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DellaCrosse M, Pleet M, Morton E, Ashtari A, Sakai K, Woolley J, Michalak E. "A sense of the bigger picture:" A qualitative analysis of follow-up interviews with people with bipolar disorder who self-reported psilocybin use. PLoS One 2022; 17:e0279073. [PMID: 36516137 PMCID: PMC9749989 DOI: 10.1371/journal.pone.0279073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES People with bipolar disorder (BD) spend more time depressed than manic/hypomanic, and depression is associated with greater impairments in psychosocial functioning and quality of life than mania/hypomania. Emerging evidence suggests psilocybin, the psychoactive compound in "magic mushrooms," is a promising treatment for unipolar depression. Clinical trials of psilocybin therapy have excluded people with BD as a precaution against possible adverse effects (e.g., mania). Our study centered the experiences of adults living with BD who consumed psilocybin-containing mushrooms, and aimed to (1) understand its subjective impacts on BD symptoms, (2) deepen understanding of Phase I survey results, and (3) elucidate specific contextual factors associated with adverse reactions in naturalistic settings. METHODS Following an international survey (Phase I), follow-up interviews were conducted with 15 respondents (Phase II) to further understand psilocybin use among adults with BD. As part of a larger mixed-methods explanatory sequential design study, reflexive thematic analysis was used to elaborate findings. RESULTS Three major themes containing sub-themes were developed. (1) Mental Health Improvements: (1.1) decreased impact and severity of depression, (1.2) increased emotion processing, (1.3) development of new perspectives, and (1.4) greater relaxation and sleep. (2) Undesired Mental Health Impacts: (2.1) changes in sleep, (2.2) increased mania severity, (2.3) hospitalization, and (2.4) distressing sensory experiences. (3) Salient Contextual Factors for psilocybin use included: (3.1) poly-substance use and psilocybin dose, (3.2) solo versus social experiences, and (3.3) pre-psilocybin sleep deprivation. CONCLUSION Our findings demonstrate both benefits and risks of psilocybin use in this population. Carefully designed clinical trials focused on safety and preliminary efficacy are warranted.
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Affiliation(s)
- Meghan DellaCrosse
- Department of Clinical Psychology, The Wright Institute, Berkeley, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, United States of America
- San Francisco Veteran’s Affairs Medical Center, San Francisco, California, United States of America
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Mollie Pleet
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, United States of America
- San Francisco Veteran’s Affairs Medical Center, San Francisco, California, United States of America
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Ashtari
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Sakai
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, United States of America
- San Francisco Veteran’s Affairs Medical Center, San Francisco, California, United States of America
| | - Josh Woolley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, United States of America
- San Francisco Veteran’s Affairs Medical Center, San Francisco, California, United States of America
| | - Erin Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Kuhns L, Kroon E, Colyer-Patel K, Cousijn J. Associations between cannabis use, cannabis use disorder, and mood disorders: longitudinal, genetic, and neurocognitive evidence. Psychopharmacology (Berl) 2022; 239:1231-1249. [PMID: 34741634 PMCID: PMC9520129 DOI: 10.1007/s00213-021-06001-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/11/2021] [Indexed: 12/16/2022]
Abstract
RATIONALE Cannabis use among people with mood disorders increased in recent years. While comorbidity between cannabis use, cannabis use disorder (CUD), and mood disorders is high, the underlying mechanisms remain unclear. OBJECTIVES We aimed to evaluate (1) the epidemiological evidence for an association between cannabis use, CUD, and mood disorders; (2) prospective longitudinal, genetic, and neurocognitive evidence of underlying mechanisms; and (3) prognosis and treatment options for individuals with CUD and mood disorders. METHODS Narrative review of existing literature is identified through PubMed searches, reviews, and meta-analyses. Evidence was reviewed separately for depression, bipolar disorder, and suicide. RESULTS Current evidence is limited and mixed but suggestive of a bidirectional relationship between cannabis use, CUD, and the onset of depression. The evidence more consistently points to cannabis use preceding onset of bipolar disorder. Shared neurocognitive mechanisms and underlying genetic and environmental risk factors appear to explain part of the association. However, cannabis use itself may also influence the development of mood disorders, while others may initiate cannabis use to self-medicate symptoms. Comorbid cannabis use and CUD are associated with worse prognosis for depression and bipolar disorder including increased suicidal behaviors. Evidence for targeted treatments is limited. CONCLUSIONS The current evidence base is limited by the lack of well-controlled prospective longitudinal studies and clinical studies including comorbid individuals. Future studies in humans examining the causal pathways and potential mechanisms of the association between cannabis use, CUD, and mood disorder comorbidity are crucial for optimizing harm reduction and treatment strategies.
