sciences, California Southern University, Costa Mesa, USA
| | | | - Polina Tregubenko
- Internal Medicine, Jacobi Medical Center - Albert Einstein College of Medicine, New York, USA
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Park SC, Oh HS, Tripathi A, Kallivayalil RA, Avasthi A, Grover S, Tanra AJ, Kanba S, Kato TA, Inada T, Chee KY, Chong MY, Lin SK, Sim K, Xiang YT, Tan CH, Javed A, Sartorius N, Shinfuku N, Park YC. Cannabis use correlates with aggressive behavior and long-acting injectable antipsychotic treatment in Asian patients with schizophrenia. Nord J Psychiatry 2019; 73:323-330. [PMID: 31240984 DOI: 10.1080/08039488.2019.1632381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Although cannabis use has been linked with schizophrenia in a dose-response pattern, to our knowledge, the relationship between cannabis and schizophrenia has rarely been reported in Asian population. Aim: We compared the clinical characteristics and psychotropic prescription patterns between cannabis users and non-users among Asian patients with schizophrenia. Moreover, we aimed to identify the independent correlates of cannabis use in these subjects. Methods: We performed the analysis of the data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), a collaborative consortium survey used to collate the prescription patterns for antipsychotic and other psychotropic medications in patients with schizophrenia in Asia. We included 132 schizophrenia patients in the group of lifetime cannabis use and 1756 in the group that had never used cannabis. A binary logistic model was fitted to detect the clinical correlates of lifetime cannabis use. Results: Adjusting for the effects of age, sex, geographical region, income group, duration of untreated psychosis, and Charlson comordity index level, a binary logistic regression model revealed that lifetime cannabis use was independently associated with aggressive behavior [adjusted odds ratio (aOR) = 1.582, 95% confidence interval (CI) = 1.006-2.490, p = .047] and with long-acting injectable antipsychotic treatment (aOR = 1.796, 95% CI = 1.444-2.820, p = .001). Conclusion: Our findings indicate a close link between lifetime cannabis use and aggressive behavior. The use of long-acting, injectable antipsychotics preferentially treats the aggressive behavior cannabis users among patients with schizophrenia in Asia, especially, the South or Southeast Asia.
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Affiliation(s)
- Seon-Cheol Park
- a Department of Psychiatry, Inje Universtiy Haeundae Paik Hospital , Busan , Republic of Korea
| | - Hong Seok Oh
- b Department of Psychiatry, Konyang University Hospital , Daejeon , Republic of Korea
| | - Adarsh Tripathi
- c Department of Psychiatry, King George's Medical University , Chowk , India
| | | | - Ajit Avasthi
- e Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Sandeep Grover
- e Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India
| | - Andi Jayalangkara Tanra
- f Faculty of Medicine, Department of Psychiatry, Hasanuddin University , Makassar , Indonesia
| | - Shigenobu Kanba
- g Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University , Fukuoka , Japan
| | - Takahiro A Kato
- g Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University , Fukuoka , Japan
| | - Toshiya Inada
- h Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine , Nagoya , Japan
| | - Kok Yoon Chee
- i Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital , Kuala Lumpur , Malaysia
| | - Mian-Yoon Chong
- j Chang Gung Memorial Hospital , Chiayi , Taiwan.,k Chang Gung University School of Medicine , Taoyuan City , Taiwan
| | - Shih-Ku Lin
- l Psychiatric Center, Taipei City Hospital , Taipei , Taiwan
| | - Kang Sim
- m West Region, Institute of Mental Health and Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore
| | - Yu-Tao Xiang
- n Faculty of Health Sciences, Unit of Psychiatry, Institute of Translational Medicine, University of Macau , Macau SAR , China
| | - Chay Hoon Tan
- o Department of Pharmacology, National University Hospital , Singapore , Singapore
| | - Afzal Javed
- p Pakistan Psychiatric Research Centre, Fountain House , Lahore , Pakistan
| | - Norman Sartorius
- q Association for the Improvement of Mental Health Programmes , Geneva , Switzerland
| | - Naotaka Shinfuku
- r Department of Social Welfare, School of Human Sciences, Seinan Gakuin University , Fukuoka , Japan
| | - Yong Chon Park
- s Department of Neuropsychiatry, Hanyang University Guri Hospital , Guri , Republic of Korea
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The prevalence and clinical correlates of cannabis use and cannabis use disorder among patients with bipolar disorder: A systematic review with meta-analysis and meta-regression. Neurosci Biobehav Rev 2019; 101:78-84. [PMID: 30974123 DOI: 10.1016/j.neubiorev.2019.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022]
Abstract
Bipolar disorder (BD) is commonly associated with comorbidities, especially substance use disorders. In light of this, the present review aimed to investigate the prevalence and clinical correlates of cannabis use in BD. Studies evaluating the prevalence of cannabis use among patients with BD and studies reporting a dichotomous sample of patients with cannabis use compared to those without the use were included. Meta-analyses using random-effects models were performed, and sources of heterogeneity were explored using meta-regression. The search resulted in 2918 publications, of which 53 were included. The prevalence of cannabis use was 24% (95%CI:18-29; k = 35; n = 51,756). Cannabis use was significantly associated with being younger, male, and single; having fewer years of education and an earlier onset of affective symptoms; and lifetime psychotic symptoms, suicide attempts, and use of tobacco, alcohol, and other substances. In conclusion, cannabis use present in almost one-quarter of patients with BD and is associated with factors that are highly relevant for both clinical practice and public health.
