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Segura AG, Mané A, Prohens L, Rodriguez N, Mezquida G, Cuesta MJ, Vieta E, Amoretti S, Lobo A, González-Pinto A, Diaz-Caneja CM, Roldán-Bejarano A, Jimenez E, Baeza I, Legido T, Saiz-Ruiz J, Bernardo M, Mas S. Exploration of cannabis use and polygenic risk scores on the psychotic symptom progression of a FEP cohort. Psychiatry Res 2023; 325:115249. [PMID: 37178502 DOI: 10.1016/j.psychres.2023.115249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Cannabis use is highly prevalent in first-episode psychosis (FEP) and plays a critical role in its onset and prognosis, but the genetic underpinnings promoting both conditions are poorly understood. Current treatment strategies for cannabis cessation in FEP are clearly inefficacious. Here, we aimed to characterize the association between cannabis-related polygenic risk scores (PRS) on cannabis use and clinical course after a FEP. A cohort of 249 FEP individuals were evaluated during 12 months. Symptom severity was measured with the Positive and Negative Severity Scale and cannabis use with the EuropASI scale. Individual PRS for lifetime cannabis initiation (PRSCI) and cannabis use disorder (PRSCUD) were constructed. Current cannabis use was associated with increased positive symptoms. Cannabis initiation at younger ages conditioned the 12-month symptom progression. FEP patients with higher cannabis PRSCUD reported increased baseline cannabis use. PRSCI was associated with the course of negative and general symptomatology over follow-up. Cannabis use and symptom progression after a FEP were modulated by cannabis PRS, suggesting that lifetime initiation and use disorders may have partially independent genetic factors. These exploratory results may be the first step to identify those FEP patients more vulnerable to cannabis use and worse outcomes to ultimately develop tailored treatments.
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Affiliation(s)
- Alex G Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Llucia Prohens
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Natalia Rodriguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Gisela Mezquida
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Silvia Amoretti
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Bipolar and Depressive Disorder Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Hospital Universitario de Alava, Vitoria-Gasteiz, Spain; Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain; University of the Basque Country, Vizcaya, Spain
| | - Covadonga M Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alexandra Roldán-Bejarano
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANTPAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Esther Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Immaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Teresa Legido
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Jeronimo Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Universidad de Alcala, Alcalá de Henares, Spain; Hospital Ramon y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
| | - Miguel Bernardo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain.
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Baeza I, Fortea A, Ilzarbe D, Sugranyes G. What Role for Long-Acting Injectable Antipsychotics in Managing Schizophrenia Spectrum Disorders in Children and Adolescents? A Systematic Review. Paediatr Drugs 2023; 25:135-49. [PMID: 36662369 DOI: 10.1007/s40272-023-00558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Long-acting injectable antipsychotics (LAIAs) are an efficacious and well-tolerated treatment in adults with schizophrenia spectrum disorders (SSD). However, there is less evidence for their use in children and adolescents. OBJECTIVES The aim of this systematic review was to summarize findings regarding the effectiveness and side effects of LAIA in children and adolescents with SSD. METHODS Four databases (Web of Science, PubMed, MEDES, and Dialnet) were systematically searched for articles published between inception and 12 March, 2022, with the following inclusion criteria: (1) original articles or case reports; (2) providing data on efficacy/effectiveness or safety/tolerability of LAIA treatment in children and adolescents diagnosed with SSD (schizophrenia, schizoaffective disorder, schizophreniform disorder, non-affective psychotic disorder); (3) mean age of samples ≤ 18 years; and (4) written in English or Spanish. Exclusion criteria were review articles, clinical guides, expert consensus as well as posters or oral communication in conferences. The risk of bias was assessed using the ROBIS tool. RESULTS From 847 articles found, 13 met the inclusion criteria. These included seven single case reports or case series, four retrospective chart reviews, a 24-week open-label trial, and one observational prospective study, covering a total of 119 adolescents (aged 12-17 years) with SSD. Almost all the articles described data on second-generation LAIA (53 patients on risperidone [once every other week], 33 on paliperidone palmitate [once monthly], 10 on aripiprazole [once monthly], and two on olanzapine pamoate [once monthly]). Twenty-one patients were reported to be only on first-generation LAIAs. Non-adherence was the main reason for starting an LAIA. In all of the studies, the use of LAIAs was associated with improvement in the patients' symptoms. CONCLUSIONS There are few studies assessing the use of LAIAs in adolescents with SSD. Overall, these treatments have suggested good effectiveness and acceptable safety and tolerability. However, we found no studies examining their use in children aged < 12 years. The problems and benefits linked to this type of antipsychotic formulation in the child and adolescent population require further study, ideally with prospective, controlled designs.
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Hudson R, Rushlow W, Laviolette SR. Phytocannabinoids modulate emotional memory processing through interactions with the ventral hippocampus and mesolimbic dopamine system: implications for neuropsychiatric pathology. Psychopharmacology (Berl) 2018; 235:447-458. [PMID: 29063964 DOI: 10.1007/s00213-017-4766-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Abstract
Growing clinical and preclinical evidence suggests a potential role for the phytocannabinoid cannabidiol (CBD) as a pharmacotherapy for various neuropsychiatric disorders. In contrast, delta-9-tetrahydrocannabinol (THC), the primary psychoactive component in cannabis, is associated with acute and neurodevelopmental propsychotic side effects through its interaction with central cannabinoid type 1 receptors (CB1Rs). CB1R stimulation in the ventral hippocampus (VHipp) potentiates affective memory formation through inputs to the mesolimbic dopamine (DA) system, thereby altering emotional salience attribution. These changes in DA activity and salience attribution, evoked by dysfunctional VHipp regulatory actions and THC exposure, could predispose susceptible individuals to psychotic symptoms. Although THC can accelerate the onset of schizophrenia, CBD displays antipsychotic properties, can prevent the acquisition of emotionally irrelevant memories, and reverses amphetamine-induced neuronal sensitization through selective phosphorylation of the mechanistic target of rapamycin (mTOR) molecular signaling pathway. This review summarizes clinical and preclinical evidence demonstrating that distinct phytocannabinoids act within the VHipp and associated corticolimbic structures to modulate emotional memory processing through changes in mesolimbic DA activity states, salience attribution, and signal transduction pathways associated with schizophrenia-related pathology.
