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Nübling R, Schiwy F, El Barbari S, Hesse K, Müller H, Straub R, Brandt J, Göttmann-Franke J, Schnell T. [APPS-Study 2020 - On outpatient psychotherapeutic care for people with psychotic disorders]. Psychother Psychosom Med Psychol 2023; 73:489-501. [PMID: 37666269 DOI: 10.1055/a-2136-7473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Although patients with psychotic disorders (PPS) are indicated for outpatient psychotherapy at any stage of their illness, they are rarely treated in this way. For this purpose, structural conditions, the experience of competence of therapists, as well as content-related aspects of training and further education of psychotherapists are analyzed. METHODS Based on a qualitative preliminary study, an online survey was conducted among 487 psychological psychotherapists. RESULTS Half of the respondents indicated a high willingness to treat PPS. In the acute phase of the disease only 20% are willing to do so. In the studies as well as in the theoretical part of the education and further education, there is hardly any preparation for a corresponding treatment. In contrast, practical experience in psychiatric clinics is considered very important. With regard to structural framework conditions, low hourly quotas and inflexible billing modalities are criticized. With regard to patients, in addition to sufficient motivation for treatment, low reliability, low cognitive ability, low insight into the illness, and frequent discontinuation of therapy are stated. Contrary to some prejudices, patients are characterized as "peaceful" in their interactions. The reduction of psychotic relapses, social integration and reduction of comorbid symptoms are mainly mentioned as achievable outcomes. The reduction of psychotic symptoms is rated less optimistically. Psychotherapists from psychiatric outpatient clinics (PIA) differ from other outpatient psychotherapists by better competence experience and correspondingly more frequent work with PPS, also in the acute stage. DISCUSSION Although every second therapist does not feel well trained, the willingness to treat PPS seems to be higher than the pure supply figures suggest. There is potential for optimization in education and training as well as in networking with other professional groups/relatives. This could be responsible for the fact that in the acute psychotic stage there are fears of contact and competence concerns. Psychotherapists in PIAs, where there is closer networking with other professional groups for structural reasons, experience corresponding deficits to a lesser extent. With regard to other structural barriers, the question arises as to whether these represent disorder-specific or rather general problems in psychotherapy.
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Argote M, Sescousse G, Brunelin J, Baudin G, Schaub MP, Rabin R, Schnell T, Ringen PA, Andreassen OA, Addington JM, Brambilla P, Delvecchio G, Bechdolf A, Wobrock T, Schneider-Axmann T, Herzig D, Mohr C, Vila-Badia R, Rodie JU, Mallet J, Ricci V, Martinotti G, Knížková K, Rodriguez M, Cookey J, Tibbo P, Scheffler F, Asmal L, Garcia-Rizo C, Amoretti S, Huber C, Thibeau H, Kline E, Fakra E, Jardri R, Nourredine M, Rolland B. Association between cannabis use and symptom dimensions in schizophrenia spectrum disorders: an individual participant data meta-analysis on 3053 individuals. EClinicalMedicine 2023; 64:102199. [PMID: 37731936 PMCID: PMC10507201 DOI: 10.1016/j.eclinm.2023.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
Background The association between cannabis use and positive symptoms in schizophrenia spectrum disorders is well documented, especially via meta-analyses. Yet, findings are inconsistent regarding negative symptoms, while other dimensions such as disorganization, depression, and excitement, have not been investigated. In addition, meta-analyses use aggregated data discarding important confounding variables which is a source of bias. Methods PubMed, ScienceDirect and PsycINFO were used to search for publications from inception to September 27, 2022. We contacted the authors of relevant studies to extract raw datasets and perform an Individual Participant Data meta-analysis (IPDMA). Inclusion criteria were: psychopathology of individuals with schizophrenia spectrum disorders assessed by the Positive and Negative Syndrome Scale (PANSS); cannabis-users had to either have a diagnosis of cannabis use disorder or use cannabis at least twice a week. The main outcomes were the PANSS subscores extracted via the 3-factor (positive, negative and general) and 5-factor (positive, negative, disorganization, depression, excitement) structures. Preregistration is accessible via Prospero: ID CRD42022329172. Findings Among the 1149 identified studies, 65 were eligible and 21 datasets were shared, totaling 3677 IPD and 3053 complete cases. The adjusted multivariate analysis revealed that relative to non-use, cannabis use was associated with higher severity of positive dimension (3-factor: Adjusted Mean Difference, aMD = 0.34, 95% Confidence Interval, CI = [0.03; 0.66]; 5-factor: aMD = 0.38, 95% CI = [0.08; 0.63]), lower severity of negative dimension (3-factor: aMD = -0.49, 95% CI [-0.90; -0.09]; 5-factor: aMD = -0.50, 95% CI = [-0.91; -0.08]), higher severity of excitement dimension (aMD = 0.16, 95% CI = [0.03; 0.28]). No association was found between cannabis use and disorganization (aMD = -0.13, 95% CI = [-0.42; 0.17]) or depression (aMD = -0.14, 95% CI = [-0.34; 0.06]). Interpretation No causal relationship can be inferred from the current results. The findings could be in favor of both a detrimental and beneficial effect of cannabis on positive and negative symptoms, respectively. Longitudinal designs are needed to understand the role of cannabis is this association. The reported effect sizes are small and CIs are wide, the interpretation of findings should be taken with caution. Funding This research did not receive any specific grant or funding. Primary financial support for authors was provided by Le Vinatier Psychiatric Hospital.