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Affiliation(s)
- Lauren Kuhns
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands.
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Emese Kroon
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands
| | - Karis Colyer-Patel
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
| | - Janna Cousijn
- Department of Psychology, Neuroscience of Addiction (NofA, University of Amsterdam, Amsterdam, the Netherlands
- The Amsterdam Brain and Cognition Center (ABC), University of Amsterdam, Amsterdam, the Netherlands
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3
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Icick R, Melle I, Etain B, Høegh MC, Gard S, Aminoff SR, Leboyer M, Andreassen OA, Belzeaux R, Henry C, Bjella TD, Kahn JP, Steen NE, Bellivier F, Lagerberg TV. Preventive Medication Patterns in Bipolar Disorder and Their Relationship With Comorbid Substance Use Disorders in a Cross-National Observational Study. Front Psychiatry 2022; 13:813256. [PMID: 35592382 PMCID: PMC9110763 DOI: 10.3389/fpsyt.2022.813256] [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: 11/11/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The potential role of sub-optimal pharmacological treatment in the poorer outcomes observed in bipolar disorder (BD) with vs. without comorbid substance use disorders (SUDs) is not known. Thus, we investigated whether patients with BD and comorbid SUD had different medication regimens than those with BD alone, in samples from France and Norway, focusing on compliance to international guidelines. METHODS Seven hundred and seventy patients from France and Norway with reliably ascertained BD I or II (68% BD-I) were included. Medication information was obtained from patients and hospital records, and preventive treatment was categorized according to compliance to guidelines. We used Bayesian and regression analyses to investigate associations between SUD comorbidity and medication. In the Norwegian subsample, we also investigated association with lack of medication. RESULTS Comorbid SUDs were as follows: current tobacco smoking, 26%, alcohol use disorder (AUD), 16%; cannabis use disorder (CUD), 10%; other SUDs, 5%. Compliance to guidelines for preventive medication was lacking in 8%, partial in 44%, and complete in 48% of the sample. Compliance to guidelines was not different in BD with and without SUD comorbidity, as was supported by Bayesian analyses (highest Bayes Factor = 0.16). Cross national differences in treatment regimens led us to conduct country-specific adjusted regression analyses, showing that (1) CUD was associated with increased antipsychotics use in France (OR = 2.4, 95% CI = 1.4-3.9, p = 0.001), (2) current tobacco smoking was associated with increased anti-epileptics use in Norway (OR = 4.4, 95% CI = 1.9-11, p < 0.001), and (3) AUD was associated with decreased likelihood of being medicated in Norway (OR = 1.2, 95% CI = 1.04-1.3, p = 0.038). CONCLUSION SUD comorbidity in BD was overall not associated with different pharmacological treatment in our sample, and not related to the level of compliance to guidelines. We found country-specific associations between comorbid SUDs and specific medications that warrant further studies.