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Affiliation(s)
- Roger Hudson
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Walter Rushlow
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, N6A 3K7, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Steven R Laviolette
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON, N6A 3K7, Canada. .,Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
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Okewole AO, Ogunwale A, Mosanya TJ, Ojo BM. A 12 year chart review of childhood and adolescent onset psychosis at a Nigerian tertiary mental health facility. J Child Adolesc Ment Health 2016; 28:189-197. [PMID: 27998263 DOI: 10.2989/17280583.2016.1245194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review the profile of children and adolescents presenting with psychosis at a specialist mental health facility, and to compare childhood with adolescent onset psychosis. METHOD Hospital records of all children and adolescents over a 12-year period (1999-2010) were perused to identify those falling under the categories of psychotic disorders. Clinical, socio-demographic, obstetric, and developmental information was extracted. RESULTS Mean age of the children ((n = 409)) was 15.9 years, with 8.1% aged 12 years or less. The most frequent diagnoses were schizophrenia (40.8%), brief psychotic disorder (25.9%), mood disorder with psychosis (15.2%), and organic psychosis (7.8%). Family history of mental illness was reported among 22.5%. Subjects with childhood onset were significantly less likely than those with adolescent onset to have a family history of mental illness (p = 0.016), more likely to report maternal illness during pregnancy (p = 0.005) and illness during infancy (p = 0.010), and more likely to have a diagnosis of psychotic disorder due to another general medical condition (p < 0.001). CONCLUSION The study suggests that antenatal/obstetric factors and illness during infancy may be particularly relevant in psychosis of childhood onset. Family history of mental illness may however be of greater relevance in adolescent onset psychosis.
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Chase KA, Feiner B, Rosen C, Gavin DP, Sharma RP. Characterization of peripheral cannabinoid receptor expression and clinical correlates in schizophrenia. Psychiatry Res 2016; 245:346-353. [PMID: 27591408 DOI: 10.1016/j.psychres.2016.08.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 01/13/2023]
Abstract
The relationship between cannabinoid receptor signaling and psychosis vulnerability requires further exploration. The endocannabinoid signaling system is extensive, with receptors exerting regulatory functions in both immune and central nervous systems. In the brain, cannabinoid receptors (CBR) directly modulate neurotransmitter systems. In the peripheral lymphocyte, CBRs mediate cytokine release, with dysregulated cytokine levels demonstrated in schizophrenia. mRNA levels of CBRs were measured in human peripheral blood mononuclear cells (PBMCs) obtained from 70 participants (35 non-clinical controls, 35 participants with schizophrenia), who were recruited for the absence of marijuana use/abuse by self-report. Changes in mRNA expression were measured using qRT-PCR. Clinical measurements collected included the MATRICS Cognitive Battery and the Positive and Negative Syndrome Scale. Levels of CB1R and CB2R mRNA in PBMCs were significantly higher in participants with schizophrenia compared to the non-clinical controls. Additionally, CB1R and CB2R mRNA levels correlated with impairments in cognitive processing and clinical symptom severity in multiple domains. These results continue to support dysregulation of particular aspects of the endocannabinoid signaling system in participants with schizophrenia selected for the self-reported absence of marijuana abuse/dependence.
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Affiliation(s)
- Kayla A Chase
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; University of California, Department of Psychiatry, 9500 Gilman Drive, MC 8505, La Jolla, San Diego, CA 92037, USA
| | - Benjamin Feiner
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA
| | - Cherise Rosen
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA
| | - David P Gavin
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612, USA
| | - Rajiv P Sharma
- The Psychiatric Institute, University of Illinois at Chicago, 1601 W. Taylor St, Chicago, IL 60612, USA; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue (M/C 151), Chicago, IL 60612, USA.
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Núñez C, Ochoa S, Huerta-Ramos E, Baños I, Barajas A, Dolz M, Sánchez B, Del Cacho N, Usall J. Differential effects of sex on substance use between first episode psychosis patients and healthy people. Compr Psychiatry 2016; 69:169-78. [PMID: 27423358 DOI: 10.1016/j.comppsych.2016.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Substance use in psychosis is an important field of study given that it can be a risk factor for the development of psychosis and can give rise to psychotic symptoms. Studies of substance use in first episode psychosis patients do not frequently assess non-pathological substance consumption among patients, but rather the prevalence of substance abuse or dependence disorders. Moreover, most of these studies do not address the effects of sex in sufficient depth, and the consumption of caffeine or tobacco, which are two of the most frequently used substances, is often not assessed. OBJECTIVES The aim of this study was to compare patterns and quantities of substance use between first episode psychosis patients and healthy controls and between men and women, and explore the potential interactive effects between group (patients or controls) and sex. METHODS A total of 158 participants (82 first episode psychosis patients and 76 healthy controls) were included in the study. Both adults and adolescents were included in the study. Frequency and amount of use of caffeine, tobacco, alcohol, cannabis, cocaine, hallucinogens, stimulants, and opiates were gathered. RESULTS A significant main effect of sex was found for the frequency of use of tobacco (p=.050). Main effects of group were found for the quantity of tobacco (p<.001) and cannabis (p<.001) consumed, as well as main effects of sex for the quantity of alcohol (p=.003) and cannabis (p=.017) consumed. There were also interaction effects between group and sex for the frequency of use of tobacco (p=.005) and cannabis (p=.009), and for the amount of cannabis consumed (p=.049). Qualitative differences between males and females regarding combined substance use are also reported. CONCLUSIONS Among patients, men used tobacco more frequently than women, but this sex difference was not the same for the control group, in which women smoked more often than men. Regarding cannabis, men smoked cannabis more frequently and in larger amounts than women, but only in the patients group, whereas no sex differences for cannabis were found for the controls. Main effects of group and sex for tobacco and alcohol, as well as the lack of differences for the frequency and amount of use of caffeine, are also commented. This is the first study to assess the different effects of sex on substance use in first episode psychosis patients and healthy controls.