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Schnell T, Grömm CM, Klöckner N. Predictive impact of different acute cannabis intoxication effects with regard to abstinence motivation and cessation of use. Sci Rep 2023; 13:709. [PMID: 36639397 PMCID: PMC9839715 DOI: 10.1038/s41598-023-27592-6] [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: 08/31/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Cannabis use is a common risk factor for psychoses. But although prevalence of consumption as well as potency of cannabis increased, the incidence of schizophrenia remained stable. The discontinuation hypothesis suggests that a potential increase of psychoses incidence may be relativized by more frequent cessation of consumption due to higher rates of adverse psychosis-like intoxication effects (PLE), caused by stronger cannabis. A mixed methods online survey was administered to 441 current and past users to analyze the predictive impact of different acute intoxication effects regarding abstinence motivation/cessation of use. Our hypothesis was that PLE would be experienced as the most aversive intoxication effect and therefore have the highest predictive significance. Possible confounds were included (craving, patterns of consumption and sociodemographics). Further analyzes compared past versus current users regarding the quality of intoxication effects, suggesting that past users retrospectively experienced more unpleasant experiences than current users. Free-text data explored subjective reasons for abstinence. We found that paranoid/dysphoric intoxication effects were most predictive for abstinence motivation. Less predictive were psychosis-like intoxication effects such as hallucinations. Group comparisons revealed significant more unpleasurable and less positive intoxication effects in past users compared with current users. Current users with the intention to stop consumption showed significantly more paranoia/dysphoria intoxication compared to users with no intention to stop use. As a conclusion, different intoxication experiences have different effects on abstinence motivation and substance use behavior. They therefore provide a focus that should be increasingly integrated into treatment concepts.
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Weierstall-Pust R, Schnell T, Heßmann P, Feld M, Höfer M, Plate A, Müller MJ. Stressors related to the Covid-19 pandemic, climate change, and the Ukraine crisis, and their impact on stress symptoms in Germany: analysis of cross-sectional survey data. BMC Public Health 2022; 22:2233. [PMID: 36451152 PMCID: PMC9709756 DOI: 10.1186/s12889-022-14682-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Climate change, the Covid-19 pandemic, and the Ukraine crisis are considered unprecedented global stressors, potentially associated with serious health consequences. However, simultaneous effects of these stressors are not yet understood, making it difficult to evaluate their relative contribution to the population burden and potential future manifestations in clinically significant psychiatric disorders. This study aimed at disentangling the relative contribution of the three stressor groups on current sub-clinical stress symptoms. METHODS A cross-sectional, representative survey study was conducted two months after the outbreak of the Ukraine war in Germany. Proportional quota sampling was applied for age, gender, income, and regional characteristics. Data were recruited by means of an online survey. 3094 data sets (1560 females) were included. Age ranged from 18-89 (M: 50.4 years; SD: 17.2). The Subclinical Stress Questionnaire (SSQ-25) served as main outcome measure. In collaboration with a professional media agency, 20 items were generated to capture salient population stressors. A three-factor exploratory structural equation model confirmed the appropriateness of this scale. RESULTS (1) Differences in subjective rankings revealed that stressors related to the Ukraine crisis were rated as most worrying, followed by climate change, and the Covid-19 pandemic (Generalized-Linear-Model: Epsilon = .97; F(1.94, 6001.14) = 1026.12, p < .001; ηp2 = .25). (2) In a linear regression model (R2 = .39), Covid-19 pandemic stressors were the only meaningful predictors for current ill-health (standardized β = .48). Ukraine crisis did not predict stress symptom profiles in the present sample. (3) Older and male individuals report less and/or less severe stress symptoms, although effect sizes were small (range: η2 .11-.21). An older age also reduced the impact of Covid-19 stressors. CONCLUSIONS Researchers from the health sciences must consider overlapping effects from population stressors. Although the Ukraine crisis and climate change mark salient stressors, including economic threats, the Covid-19 pandemic still has a profound effect on ill-health and must be considered as a relevant factor in future manifestations of psychiatric and associated health consequences.
