1
|
Hall D, Lawn W, Ofori S, Trinci K, Borissova A, Mokrysz C, Petrilli K, Bloomfield MAP, Wall MB, Freeman TP, Curran HV. The acute effects of cannabis, with and without cannabidiol, on attentional bias to cannabis related cues: a randomised, double-blind, placebo-controlled, cross-over study. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06543-7. [PMID: 38416223 DOI: 10.1007/s00213-024-06543-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/20/2024] [Indexed: 02/29/2024]
Abstract
RATIONALE Attentional bias to drug-related stimuli is hypothesised to contribute towards addiction. However, the acute effects of Δ9-tetrahydrocannabinol (THC) on attentional bias to cannabis cues, the differential response in adults and adolescents, and the moderating effect of cannabidiol (CBD) are unknown. OBJECTIVES Our study investigated (1) the acute effects of vaporised cannabis on attentional bias to cannabis-related images in adults and adolescents and (2) the moderating influences of age and CBD. METHODS We conducted a randomised, double-blind, placebo-controlled, cross-over study where three weight-adjusted vaporised cannabis preparations: 'THC' (8 mg THC for a 75-kg person), 'THC + CBD' (8 mg THC and 24 mg CBD for a 75-kg person) and PLA (matched placebo). Cannabis was administered on 3 separate days to 48 participants, who used cannabis 0.5-3 days/week: 24 adolescents (12 females, aged 16-17) and 24 adults (12 females, aged 26-29). Participants completed a visual probe task with cannabis cues. Our primary outcome was attentional bias to cannabis stimuli, measured using the differential reaction time to a cannabis vs. neutral probe, on 200-ms trials. RESULTS In contrast to hypotheses, attention was directed away from cannabis cues on placebo, and there was a main effect of the drug (F(2,92) = 3.865, p = 0.024, η2p = 0.077), indicating THC administration eliminated this bias. There was no significant impact of CBD nor an age-by-drug interaction. CONCLUSIONS Acute THC intoxication eliminated attentional bias away from cannabis cues. There was no evidence of differential response in adolescents compared to adults and no evidence that a moderate vaporised dose of CBD altered the impact of cannabis on attentional bias. TRIAL REGISTRATION This study was listed with the US National Library of Medicine and registered on ClinicalTrials.gov, URL: Do Adolescents and Adults Differ in Their Acute Response to Cannabis?-Full Text View-ClinicalTrials.gov, registration number: NCT04851392.
Collapse
Affiliation(s)
- Daniel Hall
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Daniel Hall, Springfield University Hospital, 15 Springfield Drive, London, SW17 0YF, UK
| | - Will Lawn
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Anya Borissova
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
| | - Kat Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, London, UK
| | - Michael A P Bloomfield
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, UK
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Invicro London, Hammersmith Hospital, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Educational and Health Psychology, University College London, London, UK.
| |
Collapse
|
2
|
Billings J, Zhan Yuen Wong N, Nicholls H, Burton P, Zosmer M, Albert I, Grey N, El-Leithy S, Murphy D, Tehrani N, Wheatley J, Bloomfield MAP, Greene T. Post-incident psychosocial interventions after a traumatic incident in the workplace: a systematic review of current research evidence and clinical guidance. Eur J Psychotraumatol 2023; 14:2281751. [PMID: 38032045 PMCID: PMC10990448 DOI: 10.1080/20008066.2023.2281751] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.
Collapse
Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | | | - Helen Nicholls
- Division of Psychiatry, University College London, London, UK
| | - Peter Burton
- Division of Psychiatry, University College London, London, UK
| | - Maya Zosmer
- Division of Psychiatry, University College London, London, UK
| | - Idit Albert
- King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Grey
- University of Sussex, Falmer, UK
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - Dominic Murphy
- King’s College London, London, UK
- Combat Stress, London, UK
| | | | - Jon Wheatley
- Homerton Healthcare NHS Foundation Trust, London, UK
| | - Michael A. P. Bloomfield
- Division of Psychiatry, University College London, London, UK
- Camden & Islington NHS Foundation Trust, London, UK
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
3
|
Greene T, Harju-Seppänen J, Billings J, Brewin CR, Murphy D, Bloomfield MAP. Exposure to potentially morally injurious events in U.K. health and social care workers during COVID-19: Associations with PTSD and complex PTSD. Psychol Trauma 2023:2023-83608-001. [PMID: 37347883 DOI: 10.1037/tra0001519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Health and social care workers (HSCWs) have been shown to be at risk of exposure to potentially morally injurious events (PMIEs) and mental health problems during the COVID-19 pandemic. This study aimed to examine associations between exposure to PMIEs and meeting threshold criteria for probable posttraumatic stress disorder (PTSD) and probable complex PTSD (CPTSD) in U.K. HSCWs immediately after the peak of the first COVID-19 wave. METHOD Frontline HSCWs from across the United Kingdom working in diverse roles in hospitals, nursing or care homes, and other community settings were recruited to the Frontline-COVID study via social media. Participants (n = 1,056) completed a cross-sectional online survey (May 27, 2020-July 23, 2020) which assessed exposure to PMIEs (nine-item Moral Injury Events Scale), and meeting symptom thresholds for probable PTSD and probable CPTSD (International Trauma Questionnaire). RESULTS PMIEs related to witnessing others' wrongful actions and betrayal events were more commonly endorsed than perceived self-transgressions. The rate of probable International Classification of Diseases, 11th Revision (ICD-11) PTSD was 8.3%, and of probable ICD-11 CPTSD was 14.2%. Betrayal-related PMIEs were a significant predictor of probable PTSD or probable CPTSD, together with having been redeployed during the pandemic. The only variable that differentially predicted probable CPTSD as compared with probable PTSD was not having had reliable access to personal protective equipment; none of the PMIE types were differential predictors for screening positive for probable PTSD versus probable CPTSD. CONCLUSIONS Exposure to PIMEs could be important for PTSD and CPTSD development. Interventions for moral injury in HSCWs should be investigated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Jo Billings
- Division of Psychiatry, University College London
| | | | | | | |
Collapse
|
4
|
Borissova A, Soni S, Aston ER, Lees R, Petrilli K, Wall MB, Bloomfield MAP, Mertzani E, Paksina A, Freeman TP, Mokrysz C, Lawn W, Curran HV. Age differences in the behavioural economics of cannabis use: Do adolescents and adults differ on demand for cannabis and discounting of future reward? Drug Alcohol Depend 2022; 238:109531. [PMID: 35809475 DOI: 10.1016/j.drugalcdep.2022.109531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/13/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Adolescence is a period of psychological and neural development in which harms associated with cannabis use may be heightened. We hypothesised that adolescent who use cannabis (adolescentsWUC) would have steeper delay discounting (preference for immediate over future rewards) and greater demand (relative valuation) for cannabis than adults who use cannabis (adultsWUC). METHODS This cross-sectional study, part of the 'CannTeen' project, compared adultsWUC (n = 71, 26-29 years old) and adolescentsWUC (n = 76, 16-17 years old), and gender- and age-matched adolescent (n = 63) and adult (n = 64) controls. AdolescentsWUC and adultsWUC used cannabis 1-7 days/week and were matched on cannabis use frequency (4 days/week). The Monetary Choice Questionnaire assessed delay discounting. A modified Marijuana Purchase Task (MPT) assessed cannabis demand in adolescentsWUC and adultsWUC. The MPT yielded five indices: intensity (amount of cannabis used at zero cost), Omax (total peak expenditure), Pmax (price at peak expenditure), breakpoint (cost at which cannabis demand is suppressed to zero) and elasticity (degree to which cannabis use decreases with increasing price). Analyses were adjusted for covariates of gender, socioeconomic status, other illicit drug use. RESULTS Both adolescentsWUC and adultsWUC had steeper delay discounting than controls (F, (1,254)= 9.13, p = 0.003, ηp2= 0.04), with no significant age effect or interaction. AdolescentsWUC showed higher intensity (F, (1,138)= 9.76, p = 0.002, ηp2= 0.07) and lower elasticity (F, (1,138)= 15.25, p < 0.001, ηp2= 0.10) than adultsWUC. There were no significant differences in Pmax, Omax or breakpoint. CONCLUSION Individuals who use cannabis prefer immediate rewards more than controls. AdolescentsWUC, compared to adultsWUC, may be in a high-risk category with diminished sensitivity to cannabis price increases and a greater consumption of cannabis when it is free.