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Affiliation(s)
- Christian Núñez
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Iris Baños
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana Barajas
- Research Unit, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - Montserrat Dolz
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Bernardo Sánchez
- Psychiatry Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Sarrazin S, Louppe F, Doukhan R, Schürhoff F. A clinical comparison of schizophrenia with and without pre-onset cannabis use disorder: a retrospective cohort study using categorical and dimensional approaches. Ann Gen Psychiatry 2015; 14:44. [PMID: 26692885 PMCID: PMC4676097 DOI: 10.1186/s12991-015-0083-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high prevalence of cannabis use disorder has been reported in subjects suffering from schizophrenia, fuelling intense debate about whether schizophrenia with pre-onset cannabis use disorder may be a distinct entity with specific features or whether cannabis use disorder can precipitate schizophrenia in genetically vulnerable subjects. METHODS We retrospectively assessed schizophrenia subjects with and without pre-onset cannabis use disorder on the basis of their clinical features, assessed categorically and dimensionally with the operational criteria checklist for psychotic illnesses (OCCPI). We also investigated whether the two groups could be differentiated on the basis of a history of psychiatric disorders in first-degree relatives. A principal component factor analysis of the OCCPI items was used to identify specific symptom dimensions. The relationships between symptom dimensions and cannabis status were analysed by point-biserial correlation analysis to control for sex and age at time of the assessment and illness duration. RESULTS One hundred and seventy-one subjects with a diagnosis of schizophrenia were included. Among them, forty-one patients (18.2 % of the sample) had a cannabis use disorder before or at the time of the onset of schizophrenia. We found similar results in symptoms patterns or family history between patients with and without pre-onset cannabis use disorder. CONCLUSIONS Our results clearly argue against cannabis-associated schizophrenia being a relevant distinct clinical entity of schizophrenia with specific features.
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Affiliation(s)
- Samuel Sarrazin
- AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie et d'Addictologie, 94000 Créteil, France ; INSERM U955, Equipe 15, IMRB, 94000 Créteil, France
| | - Florence Louppe
- AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie et d'Addictologie, 94000 Créteil, France
| | - Raphael Doukhan
- AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie et d'Addictologie, 94000 Créteil, France
| | - Franck Schürhoff
- AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie et d'Addictologie, 94000 Créteil, France ; INSERM U955, Equipe 15, IMRB, 94000 Créteil, France ; Faculté de Médecine, Université Paris-Est, 94000 Créteil, France ; FondaMental Fondation, Fondation de coopération scientifique, 94000 Créteil, France
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Bioque M, García-Bueno B, MacDowell KS, Meseguer A, Saiz PA, Parellada M, Gonzalez-Pinto A, Rodriguez-Jimenez R, Lobo A, Leza JC, Bernardo M. Peripheral endocannabinoid system dysregulation in first-episode psychosis. Neuropsychopharmacology 2013; 38:2568-77. [PMID: 23822951 PMCID: PMC3828529 DOI: 10.1038/npp.2013.165] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/27/2013] [Accepted: 06/25/2013] [Indexed: 01/13/2023]
Abstract
Several hypotheses involving alterations of the immune system have been proposed among etiological explanations for psychotic disorders. The endocannabinoid system (ECS) has a homeostatic role as an endogenous neuroprotective and anti-inflammatory system. Alterations of this system have been associated with psychosis. Cannabis use is a robust risk factor for these disorders that could alter the ECS signalling. In this study, 95 patients with a first episode of psychosis (FEP) and 90 healthy controls were recruited. Protein expression of cannabinoid receptor 2 (CB2), the protein levels of the main endocannabinoid synthesizing enzymes N-acyl phosphatidylethanolamine phospholipase (NAPE) and diacylglycerol lipase (DAGL), and of degradation enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL) were determined by western blot analysis in peripheral blood mononuclear cells (PBMCs). Patients with a FEP showed a decreased expression of CB2 and of both endocannabinoids synthesizing enzymes (NAPE and DAGL) in comparison to healthy controls. After controlling for age, gender, body mass index, and cannabis use, NAPE and DAGL expression remained significantly decreased, whereas FAAH and MAGL expression were increased. On the other hand, FEP subjects with history of severe cannabis use showed a larger ECS dysregulation compared with healthy controls. These results indicate an ECS dysregulation in PBMC of FEP patients. The alteration of the ECS presented at the initial phases of psychosis could be contributing to the pathophysiology of the disease and constitutes a possible biomarker of psychotic disorders and an interesting pharmacological target to take into account for therapeutic purposes.
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Affiliation(s)
- Miquel Bioque
- Schizophrenia Clinic Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Borja García-Bueno
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Karina S MacDowell
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Ana Meseguer
- Schizophrenia Clinic Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar A Saiz
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, IIS Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Hospital Universitario de Álava (sede Santiago), Universidad Nacional de Educación a Distancia, Vitoria, Spain
| | | | - Antonio Lobo
- Department of Psychiatry. Hospital Clínico Universitario and University of Zaragoza, Zaragoza, Spain
| | - Juan C Leza
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Miguel Bernardo
- Schizophrenia Clinic Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psycobiology, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - From the FLAMM-PEPs study—Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)
- Schizophrenia Clinic Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Pharmacology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital 12 de Octubre (i+12), Madrid, Spain
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain
- Child and Adolescent Psychiatry Department, IIS Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital Universitario de Álava (sede Santiago), Universidad Nacional de Educación a Distancia, Vitoria, Spain
- Department of Psychiatry. Hospital Clínico Universitario and University of Zaragoza, Zaragoza, Spain
- Department of Psychiatry and Clinical Psycobiology, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abstract
This article reviews the literature for the most pressing diagnostic and treatment challenges faced in working with adolescents. Diagnosing the treatment interventions required for this population involve psychoeducation, engagement of the patient and family in the treatment process, and use of antipsychotic medications. Cannabis may be a causal risk factor in psychotic illness, and data support recommendations to reduce or cease cannabis use in this population. Treatment strategies are discussed that are effective in adult patients and that may be efficacious for youth to abstain from substances after the resolution of psychotic symptoms.