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Lyons J, Highland P, Bos N, Lyons D, Skinner A, Schnell T, Hefron R. Measuring Perceived Agent Appropriateness in a Live-Flight Human-Autonomy Teaming Scenario. ERGONOMICS IN DESIGN 2022. [DOI: 10.1177/10648046221129393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
United States Air Force Test Pilot School students ( N = 6) participated in a study involving an agent-directed human pilot (“Blue agent”) in dogfighting scenarios against an adversary (“Red agent”). The adversary used three levels of difficulty as follows: low, medium, and high. An agent appropriateness scale was developed to gauge how appropriate the Blue agent’s behaviors were during each dogfight. Results demonstrated that agent appropriateness varied by Red agent difficulty. These results suggest that agent appropriateness is an essential element in human-autonomy teaming research. Practitioners should seek to develop agent appropriateness measures suitable for the particular context and technology in question.
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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: 0.3] [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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Scupin C, Schnell T, Kasten E. How Defined Is Gender Identity in People with Body Integrity Dysphoria? Adv Mind Body Med 2021; 35:17-32. [PMID: 34237024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Body integrity dysphoria (BID) is an intense need/desire to live in a disabled body, particularly due to a limb amputation or paraplegia. The investigators observed that significantly more people affected by BID wish to change their gender compared with the average population. The aim of this study was to find out whether gender identity (ie, typical male or female behavior) was less pronounced in a group of participants with BID than in a parallel control group of non-BID participants. The central hypothesis was that individuals in the BID group have a weak identification with their innate gender compared with the non-BID group and act more gender-neutral or contrary to their innate gender. METHODS Study participants included 25 female and 25 male individuals with BID in the BID group and 25 female and 25 male individuals in a parallel control group. RESULTS Compared with the control group, in the Minnesota Multiphasic Personality Inventory test, males with BID leaned more towards female, and females with BID leaned more toward typical male behavior. In addition, 8% of the BID group and 0% of the control group achieved the cut-off value on a test for gender dysphoria (GD). This result supports the hypothesis that BID-affected participants showed more gender-neutral behavior than the control participants. CONCLUSIONS The results indicate that gender identity in the BID group is not as defined as in the control group. These results indicate a comprehensive disruption of identification with one's own body, which is not limited to legs or arms, but also affects the gender identity of many affected individuals.
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Schnell T, Kehring A, Moritz S, Morgenroth O. Patients responses to diagnoses of mental disorders: Development and validation of a reliable self-report measure. Int J Methods Psychiatr Res 2021; 30:e1854. [PMID: 32918397 PMCID: PMC7992288 DOI: 10.1002/mpr.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Psychiatric patients are regularly informed about diagnoses. Treatment guidelines assume that informing patients fosters functional coping processes, but few research exists on how patients respond. Thus, the objective was to develop a standardized self-report measure to assess patients reactions to diagnoses. METHODS Fifty nine items were generated based on a qualitative study. The process of item selection and determination of the factor structure were performed on a sample of 252 patients: Results of an explorative factor analysis with a randomly split sub-sample 1 were cross-validated by confirmatory factor analysis on sub-sample 2. The revised 26-item instrument was revaluated using data from an independent sample of 1.271 patients with different diagnoses. RESULTS Three functional and three dysfunctional processing styles emerged from the analyses and provided good model fit in the revaluation study (TLI = 0.935; CFI = 0.943; RMSEA = 0.051; SRMR = 0.048). Variance-analytical calculations and post hoc analyses revealed significant differences among diagnoses with regard to coping styles, such as schizophrenia was associated with self-stigmatization and anorexia nervosa showed pronounced over-identification. Overall, various diagnosis-dependent specifics were found. CONCLUSIONS As patients reactions to diagnoses vary substantially, their formation, impact on treatment and overall cause should be investigated in further studies.
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Schnell T, Moritz S. Less self-stigmatization and more empowerment in patients with schizophrenia and comorbid cannabis use disorder compared to non-comorbid schizophrenia. Schizophr Res 2020; 222:523-524. [PMID: 32507374 DOI: 10.1016/j.schres.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
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Schnell T, Suhr F, Weierstall-Pust R. Post-traumatic stress disorder in volunteer firefighters: influence of specific risk and protective factors. Eur J Psychotraumatol 2020; 11:1764722. [PMID: 33029308 PMCID: PMC7473037 DOI: 10.1080/20008198.2020.1764722] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Volunteer firefighters belong to a risk population regarding the development of posttraumatic stress disorder (PTSD). However, given the frequency of work-related trauma, PTSD prevalences seem relatively low. Protective factors appear to be effective and are the focus of this study. OBJECTIVE We investigated the PTSD-prevalence as well as the influence of trauma exposure and the impact of protective factors resilience and Sense of Coherence (SoC) on symptoms of PTSD in volunteer firefighters. METHOD Data from 232 participants of an online questionnaire study were analysed using a path model approach. RESULTS 'The results suggest a possible prevalence of PTSD of 12.5% and 2.2% for partial PTSD based on self-report measures. SoC and trauma event load proved to be independent of each other, as no intercorrelations were found. But both directly predicted PTSD severity. Higher resilience scores predicted the participants' Sense of Coherence, but PTSD severity was only indirectly affected by resilience, which was entirely mediated by SoC. Further, although SoC and trauma load increase with age and years of job experience, it is only SoC that affects PTSD severity, not age or years of experience. CONCLUSIONS The results emphasize that not only exposure to potentially traumatic events predicts the later probability of developing symptoms of PTSD, but that the integration of stressful experiences into the self-concept (associated with SoC) is essential for the development of PTSD. Future research should address the question of causality between SoC and PTSD, and consider which factors moderate the SoC.
