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Cannabis use and first manic episode

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... Individuals with bipolar disorder were 6.8 times more likely to report a lifetime history of cannabis use (Agrawal et al. 2011). Cannabis use may also cause incidental episodes of mania or even long-term bipolar disorder, with cannabis use often preceding onset of the first mania (Bally et al. 2014;Henquet et al. 2006). Furthermore, NC use was also associated with a younger age of onset of the first mania and an exacerbation of depressive and manic symptomatology in patients diagnosed with bipolar disorder (Bally et al. 2014;Gibbs et al. 2015). ...
... Cannabis use may also cause incidental episodes of mania or even long-term bipolar disorder, with cannabis use often preceding onset of the first mania (Bally et al. 2014;Henquet et al. 2006). Furthermore, NC use was also associated with a younger age of onset of the first mania and an exacerbation of depressive and manic symptomatology in patients diagnosed with bipolar disorder (Bally et al. 2014;Gibbs et al. 2015). The results of our study underline this association between the cannabinoid system and mania, while demonstrating that SCs show a greater association with mania or bipolar disorder. ...
Article
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Background Synthetic cannabinoids (SCs) are a class of new psychoactive substances that have been rapidly evolving around the world throughout recent years. Many different synthetic cannabinoid analogues are on the consumer market and sold under misleading names, like “spice” or “incense.” A limited number of studies have reported serious health effects associated with SC use. In this study, we compared clinical and subclinical psychopathological symptoms associated with SC use and natural cannabis (NC) use. Methods A convenience sample of 367 NC and SC users was recruited online, including four validated psychometric questionnaires: The Drug Use Disorders Identification Test (DUDIT), Insomnia Severity Index (ISI), Altman Mania Scale (Altman), and Brief Symptom Inventory (BSI). The two groups were compared with analysis of variance (ANOVA) and covariance (ANCOVA), chi² tests, and logistic regression when appropriate. Results The SC user group did not differ in age from the NC user group (27.7 years), but contained less females (21% and 30%, respectively). SC users scored higher than NC users on all used psychometric measures, indicating a higher likelihood of drug abuse, sleep problems, (hypo)manic symptoms, and the nine dimensions comprising the BSI, somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Odds ratios (95% CI) for the SC user group vs NC user group were, respectively, drug dependence 3.56 (1.77–7.16), (severe) insomnia 5.01 (2.10–11.92), (hypo-)mania 5.18 (2.04–13.14), and BSI psychopathology 5.21 (2.96–9.17). Discussion This study shows that SC use is associated with increased mental health symptomatology compared to NC use.
... Ashton et al., 2005 Narrative review Bi-polar disorder 1 Both THC and CBD have pharmacological properties that could reduce bipolar symptoms due to sedative, anxiolytic, and antidepressant effects. Bally et al., 2014 Narrative review Bi-polar/manic episodes 2 Approximately 30% of patients with bipolar disorder have concurrent cannabis abuse or dependence. Younger age of first-episode mania is related to cannabis use. ...
... In addition, two studies of individuals with BD, report better neurocognitive functioning in cannabis users relative to non-users (Braga, Burdick, DeRosse & Malhotra, 2012;Ringen et al., 2010). The association between NMC and BD has been subject to three reviews which concluded that NMC may prolong or worsen manic states (Gibbs et al., 2015), is associated with increased odds of suicide attempts (Carrà, Bartoli, Crocamo, Brady, & Clerici, 2014) and with earlier age of BD onset (Bally, Zullino, & Aubry, 2014). Studies also suggest that CUDs in BD patients are associated with a number of poor treatment outcomes, including psychosis (van Rossum, Boomsma, Tenback, Reed, & van Os, 2009), mixed episodes (Agrawal, Nurnberger, & Lynskey, 2011), and a more severe course of illness (Lev-Ran, Le Foll, McKenzie, George, & Rehm, 2013;van Rossum et al., 2009). ...