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Affiliation(s)
- Danielle Goerke
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, F256/2B West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
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Batalla A, Garcia-Rizo C, Castellví P, Fernandez-Egea E, Yücel M, Parellada E, Kirkpatrick B, Martin-Santos R, Bernardo M. Screening for substance use disorders in first-episode psychosis: implications for readmission. Schizophr Res 2013; 146:125-31. [PMID: 23517662 PMCID: PMC4390132 DOI: 10.1016/j.schres.2013.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. METHODS After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. RESULTS Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. CONCLUSIONS The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
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Affiliation(s)
- Albert Batalla
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Pere Castellví
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain
| | - Emili Fernandez-Egea
- Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, UK, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Forvie Site, Cambridge CB2 0SZ, UK
| | - Murat Yücel
- School of Psychology and Psychiatry, Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
| | - Eduard Parellada
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Brian Kirkpatrick
- Department of Psychiatry, Texas A&M University College of Medicine, Scott & White Healthcare, 1901 South Veterans Memorial Drive, 76504, Temple, TX, United States
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Abstract
OBJECTIVE There is considerable evidence to suggest that the abuse of illicit drugs, particularly cannabis and methamphetamine, has aetiological roles in the pathogenesis of psychosis and schizophrenia. Factors that may increase susceptibility to the propsychotic effects of these drugs include the age at which the abuse starts as well as family history of genetic polymorphisms relevant to the pathophysiology of this disorder. However, the neurobiological mechanisms involved in drug abuse-associated psychosis remain largely unclear. METHODS AND RESULTS This paper presents an overview of the available evidence, including clinical, animal model, and molecular studies, with a focus on brain regions and neurotransmitters systems, such as dopamine and glutamate, previously implicated in psychosis. CONCLUSION It is clear that further studies are urgently needed to provide a greater insight into the mechanisms that mediate the long-term and neurodevelopmental effects of cannabis and methamphetamine. A dialogue between basic science and clinical research may help to identify at-risk individuals and novel pathways for treatment and prevention.
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Affiliation(s)
- Anand Gururajan
- Mental Health Research Institute, University of Melbourne, Melbourne, Australia
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12
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Deiana S. Medical use of cannabis. Cannabidiol: a new light for schizophrenia? Drug Test Anal 2012; 5:46-51. [PMID: 23109356 DOI: 10.1002/dta.1425] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/12/2022]
Abstract
The medical properties of cannabis have been known for many centuries; its first documented use dates back to 2800 BC when it was described for its hallucinogenic and pain-relieving properties. In the first half of the twentieth century, a number of pharmaceutical companies marked cannabis for indications such as asthma and pain, but since then its use has sharply declined, mainly due to its unpredictable effects, but also for socio-political issues. Recently, great attention has been directed to the medical properties of phytocannabinoids present in the cannabis plant alongside the main constituent Δ⁹-Tetrahydrocannabinol (THC); these include cannabinoids such as cannabidiol (CBD), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). Evidence suggests an association between cannabis and schizophrenia: schizophrenics show a higher use of marijuana as compared to the healthy population. Additionally, the use of marijuana can trigger psychotic episodes in schizophrenic patients, and this has been ascribed to THC. Given the need to reduce the side effects of marketed antipsychotics, and their weak efficacy on some schizophrenic symptoms, cannabinoids have been suggested as a possible alternative treatment for schizophrenia. CBD, a non-psychoactive constituent of the Cannabis sativa plant, has been receiving growing attention for its anti-psychotic-like properties. Evidence suggests that CBD can ameliorate positive and negative symptoms of schizophrenia. Behavioural and neurochemical models suggest that CBD has a pharmacological profile similar to that of atypical anti-psychotic drugs and a clinical trial reported that this cannabinoid is a well-tolerated alternative treatment for schizophrenia.
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Affiliation(s)
- Serena Deiana
- Department CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. K., Biberach an der Riss, Germany.
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13
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Dekker N, Meijer J, Koeter M, van den Brink W, van Beveren N, Kahn RS, Linszen DH, van Os J, Wiersma D, Bruggeman R, Cahn W, de Haan L, Krabbendam L, Myin-Germeys I. Age at onset of non-affective psychosis in relation to cannabis use, other drug use and gender. Psychol Med 2012; 42:1903-1911. [PMID: 22452790 DOI: 10.1017/s0033291712000062] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cannabis use is associated with an earlier age at onset of psychotic illness. The aim of the present study was to examine whether this association is confounded by gender or other substance use in a large cohort of patients with a non-affective psychotic disorder. METHOD In 785 patients with a non-affective psychotic disorder, regression analysis was used to investigate the independent effects of gender, cannabis use and other drug use on age at onset of first psychosis. RESULTS Age at onset was 1.8 years earlier in cannabis users compared to non-users, controlling for gender and other possible confounders. Use of other drugs did not have an additional effect on age at onset when cannabis use was taken into account. In 63.5% of cannabis-using patients, age at most intense cannabis use preceded the age at onset of first psychosis. In males, the mean age at onset was 1.3 years lower than in females, controlling for cannabis use and other confounders. CONCLUSIONS Cannabis use and gender are independently associated with an earlier onset of psychotic illness. Our findings also suggest that cannabis use may precipitate psychosis. More research is needed to clarify the neurobiological factors that make people vulnerable to this precipitating effect of cannabis.