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Affiliation(s)
- Romain Icick
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruno Etain
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Margrethe Collier Høegh
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sébastien Gard
- INSERM U1144, Université Paris Cité, Paris, France.,Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale et Universitaire (3/4/7), Bordeaux, France
| | - Sofie R Aminoff
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Marion Leboyer
- FondaMental Foundation, Créteil, France.,Paris Est Créteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Raoul Belzeaux
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital Sainte-Marguerite, Pôle de Psychiatrie, INT-UMR 7289, CNRS, Aix-Marseille University, Marseille, France
| | - Chantal Henry
- Université Paris Cité, Paris, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Thomas D Bjella
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jean-Pierre Kahn
- Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Laxou, France
| | - Nils Eiel Steen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frank Bellivier
- FondaMental Foundation, Créteil, France.,INSERM U1144, Université Paris Cité, Paris, France.,Université Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie, Paris, France
| | - Trine Vik Lagerberg
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Prisciandaro JJ, Mellick W, Squeglia LM, Hix S, Arnold L, Tolliver BK. Results from a randomized, double-blind, placebo-controlled, crossover, multimodal-MRI pilot study of gabapentin for co-occurring bipolar and cannabis use disorders. Addict Biol 2022; 27:e13085. [PMID: 34390300 PMCID: PMC9104469 DOI: 10.1111/adb.13085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 07/23/2021] [Indexed: 01/03/2023]
Abstract
Disrupted brain gamma-aminobutyric acid (GABA)/glutamate homeostasis is a promising target for pharmacological intervention in co-occurring bipolar disorder (BD) and cannabis use disorder (CUD). Gabapentin is a safe and well-tolerated medication, FDA-approved to treat other neurological diseases, that restores GABA/glutamate homeostasis, with treatment studies supporting efficacy in treating CUD, as well as anxiety and sleep disorders that are common to both BD and CUD. The present manuscript represents the primary report of a randomized, double-blind, placebo-controlled, crossover (1-week/condition), multimodal-MRI (proton-MR spectroscopy, functional MRI) pilot study of gabapentin (1200 mg/day) in BD + CUD (n = 22). Primary analyses revealed that (1) gabapentin was well tolerated and adherence and retention were high, (2) gabapentin increased dorsal anterior cingulate cortex (dACC) and right basal ganglia (rBG) glutamate levels and (3) gabapentin increased activation to visual cannabis cues in the posterior midcingulate cortex (pMCC, a region involved in response inhibition to rewarding stimuli). Exploratory evaluation of clinical outcomes further found that in participants taking gabapentin versus placebo, (1) elevations of dACC GABA levels were associated with lower manic/mixed and depressive symptoms and (2) elevations of rBG glutamate levels and pMCC activation to cannabis cues were associated with lower cannabis use. Though promising, the findings from this study should be interpreted with caution due to observed randomization order effects on dACC glutamate levels and identification of statistical moderators that differed by randomization order (i.e. cigarette-smoking status on rBG glutamate levels and pMCC cue activation). Nonetheless, they provide the necessary foundation for a more robustly designed (urn-randomized, parallel-group) future study of adjuvant gabapentin for BD + CUD.
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Affiliation(s)
- James J Prisciandaro
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William Mellick
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lindsay M Squeglia
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Hix
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Arnold
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bryan K Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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5
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Hendin HM, Penn AD. An episode of mania following self-reported ingestion of psilocybin mushrooms in a woman previously not diagnosed with bipolar disorder: A case report. Bipolar Disord 2021; 23:733-735. [PMID: 33934465 DOI: 10.1111/bdi.13095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Holly M Hendin
- Department of Psychiatry, St. Joseph's Hospital and Medical Center, Dignity Health Medical Group, Phoenix, AZ, USA.,Creighton University School of Medicine, Phoenix, AZ, USA
| | - Andrew D Penn
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
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6
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Rognli EB, Bramness JG, von Soest T. Cannabis use in early adulthood is prospectively associated with prescriptions of antipsychotics, mood stabilizers, and antidepressants. Acta Psychiatr Scand 2020; 141:149-156. [PMID: 31560790 DOI: 10.1111/acps.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. METHODS Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. RESULTS Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 - 18.87), mood stabilizers (OR = 5.36, 95 % CI 1.99 - 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 - 3.25), after accounting for sociodemographic variables, conduct problems, additional drug use, mental distress, and prescriptions the year before cannabis use was measured. CONCLUSIONS In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood stabilizers, and antidepressants.