Collapse
Affiliation(s)
- A Borissova
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom.
| | - S Soni
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - E R Aston
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - R Lees
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - K Petrilli
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - M B Wall
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom; Invicro London, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - M A P Bloomfield
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom; Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, London, United Kingdom; Psychiatric Imaging Group, Medical Research Council London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - E Mertzani
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - A Paksina
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - T P Freeman
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom; Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - C Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - W Lawn
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom; National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - H V Curran
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| |
Collapse
|
5
|
D'Ambrosio E, Pergola G, Pardiñas AF, Dahoun T, Veronese M, Sportelli L, Taurisano P, Griffiths K, Jauhar S, Rogdaki M, Bloomfield MAP, Froudist-Walsh S, Bonoldi I, Walters JTR, Blasi G, Bertolino A, Howes OD. A polygenic score indexing a DRD2-related co-expression network is associated with striatal dopamine function. Sci Rep 2022; 12:12610. [PMID: 35871219 PMCID: PMC9308811 DOI: 10.1038/s41598-022-16442-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
The D2 dopamine receptor (D2R) is the primary site of the therapeutic action of antipsychotics and is involved in essential brain functions relevant to schizophrenia, such as attention, memory, motivation, and emotion processing. Moreover, the gene coding for D2R (DRD2) has been associated with schizophrenia at a genome-wide level. Recent studies have shown that a polygenic co-expression index (PCI) predicting the brain-specific expression of a network of genes co-expressed with DRD2 was associated with response to antipsychotics, brain function during working memory in patients with schizophrenia, and with the modulation of prefrontal cortex activity after pharmacological stimulation of D2 receptors. We aimed to investigate the relationship between the DRD2 gene network and in vivo striatal dopaminergic function, which is a phenotype robustly associated with psychosis and schizophrenia. To this aim, a sample of 92 healthy subjects underwent 18F-DOPA PET and was genotyped for genetic variations indexing the co-expression of the DRD2-related genetic network in order to calculate the PCI for each subject. The PCI was significantly associated with whole striatal dopamine synthesis capacity (p = 0.038). Exploratory analyses on the striatal subdivisions revealed a numerically larger effect size of the PCI on dopamine function for the associative striatum, although this was not significantly different than effects in other sub-divisions. These results are in line with a possible relationship between the DRD2-related co-expression network and schizophrenia and extend it by identifying a potential mechanism involving the regulation of dopamine synthesis. Future studies are needed to clarify the molecular mechanisms implicated in this relationship.
Collapse
Affiliation(s)
- Enrico D'Ambrosio
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.,Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giulio Pergola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Tarik Dahoun
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Information Engineering, University of Padua, Padua, Italy
| | - Leonardo Sportelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Taurisano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Kira Griffiths
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sameer Jauhar
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Rogdaki
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Michael A P Bloomfield
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Giuseppe Blasi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London, UK. .,H. Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.
| |
Collapse
|
6
|
Ottisova L, Gillard JA, Wood M, Langford S, John-Baptiste Bastien R, Madinah Haris A, Wild J, Bloomfield MAP, Robertson M. Effectiveness of psychosocial interventions in mitigating adverse mental health outcomes among disaster-exposed health care workers: A systematic review. J Trauma Stress 2022; 35:746-758. [PMID: 35182077 DOI: 10.1002/jts.22780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/22/2022] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 02/01/2023]
Abstract
Health care workers worldwide are at an increased risk of a range of adverse mental health outcomes, including posttraumatic stress disorder (PTSD), following the unprecedented demand placed upon them during the COVID-19 pandemic. Psychosocial interventions offered to mitigate these risks should be based on the best available evidence; however, limited information regarding the comparative effectiveness of interventions is available. We undertook a systematic review of psychosocial interventions delivered to health care workers before, during, and after disasters. Eight databases were searched, including the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, and PsycINFO. Our primary outcomes were changes in symptoms of PTSD, anxiety, depression, and sleep. We calculated effect sizes, where unreported, and reliable change indices to appraise intervention effectiveness. The study was registered with PROSPERO (CRD42020182774). In total, 12,198 papers were screened, 14 of which were included in the present review. Interventions based on evidence-based protocols, including individual and group-based cognitive behavioral therapy (CBT) for PTSD, anxiety, and depression were found to lead to reliable changes in PTSD and anxiety symptoms. Single-session debriefing and psychological first aid workshops showed limited efficacy. There is limited evidence on psychosocial interventions for health care workers faced with disasters, with the strongest evidence base for CBT-based approaches. Future research should include controlled evaluations of interventions and aim to target identified risk factors.
Collapse
Affiliation(s)
- Livia Ottisova
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Julia A Gillard
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Maximillian Wood
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Sarah Langford
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Rayanne John-Baptiste Bastien
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom
| | - Aishah Madinah Haris
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Michael A P Bloomfield
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, United Kingdom.,University College London Hospitals NHS Foundation Trust, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Mary Robertson
- Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Greene T, El-Leithy S, Billings J, Albert I, Birch J, Campbell M, Ehntholt K, Fortune L, Gilbert N, Grey N, Hana L, Kennerley H, Lee D, Lunn S, Murphy D, Robertson M, Wade D, Brewin CR, Bloomfield MAP. Anticipating PTSD in severe COVID survivors: the case for screen-and-treat. Eur J Psychotraumatol 2022; 13:1959707. [PMID: 35096282 PMCID: PMC8797726 DOI: 10.1080/20008198.2021.1959707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 12/29/2022] Open
Abstract
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.
Collapse
Affiliation(s)
- Talya Greene
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London & St George's Mental Health NHS Trust, London, UK
| | - Jo Billings
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Birch
- Department of Clinical Psychology and Psychology Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.,Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Kim Ehntholt
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Lorna Fortune
- Barnet Enfield & Haringey MHT, London, UK.,North Middlesex University Hospital NHS Trust, London, UK
| | | | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Sussex, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Laurinne Hana
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Oxford Cognitive Therapy Centre, University of Oxford, Oxford, UK
| | - Deborah Lee
- Berkshire Traumatic Stress Service, Berkshire Foundation NHS Trust, Reading, UK
| | - Sarah Lunn
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,Whittington Health NHS Trust, London, UK
| | - Dominic Murphy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mary Robertson
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| | - Dorothy Wade
- Critical Care Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael A P Bloomfield
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK.,Translational Psychiatry Research Group, Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| |
Collapse
|
8
|
Berkhout SG, Billings J, Abou Seif N, Singleton D, Stein H, Hegarty S, Ondruskova T, Soulios E, Bloomfield MAP, Greene T, Seto A, Abbey S, Sheehan K. Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK. Eur J Psychotraumatol 2022; 13:2107810. [PMID: 35979505 PMCID: PMC9377263 DOI: 10.1080/20008066.2022.2107810] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/03/2022] Open
Abstract
Background: COVID-19 has had a significant impact on the wellbeing of healthcare workers, with quantitative studies identifying increased stress, anxiety, depression, insomnia, and PTSD in a wide range of settings. Limited qualitative data so far has offered in-depth details concerning what underlies these challenges, but none provide comprehensive comparison across different healthcare systems. Objective: To explore qualitative findings relating to healthcare worker distress from two different countries to understand the nuanced similarities and differences with respect to the sources and impact of distress relating to COVID-19. Method: A comparative interpretive thematic analysis was carried out between two qualitative data sets examining healthcare workers' experiences of distress during the COVID-19 pandemic. Data from Canada and the UK were collected in parallel and analyzed in an iterative, collaborative process. Results: A number of sources of distress cut across both study settings including concerns about safety and patient care, challenges at home or in one's personal life, communication issues, work environment, media and public perception, and government responses to the pandemic. These sit on a spectrum from individual to institutional sources and were mutually reinforcing. Our analysis also suggested that common mechanisms such as exacerbations in uncertainty, hypervigilance, and moral injury underpinned these sources, which contributed to how they were experienced as distressing. Conclusion: This is the first international collaboration utilising qualitative data to examine this pressing issue. Despite differences in the political, social, health service, and pandemic-related context, the sources and mechanisms of distress experienced by healthcare workers in Canada and the UK were remarkably similar. HIGHLIGHTS This international comparative qualitative study explores how mechanisms that lead to distress are shared across different geographies and cultures, even as the local context shapes the sources of distress themselves.
Collapse
Affiliation(s)
- Suze G Berkhout
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Nada Abou Seif
- Division of Psychiatry, University College London, London, UK
| | - David Singleton
- Division of Psychiatry, University College London, London, UK
| | - Hilarie Stein
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Siobhan Hegarty
- Division of Psychiatry, University College London, London, UK
| | | | - Emilia Soulios
- Division of Psychiatry, University College London, London, UK
| | | | - Talya Greene
- Division of Psychiatry, University College London, London, UK.,Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Susan Abbey
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Kathleen Sheehan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| |
Collapse
|
9
|
Mokrysz C, Shaban NDC, Freeman TP, Lawn W, Pope RA, Hindocha C, Freeman A, Wall MB, Bloomfield MAP, Morgan CJA, Nutt DJ, Curran HV. Acute effects of cannabis on speech illusions and psychotic-like symptoms: two studies testing the moderating effects of cannabidiol and adolescence. Psychol Med 2021; 51:2134-2142. [PMID: 32340632 DOI: 10.1017/s0033291720001038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute cannabis administration can produce transient psychotic-like effects in healthy individuals. However, the mechanisms through which this occurs and which factors predict vulnerability remain unclear. We investigate whether cannabis inhalation leads to psychotic-like symptoms and speech illusion; and whether cannabidiol (CBD) blunts such effects (study 1) and adolescence heightens such effects (study 2). METHODS Two double-blind placebo-controlled studies, assessing speech illusion in a white noise task, and psychotic-like symptoms on the Psychotomimetic States Inventory (PSI). Study 1 compared effects of Cann-CBD (cannabis containing Δ-9-tetrahydrocannabinol (THC) and negligible levels of CBD) with Cann+CBD (cannabis containing THC and CBD) in 17 adults. Study 2 compared effects of Cann-CBD in 20 adolescents and 20 adults. All participants were healthy individuals who currently used cannabis. RESULTS In study 1, relative to placebo, both Cann-CBD and Cann+CBD increased PSI scores but not speech illusion. No differences between Cann-CBD and Cann+CBD emerged. In study 2, relative to placebo, Cann-CBD increased PSI scores and incidence of speech illusion, with the odds of experiencing speech illusion 3.1 (95% CIs 1.3-7.2) times higher after Cann-CBD. No age group differences were found for speech illusion, but adults showed heightened effects on the PSI. CONCLUSIONS Inhalation of cannabis reliably increases psychotic-like symptoms in healthy cannabis users and may increase the incidence of speech illusion. CBD did not influence psychotic-like effects of cannabis. Adolescents may be less vulnerable to acute psychotic-like effects of cannabis than adults.