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Affiliation(s)
- N Dekker
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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14
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Galvez-Buccollini JA, Proal AC, Tomaselli V, Trachtenberg M, Coconcea C, Chun J, Manschreck T, Delisi LE, Delisi LE. Association between age at onset of psychosis and age at onset of cannabis use in non-affective psychosis. Schizophr Res 2012; 139:157-60. [PMID: 22727454 PMCID: PMC3415971 DOI: 10.1016/j.schres.2012.06.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/29/2012] [Accepted: 06/04/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Several studies have associated cannabis use with the development of schizophrenia. However, it has been difficult to disentangle the effects of cannabis from that of other illicit drugs, as previous studies have not evaluated pure cannabis users. To test whether the onset of cannabis use had an effect on the initiation of psychosis, we examined the time relationship between onset of use and onset of psychosis, restricting our analysis to a cohort of individuals who only used cannabis and no other street drugs. METHODS Fifty-seven subjects with non-affective psychoses who used cannabis prior to developing a psychosis were interviewed using the Diagnostic Interview for Genetic Studies (DIGS). The Family Interview for Genetic Studies (FIGS) was also used to interview a family informant about psychiatric illness in the patient and the entire family. Multiple linear regression techniques were used to estimate the association between variables. RESULTS After adjusting for potential confounding factors such as sex, age, lifetime diagnosis of alcohol abuse or dependence, and family history of schizophrenia, the age at onset of cannabis was significantly associated with age at onset of psychosis (β=0.4, 95% CI=0.1-0.7, p=0.004) and age at first hospitalization (β=0.4, 95% CI=0.1-0.8, p=0.008). The mean time between beginning to use cannabis and onset of psychosis was 7.0±4.3. Age at onset of alcohol use was not associated with age at onset of psychosis or age at first hospitalization. CONCLUSION Age at onset of cannabis is directly associated with age at onset of psychosis and age at first hospitalization. These associations remain significant after adjusting for potential confounding factors and are consistent with the hypothesis that cannabis could cause or precipitate the onset of psychosis after a prolonged period of time.
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Affiliation(s)
- Juan A. Galvez-Buccollini
- VA Boston Healthcare System. 940 Belmont Street, Brockton MA, 02301,Harvard Medical School. 25 Shattuck Street Boston, MA 02115
| | - Ashley C. Proal
- VA Boston Healthcare System. 940 Belmont Street, Brockton MA, 02301
| | | | | | - Cristinel Coconcea
- Beth Israel Deaconess Medical Center. 330 Brookline Avenue, Boston, MA 02215
| | - Jinsoo Chun
- Beth Israel Deaconess Medical Center. 330 Brookline Avenue, Boston, MA 02215
| | - Theo Manschreck
- Beth Israel Deaconess Medical Center. 330 Brookline Avenue, Boston, MA 02215
| | - Lynn E. Delisi
- VA Boston Healthcare System. 940 Belmont Street, Brockton MA, 02301,Harvard Medical School. 25 Shattuck Street Boston, MA 02115
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15
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Abstract
AIM Duration of untreated psychosis (DUP) can influence the prognosis of schizophrenia. Previous studies have suggested that gender may influence the length of DUP. This study reports the result of the first systematic literature review and meta-analysis on the role of gender in influencing DUP in first-episode psychosis. METHOD Systematic literature search in PubMed/Medline and Ovid/PsychINFO. Twenty-seven studies presenting data on 4721 patients diagnosed with psychosis at their first episode (2834 males and 1887 females) were included in the analysis. RESULTS Samples had a higher proportion of males: odds ratio = 2.5 (95% confidence interval: 1.8-3.3). Mean age at first contact was 25.4 for males and 27.5 for females. Patients from non-Western countries were older at first contact than patients from Western countries. Average DUP in schizophrenia was 64 weeks and did not differ between genders but was shorter in Western compared with non-Western countries. CONCLUSION Earlier age at first contact and larger incidence in males support the existence of specific gender differences in first-episode psychosis; however, these are not associated with DUP length.
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Affiliation(s)
- Maria Teresa Cascio
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
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16
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Abstract
Adolescence represents a critical period for brain development and the endocannabinoid system plays a crucial role in the regulation of neuronal refinement during this period. Cannabis is the most consumed drug among adolescent people and its heavy use may affect maturational refinement by disrupting the regulatory role of the endocannabinoid system. In animals, adolescent cannabinoid exposure has been reported to cause long-term impairment in specific components of learning and memory and to differentially affect emotional reactivity with milder effects on anxiety behaviour and more pronounced effects on depression-like behaviour. Moreover, adolescent exposure to cannabinoids might represent a risk factor for developing psychotic-like symptoms at adulthood. Also epidemiological studies suggest that heavy adolescent cannabis use may increase the risk of cognitive abnormalities, psychotic illness, mood disorders and other illicit substance use later in life. In conclusion, the available data point to the hypothesis that heavy cannabis use in adolescence could increase the risk of developing psychiatric disorders, especially in people who already have a vulnerability to develop a psychiatric syndrome. Only few papers have investigated the neurobiological substrates of this vulnerability, thus further studies are needed to clarify the molecular mechanisms underlying the effect of cannabis on the adolescent brain.
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Affiliation(s)
- Tiziana Rubino
- DBSF and Neuroscience Center, University of Insubria, Busto Arsizio, Italy
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17
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Marco EM, García-Gutiérrez MS, Bermúdez-Silva FJ, Moreira FA, Guimarães F, Manzanares J, Viveros MP. Endocannabinoid system and psychiatry: in search of a neurobiological basis for detrimental and potential therapeutic effects. Front Behav Neurosci 2011; 5:63. [PMID: 22007164 PMCID: PMC3186912 DOI: 10.3389/fnbeh.2011.00063] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 09/09/2011] [Indexed: 01/19/2023] Open
Abstract
Public concern on mental health has noticeably increased given the high prevalence of neuropsychiatric disorders. Cognition and emotionality are the most affected functions in neuropsychiatric disorders, i.e., anxiety disorders, depression, and schizophrenia. In this review, most relevant literature on the role of the endocannabinoid (eCB) system in neuropsychiatric disorders will be presented. Evidence from clinical and animal studies is provided for the participation of CB1 and CB2 receptors (CB1R and CB2R) in the above mentioned neuropsychiatric disorders. CBRs are crucial in some of the emotional and cognitive impairments reported, although more research is required to understand the specific role of the eCB system in neuropsychiatric disorders. Cannabidiol (CBD), the main non-psychotropic component of the Cannabis sativa plant, has shown therapeutic potential in several neuropsychiatric disorders. Although further studies are needed, recent studies indicate that CBD therapeutic effects may partially depend on facilitation of eCB-mediated neurotransmission. Last but not least, this review includes recent findings on the role of the eCB system in eating disorders. A deregulation of the eCB system has been proposed to be in the bases of several neuropsychiatric disorders, including eating disorders. Cannabis consumption has been related to the appearance of psychotic symptoms and schizophrenia. In contrast, the pharmacological manipulation of this eCB system has been proposed as a potential strategy for the treatment of anxiety disorders, depression, and anorexia nervosa. In conclusion, the eCB system plays a critical role in psychiatry; however, detrimental consequences of manipulating this endogenous system cannot be underestimated over the potential and promising perspectives of its therapeutic manipulation.