Article
This review considers the potential influences of the use of cannabis for therapeutic purposes (CTP) on areas of interest to mental health professionals, with foci on psychological intervention and assessment. We identified 31 articles relating to CTP use and mental health, and 29 review articles on cannabis use and mental health that did not focus on use for therapeutic purposes. Results reflect the prominence of mental health conditions among the reasons for CTP use, and the relative dearth of high-quality evidence related to CTP in this context, thereby highlighting the need for further research into the harms and benefits of medical cannabis relative to other therapeutic options. Preliminary evidence suggests that CTP may have potential for the treatment of PTSD, and as a substitute for problematic use of other substances. Extrapolation from reviews of non-therapeutic cannabis use suggests that the use of CTP may be problematic among individuals with psychotic disorders. The clinical implications of CTP use among individuals with mood disorders are unclear. With regard to assessment, evidence suggests that CTP use does not increase risk of harm to self or others. Acute cannabis intoxication and recent CTP use may result in reversible deficits with the potential to influence cognitive assessment, particularly on tests of short-term memory.
... Despite previously mixed findings regarding the relationship between AAO and alcohol use, our finding that alcohol use was associated with a later AAO and cannabis use was associated with an earlier AAO, directly corroborates previous research that controlled for age as a potential confound. 20 Furthermore, evidence from systematic reviews and meta-analyses points toward a significant association between cannabis use and an earlier AAO in bipolar disorder, [82][83][84] with results suggesting that cannabis use may trigger the onset of mania. [84][85][86] The mechanism behind this effect is unclear, but it has been hypothesised that the principal ingredients in cannabis (tetrahydrocannabinol and cannabidiol) affect mood via their interaction with the endocannabinoid, dopamine and serotonin neurotransmitter systems. ...
... 20 Furthermore, evidence from systematic reviews and meta-analyses points toward a significant association between cannabis use and an earlier AAO in bipolar disorder, [82][83][84] with results suggesting that cannabis use may trigger the onset of mania. [84][85][86] The mechanism behind this effect is unclear, but it has been hypothesised that the principal ingredients in cannabis (tetrahydrocannabinol and cannabidiol) affect mood via their interaction with the endocannabinoid, dopamine and serotonin neurotransmitter systems. 87,88 In contrast, alcohol use is thought to increase the risk for depressive rather than manic symptoms. ...
Article
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Background Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown. Aims We aim to identify psychosocial factors associated with bipolar disorder AAO. Method Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure. Results We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = −0.2855), regular cannabis use in the year before onset (β = −0.2765), death of a close family friend or relative in the 6 months before onset (β = −0.2435), family history of suicide (β = −0.1385), schizotypal personality traits (β = −0.1055) and irritable temperament (β = −0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575). Conclusions The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
... 38 Chronic use is associated with mood disturbances, mania, and depression. 36,37,39,40 Cannabis addiction and dependency. 9,13 Cognitive and CNS alterations Impairment of a wide range of cognitive functions following cannabis intoxication in a dose-relation manner. ...
... 14,17,30,32 Cannabis could trigger or enhance manic symptoms among individuals who were diagnosed with bipolar disorder. 36,37 In addition, there is evidence that repeated cannabis use is associated with elevated anxiety symptoms and panic disorder. 38 Cross-sectional and longitudinal studies provided evidence for the association between cannabis use and depression in which a diagnosis of major depression and depressive symptoms have been found to be in relatively high rates among cannabis users. ...
Article
Cannabis is the most popular illicit drug in the Western world. Repeated cannabis use has been associated with short and long‐term side effects including respiratory and cardiovascular disorders, cognitive alterations, psychosis, schizophrenia and mood disorders. However, casual relations between cannabis use and these adverse effects are missing. On the other hand, recent research proposed promising therapeutic potential of cannabinoid‐based drugs for a wide range of medical conditions including neurological and psychiatric disorders. The current article presents a contemporary review on the adverse effects, safety and the therapeutic potential of cannabis and cannabinoid‐based drugs. Given the growing popularity in the use of cannabinoid‐based drugs for both recreational and medical purposes and their potential harmful effects, there is a need for further investigation in this field. This article is protected by copyright. All rights reserved.
... Problematic cannabis use can worsen the occurrence of mood symptoms thereby increasing the risk of mania in patients with BP (Gibbs et al., 2015). Cannabis use is associated with a younger age of onset of BP mania and is associate with worse outcomes and rapid cycling (Bally et al., 2014). Cannabis use was the second most prevalent (23%) substance used by inpatients with BP mania in our study, and also increased the odds for hospitalization by 53%. ...