Collapse
Affiliation(s)
- Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, London, UK
| | | | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Will Lawn
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Rebecca A Pope
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Abigail Freeman
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, University College London, London, UK
- Invicro, Burlington Danes Building, Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
- Division of Brain Sciences, Imperial College London, London, UK
| | - Michael A P Bloomfield
- Clinical Psychopharmacology Unit, University College London, London, UK
- Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, UK
- Division of Psychiatry, Translational Psychiatry Research Group, University College London, Maple House, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospitals NHS Foundation Trust, London, UK
| | - Celia J A Morgan
- Clinical Psychopharmacology Unit, University College London, London, UK
- Psychopharmacology and Addiction Research Centre, University of Exeter, Exeter, UK
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Experimental Medicine, Imperial College London, Burlington Danes Building, Du Cane Road, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| |
Collapse
|
10
|
Brewin CR, Bloomfield MAP, Billings J, Harju-Seppänen J, Greene T. What symptoms best predict severe distress in an online survey of UK health and social care staff facing COVID-19: development of the two-item Tipping Point Index. BMJ Open 2021; 11:e047345. [PMID: 34452960 PMCID: PMC8406458 DOI: 10.1136/bmjopen-2020-047345] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES COVID-19 has altered standard thresholds for identifying anxiety and depression. A brief questionnaire to determine when individuals are at a tipping point for severe anxiety or depression would greatly help decisions about when to seek assessment or treatment. DESIGN Data were collected as part of the Frontline-COVID Study, a cross-sectional national online survey with good coverage of health and social care settings. New questionnaire items reflecting when coping was actually breaking down were compared with standard measures of severe anxiety and depression. Data were collected between 27 May and 23 July 2020. SETTING The majority of participants worked in hospitals (53%), in nursing or care homes (15%), or in other community settings (30%). PARTICIPANTS Of 1194 qualifying respondents, 1038 completed the six tipping point items. Respondents included nurses, midwives, doctors, care workers, healthcare assistants, allied healthcare professionals and other non-medical staff. Over 90% were white and female. MAIN OUTCOME MEASURES Threshold for severe anxiety according to the Generalised Anxiety Disorder Scale-7 or moderately severe depression according to the Patient Health Questionnaire-9. RESULTS Answering yes to one of two simple questions ('Over the last week have you been often feeling panicky or on the point of losing control of your emotions?', 'Over the last week have you felt complete hopelessness about the future?') demonstrated very high sensitivity (0.95, 95% CI 0.92 to 0.97) and negative predictive value (0.97, 95% CI 0.95 to 0.98). Answering yes to both questions yielded high specificity (0.90, 95% CI 0.87 to 0.92) and positive predictive value (0.72, 95% CI 0.67 to 0.77). Results were replicated in two random subsamples and were consistent across different genders, ethnic backgrounds, and health or social care settings. CONCLUSIONS Answering two simple yes/no questions can provide simple and immediate guidance to assist with decisions about whether to seek further assessment or treatment.
Collapse
Affiliation(s)
- Chris R Brewin
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Jasmine Harju-Seppänen
- Division of Psychiatry and Division of Psychology and Language Sciences, University College London, London, UK
| | - Talya Greene
- Community Mental Health, University of Haifa, Haifa, Israel
| |
Collapse
|
11
|
Abstract
BACKGROUND Clinical guidelines recommend a phase-based approach to treatment for complex post-traumatic stress disorder (CPTSD), yet little is known about what interventions are being offered and which may be effective in the final 'reintegration' phase. OBJECTIVE To systematically review literature on reintegration interventions for CPTSD, describing the nature and effectiveness of interventions. METHOD We searched four electronic databases (Medline, PsycINFO, Embase, and PTSDpubs) for interventions aiming to facilitate reintegration for participants with probable CPTSD. We had two aims: firstly, to describe the interventions and secondly, to describe their effectiveness as measured through measures of reintegration, PTSD and/or disturbances in self-organization (DSO), or qualitative data describing changes experienced. Results are presented using narrative synthesis. RESULTS Fifteen studies met our inclusion criteria. Interventions included yoga, exercise, use of service dogs, residential treatment, education, self-defence and patient research involvement. Overall study quality was low, as assessed by critical appraisal tools. Of the six studies including a control group, two reported a statistically significant improvement in the measure of reintegration between the intervention and control group, four studies reported a statistically significant difference in the measure of PTSD symptoms, but none reported any significant differences between intervention and control groups in DSO. Of all eight quantitative studies, three reported a statistically significant difference in the reintegration measure pre- to post-intervention for the intervention group, five a statistically significant improvement in the measure of PTSD symptoms, and three a significant difference in the DSO measure. From eight studies reporting qualitative date we synthesized themes into eight categories, within which facilitation of connection with others was the most commonly reported benefit. CONCLUSIONS The interventions outlined may facilitate reintegration, however, research in this area is still in its infancy and quality research is lacking. Further research is needed to establish whether reintegration interventions enhance treatment for CPTSD.
Collapse
Affiliation(s)
- Lucy R Purnell
- Division of Psychiatry, University College London, London, UK
| | | | - Michael A P Bloomfield
- Division of Psychiatry, University College London, London, UK.,Translational Psychiatry Research Group, Mental Health Neuroscience Department, Division of Psychiatry, Institute of Mental Health, University College London, London, UK.,Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.,National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
12
|
Bloomfield MAP, Green SF, Hindocha C, Yamamori Y, Yim JLL, Jones APM, Walker HR, Tokarczuk P, Statton B, Howes OD, Curran HV, Freeman TP. The effects of acute cannabidiol on cerebral blood flow and its relationship to memory: An arterial spin labelling magnetic resonance imaging study. J Psychopharmacol 2020; 34:981-989. [PMID: 32762272 PMCID: PMC7436497 DOI: 10.1177/0269881120936419] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cannabidiol (CBD) is being investigated as a potential treatment for several medical indications, many of which are characterised by altered memory processing. However, the mechanisms underlying these effects are unclear. AIMS Our primary aim was to investigate how CBD influences cerebral blood flow (CBF) in regions involved in memory processing. Our secondary aim was to determine if the effects of CBD on CBF were associated with differences in working and episodic memory task performance. METHODS We used a randomised, crossover, double-blind design in which 15 healthy participants were administered 600 mg oral CBD or placebo on separate days. We measured regional CBF at rest using arterial spin labelling 3 h after drug ingestion. We assessed working memory with the digit span (forward, backward) and n-back (0-back, 1-back, 2-back) tasks, and we used a prose recall task (immediate and delayed) to assess episodic memory. RESULTS CBD increased CBF in the hippocampus (mean (95% confidence intervals) = 15.00 (5.78-24.21) mL/100 g/min, t14 = 3.489, Cohen's d = 0.75, p = 0.004). There were no differences in memory task performance, but there was a significant correlation whereby greater CBD-induced increases in orbitofrontal CBF were associated with reduced reaction time on the 2-back working memory task ( r= -0.73, p = 0.005). CONCLUSIONS These findings suggest that CBD increases CBF to key regions involved in memory processing, particularly the hippocampus. These results identify potential mechanisms of CBD for a range of conditions associated with altered memory processing, including Alzheimer's disease, schizophrenia, post-traumatic stress disorder and cannabis-use disorders.
Collapse
Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK,Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,Psychiatric Imaging Group, Medical Research Council London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK,NIHR University College Hospitals London Biomedical Research Centre, University College London, London, UK,The Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK,Michael Bloomfield, Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, Maple House, Tottenham Court Road, London W1T 7NF, UK.
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK,Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,NIHR University College Hospitals London Biomedical Research Centre, University College London, London, UK
| | - Yumeya Yamamori
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Jocelyn Lok Ling Yim
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Augustus P M Jones
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Hannah R Walker
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Pawel Tokarczuk
- Medical Research Council London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Ben Statton
- Medical Research Council London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Oliver D Howes
- Psychiatric Imaging Group, Medical Research Council London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK,Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK,NIHR University College Hospitals London Biomedical Research Centre, University College London, London, UK
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Institute of Mental Health, University College London, London, UK,Department of Psychology, University of Bath, Bath, UK,Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
13
|
Billings J, Greene T, Kember T, Grey N, El-Leithy S, Lee D, Kennerley H, Albert I, Robertson M, Brewin CR, Bloomfield MAP. Supporting Hospital Staff During COVID-19: Early Interventions. Occup Med (Lond) 2020; 70:327-329. [PMID: 32449752 PMCID: PMC7313813 DOI: 10.1093/occmed/kqaa098] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Jo Billings
- Division of Psychiatry, University College London, London, UK
| | - Talya Greene
- Division of Psychiatry, University College London, London, UK.,Community Mental Health Department, University of Haifa, Haifa, Israel
| | - Tim Kember
- Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,University of Sussex, Sussex, UK
| | - Sharif El-Leithy
- Traumatic Stress Service, South West London and St George's Mental Health NHS Trust, London, UK
| | - Deborah Lee
- Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, University of Oxford, Oxford, UK
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Foundation Trust, London, UK.,Kings College London, London, UK
| | - Mary Robertson
- Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael A P Bloomfield
- Division of Psychiatry, University College London, London, UK.,Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK.,NIHR UCL Biomedical Research Centre, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
14
|
Ogunbiyi MO, Hindocha C, Freeman TP, Bloomfield MAP. Acute and chronic effects of Δ 9-tetrahydrocannabinol (THC) on cerebral blood flow: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109900. [PMID: 32109508 DOI: 10.1016/j.pnpbp.2020.109900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/15/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Acute and chronic exposure to cannabis and its main psychoactive component, Δ9-tetrahydrocannabinol (THC), is associated with changes in brain function and cerebral blood flow (CBF). We therefore sought to systematically review the literature on the effects of THC on CBF following PRISMA guidelines. Studies assessing the acute and chronic effects of THC on CBF, perfusion and volume were searched in the PubMed database between January 1972 and June 2019. We included thirty-four studies, which altogether investigated 1259 humans and 28 animals. Acute and chronic THC exposure have contrasting and regionally specific effects on CBF. While acute THC causes an overall increase in CBF in the anterior cingulate cortex, frontal cortex and insula, in a dose-dependent manner, chronic cannabis use results in an overall reduction in CBF, especially in the prefrontal cortex, which may be reversed upon prolonged abstinence from the drug. Future studies should focus on standardised methodology and longitudinal assessment to strengthen our understanding of the region-specific effects of THC on CBF and its clinical and functional significance.