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Affiliation(s)
- Eva M. Marco
- Departamento de Fisiología (Fisiología Animal II), Facultad de Ciencias Biológicas, Universidad Complutense de MadridMadrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San CarlosMadrid, Spain
| | - María S. García-Gutiérrez
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández – CSICSan Juan de Alicante, Spain
| | - Francisco-Javier Bermúdez-Silva
- Laboratorio de Medicina Regenerativa, Hospital Carlos Haya de Malaga, Fundacion IMABISMalaga, Spain
- Neurocentre Magendie, INSERM, Université Bordeaux 2Bordeaux, France
| | - Fabricio A. Moreira
- Department of Pharmacology, Institute of Biological Sciences, Universidade Federal de Minas GeraisBelo Horizonte, MG, Brazil
| | - Francisco Guimarães
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São PauloRibeirão Preto, SP, Brazil
| | - Jorge Manzanares
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández – CSICSan Juan de Alicante, Spain
| | - María-Paz Viveros
- Departamento de Fisiología (Fisiología Animal II), Facultad de Ciencias Biológicas, Universidad Complutense de MadridMadrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San CarlosMadrid, Spain
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18
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Safont G, Corripio I, Escartí MJ, Portella MJ, Pérez V, Ferrer M, Camacho V, Sauras RB, Alonso A, Grasa EM, Arranz B, San L, Dueñas R, Carrió I, Álvarez E. Cannabis use and striatal D2 receptor density in untreated first-episode psychosis: an in vivo SPECT study. Schizophr Res 2011; 129:169-71. [PMID: 21459559 DOI: 10.1016/j.schres.2011.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 02/24/2011] [Accepted: 03/07/2011] [Indexed: 11/17/2022]
Abstract
The biological basis of the association between cannabis-induced dopamine dysregulation and psychosis remains poorly understood. This (123)I-IBZM SPECT study assessed striatal dopamine D2 receptor (D2R) binding in 37 untreated first-episode psychosis (FEP) subjects, and 18 healthy controls. The aim was to examine if there were differences between FEP subjects with (n=14) and without (n=23) cannabis use in uptake ratios in the D2R. Striatal/Frontal cortex (S/F) uptake ratios were obtained. Healthy controls showed the lowest D2R binding ratios. No differences were found in S/F ratios between users and non-users, suggesting similar dopaminergic mechanisms underlying psychotic symptoms in both groups.
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Affiliation(s)
- Gemma Safont
- Department of Psychiatry, Hospital Universitari Mútua Terrassa, Universitat de Barcelona (UB), Plaça Dr. Robert, 5. 08221, Terrassa, Barcelona, Spain.
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19
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Ortega-Alvaro A, Aracil-Fernández A, García-Gutiérrez MS, Navarrete F, Manzanares J. Deletion of CB2 cannabinoid receptor induces schizophrenia-related behaviors in mice. Neuropsychopharmacology 2011; 36:1489-504. [PMID: 21430651 DOI: 10.1038/npp.2011.34] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The possible role of the CB(2) receptor (CB(2)r) in psychiatric disorders has been considered. Several animal models use knockout (KO) mice that display schizophrenia-like behaviors and this study evaluated the role of CB(2)r in the regulation of such behaviors. Mice lacking the CB(2)r (CB(2)KO) were challenged in open field, light-dark box, elevated plus-maze, tail suspension, step down inhibitory avoidance, and pre-pulse inhibition tests (PPI). Furthermore, the effects of treatment with cocaine and risperidone were evaluated using the OF and the PPI test. Gene expression of dopamine D(2) (D(2)r), adrenergic-α(2C) (α(2C)r), serotonergic 5-HT(2A) and 5-HT(2C) receptors (5-HT(2A)r and 5-HT(2C)r) were studied by RT-PCR in brain regions related to schizophrenia. Deletion of CB(2)r decreased motor activity in the OF test, but enhanced response to acute cocaine and produced mood-related alterations, PPI deficit, and cognitive impairment. Chronic treatment with risperidone tended to impair PPI in WT mice, whereas it 'normalized' the PPI deficit in CB(2)KO mice. CB(2)KO mice presented increased D(2)r and α(2C)r gene expressions in the prefrontal cortex (PFC) and locus coeruleus (LC), decreased 5-HT(2C)r gene expression in the dorsal raphe (DR), and 5-HT(2A)r gene expression in the PFC. Chronic risperidone treatment in WT mice left α(2C)r gene expression unchanged, decreased D(2)r gene expression (15 μg/kg), and decreased 5-HT(2C)r and 5-HT(2A)r in PFC and DR. In CB(2)KO, the gene expression of D(2)r in the PFC, of α(2C)r in the LC, and of 5-HT(2C)r and 5-HT(2A)r in PFC was reduced; 5-HT(2C)r and 5-HT(2A)r gene expressions in DR were increased after treatment with risperidone. These results suggest that deletion of CB(2)r has a relation with schizophrenia-like behaviors. Pharmacological manipulation of CB(2)r may merit further study as a potential therapeutic target for the treatment of schizophrenia-related disorders.