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Dhanesha N, Schnell T, Rahmatalla S, DeShaw J, Thedens D, Parker BM, Zimmerman MB, Pieper AA, Chauhan AK, Leira EC. Low-Frequency Vibrations Enhance Thrombolytic Therapy and Improve Stroke Outcomes. Stroke 2020; 51:1855-1861. [PMID: 32397935 PMCID: PMC7263385 DOI: 10.1161/strokeaha.120.029405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background and Purpose- We aim to determine the potential impact on stroke thrombolysis of drip-and-ship helicopter flights and specifically of their low-frequency vibrations (LFVs). Methods- Mice with a middle cerebral artery autologous thromboembolic occlusion were randomized to receive rtPA (recombinant tissue-type plasminogen activator; or saline) 90 minutes later in 3 different settings: (1) a motion platform simulator that reproduced the LFV signature of the helicopter, (2) a standardized actual helicopter flight, and (3) a ground control. Results- Mice assigned to the LFV simulation while receiving tPA had smaller infarctions (31.6 versus 54.9 mm3; P=0.007) and increased favorable neurological outcomes (86% versus 28%; P=0.0001) when compared with ground controls. Surprisingly, mice receiving tPA in the helicopter did not exhibit smaller infarctions (47.8 versus 54.9 mm3; P=0.58) nor improved neurological outcomes (37% versus 28%; P=0.71). This could be due to a causative effect of the 20- to 30-Hz band, which was inadvertently attenuated during actual flights. Mice using saline showed no differences between the LFV simulator and controls with respect to infarct size (80.9 versus 95.3; P=0.81) or neurological outcomes (25% versus 11%; P=0.24), ruling out an effect of LFV alone. There were no differences in blood-brain barrier permeability between LFV simulator or helicopter, compared with controls (2.45-3.02 versus 4.82 mm3; P=0.14). Conclusions- Vibration in the low-frequency range (0.5-120 Hz) is synergistic with rtPA, significantly improving the effectiveness of thrombolysis without impairing blood-brain barrier permeability. Our findings reveal LFV as a novel, safe, and simple-to-deliver intervention that could improve the outcomes of patients. Visual Overview- An online visual overview is available for this article.
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Dhanesha N, Schnell T, Rahmatalla S, DeShaw J, Thedens D, Parker B, Zimmerman MB, Pieper AA, Chauhan AK, Leira EC. Abstract WMP79: Recapitulation on the Ground of Helicopter Flight Low Frequency Vibration Enhances Stroke Thrombolysis. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Understanding the potential effects on stroke outcome of the unique physical factors present in a helicopter ambulance flight is critical in the era of thrombectomy. However, this factor in patient care has not been adequately investigated.
Methods:
This was a prospective randomized blinded end-point animal study. A murine model of middle cerebral artery autologous thromboembolic occlusion (eMCAO) with rtPA reperfusion was exposed to three different settings: 1) a standardized actual helicopter flight, 2) a motion platform simulator that delivered the exact LFV signature of the helicopter, and 3) a ground control. Outcome measures included infarct size and BBB permeability on MRI, and neurological scores.
Results:
A total of 106 mice were analyzed. Within the rtPA group, LFV simulator mice displayed lower infarction volumes on MRI (31.6 vs. 54.9 mm
3
, p=0.007) and improved neurological scores (87 vs. 28%, p=0.0001) compared to ground control mice. By contrast, mice receiving saline did not show change in either infarction volume (80.9 vs. 95.3, p=0.8) or neurological scores (37 vs. 28%, p=0.7). No differences were seen in the actual helicopter flight group as compared with ground control. No treatment group showed any difference in permeability of the blood brain barrier, assessed by MRI.
Conclusion:
We found a synergistic beneficial effect of combining helicopter-like LFV and rtPA, which could provide a novel, safe, and potentially more efficacious intervention for patients with stroke. These results also suggest that non-LFV helicopter physical factors, such, as hypobaric environment, accelerations and noise, may have a negating effect on the otherwise positive effect of helicopter vibration on stroke outcomes. If so, strategies to minimize these negating factors might be expected to improve patient outcome.
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Weitkamp K, Laues M, Schnell T. “Practical self-love”—A qualitative interview study on women participating in Self:Cervix: an online sexual mindfulness and sensitivity course. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2019.1696458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Reiß M, Schulte B, Schmidt CS, Carstens A, Görne H, Kreibich R, Tietje W, Weber B, Schnell T, Verthein U. Selbst- und Fremdbeurteilung von Depressivität bei opioidabhängigen Patienten in Substitutionsbehandlung. SUCHTTHERAPIE 2019. [DOI: 10.1055/a-1032-6735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund Opioidabhängige sind häufig von psychischen Komorbiditäten, insbesondere affektiven Störungen wie Depressionen betroffen. Die Diagnostik und Behandlung von depressiven Störungen in der Substitutionsbehandlung Opioidabhängiger stellen eine besondere Herausforderung dar. Dabei besteht die Gefahr, dass ein Teil der Patienten mit depressiven Symptomen unterversorgt bleibt.