Collapse
Affiliation(s)
- M Olabisi Ogunbiyi
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, UCL Institute of Mental Health, University College London, UK
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, UCL Institute of Mental Health, University College London, UK; Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, Division of Psychology, University College London, UK; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, UCL Institute of Mental Health, University College London, UK; Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, Division of Psychology, University College London, UK; Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, UCL Institute of Mental Health, University College London, UK; Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, Division of Psychology, University College London, UK; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK; The Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.
| |
Collapse
|
15
|
Billings J, Greene T, Kember T, Grey N, El-Leithy S, Lee D, Kennerley H, Albert I, Robertson M, Brewin CR, Bloomfield MAP. Corrigendum to: Supporting Hospital Staff During COVID-19: Early Interventions. Occup Med (Lond) 2020; 70:453. [PMID: 32614040 PMCID: PMC7337825 DOI: 10.1093/occmed/kqaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
16
|
Greene T, Bloomfield MAP, Billings J. Psychological trauma and moral injury in religious leaders during COVID-19. Psychol Trauma 2020; 12:S143-S145. [PMID: 32538649 DOI: 10.1037/tra0000641] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Religious leaders are at risk of psychological trauma and moral injury during the COVID-19 pandemic. This article highlights potentially traumatic or morally injurious experiences for religious leaders and provides evidence-based recommendations for mitigating their impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
17
|
Bloomfield MAP, Yusuf FNIB, Srinivasan R, Kelleher I, Bell V, Pitman A. Trauma-informed care for adult survivors of developmental trauma with psychotic and dissociative symptoms: a systematic review of intervention studies. Lancet Psychiatry 2020; 7:449-462. [PMID: 32004444 DOI: 10.1016/s2215-0366(20)30041-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/11/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 12/29/2022]
Abstract
Developmental trauma is associated with an increased risk of psychosis and predicts poor prognosis. Despite this association, little is known about which treatments work best for survivors of developmental trauma with psychosis. We sought to do the first review, to our knowledge, to investigate treatments for people with psychotic and dissociative symptoms who have a history of developmental trauma. We searched MEDLINE, PsychINFO, and Google Scholar for studies reporting psychological and pharmacological treatments of psychotic or dissociative symptoms in adult survivors of developmental trauma. We identified 24 studies, most of which investigated various modalities of psychotherapy with two case reports of pharmacological treatments. There is preliminary evidence in favour of third wave cognitive therapies. However, because of low methodological quality and reporting in most of the studies found, it remains unknown which treatments are most effective in this clinical group. Nonetheless, our findings of potential treatment targets, including emotion regulation, acceptance, interpersonal skills, trauma re-processing, and the integration of dissociated ego states, could guide future work in this area. Methodologically rigorous studies are needed to enable clinicians and patients to collaboratively form evidence-based treatment plans. Our Review is registered with PROSPERO, number CRD42018104533.
Collapse
Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK; Division of Psychiatry, University College London, Institute of Mental Health, and Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, Division of Psychology, University College London, London, UK; The Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, UK; St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK; National Hospital for Neurology and Neurosurgery, London, UK.
| | - Fatin N I B Yusuf
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK
| | - Ramya Srinivasan
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK
| | - Ian Kelleher
- Royal College of Surgeons in Ireland, Department of Psychiatry, Dublin, Ireland
| | - Vaughan Bell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- Epidemiology and Applied Clinical Research Department, University College London, London, UK; The Huntley Centre, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| |
Collapse
|
18
|
Abstract
Objectives: Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health problem. There has been a recent surge of interest regarding the use of cannabinoids in the treatment of PTSD. We therefore sought to systematically review and assess the quality of the clinical evidence of the effectiveness of cannabinoids for the treatment of PTSD. Method: We included all studies published until December 2018 where a patient has had PTSD diagnosed and had been prescribed or were using a cannabinoid for the purpose of reducing PTSD symptoms. Our primary outcome measure was the reduction in PTSD symptoms using a validated instrument. In the absence of randomized controlled trials, we included the next best available levels of evidence including observational and retrospective studies and case reports. We assessed risk of bias and quality using validated tools appropriate for the study design. Results: We included 10 studies in this review, of which only one study was a pilot randomized, double-blind, placebo-controlled, crossover clinical trial. Every identified study had medium to high risk of bias and was of low quality. We found that cannabinoids may decrease PTSD symptomology, in particular sleep disturbances and nightmares. Conclusions: Most studies to date are small and of low quality, with significant limitations to the study designs precluding any clinical recommendations about its use in routine clinical practice. Evidence that cannabinoids may help reduce global PTSD symptoms, sleep disturbances, and nightmares indicates that future well-controlled, randomized, double-blind clinical trials are highly warranted.PROSPERO registration number: 121646.
Collapse
Affiliation(s)
- C Hindocha
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom.,NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - J Cousijn
- Neuroscience of Addiction (NofA) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - M Rall
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - M A P Bloomfield
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom.,Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom.,NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom.,The Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK
| |
Collapse
|
19
|
McCutcheon RA, Bloomfield MAP, Dahoun T, Mehta M, Howes OD. Chronic psychosocial stressors are associated with alterations in salience processing and corticostriatal connectivity. Schizophr Res 2019; 213:56-64. [PMID: 30573409 PMCID: PMC6817361 DOI: 10.1016/j.schres.2018.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 12/23/2022]
Abstract
Psychosocial stressors including childhood adversity, migration, and living in an urban environment, have been associated with several psychiatric disorders, including psychotic disorders. The neural and psychological mechanisms mediating this relationship remain unclear. In parallel, alterations in corticostriatal connectivity and abnormalities in the processing of salience, are seen in psychotic disorders. Aberrant functioning of these mechanisms secondary to chronic stress exposure, could help explain how common environmental exposures are associated with a diverse range of symptoms. In the current study, we recruited two groups of adults, one with a high degree of exposure to chronic psychosocial stressors (the exposed group, n = 20), and one with minimal exposure (the unexposed group, n = 22). All participants underwent a resting state MRI scan, completed the Aberrant Salience Inventory, and performed a behavioural task - the Salience Attribution Test (SAT). The exposed group showed reduced explicit adaptive salience scores (cohen's d = 0.69, p = 0.03) and increased aberrant salience inventory scores (d = 0.65, p = 0.04). The exposed group also showed increased corticostriatal connectivity between the ventral striatum and brain regions previously implicated in salience processing. Corticostriatal connectivity in these regions negatively correlated with SAT explicit adaptive salience (r = -0.48, p = 0.001), and positively correlated with aberrant salience inventory scores (r = 0.42, p = 0.006). Furthermore, in a mediation analysis there was tentative evidence that differences in striato-cortical connectivity mediated the group differences in salience scores.
Collapse
Affiliation(s)
- Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK
| | - Michael A P Bloomfield
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London WC1T 7NF, UK; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, Euston Road, London W1T 7DN, UK; The Traumatic Stress Clinic, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK
| | - Tarik Dahoun
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX37 JX, UK
| | - Mitul Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
| |
Collapse
|
20
|
D'Ambrosio E, Dahoun T, Pardiñas AF, Veronese M, Bloomfield MAP, Jauhar S, Bonoldi I, Rogdaki M, Froudist-Walsh S, Walters JTR, Howes OD. The effect of a genetic variant at the schizophrenia associated AS3MT/BORCS7 locus on striatal dopamine function: A PET imaging study. Psychiatry Res Neuroimaging 2019; 291:34-41. [PMID: 31386983 PMCID: PMC7099976 DOI: 10.1016/j.pscychresns.2019.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 07/18/2019] [Indexed: 11/21/2022]
Abstract
One of the most statistically significant loci to result from large-scale GWAS of schizophrenia is 10q24.32. However, it is still unclear how this locus is involved in the pathoaetiology of schizophrenia. The hypothesis that presynaptic dopamine dysfunction underlies schizophrenia is one of the leading theories of the pathophysiology of the disorder. Supporting this, molecular imaging studies show evidence for elevated dopamine synthesis and release capacity. Thus, altered dopamine function could be a potential mechanism by which this genetic variant acts to increase the risk of schizophrenia. We therefore tested the hypothesis that the 10q24.32 region confers genetic risk for schizophrenia through an effect on striatal dopamine function. To this aim we investigated the in vivo relationship between a GWAS schizophrenia-associated SNP within this locus and dopamine synthesis capacity measured using [18F]-DOPA PET in healthy controls. 92 healthy volunteers underwent [18F]-DOPA PET scans to measure striatal dopamine synthesis capacity (indexed as Kicer) and were genotyped for the SNP rs7085104. We found a significant association between rs7085104 genotype and striatal Kicer. Our findings indicate that the mechanism mediating the 10q24.32 risk locus for schizophrenia could involve altered dopaminergic function. Future studies are needed to clarify the neurobiological pathway implicated in this association.