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Affiliation(s)
- Eline Borger Rognli
- Section for Clinical Addiction Research, Department on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | - Jørgen Gustav Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Institute for Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Tilmann von Soest
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway.,Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Norway
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7
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Botsford SL, Yang S, George TP. Cannabis and Cannabinoids in Mood and Anxiety Disorders: Impact on Illness Onset and Course, and Assessment of Therapeutic Potential. Am J Addict 2020; 29:9-26. [PMID: 31577377 PMCID: PMC6925309 DOI: 10.1111/ajad.12963] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/11/2019] [Accepted: 09/17/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cannabis use is common in people with and mood and anxiety disorders (ADs), and rates of problematic use are higher than in the general population. Given recent policy changes in favor of cannabis legalization, it is important to understand how cannabis and cannabinoids may impact people with these disorders. We aimed to assess the effects of cannabis on the onset and course of depression, bipolar disorder, ADs, and post-traumatic stress disorder (PTSD), and also to explore the therapeutic potential of cannabis and cannabinoids for these disorders. METHODS A systematic review of the literature was completed. The PubMed® database from January 1990 to May 2018 was searched. We included longitudinal cohort studies, and also all studies using cannabis or a cannabinoid as an active intervention, regardless of the study design. RESULTS Forty-seven studies were included: 32 reported on illness onset, nine on illness course, and six on cannabinoid therapeutics. Cohort studies varied significantly in design and quality. The literature suggests that cannabis use is linked to the onset and poorer clinical course in bipolar disorder and PTSD, but this finding is not as clear in depression and anxiety disorders (ADs). There have been few high-quality studies of cannabinoid pharmaceuticals in clinical settings. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE These conclusions are limited by a lack of well-controlled longitudinal studies. We suggest that future research be directed toward high-quality, prospective studies of cannabis in clinical populations with mood and ADs, in addition to controlled studies of cannabinoid constituents and pharmaceuticals in these populations. (Am J Addict 2019;00:00-00).
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Affiliation(s)
- Sabrina L Botsford
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
| | - Sharon Yang
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- Department of Psychiatry, Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
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8
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Abstract
Objective: This review discusses the relationship between cannabis use and psychotic, bipolar, depressive, and anxiety disorders, as well as suicide. It summarizes epidemiological evidence from cross-sectional and long-term prospective studies and considers possible etiological mechanisms. Methods: Systematic reviews and methodologically robust studies in the field (from inception to February 2019) were identified using a comprehensive search of Medline, PsychINFO, and Embase and summarized using a narrative synthesis. Results: Consistent evidence, both from observational and experimental studies, has confirmed the important role of cannabis use in the initiation and persistence of psychotic disorders. The size of the effect is related to the extent of cannabis use, with greater risk for early cannabis use and use of high-potency varieties and synthetic cannabinoids. Accumulating evidence suggests that frequent cannabis use also increases the risk for mania as well as for suicide. However, the effect on depression is less clear and findings on anxiety are contradictory with only a few methodologically robust studies. Furthermore, the relationship with common mental disorders may involve reverse causality, as depression and anxiety are reported to lead to greater cannabis consumption in some studies. Pathogenetic mechanisms focus on the effect of tetrahydrocannabinol (THC, the main psychoactive ingredient of cannabis) interacting with genetic predisposition and perhaps other environmental risk factors. Cannabidiol (CBD), the other important ingredient of traditional cannabis, ameliorates the psychotogenic effects of THC but is absent from the high-potency varieties that are increasingly available. Conclusions: The evidence that heavy use of high-THC/low-CBD types of cannabis increases the risk of psychosis is sufficiently strong to merit public health education. Evidence of similar but smaller effects in mania and suicide is growing, but is not convincing for depression and anxiety. There is much current interest in the possibility that CBD may be therapeutically useful.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Harriet Quigley
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
| | - Caterina La Cascia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,Department of Biomedicine, Neurosciences, and Advanced Diagnostic, University of Palermo, Palermo, Italy.,South London and Maudsley NHS Trust Biomedical Research Centre, London, UK
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9
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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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10
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Weinberger AH, Pacek LR, Sheffer CE, Budney AJ, Lee J, Goodwin RD. Serious psychological distress and daily cannabis use, 2008 to 2016: Potential implications for mental health? Drug Alcohol Depend 2019; 197:134-140. [PMID: 30825793 PMCID: PMC6440801 DOI: 10.1016/j.drugalcdep.2019.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Daily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psychological distress (SPD; measured by the Kessler Psychological Distress Scale (K6)) in 2016 and estimated trends in daily cannabis use by past-30-day SPD status from 2008 to 2016. METHODS Data were drawn from adults age 18 and older in the 2008-2016 National Survey on Drug Use and Health (combined total analytic sample n = 356,413). Linear time trends of daily cannabis use, stratified by SPD status, were assessed using logistic regression models with continuous year as the predictor. RESULTS In 2016, past-month daily cannabis use was significantly more common among those with past-month SPD (8.07%), compared to those without past-month SPD (2.66%). Daily cannabis use increased significantly from 2008 to 2016 among those both with and without SPD although use among those with SPD was persistently higher than use among those without SPD over the time period studied. CONCLUSIONS Daily cannabis use is significantly more common among persons with serious psychological distress and is increasing in this group, as well as among those without. Given this increase and the high prevalence of cannabis use among those with SPD, it may be important to consider potential consequences of this increased use for those with mental health vulnerabilities.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Alan J Budney
- Geisel School of Medicine at Dartmouth, Center for Technology and Behavioral Health, Lebanon, NH, USA.