... THC enhances mesolimbic dopaminergic activity which is related to the addictive properties of cannabis, thereby leading to the vicious cycle of increased consumption leading to cannabis use disorders (abuse/dependence). THC is also found to increase the cortical glutamate levels which play a significant role in the causation of acute mania (Bally et al., 2014). ...
Article
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Objectives To evaluate the odds for bipolar disorder (BP) mania and depression-related hospitalization due to cannabis use disorders (CUD). Methods We conducted a cross-sectional study using the national inpatient sample (NIS), and included adult BP hospitalizations sub-grouped by manic (N = 209,785) versus depressive episodes (N = 170480). A logistic regression model was used to evaluate adjusted odds ratio (aOR) of association between CUD and BP-mania-related hospitalizations and was adjusted for demographics confounders, psychiatric comorbidities and other substance use disorders (SUD). Results Comorbidities were less prevalent in BP mania compared to BP depression: anxiety disorders (22.7% vs. 35.3%), PTSD (8.7% vs. 14.3%), and personality disorders (15.4% vs. 20.5%). Among SUD, methamphetamine (aOR 1.27, 95%CI 1.22 − 1.32) and CUD (aOR 1.53, 95%CI 1.50 − 1.56) had increased odds for hospitalization for BP mania. Conclusion CUD increases the odds for hospitalization for BP manic episode by 53%. Due to the rising prevalence of cannabis use among patients with BP it is important to provide substance use counseling/psychoeducation and discourage cannabis use among youth to prevent long-term adverse consequences.
... El hecho de que el sistema cannabinoide esté implicado en la regulación del humor podría explicar la relación descrita en la literatura entre los trastornos del estado de ánimo y el uso de cannabis (36). La prevalencia de uso de cannabis es cercana al 70% entre pacientes con trastornos del ánimo (37). Según diversos estudios el consumo de cannabis estaría asociado en el trastorno bipolar al inicio de manía más temprana, más episodios de depresión, manías más frecuentes, peores resultados de tratamiento, incremento de riesgo de ciclación rápida y episodios mixtos (37,38). ...
... La prevalencia de uso de cannabis es cercana al 70% entre pacientes con trastornos del ánimo (37). Según diversos estudios el consumo de cannabis estaría asociado en el trastorno bipolar al inicio de manía más temprana, más episodios de depresión, manías más frecuentes, peores resultados de tratamiento, incremento de riesgo de ciclación rápida y episodios mixtos (37,38). Por otra parte, en la depresión, los resultados de las investigaciones son contradictorios, algunos autores señalan que el uso de la sustancia mejora el ánimo y el afecto (39), y otros que la gravedad de la depresión aumenta con el uso de cannabis (40,41). ...
Article
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Descriptive and comparative study of cross-sectional that had as objective to evaluate and compare the beliefs about cannabis, its use and potential consequences between two groups of Colombian university students, matched by gender and age. The frst group consisted of ordinary consumers of cannabis (n=35) the second group consisted of students that have never tried cannabis (n=35). The results showed that the group of consumers presents a moderate risk of abuse and only the 20% fulflled dependence criteria. Furthermore, the non-consumers group was mostly agree about that the marijuana use: damages the memory, deteriorates the cognitive functions, creates dependency, can affect the neurons and mental health. Also, it can lead to legal problems, it is a harmful drug for the health, it affects the academic performance, it creates problems with the family, friends, couple and the like, it reduces the driving ability, and, that the marijuana that is sold in the street is always pure. The consumer group, instead, agreed that smoking tobacco affects the lungs more than smoking marijuana. Marijuana has a positive in?uence on the brain, it increases the creativity, and it is less damaging than alcohol and tobacco. Smart people smoke marijuana and it has medicinal effects. In conclusion, according to the kind of beliefs that they have about this drug, the cannabis consumers would have a decreased perception of risk in relation to the potential risk that the consumption brings from two points of view: a. They minimize the real risks of consuming and, b. They attribute some benefts and virtues to the cannabis. The kind of beliefs that the consumer have are maybe in?uenced, at least, in part, for experiences of family and other consumers and, furthermore, the reinforcement of the same consume.
... Across prior reviews, the lifetime prevalence of CUD among patients with BD is reported in 20% to 40%. [21][22][23] Comorbid SUDs are more common among males with BD, appear to be associated with earlier BD onset and more hospitalizations, and have similar prevalences across bipolar subtypes. 23 However, it is not clear if any of these trends extend to CUD comorbidity, which may be a distinct phenomenon from other comorbid SUDs. ...