Collapse
Affiliation(s)
- Enrico D'Ambrosio
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; Psychiatric Neuroscience Group, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Tarik Dahoun
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX37 JX, UK
| | - Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Michael A P Bloomfield
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Translational Psychiatry, Research Department of Mental Health Neuroscience, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Sameer Jauhar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Trust, London, UK
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Trust, London, UK
| | - Maria Rogdaki
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
| | | | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, W12 0NN, UK; South London and Maudsley NHS Trust, London, UK.
| |
Collapse
|
21
|
Lawn W, Freeman TP, East K, Gaule A, Aston ER, Bloomfield MAP, Das RK, Morgan CJA, Curran HV. The Acute Effects of a Dopamine D3 Receptor Preferring Agonist on Motivation for Cigarettes in Dependent and Occasional Cigarette Smokers. Nicotine Tob Res 2019; 20:800-809. [PMID: 29065193 PMCID: PMC5991206 DOI: 10.1093/ntr/ntx159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
Abstract
Background Dopaminergic functioning is thought to play critical roles in both motivation and addiction. There is preliminary evidence that dopamine agonists reduce the motivation for cigarettes in smokers. However, the effects of pramipexole, a dopamine D3 receptor preferring agonist, have not been investigated. The aim of this study was to examine the effects of an acute dose of pramipexole on the motivation to earn cigarettes and nondrug rewards. Methods Twenty dependent and 20 occasional smokers received 0.5 mg pramipexole using a double-blind, placebo-controlled crossover design. Motivation for cigarettes and consummatory nondrug rewards was measured using the DReaM-Choice task, in which participants earned, and later “consumed,” cigarettes, music, and chocolate. Demand for cigarettes was measured using the Cigarette Purchase Task (CPT). Self-reported craving, withdrawal, and drug effects were also recorded. Results Dependent smokers chose (p < .001) and button-pressed for (p < .001) cigarettes more, and chose chocolate less (p < .001), than occasional smokers. Pramipexole did not affect the number of choices for or amount of button-pressing for any reward including cigarettes, which was supported by a Bayesian analysis. The dependent smokers had greater demand for cigarettes than occasional smokers across all CPT outcomes (ps < .021), apart from elasticity. Pramipexole did not affect demand for cigarettes, and this was supported by Bayesian analyses. Pramipexole produced greater subjective “feel drug” and “dislike drug” effects than placebo. Conclusions Dependent and occasional cigarette smokers differed in their motivation for cigarettes but not for the nondrug rewards. Pramipexole did not acutely alter motivation for cigarettes. These findings question the role of dopamine D3 receptors in cigarette-seeking behavior in dependent and occasional smokers. Implications This study adds to the growing literature about cigarette versus nondrug reward processing in nicotine dependence and the role of dopamine in cigarette-seeking behavior. Our results suggest nicotine dependence is associated with a hypersensitivity to cigarette rewards but not a hyposensitivity to nondrug rewards. Furthermore, our results question the importance of dopamine D3 receptors in motivational processing of cigarettes in occasional and dependent smokers.
Collapse
Affiliation(s)
- Will Lawn
- Clinical Psychopharmacology unit, University College London, London, UK
| | - Tom P Freeman
- Clinical Psychopharmacology unit, University College London, London, UK.,Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katie East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annie Gaule
- Clinical Psychopharmacology unit, University College London, London, UK
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Michael A P Bloomfield
- Clinical Psychopharmacology unit, University College London, London, UK.,Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, UK.,Division of Psychiatry, University College London, Maple House, London, UK
| | - Ravi K Das
- Clinical Psychopharmacology unit, University College London, London, UK
| | - Celia J A Morgan
- Clinical Psychopharmacology unit, University College London, London, UK.,Department of Psychology, University of Exeter, Washington Singer Building, Exeter, UK
| | - H Valerie Curran
- Clinical Psychopharmacology unit, University College London, London, UK
| |
Collapse
|
22
|
Beck K, Lally J, Shergill SS, Bloomfield MAP, MacCabe JH, Gaughran F, Howes OD. Prevalence of serum N-methyl-d-aspartate receptor autoantibodies in refractory psychosis - ADDENDUM. Br J Psychiatry 2019; 215:507. [PMID: 31180301 PMCID: PMC8055578 DOI: 10.1192/bjp.2019.141] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
23
|
Affiliation(s)
- Tom P Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, UK
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational & Health Psychology, University College London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational & Health Psychology, University College London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Michael A P Bloomfield
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational & Health Psychology, University College London, UK
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College London, UK
- The Traumatic Stress Clinic, St Pancras Hospital, Camden & Islington NHS Foundation Trust, London, UK
| |
Collapse
|
24
|
Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, UCL Institute of Mental Health, University College London, London W1T 7NF, UK; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College London, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK; The Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK.
| |
Collapse
|
25
|
Bloomfield MAP, Hindocha C, Green SF, Wall MB, Lees R, Petrilli K, Costello H, Ogunbiyi MO, Bossong MG, Freeman TP. The neuropsychopharmacology of cannabis: A review of human imaging studies. Pharmacol Ther 2018; 195:132-161. [PMID: 30347211 PMCID: PMC6416743 DOI: 10.1016/j.pharmthera.2018.10.006] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The laws governing cannabis are evolving worldwide and associated with changing patterns of use. The main psychoactive drug in cannabis is Δ9-tetrahydrocannabinol (THC), a partial agonist at the endocannabinoid CB1 receptor. Acutely, cannabis and THC produce a range of effects on several neurocognitive and pharmacological systems. These include effects on executive, emotional, reward and memory processing via direct interactions with the endocannabinoid system and indirect effects on the glutamatergic, GABAergic and dopaminergic systems. Cannabidiol, a non-intoxicating cannabinoid found in some forms of cannabis, may offset some of these acute effects. Heavy repeated cannabis use, particularly during adolescence, has been associated with adverse effects on these systems, which increase the risk of mental illnesses including addiction and psychosis. Here, we provide a comprehensive state of the art review on the acute and chronic neuropsychopharmacology of cannabis by synthesizing the available neuroimaging research in humans. We describe the effects of drug exposure during development, implications for understanding psychosis and cannabis use disorder, and methodological considerations. Greater understanding of the precise mechanisms underlying the effects of cannabis may also give rise to new treatment targets.
Collapse
Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, United Kingdom.
| | - Chandni Hindocha
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College Hospital, London, United Kingdom
| | - Sebastian F Green
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Centre for Neuropsychopharmacology, Division of Brain Sciences, Faculty of Medicine, Imperial College London, United Kingdom; Invicro UK, Hammersmith Hospital, London, United Kingdom
| | - Rachel Lees
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Katherine Petrilli
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Institute of Cognitive Neuroscience, Faculty of Brain Sciences, University College London, United Kingdom
| | - Harry Costello
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - M Olabisi Ogunbiyi
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Tom P Freeman
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom; Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, United Kingdom; Department of Psychology, University of Bath, United Kingdom; National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| |
Collapse
|
26
|
Dahoun T, Pardiñas AF, Veronese M, Bloomfield MAP, Jauhar S, Bonoldi I, Froudist-Walsh S, Nosarti C, Korth C, Hennah W, Walters J, Prata D, Howes OD. The effect of the DISC1 Ser704Cys polymorphism on striatal dopamine synthesis capacity: an [18F]-DOPA PET study. Hum Mol Genet 2018; 27:3498-3506. [PMID: 29945223 PMCID: PMC6168972 DOI: 10.1093/hmg/ddy242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 11/14/2022] Open
Abstract
Whilst the role of the Disrupted-in-Schizophrenia 1 (DISC1) gene in the aetiology of major mental illnesses is debated, the characterization of its function lends it credibility as a candidate. A key aspect of this functional characterization is the determination of the role of common non-synonymous polymorphisms on normal variation within these functions. The common allele (A) of the DISC1 single-nucleotide polymorphism (SNP) rs821616 encodes a serine (ser) at the Ser704Cys polymorphism, and has been shown to increase the phosphorylation of extracellular signal-regulated protein Kinases 1 and 2 (ERK1/2) that stimulate the phosphorylation of tyrosine hydroxylase, the rate-limiting enzyme for dopamine biosynthesis. We therefore set out to test the hypothesis that human ser (A) homozygotes would show elevated dopamine synthesis capacity compared with cysteine (cys) homozygotes and heterozygotes (TT and AT) for rs821616. [18F]-DOPA positron emission tomography (PET) was used to index striatal dopamine synthesis capacity as the influx rate constant Kicer in healthy volunteers DISC1 rs821616 ser homozygotes (N = 46) and healthy volunteers DISC1 rs821616 cys homozygotes and heterozygotes (N = 56), matched for age, gender, ethnicity and using three scanners. We found DISC1 rs821616 ser homozygotes exhibited a significantly higher striatal Kicer compared with cys homozygotes and heterozygotes (P = 0.012) explaining 6.4% of the variance (partial η2 = 0.064). Our finding is consistent with its previous association with heightened activation of ERK1/2, which stimulates tyrosine hydroxylase activity for dopamine synthesis. This could be a potential mechanism mediating risk for psychosis, lending further credibility to the fact that DISC1 is of functional interest in the aetiology of major mental illness.