Ziel Die Studie untersucht das Ausmaß depressiver Symptome bei opioidabhängigen Patienten in einer Substitutionsbehandlung und prüft die Übereinstimmung von Selbst- und Fremdbeurteilungen durch den Patienten und den jeweiligen substituierenden Arzt.
Methoden Zeitgleiche Fragebogenerhebung in 6 substituierenden Einrichtungen in Hamburg, Bremen und Kassel. Die Selbstbeurteilung zum Ausmaß von depressiven Symptomen erfolgte bei den Patienten mittels Beck Depressionsinventar (BDI-II). Zeitgleich wurden die substituierenden Ärzte anhand der Hamilton Depressions-Skala (HAMD) zur Beurteilung der depressiven Symptombelastung ihrer Patienten befragt.
Ergebnisse Opioidabhängige Patienten in Substitutionstherapie sind häufig in einem klinisch relevanten Ausmaß von depressiven Symptomen betroffen. Es konnte ein positiver Zusammenhang zwischen den Instrumenten in 4 kategorialen Ausprägungen bestätigt werden. Im Vergleich zur Selbstbeurteilung schätzten die Ärzte die depressive Belastung ihrer Patienten als weniger schwer ein.
Schlussfolgerung Die beiden verwendeten Instrumente sind geeignet, die Diagnostik von depressiven Symptomen bei Opioidabhängigen in Substitutionstherapie zu unterstützen, wobei die Fremdbeurteilung durch die substituierenden Ärzte zurückhaltender ausfällt. Die Studienergebnisse verweisen auf die hohe Relevanz der Diagnostik depressiver Symptomatik unter Opioid-Substituierten, um ggf. geeignete Behandlungsmaßnahmen einzuleiten.
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Schnell T, Heekeren K, Daumann J, Gouzoulis-Mayfrank E. Inhibition of return (IOR) in patients with schizophrenia and cannabis use. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:65-72. [PMID: 30184467 DOI: 10.1016/j.pnpbp.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022]
Abstract
Research concerning the spatial orientation in patients with schizophrenia has demonstrated a state independent deficit in inhibition of return (IOR), which has been discussed as a vulnerability marker for schizophrenia. Other recent investigations on brain structure and cognitive processing have revealed less deficits in schizophrenia patients with comorbid cannabis use (SCH + CUD) compared to abstinent schizophrenia patients (SCH). It was hypothesized that these results may reflect a premorbid lower vulnerability in at least a subgroup of comorbid patients. The aim of the present study is to extend previous work by investigating IOR functioning in patients with schizophrenia and cannabis use. This in turn should supplement the existing studies on the vulnerability of this patient group. Therefore, we compared IOR functioning in four groups: 62 patients with schizophrenia and 46 healthy controls, both with and without cannabis use. Participants underwent a covert orienting of attention task (COVAT) with peripheral cues and three stimulus onset asynchronies (SOAs: 200 ms, 400 ms and 800 ms). Both schizophrenia groups displayed delayed IOR with a more pronounced IOR effect in SCH + CUD compared to SCH. In healthy controls, IOR did not seem to be significantly affected by cannabis use. Significant IOR-differences between groups were only seen between SCH patients without cannabis use and both healthy groups at SOA 400 ms. Patterns of cannabis use as well as clinical parameters of psychoses did not affect IOR. Our results may support the hypothesis of IOR as a vulnerability marker for schizophrenia and of a lower biological vulnerability in at least a subgroup of SCH + CUD.
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Dhanesha N, Schnell T, Rahmatalla S, DeShaw J, Parker B, Chauhan A, Pieper A, Leira E. Abstract TP334: A Novel Murine Model of the Effects of Helicopter Emergency Medical Services Transportation on Ischemia and Thrombolysis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Helicopter emergent medical services (HEMS) transportation is critical for rapid transportation of patients for mechanical thrombectomy and rtPA-mediated reperfusion. However, the effect of the multiple unique physical factors present in HEMS on the outcomes of these procedures is not known. Experimental models of ischemia-reperfusion that replicate HEMS conditions are needed in order to address this issue before putative neuroprotective therapies during flight trials can be accurately evaluated.
Methods:
A novel experimental model of “drip & ship” during HEMS was developed using middle cerebral artery occlusion (MCAO) with autologous clot in mice and an Mi2 helicopter adapted for animal research. Since vibration is one of the most salient physical components in HEMS, we isolated this factor for mechanistic investigation. The vibratory signature during HEMS was recorded in-flight using accelerometers and then recapitulated in a six-degree-of-freedom man-rated Moog-FCS motion platform in the laboratory. We evaluated two approaches (simultaneous vs. sequential) to expose mice with MCAO to the three different settings (helicopter/simulator/ground) in order to find the most optimal methodologically.