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Madoz-Gúrpide A, Ochoa Mangado E. Manejo del consumo de cannabis en población joven en Atención Primaria. Aten Primaria 2011; 43:319-24. [DOI: 10.1016/j.aprim.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 09/23/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022] Open
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Decoster J, van Os J, Kenis G, Henquet C, Peuskens J, De Hert M, van Winkel R. Age at onset of psychotic disorder: cannabis, BDNF Val66Met, and sex-specific models of gene-environment interaction. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:363-9. [PMID: 21305693 DOI: 10.1002/ajmg.b.31174] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 12/30/2011] [Indexed: 11/10/2022]
Abstract
Discovering modifiable predictors for age at onset may help to identify predictors of transition to psychotic disorder in the "at-risk mental state." Inconsistent effects of sex, BDNF Val66Met (rs6265), and cannabis use on age of onset were previously reported. BDNF Val66Met and cannabis use before illness onset were retrospectively assessed in a sample of 585 patients with schizophrenia and their association with age at onset was evaluated. Cannabis use was significantly associated with earlier age at onset of psychotic disorder (AOP; average difference 2.7 years, P < 0.001), showing dose-response effects with higher frequency and earlier age at first use. There was a weak association between BDNF Val66Met genotype and AOP (difference 1.2 years; P = 0.050). No evidence was found for BDNF × cannabis interaction (interaction χ(2) (1) = 0.65, P = 0.420). However, a significant BDNF × cannabis × sex interaction was found (interaction χ(2) (1) = 4.99, P = 0.026). In female patients, cannabis use was associated with earlier AOP in BDNF Met-carriers (difference 7 years), but not in Val/Val-genotypes. In male patients, cannabis use was associated with earlier AOP irrespective of BDNF Val66Met genotype (difference 1.3 years). BDNF Val66Met genotype in the absence of cannabis use did not influence AOP, neither in female or male patients with psychotic disorder. Complex interactions between cannabis and BDNF may shape age at onset in female individuals at risk of psychotic disorder. No compelling evidence was found that BDNF genotype is associated with age at onset of psychotic disorder in the absence of cannabis use.
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Affiliation(s)
- Jeroen Decoster
- University Psychiatric Centre Catholic University Leuven, Kortenberg, Belgium
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22
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De Hert M, Wampers M, Jendricko T, Franic T, Vidovic D, De Vriendt N, Sweers K, Peuskens J, van Winkel R. Effects of cannabis use on age at onset in schizophrenia and bipolar disorder. Schizophr Res 2011; 126:270-6. [PMID: 20674280 DOI: 10.1016/j.schres.2010.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 06/13/2010] [Accepted: 07/09/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cannabis use may decrease age at onset in both schizophrenia and bipolar disorder, given the evidence for substantial phenotypic and genetic overlap between both disorders. METHODS 766 patients, aged 16 to 65 years, were assessed with the Composite International Diagnostic Interview (CIDI) for substance abuse/use. 676 subjects were diagnosed with schizophrenia and 90 subjects with bipolar disorder. The influence of cannabis use on age at onset in both schizophrenia and bipolar disorder was examined using regression analysis. RESULTS Cannabis and other substance use was more frequent in patients with schizophrenia compared to the bipolar group. Both cannabis use and a schizophrenia diagnosis predicted earlier age at onset. There was a significant interaction between cannabis use and diagnosis, cannabis having a greater effect in bipolar patients. Age at onset in users of cannabis was comparable in both diagnostic groups whereas bipolar non-users were significantly older than schizophrenia non-users at onset. CONCLUSION Cannabis use may decrease age at onset in both schizophrenia and bipolar patients and reduce the effect of diagnosis. This is consistent with the view that cannabis use may unmask a pre-existing genetic liability that is partly shared between patients with schizophrenia and bipolar disorder.
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23
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Makkos Z, Fejes L, Inczédy-Farkas G, Kassai-Farkas A, Faludi G, Lazary J. Psychopharmacological comparison of schizophrenia spectrum disorder with and without cannabis dependency. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:212-7. [PMID: 21087649 DOI: 10.1016/j.pnpbp.2010.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 10/02/2010] [Accepted: 11/05/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although incidence of schizophrenia is higher among cannabis users and marijuana is the most common abused drug by adolescents, etiological linkage between schizophrenia and cannabis use is still not clarified. Clinical experiences suggest that regular cannabis user can show similar psychotic episode to schizophrenic disorders but it is still unclear if chronic cannabis use with schizophreniform disorder is a distinct entity requiring special therapy or it can be treated as classical schizophrenia. There are no data available on the comparison of pharmacotherapy between schizophreniform patients with and without cannabis use. METHODS Clinical data of 85 patients with schizophrenia spectrum disorder were analyzed retrospectively. Cannabis use was not reported by 43 persons (Cnbs0 subgroup) and 42 patients used regularly cannabis during at least 1 year (Cnbs1 subgroup). Comparison of anamnesis, family history, social-demographic condition, positive and negative symptoms, acute and long-term therapies recorded by clinical interviews was performed with chi square tests, logistic binary regression and t-tests using SPSS 13.0 for Windows software. RESULTS Men were over-represented in cannabis dependent group while mean age was lower among them compared to Cnbs0 subgroup. Prevalence of suicidal attempt was increased in men without cannabis use (OR = 5.25, p = 0.016). Patients without cannabis use spent more time in hospital (p = 0.026) and smoking was more frequent among them (OR = 1.36, p = 0.047). The chance to get olanzapine for acute therapy and aripiprazol for long term therapy was more than two fold in Cnbs1 subgroup (OR = 2.66, OR = 3.67, respectively). However, aripiprazol was used for acute therapy with significantly lower risk in Cnbs1 subgroup (OR = 0.47, p = 0.023). Olanzapine was administered for long term therapy in a higher dose to Cnbs0 patients (p = 0.040). Also higher dose of risperidon LAI was used in women without cannabis dependency compared to women of Cnbs1 subgroup (p=0.020). Positive and negative symptoms and family history did not differ significantly between the two subgroups. CONCLUSION Although symptom profile was similar, hospitalization time, suicidal anamnesis, smoking habit and also dosage, intensity and lasting of therapy were different between the two subgroups. Further prospective studies are required for the investigation of the clinical and molecular background of this discrepancy in order to determine a relevant protocol of prevention and treatment of the chronic cannabis use related psychotic disorder.