Collapse
Affiliation(s)
- Tarik Dahoun
- Psychiatric Imaging Group, Robert Steiner MRI Unit, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, Hammersmith Hospital, London, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX37 JX, UK
| | - Antonio F Pardiñas
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Mattia Veronese
- Centre for Neuroimaging Sciences, King’s College London, London, UK
| | - Michael A P Bloomfield
- Psychiatric Imaging Group, Robert Steiner MRI Unit, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, Hammersmith Hospital, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
- Division of Psychiatry, University College London, London, UK
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sameer Jauhar
- Psychiatric Imaging Group, Robert Steiner MRI Unit, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, Hammersmith Hospital, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | - Ilaria Bonoldi
- Psychiatric Imaging Group, Robert Steiner MRI Unit, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, Hammersmith Hospital, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| | | | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
- Division of Imaging Sciences & Biomedical Engineering, Centre for the Developing Brain, King’s College London, London, UK
| | - Carsten Korth
- Department Neuropathology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - William Hennah
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
- Mental Health Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
| | - James Walters
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisbon, Portugal
| | - Oliver D Howes
- Psychiatric Imaging Group, Robert Steiner MRI Unit, MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Faculty of Medicine, Institute of Clinical Sciences (ICS), Imperial College London, Hammersmith Hospital, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, UK
| |
Collapse
|
27
|
McCutcheon R, Bloomfield MAP, Dahoun T, Quinlan M, Terbeck S, Mehta M, Howes O. Amygdala reactivity in ethnic minorities and its relationship to the social environment: an fMRI study. Psychol Med 2018; 48:1985-1992. [PMID: 29328019 PMCID: PMC5933521 DOI: 10.1017/s0033291717003506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ethnic minority individuals have an increased risk of developing a psychotic disorder, particularly if they live in areas of ethnic segregation, or low own group ethnic density. The neurobiological mechanisms underlying this ethnic minority associated risk are unknown. We used functional MRI to investigate neural responses to faces of different ethnicity, in individuals of black ethnicity, and a control group of white British ethnicity individuals. METHODS In total 20 individuals of black ethnicity, and 22 individuals of white British ethnicity underwent a 3T MRI scan while viewing faces of black and white ethnicity. Own group ethnic density was calculated from the 2011 census. Neighbourhood segregation was quantified using the Index of Dissimilarity method. RESULTS At the within-group level, both groups showed greater right amygdala activation to outgroup faces. Between groups, the black ethnicity group showed greater right amygdala activation to white faces, compared to the white ethnicity group. Within the black ethnicity group, individuals living in areas of lower own group ethnic density showed greater right amygdala reactivity to white faces (r = -0.61, p = 0.01). CONCLUSIONS This is the first time an increased amygdala response to white faces has been demonstrated in individuals of black ethnicity. In the black ethnicity group, correlations were observed between amygdala response and neighbourhood variables associated with increased psychosis risk. These results may have relevance for our understanding of the increased rates of paranoia and psychotic disorders in ethnic minority individuals.
Collapse
Affiliation(s)
- Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Michael A. P. Bloomfield
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London WC1T 7NF, UK
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Tarik Dahoun
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Marina Quinlan
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
| | - Sylvia Terbeck
- School of Psychology, Plymouth University, Drake Circus, Plymouth PL48AA, UK
| | - Mitul Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| |
Collapse
|
28
|
Freeman TP, Pope RA, Wall MB, Bisby JA, Luijten M, Hindocha C, Mokrysz C, Lawn W, Moss A, Bloomfield MAP, Morgan CJA, Nutt DJ, Curran HV. Cannabis Dampens the Effects of Music in Brain Regions Sensitive to Reward and Emotion. Int J Neuropsychopharmacol 2018; 21:21-32. [PMID: 29025134 PMCID: PMC5795345 DOI: 10.1093/ijnp/pyx082] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Despite the current shift towards permissive cannabis policies, few studies have investigated the pleasurable effects users seek. Here, we investigate the effects of cannabis on listening to music, a rewarding activity that frequently occurs in the context of recreational cannabis use. We additionally tested how these effects are influenced by cannabidiol, which may offset cannabis-related harms. METHODS Across 3 sessions, 16 cannabis users inhaled cannabis with cannabidiol, cannabis without cannabidiol, and placebo. We compared their response to music relative to control excerpts of scrambled sound during functional Magnetic Resonance Imaging within regions identified in a meta-analysis of music-evoked reward and emotion. All results were False Discovery Rate corrected (P<.05). RESULTS Compared with placebo, cannabis without cannabidiol dampened response to music in bilateral auditory cortex (right: P=.005, left: P=.008), right hippocampus/parahippocampal gyrus (P=.025), right amygdala (P=.025), and right ventral striatum (P=.033). Across all sessions, the effects of music in this ventral striatal region correlated with pleasure ratings (P=.002) and increased functional connectivity with auditory cortex (right: P< .001, left: P< .001), supporting its involvement in music reward. Functional connectivity between right ventral striatum and auditory cortex was increased by cannabidiol (right: P=.003, left: P=.030), and cannabis with cannabidiol did not differ from placebo on any functional Magnetic Resonance Imaging measures. Both types of cannabis increased ratings of wanting to listen to music (P<.002) and enhanced sound perception (P<.001). CONCLUSIONS Cannabis dampens the effects of music in brain regions sensitive to reward and emotion. These effects were offset by a key cannabis constituent, cannabidol.
Collapse
Affiliation(s)
- Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, United Kingdom.,National Addiction Centre, King's College London, United Kingdom
| | - Rebecca A Pope
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| | - Matthew B Wall
- Clinical Psychopharmacology Unit, University College London, United Kingdom.,Imanova Centre for Imaging Sciences, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Neuropsychopharmacology Unit, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - James A Bisby
- Institute of Cognitive Neuroscience, University College London, United Kingdom
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Chandni Hindocha
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| | - Will Lawn
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| | - Abigail Moss
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| | - Michael A P Bloomfield
- Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom.,Division of Psychiatry, University College London, United Kingdom
| | - Celia J A Morgan
- Clinical Psychopharmacology Unit, University College London, United Kingdom.,Department of Psychology, University of Exeter, United Kingdom
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, United Kingdom
| |
Collapse
|
29
|
Egerton A, Howes OD, Houle S, McKenzie K, Valmaggia LR, Bagby MR, Tseng HH, Bloomfield MAP, Kenk M, Bhattacharyya S, Suridjan I, Chaddock CA, Winton-Brown TT, Allen P, Rusjan P, Remington G, Meyer-Lindenberg A, McGuire PK, Mizrahi R. Elevated Striatal Dopamine Function in Immigrants and Their Children: A Risk Mechanism for Psychosis. Schizophr Bull 2017; 43:293-301. [PMID: 28057720 PMCID: PMC5605255 DOI: 10.1093/schbul/sbw181] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 01/26/2023]
Abstract
Migration is a major risk factor for schizophrenia but the neurochemical processes involved are unknown. One candidate mechanism is through elevations in striatal dopamine synthesis and release. The objective of this research was to determine whether striatal dopamine function is elevated in immigrants compared to nonimmigrants and the relationship with psychosis. Two complementary case-control studies of in vivo dopamine function (stress-induced dopamine release and dopamine synthesis capacity) in immigrants compared to nonimmigrants were performed in Canada and the United Kingdom. The Canadian dopamine release study included 25 immigrant and 31 nonmigrant Canadians. These groups included 23 clinical high risk (CHR) subjects, 9 antipsychotic naïve patients with schizophrenia, and 24 healthy volunteers. The UK dopamine synthesis study included 32 immigrants and 44 nonimmigrant British. These groups included 50 CHR subjects and 26 healthy volunteers. Both striatal stress-induced dopamine release and dopamine synthesis capacity were significantly elevated in immigrants compared to nonimmigrants, independent of clinical status. These data provide the first evidence that the effect of migration on the risk of developing psychosis may be mediated by an elevation in brain dopamine function.
Collapse
Affiliation(s)
- Alice Egerton
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint first authors
| | - Oliver D. Howes
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint first authors
| | - Sylvain Houle
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,These authors are joint first authors
| | - Kwame McKenzie
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lucia R. Valmaggia
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael R. Bagby
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,Department of Psychology, University of Toronto
| | - Huai-Hsuan Tseng
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | - Michael A. P. Bloomfield
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Division of Psychiatry, University College London, London, UK;,Psychiatric Imaging Group, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK
| | - Miran Kenk
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivonne Suridjan
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada
| | | | - Toby T. Winton-Brown
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Allen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Department of Psychology, Whitelands College, University of Roehampton, London, UK
| | - Pablo Rusjan
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gary Remington
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Philip K. McGuire
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,These authors are joint last authors
| | - Romina Mizrahi
- Research Imaging Center, CAMH, PET Centre, Toronto, ON, Canada;,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada;,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada;,These authors are joint last authors
| |
Collapse
|
30
|
Moss A, Curran HV, Bloomfield MAP, Kamboj SK, Blackwell SE, Freeman TP. Bringing together pharmacological and psychological approaches to mental health research. Lancet Psychiatry 2016; 3:700-702. [PMID: 27475758 DOI: 10.1016/s2215-0366(16)30080-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Abigail Moss
- Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK
| | - Michael A P Bloomfield
- Division of Psychiatry, University College London, UK; Psychiatric Imaging Group, MRC Clinical Sciences Centre, London, UK
| | - Sunjeev K Kamboj
- Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK
| | - Simon E Blackwell
- MRC Cognition & Brain Sciences Unit, Cambridge, UK; Mental Health Research and Treatment Centre, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK.