Results:
A clot length of 30 mm and 90 min of rTPA initiation post MCAO achieved significant infarctions while minimizing periprocedural mortality. Two MCAOs were the maximum capable of achieving occlusion times <15 minutes apart. In order to maintain MCAO to rtPA times close to 90 minutes, a sequential exposure to the three settings (helicopter/simulator/ground) was established with 2 mice each. Randomly assigned exposure lasted for 1 h and occurred at the same time of the rtPA exposure. The three exposures were 2 hours apart to minimize the effect of atmospheric variations. The animal MRI facility was coordinated to acutely scan the animals after the three exposures.
Conclusion:
We have developed an animal model to study the effects of HEMS on rtPA/reperfusion. An ongoing experiment measuring infarction volume and clinical outcomes will determine the need to maintain an actual HEMS for future experiments, or whether a laboratory simulator will suffice.
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Schnell T, Gliese R, Schröter R, Kasten E, Gouzoulis-Mayfrank E. Motivational changes of cannabis use prior to and during the course of schizophrenia. Am J Addict 2016; 26:122-128. [PMID: 28004866 DOI: 10.1111/ajad.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/14/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated subjective reasons/motivation for cannabis use in patients with schizophrenia (n = 51) compared to otherwise healthy cannabis users (n = 109). Moreover, we explored possible changes in the motivational patterns of both groups over time. METHODS A questionnaire was developed with six dimensions of motivations to use cannabis: affect regulation, relaxation, habit, structuring everyday life, creativity, and sociability. Participants filled out the instrument regarding their present and initial use of cannabis. RESULTS At the time of onset of consumption, groups only differed significantly in habit with higher ratings for patients with schizophrenia and cannabis use (SCH+CAN group) and in sociability with higher ratings for otherwise healthy users (CAN group). In respect of present use, the motivation to consume cannabis was significantly higher for affect regulation and structuring everyday life in the SCH+CAN group and for relaxation and sociability in the CAN group. With reference to time-based variations, the SCH+CAN group reported increased relevance of structuring everyday life over time. Furthermore, the CAN group reported increased importance of habit over time, whereas the SCH+CAN patients showed decreased ratings of habit over time. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Our findings must be considered preliminary because of the retrospective nature of the assessment. Nevertheless, the present study provides an indication of the time-dependent variation of cannabis-use motivation in schizophrenia, which may provide a better understanding of the functions of cannabis use within the population. Results argue for specific motivational based interventions for the group of schizophrenia patients with regular cannabis use. (Am J Addict 2017;26:122-128).
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18
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Zwahlen HT, Schnell T. Visibility of Yellow Center Line Pavement Markings as a Function of line Configuration and Line Width. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193129604001811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The end detection distance of finite length yellow center lines (tape, no edge lines included) was determined in the field at night under automobile low beam illumination as a function of the line configuration (single dashed, single solid, and double solid) and width (0.05m, 0.1m). Ten subjects were used in the study. The factor line type (configuration and width), and approach direction were statistically significant. A 16 fold increase in the retro-reflective area resulted in a near 100% average end detection distance increase in the westbound direction, and in a 65% average end detection distance increase in the eastbound direction (different backgrounds). The findings confirm that an about 65% to near 100% increase in the average end detection distance represents the approximate upper limit of what can be achieved by adding more retro-reflective area to a yellow center line. Increasing the material retroreflectivity and/or improving the material angularity might be much more effective to increase the detection distance.
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19
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Leira EC, Stilley JD, Schnell T, Audebert HJ, Adams HP. Helicopter transportation in the era of thrombectomy: The next frontier for acute stroke treatment and research. Eur Stroke J 2016; 1:171-179. [PMID: 31008278 DOI: 10.1177/2396987316658994] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/18/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose Many patients suffer a stroke at a significant distance from a specialized center capable of delivering endovascular therapy. As a result, they require rapid transport by helicopter emergency medical services, sometimes while receiving a recombinant tissue plasminogen activator infusion (drip and ship). Despite its critical role in the new era of reperfusion, helicopter emergency medical services remains a poorly evaluated aspect of stroke care. Method Comprehensive narrative review of all published articles of helicopter emergency medical services related to acute stroke care in the inter-hospital and pre-hospital settings, including technical aspects and physical environment implications. Findings Helicopter emergency medical services transports are conducted during a critical early time period when specific interventions and ancillary care practices may have a significant influence on outcomes. We have limited knowledge of the potential impact of the unusual physical factors generated by the helicopter on the ischemic brain, which affects our ability to establish rational guidelines for ancillary care and the delivery of specific interventions. Discussion Unlike the pre-hospital and hospital settings where stroke interventions are delivered, the inter-hospital helicopter emergency medical services transfer setting remains a "black box" for acute stroke care and research. This gap is particularly relevant for many patients living in rural areas, or in congested urban areas, that depend on helicopter emergency medical services for rapid access to a tertiary stroke center. Conclusion Addressing the helicopter emergency medical services stroke gap in clinical trials and acute care delivery would homogenize capabilities through all care settings, thus minimizing potential disparities in research access and outcomes based on geographical location.