... For example, in prospective studies of BD patients, chronic cannabis use and CUD are associated with male sex, younger age, and fewer years of education; earlier onset of affective symptoms; rapid cycling, and more frequent depressive, hypomanic, and manic episodes; decreased treatment adherence; more psychotic symptoms and suicidality; lower neuropsychological performance; and greater co-use of tobacco, alcohol and other substances. 8,14,15,19,21,23,26,[49][50][51][52] Previous epidemiological studies have demonstrated that BD psychopathology might be a risk factor for developing CUD, that BD psychopathology may modify the course of an established CUD, that BD symptoms may emerge during the intoxication and withdrawal from cannabis, or that there may be shared etiologic features. The present systematic review confirms a high prevalence of CUD in BD and negatively associated BD's clinical course. ...
Article
Background: Emerging epidemiological evidence suggests an association between cannabis use and bipolar disorder (BD). To date, the prevalence of comorbid cannabis use disorder (CUD) has not been well described, nor has the association between CUD and the clinical course of BD. Aim: To estimate the prevalence of CUD comorbidity among individuals with BD and identify clinical features associated with CUD. Methods: We searched PubMed from inception to December 2020, supplemented by manual searches of reference lists of included articles and prior review for eligible records. We included articles if they (1) were in English, (2) reported on individuals with a diagnosis of BD as a primary study group, (3) reported on the prevalence of CUD, and (4) used an observational study design (eg, cohort or cross-sectional). All abstracts, full-text articles, and other sources were reviewed, and data were extracted for quantitative analyses. We estimated CUD prevalence using a random-effects meta-analysis model, alongside stratification, to characterize heterogeneity. We reported CUD prevalence as a percentage with 95% CIs. We assessed the study-level risk of bias using the Joanna Briggs Institute checklist for observational studies. We estimated heterogeneity using the I2 statistic. Findings: 48 studies, representing 86,833 participants, met all inclusion criteria. Most participants had Bipolar I Disorder (92%), were Caucasian (74%), female (55%), and the median (SD) age was 37.4 (6.8) years. The overall pooled prevalence of CUD was 17% (95% CI: 13%–20%), with significant heterogeneity between estimates (I2 = 99%). When stratified by source, the prevalence of CUD was 6% (95% CI: 4%–8%) in population-based samples, 16% in community samples (95% CI: 14%–18%), and 39% in inpatient samples (95% CI: 33%-46%), which were significantly different (P < 0.01). CUD comorbidity was higher in males (odds ratio [OR] = 2.05, 95% CI: 1.69–2.47). The age at BD onset was approximately 3 years earlier in those with CUD (mean difference [MD] = −3.04 yrs, 95% CI: −5.36, −0.73). The lifetime prevalence of psychosis symptoms (OR = 1.94, 95% CI: 1.63–2.31), mixed episodes (OR = 1.50, 95% CI: 1.25–1.80), rapid cycling (OR = 2.06, 95% CI: 1.41–3.01), and suicide attempts (OR = 2.74, 95% CI: 1.39–5.39) was higher among BD patients with comorbid CUD. Conclusions: These findings suggest that CUD appears to be prevalent among individuals with BD cannabis, with the highest prevalence in in-patient populations. Clinicians should be aware of the increased prevalence of CUD in BD populations and its association with more deleterious outcomes and prognosis.
... CUD psychiatric comorbidity is clinically relevant because its presence is often associated with a poorer prognosis for CUD, the other psychiatric disorder, or both [3]. Clinically significant adverse consequences, such as poor treatment adherence and retention, more severe symptoms, greater functional disability, longer duration of active illness, more frequent occurrence of acute exacerbations, and/or greater rates of hospitalization, have been shown for bipolar disorder [9,10,11,12,13], depression [14], PTSD [15], and schizophrenia [16,17]. ...
Chapter
Objective: This chapter reviews the epidemiology and treatment of cannabis use disorder (CUD) with psychiatric comorbidity.