| |
Collapse
|
31
|
Mouchlianitis E, Bloomfield MAP, Law V, Beck K, Selvaraj S, Rasquinha N, Waldman A, Turkheimer FE, Egerton A, Stone J, Howes OD. Treatment-Resistant Schizophrenia Patients Show Elevated Anterior Cingulate Cortex Glutamate Compared to Treatment-Responsive. Schizophr Bull 2016; 42:744-52. [PMID: 26683625 PMCID: PMC4838083 DOI: 10.1093/schbul/sbv151] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [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] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Resistance to antipsychotic treatment is a significant clinical problem in patients with schizophrenia with approximately 1 in 3 showing limited or no response to repeated treatments with antipsychotic medication. The neurobiological basis for treatment resistance is unknown but recent evidence implicates glutamatergic function in the anterior cingulate cortex. We examined glutamate levels of chronically ill treatment-resistant patients directly compared to treatment-responsive patients. METHODS We acquired proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla from 21 treatment-resistant and 20 treatment-responsive patients. All participants had a DSM-IV diagnosis of schizophrenia. Treatment-resistant patients were classified using the modified Kane criteria. The groups were matched for age, sex, smoking status, and illness duration. RESULTS Glutamate to creatine ratio levels were higher in treatment-resistant patients (Mean [SD] = 1.57 [0.24]) than in treatment-responsive patients (Mean[SD] = 1.38 [0.23]), (T[35] = 2.34, P = .025, 2-tailed), with a large effect size of d = 0.76. A model assuming 2 populations showed a 25% improvement in the fit of the Akaike weights (0.55) over a model assuming 1 population (0.44), producing group values almost identical to actual group means. DISCUSSION Increased anterior cingulate glutamate level is associated with treatment-resistant schizophrenia. This appears to be a stable neurobiological trait of treatment-resistant patients. We discuss possible explanations for glutamatergic dysfunction playing a significant role in resistance to conventional antipsychotic treatments, which are all dopamine-2 receptor blockers. Our findings suggest that glutamatergic treatments may be particularly effective in resistant patients and that 1H-MRS glutamate indices can potentially have clinical use.
Collapse
Affiliation(s)
- Elias Mouchlianitis
- Medical Research Council Clinical Sciences Centre, Psychiatric Imaging Group, Hammersmith Hospital, London, UK; Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King's College London, UK;
| | - Michael A. P. Bloomfield
- Medical Research Council Clinical Sciences Centre, Psychiatric Imaging Group, Hammersmith Hospital, London, UK;,University College London, Division of Psychiatry, London, UK
| | - Vincent Law
- Medical Research Council Clinical Sciences Centre, Psychiatric Imaging Group, Hammersmith Hospital, London, UK
| | - Katherine Beck
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, UK
| | - Sudhakar Selvaraj
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, TX
| | | | - Adam Waldman
- Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Federico E. Turkheimer
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, UK
| | - Alice Egerton
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, UK
| | - James Stone
- Medical Research Council Clinical Sciences Centre, Psychiatric Imaging Group, Hammersmith Hospital, London, UK;,Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, UK
| | - Oliver D. Howes
- Medical Research Council Clinical Sciences Centre, Psychiatric Imaging Group, Hammersmith Hospital, London, UK;,Institute of Psychiatry Psychology and Neuroscience, Department of Psychosis Studies, King’s College London, UK
| |
Collapse
|
32
|
Volkow ND, Swanson JM, Evins AE, DeLisi LE, Meier MH, Gonzalez R, Bloomfield MAP, Curran HV, Baler R. Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry 2016; 73:292-7. [PMID: 26842658 DOI: 10.1001/jamapsychiatry.2015.3278] [Citation(s) in RCA: 484] [Impact Index Per Article: 60.5] [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] [Indexed: 11/14/2022]
Abstract
With a political debate about the potential risks and benefits of cannabis use as a backdrop, the wave of legalization and liberalization initiatives continues to spread. Four states (Colorado, Washington, Oregon, and Alaska) and the District of Columbia have passed laws that legalized cannabis for recreational use by adults, and 23 others plus the District of Columbia now regulate cannabis use for medical purposes. These policy changes could trigger a broad range of unintended consequences, with profound and lasting implications for the health and social systems in our country. Cannabis use is emerging as one among many interacting factors that can affect brain development and mental function. To inform the political discourse with scientific evidence, the literature was reviewed to identify what is known and not known about the effects of cannabis use on human behavior, including cognition, motivation, and psychosis.
Collapse
Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston4Harvard Medical School, Boston, Massachusetts
| | - Lynn E DeLisi
- Veterans Affairs Boston Healthcare System, Harvard Medical School, Brockton, Massachusetts
| | | | - Raul Gonzalez
- Center for Children and Families, Department of Psychology, Florida International University, Miami
| | - Michael A P Bloomfield
- Division of Psychiatry, University College London, London, England9Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, England
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Clinical Health Psychology, University College London, London, England
| | - Ruben Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
33
|
Carhart-Harris RL, Murphy K, Leech R, Erritzoe D, Wall MB, Ferguson B, Williams LTJ, Roseman L, Brugger S, De Meer I, Tanner M, Tyacke R, Wolff K, Sethi A, Bloomfield MAP, Williams TM, Bolstridge M, Stewart L, Morgan C, Newbould RD, Feilding A, Curran HV, Nutt DJ. The Effects of Acutely Administered 3,4-Methylenedioxymethamphetamine on Spontaneous Brain Function in Healthy Volunteers Measured with Arterial Spin Labeling and Blood Oxygen Level-Dependent Resting State Functional Connectivity. Biol Psychiatry 2015; 78:554-62. [PMID: 24495461 PMCID: PMC4578244 DOI: 10.1016/j.biopsych.2013.12.015] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/05/2013] [Accepted: 12/16/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND The compound 3,4-methylenedioxymethamphetamine (MDMA) is a potent monoamine releaser that produces an acute euphoria in most individuals. METHODS In a double-blind, placebo-controlled, balanced-order study, MDMA was orally administered to 25 physically and mentally healthy individuals. Arterial spin labeling and seed-based resting state functional connectivity (RSFC) were used to produce spatial maps displaying changes in cerebral blood flow (CBF) and RSFC after MDMA administration. Participants underwent two arterial spin labeling and two blood oxygen level-dependent scans in a 90-minute scan session; MDMA and placebo study days were separated by 1 week. RESULTS Marked increases in positive mood were produced by MDMA. Decreased CBF only was observed after MDMA, and this was localized to the right medial temporal lobe (MTL), thalamus, inferior visual cortex, and the somatosensory cortex. Decreased CBF in the right amygdala and hippocampus correlated with ratings of the intensity of global subjective effects of MDMA. The RSFC results complemented the CBF results, with decreases in RSFC between midline cortical regions, the medial prefrontal cortex, and MTL regions, and increases between the amygdala and hippocampus. There were trend-level correlations between these effects and ratings of intense and positive subjective effects. CONCLUSIONS The MTLs appear to be specifically implicated in the mechanism of action of MDMA, but further work is required to elucidate how the drug's characteristic subjective effects arise from its modulation of spontaneous brain activity.
Collapse
Affiliation(s)
- Robin L Carhart-Harris
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London.
| | - Kevin Murphy
- Cardiff University Brain Research Imaging Centre (KM), School of Psychology, Cardiff University, Cardiff, London, United Kingdom
| | | | - David Erritzoe
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Matthew B Wall
- Institute of Neurology (MBW),; Imanova (MBW, IDM, MT, RDN), Centre for Imaging Sciences, London
| | - Bart Ferguson
- Clinical Psychopharmacology Unit (BF, LS, CM, HVC), University College London, London; University College London, London
| | - Luke T J Williams
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Leor Roseman
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Stefan Brugger
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Ineke De Meer
- Imanova (MBW, IDM, MT, RDN), Centre for Imaging Sciences, London
| | - Mark Tanner
- Imanova (MBW, IDM, MT, RDN), Centre for Imaging Sciences, London
| | - Robin Tyacke
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Kim Wolff
- School of Biomedical Sciences (KW), Kings College London, London, United Kingdom
| | - Ajun Sethi
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Michael A P Bloomfield
- Psychiatric Imaging Group (MAPB), MRC Clinical Sciences Centre, Institute of Clinical Science, Imperial College London, London
| | - Tim M Williams
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Mark Bolstridge
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| | - Lorna Stewart
- Clinical Psychopharmacology Unit (BF, LS, CM, HVC), University College London, London; University College London, London
| | - Celia Morgan
- Clinical Psychopharmacology Unit (BF, LS, CM, HVC), University College London, London; University College London, London
| | | | | | - H Val Curran
- Clinical Psychopharmacology Unit (BF, LS, CM, HVC), University College London, London; University College London, London
| | - David J Nutt
- Centre for Neuropsychopharmacology (RLC-H, DE, LTJW, LR, SB, RT, AS, TMW, MB, DJN) and C3NL (RL), Division of Brain Sciences, Faculty of Medicine, London, London
| |
Collapse
|
34
|
Bloomfield MAP, Jauhar S, Froudist-Walsh S, Bonoldi I, Howes OD. Commentary on a study of the prevalence of mental disorders by Breslau et al. J Psychiatr Res 2015; 61:231-2. [PMID: 25499560 DOI: 10.1016/j.jpsychires.2014.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Michael A P Bloomfield
- Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom; Division of Psychiatry, University College London, Charles Bell House, 1st and 2nd Floor, 67-73 Riding House Street, London W1W 7EJ, United Kingdom.
| | - Sameer Jauhar
- Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Sean Froudist-Walsh
- Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Ilaria Bonoldi
- Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Oliver D Howes
- Medical Research Council Clinical Sciences Centre, Institute of Clinical Science, Hammersmith Hospital, Imperial College London, Du Cane Road, London W12 0NN, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| |
Collapse
|
35
|
Beck K, Lally J, Shergill SS, Bloomfield MAP, MacCabe JH, Gaughran F, Howes OD. Prevalence of serum N-methyl-D-aspartate receptor autoantibodies in refractory psychosis. Br J Psychiatry 2015; 206:164-5. [PMID: 25431428 PMCID: PMC4312967 DOI: 10.1192/bjp.bp.113.142216] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
N-methyl-d-aspartate receptor (NMDA-R) autoantibodies have been reported in people with acute psychosis. We hypothesised that their presence may be implicated in the aetiology of treatment-refractory psychosis. We sought to ascertain the point prevalence of NMDA-R antibody positivity in patients referred to services for treatment-refractory psychosis. We found that 3 (7.0%) of 43 individuals had low positive NMDA-R antibody titres. This suggests that NMDA-R autoantibodies are unlikely to account for a large proportion of treatment-refractory psychosis.