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20
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Grünke B, Jensen M, Schnell T. [Influence of Depressive Symptoms on Group Therapeutic Psychoeducational Intervention in Psychiatric Patient Groups of Mixed Diagnosis]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2016; 84:71-75. [PMID: 26953545 DOI: 10.1055/s-0042-101544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyse the extent of influence of depressive symptoms on the efficiency of group therapeutic psychoeducative intervention in psychiatric patients groups with mixed diagnoses, independently of the primary diagnosis. METHODS 34 psychiatric inpatients with different diagnoses were allocated to two groups according to the severity of their depressive symptoms. After the psychoeducational group intervention, patients were asked about several parameters concerning the effectiveness of the intervention. RESULTS Patients suffering from pronounced depressive symptoms seem to benefit less from the intervention. CONCLUSIONS Psychoeducational intervention is less effective in patients with severe symptoms of depression. This should be taken into consideration concerning the time point when patients should be integrated in such a group, as well as concerning the intensity of the intervention itself.
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Gouzoulis-Mayfrank E, König S, Koebke S, Schnell T, Schmitz-Buhl M, Daumann J. Trans-Sector Integrated Treatment in Psychosis and Addiction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:683-91. [PMID: 26554316 PMCID: PMC4643160 DOI: 10.3238/arztebl.2015.0683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat. Long-term integrated treatment programs might improve such patients' outcomes, at least to a moderate extent, but they have not yet been adequately studied or implemented in Germany to date. METHODS 100 dual diagnosis patients participated in a single-center, randomized, controlled trial under standard hospital treatment conditions. They were randomly allotted to two groups. Patients in the intervention group were admitted to a specialized open hospital ward, where they were given integrated treatment, including disorder-specific group therapy. Their treatment was continued with further disorder-specific group therapy in the outpatient setting. Patients in the control group were admitted to an open general psychiatric ward and received treatment as usual, but no disorder-specific treatment either during their hospitalization or in the subsequent outpatient phase. Follow-up examinations were performed three, six, and twelve months after inclusion. The primary outcome was defined as the changes in substance use and abstinence motivation. The secondary outcome consisted of the patients' satisfaction with treatment and with life in general, retention rate, psychopathology, rehospitalizations, and global level of functioning. RESULTS The patients in the intervention group developed higher abstinence motivation than those in the control group (p = 0.009) and transiently reduced their substance use to a greater extent (p = 0.039 at three months). They were also more satisfied with their treatment (group effect: p = 0.011). Their global level of functioning and their retention rate were also higher, but these differences did not reach statistical significance. CONCLUSION Low-threshold, motivational, integrated treatment programs with psycho-educative and behavioral therapeutic elements may be helpful in the treatment of dual diagnosis patients and should be more extensively implemented as part of standard hospital treatment. Larger-scale, methodologically more complex studies will be needed to identify subgroups of patients that respond to such treatments in different ways.
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Schnell T, von Katte S, Gast U. [Willingness of Psychotherapists in Private Practice to Treat Patients With Complex Post-Traumatic Stress and Dissociative Disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2015; 83:516-21. [PMID: 26421859 DOI: 10.1055/s-0035-1553729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Analyses of patient care with severe mental disorders. METHODS Psychotherapists in private praxis were interviewed about their willingness to treat patients with a range of diagnoses in the context of post-traumatic disorders. RESULTS Therapists were found more willing to treat "less severe" disorders, independent of years in practice, school of psychotherapy, a rural or urban practice setting. Therapists criticized the quality of their training and the health insurance review process. CONCLUSIONS Therapists are generally willing to treat patients with severe mental disorders, but experience limits of competency attributed to training deficits. They further experience the bureaucratic procedures of the health insurance review process as barriers to accepting these patients into treatment.These results indicate that recently developed concepts of psychotherapy for these patient groups should be more intensively integrated into the existing training curricula. Furthermore, a simplified health insurance review process ought to be considered.