... Another situation, where BZD use may be problematic in BD, is substance abuse comorbidity. Bipolar disorders are associated with the highest rate of substance abuse among mood disorders (65). In patients with BD, substance use disorders are related to an increased risk of relapse, rapid cycling and other negative consequences, including increased symptom severity (66) and poor treatment compliance (67,68), resulting in poor prognosis, and higher rates of utilization of acute services, leading to more costly care (69). ...
Article
Although benzodiazepines have many benefits for patients with bipolar disorders, their use must be very cautious, because of the associated risk of misuse and other possible consequences, especially in some particular clinical situations. Concerns remain about efficacious alternatives to manage comorbid anxiety, sleep disturbances and substance use disorders. Despite the clinical importance of that issue, there is a lack of randomized studies. Due to ethical reasons, this situation highlights the need to explore more deeply this question, by naturalistic studies and neurobiological research, to better understand the role of BZD and GABAergic mechanisms in the pathophysiology of BD, anxiety and sleep disturbances.
... The logistic regression analysis corroborated this finding, showing that the presence of cannabis use disorder predicted primary psychotic disorder in the TC. The available data demonstrated that the risk of psychotic disorders increases with the frequency and intensity of cannabis use (Bally, Zullino, and Aubry 2014). Previous studies have indicated that cannabis use is related to the earlier onset of psychosis (Schimmelmann et al. 2011), and a meta-analysis confirmed this finding (Large et al. 2011). ...
Article
Cocaine continues to be a worldwide public health concern in Europe. To improve prognosis and intervention, it is necessary to understand the characteristics of the patients who depend on the services where they receive care. The objective is to analyze the differences among patients who use cocaine and between ambulatory and residential resources to better adapt treatment. This is a descriptive, observational study of two populations of cocaine users in treatment: the ambulatory therapeutic community (ATC) and the therapeutic community (TC). The PRISM diagnostic interview was used for both groups. An analysis of both populations indicates a high prevalence of cocaine, heroin, cannabis, sedative, psychostimulant, and hallucinogen use disorders in the TC population compared to the ATC. In alcohol use disorder, differences between both mental health services were not observed. The degree of severity of cocaine use disorders (CUD) is greater in the TC population. The prevalence of psychiatric comorbidity is not statistically significant between the two populations, except for primary psychotic disorders, which are more prevalent in the TC population. This difference in the prevalence of psychotic disorders may be related to the high prevalence of cannabis use disorders in TC patients. Differences in the prevalence of substance use disorders, severity of CUD, and psychiatric comorbidity may limit the efficiency of mental health services involved in substance use disorder therapeutics. These results suggest the need for careful and extensive phenotyping of patients to improve intervention and prognosis in a clinical resource-dependent manner.
... Individuals with bipolar disorder (BD) have high lifetime prevalence rates (~70%) of cannabis use 1,2 and are 6.8 times more likely to report lifetime cannabis use compared to healthy controls. 3 A study using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that an increased incidence of BD was associated with weekly to almost daily cannabis use. 4 Cannabis use in people with BD has also been linked to: • Younger age at first manic episode 1 • Exacerbation of manic symptoms 5 • Increased suicide attempts 3 • Greater likelihood of mixed episodes 3 • Greater disability 3 Prevalence rates of cannabis use disorder (CUD) in 12 months prior to the NESARC were 7.2% in BD compared to 1.2% in general population. ...
... This patient did have a history of cannabis- induced psychosis, and the association of cannabis and mania is described elsewhere. 14 However, this episode occurred 5 years earlier, and the patient and spouse did not report any continuing symptoms. The onset of this patient's manic symptoms occurred approximately 1 week following initiation of bupropion therapy, which suggests a bupropion-induced mood shift in this patient. ...
Article
Full-text available
Bupropion is an antidepressant thought to have a reduced risk of inducing mood switching as compared to other antidepressants. Minimal information is available on the induction of mood shifts when used for smoking cessation. This case describes a 38-year-old female who experienced mania following initiation of bupropion for smoking cessation. After completion of a thorough literature search, this appears to be the first case report describing mania induced by bupropion that was refractory to medications and was resolved with electroconvulsive therapy. This case highlights the need for clinicians to perform thorough histories of patients to avoid missing psychiatric history prior to starting bupropion as well as monitor for changes in mood or behavior after initiation of therapy.