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Renee D Goodwin
- Institute for Implementation Science and Population Health, CUNY School of Public Health and Health Policy, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY School of Public Health, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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11
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Lowe DJ, Sasiadek JD, Coles AS, George TP. Cannabis and mental illness: a review. Eur Arch Psychiatry Clin Neurosci 2019; 269:107-120. [PMID: 30564886 PMCID: PMC6397076 DOI: 10.1007/s00406-018-0970-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
With the increasing push to legalize cannabis in Western nations, there is a need to gage the potential impact of this policy change on vulnerable populations, such as those with mental illness, including schizophrenia, mood, and anxiety disorders. This is particularly important as there are strong motives in these individuals to seek short-term reward (e.g., "getting high"). Nonetheless, data to support the beneficial effects of cannabis use in psychiatric populations are limited, and potential harms in patients with psychotic and mood disorders have been increasingly documented. This article reviews the effects of cannabis in people with mental illness. Then, we provide a reconciliation of the addiction vulnerability and allostatic hypotheses to explain co-morbidity addiction in mentally ill cannabis users, as well as to further aid in developing a rational framework for the assessment and treatment of problematic cannabis use in these patients.
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Affiliation(s)
- Darby J.E. Lowe
- Addictions Division, Centre for Addiction and Mental Health (CAMH),Institute of Medical Sciences, University of Toronto
| | | | | | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health (CAMH),Division and Brain and Therapeutics, Department of Psychiatry, University of Toronto
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12
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Abstract
The evolving legal cannabis landscape in the US continues to present novel regulatory challenges that necessitate the development of a Cannabis Regulatory Science. Two specific issues of concern within Cannabis Regulatory Science are (1) the impact that cannabis use has on the incidence, prevalence, and severity of mental disorders, and (2) how cannabis laws and regulations modify this impact. This paper first provides several conceptual points that are useful for evaluating the relationship between cannabis use and mental disorders. Second, it selectively reviews and comments on data relevant to the relationship between cannabis use and depression, several forms of anxiety, post-traumatic stress disorder, schizophrenia, and bipolar disorder. Next, regulatory and public health parallels between the nascent cannabis industry and the pharmaceutical, tobacco, and alcohol industries are discussed. The focus is on specific types of industry practices that may harm those with or at risk for mental disorders. Recommendations are then offered for legal cannabis regulations that could mitigate this harm. Last, future research goals are discussed for building the field of Cannabis Regulatory Science and addressing the potential negative impact of cannabis on those with mental disorders.
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Affiliation(s)
- Jacob T. Borodovsky
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States,The Dartmouth Institute for Health Policy and Clinical Practice, 74 College St. Hanover, NH 03755, United States
| | - Alan J. Budney
- Dartmouth Geisel School of Medicine, Center for Technology and Behavioral Health, 46 Centerra Parkway, Lebanon, NH 03766, United States
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13
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Bartoli F. Commentary on Ostergaard et al. (2017): Evidence of an association between cannabis use and suicide in subjects with bipolar disorder. Addiction 2017; 112:1260-1261. [PMID: 28586550 DOI: 10.1111/add.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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14
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Suryadevara U, Bruijnzeel DM, Nuthi M, Jagnarine DA, Tandon R, Bruijnzeel AW. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders. Curr Neuropharmacol 2017; 15:800-814. [PMID: 27804883 PMCID: PMC5652027 DOI: 10.2174/1570159x14666161101095325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/26/2016] [Accepted: 10/28/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), bipolar disorder, and schizophrenia. OBJECTIVE This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. RESULTS The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer's patients, cannabis products may improve food intake, sleep quality, and diminish agitation. CONCLUSION Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence.