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Leira EC, Zaheer A, Schnell T, Torner JC, Olalde HM, Pieper AA, Ortega-Gutierrez S, Nagaraja N, Marks NL, Adams HP. Effect of helicopter transport on neurological outcomes in a mouse model of embolic stroke with reperfusion: AIR-MICE pilot study. Int J Stroke 2015; 10 Suppl A100:119-24. [PMID: 26376603 DOI: 10.1111/ijs.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients often suffer a stroke at a significant distance from a center capable of delivering endovascular therapy, thus requiring rapid transport by helicopter emergency medical services while receiving a recombinant tissue plasminogen activator infusion that was initiated locally. But little is known about how a helicopter flight may impact the safety and efficacy of recombinant tissue plasminogen activator-induced reperfusion and patient outcomes. AIM To establish a new animal method to address with fidelity the safety and overall effect of helicopter emergency medical services during thrombolysis. METHODS Prospective randomized open blinded end-point study of an actual helicopter flight exposure. Adult C57BL/6 male mice were treated with a 10 mg/kg recombinant tissue plasminogen activator infusion two-hours after an embolic middle cerebral artery occlusion. Mice were randomized in pairs to simultaneously receive the infusion during a local helicopter flight or in a ground hangar. RESULTS Eighteen mice (nine pairs) were analyzed. The paired t-test analysis showed nonsignificant smaller infarction volumes in the helicopter-assigned animals (mean pair difference 33 mm(3) , P = 0·33). The amount of hemorrhagic transformation between the helicopter and ground groups was 4·08 vs. 4·56 μl, respectively (paired t-test, P = 0·45). CONCLUSIONS This study shows that helicopter emergency medical services do not have an inherent adverse effect on outcome in a mouse model of ischemic stroke with reperfusion. These results endorse the safety of the practice of using helicopter emergency medical services in stroke patients. The observed potential synergistic effect of helicopter-induced factors, such as vibration and changes in altitude, with reperfusion merits further exploration in animal experimental models and in stroke patients.
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Leira EC, Khan MM, Zaheer A, Schnell T, Torner JC, Olalde HM, Nagaraja N, Ortega-Gutierrez S, Pieper C, Adams HP. Abstract T P235: Assessing the Impact of Rotorcrafts in a Model of Induced Cerebral Embolism (AIR-MICE). Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Stroke is a time-dependent emergency that often requires emergent helicopter evacuation, a critical early setting for which little is known about the positive or deleterious effect of altitude change, noise, acceleration and vibration. While many of these factors could worsen ischemic injury, the low frequency vibrations might augment clot lysis and enhance rtPA treatment. The objective of this study is to measure the feasibility, safety and potential effect of helicopter transport during thrombolysis in an animal model.
Methodology:
Prospective, randomized, open intervention and blinded end-point pilot study that combines a controlled experimental model with a real life helicopter flight exposure. Subjects were adult C57BL/6 male mice that simultaneously underwent an embolic middle cerebral artery occlusion (eMCAO) in pairs. Each pair of mice were randomized to receive 10 mg/kg of rtPA at two hours after eMCAO either during a one hour local flight in a MI2 turbine helicopter, or to simultaneously receive the same rtPA infusion while waiting in an airport hangar. Mice were sacrificed at 24 h. Primary outcome measure was infarct volume. Secondary outcome was neurological scores.
Results:
Eighteen mice (9 pairs) were analyzed. Lower infarction volumes were seen in the helicopter assigned group in 6/9 pairs. The mean infarction volumes were 246.6 mm
3
(SD 154) for ground group and 213.6 mm
3
(SD 170) for the helicopter group. A paired t-test analysis showed lesser infarction volumes in the helicopter group (mean difference 33 mm
3
, p=0.33), a difference that was not influenced when adjusting for ambient temperature and atmospheric pressure. The neurological scores were similar in the ground and helicopter groups (1.28 vs. 1.22, p=0.88).
Conclusion:
Randomized trials of the effect of helicopter transport in a mouse model of eMCAO are feasible, and desirable to test the effect of neuroprotective therapies in this unique setting. These results endorse the safety of aerial transport, which might be associated with lower infarction volumes. The potential synergist effect of vibration in the rotorcraft with reperfusion needs to be explored further.
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Schnell T, Koethe D, Krasnianski A, Gairing S, Schnell K, Daumann J, Gouzoulis-Mayfrank E. Ziprasidone versus clozapine in the treatment of dually diagnosed (DD) patients with schizophrenia and cannabis use disorders: a randomized study. Am J Addict 2014; 23:308-12. [PMID: 24628830 DOI: 10.1111/j.1521-0391.2014.12126.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 09/29/2013] [Accepted: 10/06/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clozapine is considered to be particularly effective in the treatment of dually diagnosed (DD) patients with psychosis and substance use disorders. However, its use is restricted by potentially severe side effects. The aim of the present pilot study was to compare the effects of clozapine with the newer second generation antipsychotic (SGA) ziprasidone in DD-patients. METHODS Thirty (n = 30) patients with schizophrenia and cannabis abuse/dependence were randomized to ziprasidone or clozapine and were followed up for up to 12 months. RESULTS Cannabis use was reduced in both groups during follow-up. Clozapine treatment was associated with less positive symptoms of schizophrenia, more side effects and poorer compliance with treatment. CONCLUSIONS Results from this small pilot RCT suggest beneficial effects of both clozapine and ziprasidone in the treatment of cannabis use disorders in psychotic patients. Larger-scale RCTs are needed in order to assess advantages and disadvantages of the different SGAs in dually diagnosed populations.
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