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Blest-Hopley G, Giampietro V, Bhattacharyya S. Regular cannabis use is associated with altered activation of central executive and default mode networks even after prolonged abstinence in adolescent users: Results from a complementary meta-analysis. Neurosci Biobehav Rev 2018; 96:45-55. [PMID: 30395923 PMCID: PMC6331661 DOI: 10.1016/j.neubiorev.2018.10.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 01/17/2023]
Abstract
Adolescent abstinent cannabis users showed significantly greater activation in the dorsolateral and ventrolateral prefrontal and posterior parietal cortices compared to controls. Adolescent users showed increased activation in regions involved in executive functioning, attentional control and the default mode network compared to non-using controls. No significant group differences in brain activation observed between abstinent and current adolescent cannabis users.
Whether the effects of cannabis use on brain function persist or recover following abstinence remains unclear. Therefore, using meta-analytic techniques, we examined whether functional alterations measured using fMRI persist in cannabis users abstinent for over 25 days (or 600 h) as evidence suggests that the effects on cognitive performance no longer persist beyond this period. Systematic literature search identified 20 studies, of which, 12 examined current cannabis users (CCU) (361 CCU versus 394 non-cannabis using controls (NU)) and 3 examined abstinent cannabis users (ACU) in 5 separate comparisons (98 ACU versus 106 NU). Studies in ACU were carried out in adolescents and suggest significantly greater activation in components of the central executive and default mode networks in adolescent ACU compared to NU. While this evidence is to be interpreted with caution because studies were carried out in overlapping samples, they indicate a pressing need for independent confirmation whether certain neurofunctional alterations in adolescent cannabis users may persist even after cannabis and its metabolites are likely to have left their bodies.
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Affiliation(s)
- Grace Blest-Hopley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Vincent Giampietro
- Department of Neuroimaging, Centre for Neuroimaging Sciences, PO Box 089, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK.
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Colizzi M, Bhattacharyya S. Cannabis use and the development of tolerance: a systematic review of human evidence. Neurosci Biobehav Rev 2018; 93:1-25. [DOI: 10.1016/j.neubiorev.2018.07.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
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Colizzi M, Burnett N, Costa R, De Agostini M, Griffin J, Bhattacharyya S. Longitudinal assessment of the effect of cannabis use on hospital readmission rates in early psychosis: A 6-year follow-up in an inpatient cohort. Psychiatry Res 2018; 268:381-387. [PMID: 30121541 DOI: 10.1016/j.psychres.2018.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/02/2018] [Accepted: 08/01/2018] [Indexed: 11/25/2022]
Abstract
Cannabis is the most commonly used illicit drug in psychosis patients and has been identified as a risk factor for relapse and subsequent hospital readmission, having substantial economic implications. To clarify the contribution of cannabis consumption to hospital readmission, a consecutive inpatient cohort of 161 early psychosis patients was included into the study. Data on cannabis use at admission and number of hospital readmissions and length of stay (LOS, number of inpatient days) in a 6-year follow-up was extracted from clinical notes. 62.4% of the patients had lifetime cannabis use. Their admission lasted on average 54.3 ± 75 days and over the following 6 years patients had 2.2 ± 2.8 hospital readmissions, for a total of 197.4 ± 331.5 days. Cannabis use significantly predicted the number of hospital readmissions and LOS in the following 6 years, the latter remaining significant after adjusting for use of other substance. Cannabis-using patients of male gender and Black ethnicity had a longer LOS at follow-up compared to female patients and other ethnic groups, respectively. Having a history of cannabis use when admitted to an early intervention inpatient unit for psychosis is associated with a higher number of subsequent hospital readmissions and a longer LOS, especially in male and Black patients.
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Affiliation(s)
- Marco Colizzi
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
| | - Natoy Burnett
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Rosalia Costa
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London NW3 5BA, United Kingdom; Azienda Unità Sanitaria Locale Taranto, Dipartimento Salute Mentale, Centro Salute Mentale Taranto, Polo Centrale, Taranto 74123, Italy
| | - Mattia De Agostini
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom; Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy
| | - James Griffin
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Sagnik Bhattacharyya
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, United Kingdom.
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Colizzi M, Bhattacharyya S. Neurocognitive effects of cannabis: Lessons learned from human experimental studies. PROGRESS IN BRAIN RESEARCH 2018; 242:179-216. [DOI: 10.1016/bs.pbr.2018.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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