Collapse
|
36
|
Beck K, McCutcheon R, Bloomfield MAP, Gaughran F, Reis Marques T, MacCabe J, Selvaraj S, Taylor D, Howes OD. The practical management of refractory schizophrenia--the Maudsley Treatment REview and Assessment Team service approach. Acta Psychiatr Scand 2014; 130:427-38. [PMID: 25201058 DOI: 10.1111/acps.12327] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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] [Accepted: 08/05/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe a practical approach to the community management of treatment-resistant schizophrenia (TRS). METHOD A descriptive review of an approach to the assessment and management of patients with TRS, including the community titration of clozapine treatment, and a report of the management recommendations for the first one hundred patients assessed by the Treatment REview and Assessment Team (TREAT). RESULTS The standardized model for the community assessment, management and titration of clozapine is described. To date, 137 patients have been referred to this service and 100 patients (72%) attended for assessment. Of these, 33 have been initiated on clozapine while fifteen have had clozapine recommended but have not wished to undertake clozapine treatment. Other management options recommended have included augmentation strategies and long-acting injectable antipsychotics. CONCLUSION The service had increased the number of patients receiving community assessment and initiation of clozapine by five-fold relative to the rate prior to the establishment of the service. The large number of referrals and high attendance rate indicates that there is clinical demand for the model. Systematic evaluation is required to determine the clinical and cost-effectiveness of this model and its potential application to other clinical settings.
Collapse
Affiliation(s)
- K Beck
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Bloomfield MAP, Morgan CJA, Egerton A, Kapur S, Curran HV, Howes OD. Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biol Psychiatry 2014; 75:470-8. [PMID: 23820822 DOI: 10.1016/j.biopsych.2013.05.027] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [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: 11/15/2012] [Revised: 05/17/2013] [Accepted: 05/23/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cannabis is the most widely used illicit drug globally, and users are at increased risk of mental illnesses including psychotic disorders such as schizophrenia. Substance dependence and schizophrenia are both associated with dopaminergic dysfunction. It has been proposed, although never directly tested, that the link between cannabis use and schizophrenia is mediated by altered dopaminergic function. METHODS We compared dopamine synthesis capacity in 19 regular cannabis users who experienced psychotic-like symptoms when they consumed cannabis with 19 nonuser sex- and age-matched control subjects. Dopamine synthesis capacity (indexed as the influx rate constant [Formula: see text] ) was measured with positron emission tomography and 3,4-dihydroxy-6-[(18)F]-fluoro-l-phenylalanine ([(18)F]-DOPA). RESULTS Cannabis users had reduced dopamine synthesis capacity in the striatum (effect size: .85; t36 = 2.54, p = .016) and its associative (effect size: .85; t36 = 2.54, p = .015) and limbic subdivisions (effect size: .74; t36 = 2.23, p = .032) compared with control subjects. The group difference in dopamine synthesis capacity in cannabis users compared with control subjects was driven by those users meeting cannabis abuse or dependence criteria. Dopamine synthesis capacity was negatively associated with higher levels of cannabis use (r = -.77, p < .001) and positively associated with age of onset of cannabis use (r = .51, p = .027) but was not associated with cannabis-induced psychotic-like symptoms (r = .32, p = .19). CONCLUSIONS These findings indicate that chronic cannabis use is associated with reduced dopamine synthesis capacity and question the hypothesis that cannabis increases the risk of psychotic disorders by inducing the same dopaminergic alterations seen in schizophrenia.
Collapse
Affiliation(s)
- Michael A P Bloomfield
- Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Sciences, Hammersmith Hospital, Imperial College London; Department of Psychosis Studies, Institute of Psychiatry, King's College London (King's Health Partners), London, United Kingdom
| | - Celia J A Morgan
- Clinical Psychopharmacology Unit, Division of Psychology and Language Sciences, University College London
| | - Alice Egerton
- Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Sciences, Hammersmith Hospital, Imperial College London; Department of Psychosis Studies, Institute of Psychiatry, King's College London (King's Health Partners), London, United Kingdom
| | - Shitij Kapur
- Department of Psychosis Studies, Institute of Psychiatry, King's College London (King's Health Partners), London, United Kingdom
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, Division of Psychology and Language Sciences, University College London
| | - Oliver D Howes
- Psychiatric Imaging Group, Medical Research Council Clinical Sciences Centre, Institute of Clinical Sciences, Hammersmith Hospital, Imperial College London; Department of Psychosis Studies, Institute of Psychiatry, King's College London (King's Health Partners), London, United Kingdom.
| |
Collapse
|
38
|
Stokes PRA, Benecke A, Puraite J, Bloomfield MAP, Shotbolt P, Reeves SJ, Lingford-Hughes AR, Howes O, Egerton A. Does human presynaptic striatal dopamine function predict social conformity? J Psychopharmacol 2014; 28:237-43. [PMID: 24257812 DOI: 10.1177/0269881113512037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 02/04/2023]
Abstract
Socially desirable responding (SDR) is a personality trait which reflects either a tendency to present oneself in an overly positive manner to others, consistent with social conformity (impression management (IM)), or the tendency to view one's own behaviour in an overly positive light (self-deceptive enhancement (SDE)). Neurochemical imaging studies report an inverse relationship between SDR and dorsal striatal dopamine D₂/₃ receptor availability. This may reflect an association between SDR and D₂/₃ receptor expression, synaptic dopamine levels or a combination of the two. In this study, we used a [¹⁸F]-DOPA positron emission tomography (PET) image database to investigate whether SDR is associated with presynaptic dopamine function. Striatal [¹⁸F]-DOPA uptake, (k(i)(cer), min⁻¹), was determined in two independent healthy participant cohorts (n=27 and 19), by Patlak analysis using a cerebellar reference region. SDR was assessed using the revised Eysenck Personality Questionnaire (EPQ-R) Lie scale, and IM and SDE were measured using the Paulhus Deception Scales. No significant associations were detected between Lie, SDE or IM scores and striatal [¹⁸F]-DOPA k(i)(cer). These results indicate that presynaptic striatal dopamine function is not associated with social conformity and suggests that social conformity may be associated with striatal D₂/₃ receptor expression rather than with synaptic dopamine levels.
Collapse
Affiliation(s)
- Paul R A Stokes
- 1Centre for Neuropsychopharmacology, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Egerton A, Chaddock CA, Winton-Brown TT, Bloomfield MAP, Bhattacharyya S, Allen P, McGuire PK, Howes OD. Presynaptic striatal dopamine dysfunction in people at ultra-high risk for psychosis: findings in a second cohort. Biol Psychiatry 2013; 74:106-12. [PMID: 23312565 DOI: 10.1016/j.biopsych.2012.11.017] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [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: 05/24/2012] [Revised: 11/13/2012] [Accepted: 11/15/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Using positron emission tomography (PET), we previously observed increases in 3,4-dihydroxy-6-[(18)F]fluoro-L-phenylalanine ((18)F-DOPA) uptake in the striatum of subjects at ultra-high risk (UHR) for psychosis, indicating elevated presynaptic dopamine synthesis capacity. The purpose of this study was to test if this finding would be replicated in a second UHR cohort. METHODS (18)F-DOPA PET was used to estimate dopamine synthesis capacity in the striatum of an entirely new cohort of 26 individuals at UHR for psychosis (14 males, mean±SD age = 22.7±4.7 years) and 20 healthy volunteers matched for age and gender (11 males, mean±SD age = 24.5±4.5 years). RESULTS Dopamine synthesis capacity was elevated in the whole [t(44) = 2.6; p = .01, effect size = .81] and associative striatum [t(44) = 2.6; p = .01, effect size = .73] of UHR compared with control subjects. When the two samples were combined to give a final sample of 32 control and 50 UHR subjects, the higher levels of dopamine synthesis capacity in the UHR group reached significance across the whole [F(1,81) = 11.0; p = .001], associative [F(1,81) = 12.7; p = .001], and sensorimotor [F(1,81) = 4.7; p = .03], but not the limbic [F(1,81) = 2.1; p = .2], striatum. CONCLUSIONS The findings indicate that elevated dopamine synthesis capacity in the dorsal striatum is a robust feature of individuals at UHR for psychosis and provide further evidence that dopaminergic abnormalities precede the onset of psychosis.
Collapse
Affiliation(s)
- Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|