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Affiliation(s)
- Zoltan Makkos
- 1st Department of Psychiatry, Nyírő Gyula Hospital, Budapest, Hungary
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Abstract
Cannabis is one of the most widely used illicit drugs among adolescents, and most users first experiment with it in adolescence. Adolescence is a critical phase for brain development, characterized by neuronal maturation and rearrangement processes, such as myelination, synaptic pruning and dendritic plasticity. The endocannabinoid system plays an important role in fundamental brain developmental processes such as neuronal cell proliferation, migration and differentiation. Therefore changes in endocannabinoid activity during this specific developmental phase, induced by the psychoactive component of marijuana, Delta(9)-tetrahydrocannabinol, might lead to subtle but lasting neurobiological changes that can affect brain functions and behaviour. In this review, we outline recent research into the endocannabinoid system focusing on the relationships between adolescent exposure to cannabinoids and increased risk for certain neuropsychiatric diseases such as schizophrenia, as highlighted by both human and animal studies. Particular emphasis will be given to the possible mechanisms by which adolescent cannabis consumption could render a person more susceptible to developing psychoses such as schizophrenia.
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Affiliation(s)
- Daniel T Malone
- Medicinal Chemistry and Drug Action, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
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Barrigón ML, Gurpegui M, Ruiz-Veguilla M, Diaz FJ, Anguita M, Sarramea F, Cervilla J. Temporal relationship of first-episode non-affective psychosis with cannabis use: a clinical verification of an epidemiological hypothesis. J Psychiatr Res 2010; 44:413-20. [PMID: 19900684 DOI: 10.1016/j.jpsychires.2009.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/15/2009] [Accepted: 10/06/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine. METHOD We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use. RESULTS We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank chi(2)=23.43, df=1, p<0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5years (27, 45) (for log-transformed AOPT, t=5.6, df=110, p<0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05). CONCLUSIONS Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.
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Abstract
Impaired cognitive functioning, including deficits in working memory, is considered to be a core and disabling feature of schizophrenia that is difficult to treat. Deficits in working memory in schizophrenia are attributable, at least in part, to specific pathological alterations in the neuronal circuitry of the dorsolateral prefrontal cortex that involve, but are not restricted to, disturbances in glutamate, GABA, and dopamine neurotransmission. Cannabis use provides an example of an environmental exposure that may have a deleterious impact on these neurotransmitter systems and thereby contribute to worsening of cognitive functioning in schizophrenia. Increasing knowledge of the nature of the molecular alterations in these cortical circuits may lead to the development of new pathophysiologically informed treatment options for cognitive deficits in schizophrenia.
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Affiliation(s)
- David W Volk
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, BST W1653, Pittsburgh, PA 15213, USA.
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Abstract
The major psychotic disorders schizophrenia and bipolar disorder are etiologically complex involving both heritable and nonheritable factors. The absence of consistently replicated major genetic effects, together with evidence for lasting changes in gene expression after environmental exposures, is consistent with the concept that the biologic underpinnings of these disorders are epigenetic in form rather than DNA sequence based. Psychosis-associated environmental exposures, particularly at key developmental stages, may result in long-lasting epigenetic alterations that impact on the neurobiological processes involved in pathology. Although direct evidence for epigenetic dysfunction in both schizophrenia and bipolar disorder is still limited, methodological technologies in epigenomic profiling have advanced. This means that we are at the exciting stage where it is feasible to start investigating molecular modifications to DNA and histones and examine the mechanisms by which environmental factors can act upon the genome to bring about epigenetic changes in gene expression involved in the etiology of these disorders. Given the dynamic nature of the epigenetic machinery and potential reversibility of epigenetic modifications, the understanding of such mechanisms is of key relevance for clinical psychiatry and for identifying new targets for prevention and/or intervention.
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Affiliation(s)
- Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, European Graduate School of Neuroscience, South Limburg Mental Health Research and Teaching Network, Vijverdalseweg 1, Maastricht 6226 NB, The Netherlands,To whom correspondence should be addressed; tel: +31-43-3688697, fax: +31-43-3688669, e-mail:
| | - Jonathan Mill
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK
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Niendam TA, Jalbrzikowski M, Bearden CE. Exploring predictors of outcome in the psychosis prodrome: implications for early identification and intervention. Neuropsychol Rev 2009; 19:280-93. [PMID: 19597747 PMCID: PMC2745530 DOI: 10.1007/s11065-009-9108-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/02/2009] [Indexed: 12/18/2022]
Abstract
Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth.
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Affiliation(s)
- Tara A Niendam
- UC Davis Department of Psychiatry & Behavioral Sciences, UC Davis Imaging Research Center, 4701 X Street, Suite E, Sacramento, CA 95816, USA.
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Abstract
Cannabis is the most widely used illegitimate substance in the world, and the number of users has increased by 10% over the last decade worldwide. Therefore, it is important to review the evidence on psychoactive properties of cannabis and its possible association with schizophrenia spectrum disorders (SSD). We searched MEDLINE with the key words cannabis and schizophrenia. The search was limited to articles published in English over the last 10 years (1999-2009). Bibliographies of cited literature were also searched. Data sources included reviews published in core clinical journals, cohort studies, interventional studies, case-control studies, cross-sectional analyses and epidemiological data. Results are discussed under 2 topics. Firstly, evidence related to biochemical functioning of cannabinoids and their relationship to endocannabinoid system is discussed briefly. Secondly, the evidence from clinical studies on cannabis, psychosis proneness and SSD are discussed in detail. The discussion is structured to fit in the evidence from results section to 3 plausible hypotheses on cannabis use and SSD. The evidence for and against each hypothesis is discussed. Despite new evidence, the exact relationship between cannabis and SSD is unclear. There is no firm evidence that cannabis causes SSD. The evidence for the argument that schizophrenic patients are attracted to cannabis is also not strong. The most plausible explanation is that cannabis use and psychosis proneness may have synergistic effects in a vulnerable minority.
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Affiliation(s)
- Chaturaka Rodrigo
- Mental Health Unit, Provincial General Hospital, Ratnapura, Sri Lanka
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