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Affiliation(s)
- Uma Suryadevara
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Meena Nuthi
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Rajiv Tandon
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Adriaan W. Bruijnzeel
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
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15
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Abstract
Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol – the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts.
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Affiliation(s)
- Gordon D Ko
- Apollo Applied Research Inc.; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto
| | | | - Sean Mindra
- University of Ottawa Medical School, Ottawa, ON, Canada
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16
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Passos IC, Mwangi B, Vieta E, Berk M, Kapczinski F. Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatr Scand 2016; 134:91-103. [PMID: 27097559 DOI: 10.1111/acps.12581] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to review clinical features and biological underpinnings related to neuroprogression in bipolar disorder (BD). Also, we discussed areas of controversy and future research in the field. METHOD We systematically reviewed the extant literature pertaining to neuroprogression and BD by searching PubMed and EMBASE for articles published up to March 2016. RESULTS A total of 114 studies were included. Neuroimaging and clinical evidence from cross-sectional and longitudinal studies show that a subset of patients with BD presents a neuroprogressive course with brain changes and unfavorable outcomes. Risk factors associated with these unfavorable outcomes are number of mood episodes, early trauma, and psychiatric and clinical comorbidity. CONCLUSION Illness trajectories are largely variable, and illness progression is not a general rule in BD. The number of manic episodes seems to be the clinical marker more robustly associated with neuroprogression in BD. However, the majority of the evidence came from cross-sectional studies that are prone to bias. Longitudinal studies may help to identify signatures of neuroprogression and integrate findings from the field of neuroimaging, neurocognition, and biomarkers.
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Affiliation(s)
- I C Passos
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - B Mwangi
- Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - E Vieta
- Bipolar Disorders Program, Institut d'Investigacions Biomédiques Agustí Pi Sunyer, CIBERSAM, University of Barcelona Hospital Clinic, Barcelona, Catalonia, Spain
| | - M Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia
| | - F Kapczinski
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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17
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Hsieh CJ, Godwin D, Mamah D. Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder. Front Psychiatry 2016; 7:149. [PMID: 27616996 PMCID: PMC4999826 DOI: 10.3389/fpsyt.2016.00149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/15/2016] [Indexed: 12/19/2022] Open
Abstract
Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are limited. Thus, individuals at earlier stages of illness are often not identified. The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen is a self-report questionnaire originally developed to identify clinical risk for developing bipolar or psychotic disorders. The goal of the current study was to investigate the utility of the WERCAP Screen and two complementary questionnaires, the WERC Stress Screen and the WERC Substance Screen, in identifying individuals with established SCZ or BPD. Participants consisted of 35 BPD and 34 SCZ patients, as well as 32 controls (CON), aged 18-30 years. Univariate analyses were used to test for score differences between groups. Logistic regression and receiver operating characteristic (ROC) curves were used to identify diagnostic predictors. Significant group differences were found for the psychosis section of the WERCAP (pWERCAP; p < 0.001), affective section of the WERCAP (aWERCAP; p = 0.001), and stress severity (p = 0.027). No significant group differences were found in the rates of substance use as measured by the WERC Substance Screen (p = 0.267). Only the aWERCAP and pWERCAP scores were useful predictors of diagnostic category. ROC curve analysis showed the optimal cut point on the aWERCAP to identify BPD among our participant groups was a score of >20 [area under the curve (AUC): 0.87; sensitivity: 0.91; specificity: 0.71], while that for the pWERCAP to identify SCZ was a score of >13 (AUC: 0.89; sensitivity: 0.88; specificity: 0.82). These results indicate that the WERCAP Screen may be useful in screening individuals for BPD and SCZ and that identifying stress and substance-use severity can be rapidly done using self-report questionnaires. Larger studies in undiagnosed individuals will be needed to test the WERCAP Screen's ability to identify mania or psychosis in the community.
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Affiliation(s)
- Christina J Hsieh
- Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Douglass Godwin
- Department of Psychiatry, Washington University Medical School , St. Louis, MO , USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School , St. Louis, MO , USA
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