... Over half of the first-treatment patients had used cannabis, of which a third could be labelled with "excessive use". These findings of highly prevalent use in BD are in line with existing data (Bally et al., 2014;Gibbs et al., 2015). In line with our previous report from a multiepisode group the current study also found that patients with secondary excessive cannabis use had significantly longer DUM, and nominally longer DUB, compared to patients without excessive cannabis use. ...
Article
There is little knowledge about the role of the duration of untreated bipolar (DUB) illness in first-treatment bipolar disorder I (BD I), its association with symptoms at start of first treatment, and development over the first year, and limited knowledge about factors that influence the length of DUB. Substance use has shown to delay identification of primary psychiatric disorders, and while cannabis use is common in BD the role of cannabis in relationship to DUB is unclear. The aim of the present study is to examine the associations between DUB and key clinical outcomes at baseline in BD I, and at one year follow-up, and to evaluate the influence of cannabis use. Patients with first-treatment BD I (N = 62) completed comprehensive clinical evaluations, which included both DUB and the number of previous episodes. There were no significant associations between DUB and key clinical outcomes. Longer duration from first manic episode to treatment was associated with risk of starting excessive cannabis use after onset of the bipolar disorder. The main finding is the lack of significant associations between features of previous illness episodes and clinical outcomes. Long duration of untreated mania seems to increase the risk for later cannabis use.
... The high comorbidity rates may also be due to cultural or social reasons such as increased access and opportunity to use illicit drugs in the community (Liang et al., 2011). Recent research indicates that cannabis use is highly prevalent in BD and may trigger or induce manic symptoms resulting in earlier age of onset of bipolar illness (Bally et al., 2014;Gibbs et al., 2015;Leweke and Koethe, 2008). Identification of those at risk of developing a SUD at an early age is important because the onset of BD often precedes the development of a SUD, thus, there is a narrow window of opportunity for prevention (Goldstein and Bukstein, 2010). ...
Article
Background: Substance use disorders (SUDs) are common in people with a bipolar disorder (BD). This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in persons with BD based on national or international surveys of household populations. Methods: Studies published from 1990 to Dec 31, 2015 were identified from MEDLINE, EMBASE. psychINFO, and CINAHL databases and reference lists. We calculated prevalence rates and conducted meta-analysis with random-effects model. Results: We identified 9 unique surveys of which two surveys were repeated 10 years later using independent samples. The total sample size was 218,397 subjects. The mean prevalence for any illicit drug use disorder was 17%, for alcohol use disorder (AUD) it was 24% and SUD it was 33%. The strongest associations were found between BD and illicit drug use (pooled odds ratio (OR) 4.96, 95% CI 3.98-6.17) followed closely by BD and AUD (OR 4.09, 95% CI 3.37-4.96). The association was higher for BD respondents using illicit drugs compared to bipolar II respondents (ORs 7.48 vs. 3.30). Limitations: Some of the meta-analysis grouped illicit substances together without taking into consideration types of substance use which may differ widely between countries and over time. All included studies were cross-sectional so onset and causality can not be determined. Conclusions: The meta-analysis revealed that people with an alcohol use disorder were 4.1 times of greater risk of having a BD compared to those without an AUD. The risks were even higher for illicit drug users where they were 5.0 times of greater risk of having BD compared to non-users. These data confirm strong associations between co-occurring SUDs and BD, indicating a need for more informative studies to help develop better interventions in treating persons with BD and comorbid SUDs.
... For some, substance use may precede or follow the onset of BD while in others, substances are used as a means of self-medication that can predispose or facilitate early onset of an affective disorder (Goldstein and Bukstein, 2010). Thus, substance use is enmeshed with BD and appears to be both a cause and a consequence of early onset (Bally et al., 2014;Gibbs et al., 2015). ...
Article
Background: Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. Methods: A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. Results: There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. Limitations: The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. Conclusions: This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
... In the present sample, participants with CUD were signifanctly younger than those without, and both groups tended to exhibit higher rate of SA/year of BD than their counterparts (data not shown). Moreover, continued cannabis use has been associated with mixed episodes in BD (Bally et al., 2014), as was CUD in the present sample (Chi 2 test=16.965, p=9.4 x 10 -3 ). ...
Article
Background: Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. Methods: 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. Results: 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. Limitations: Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. Conclusion: Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
... A recently published review also suggests a potential association between the use of cannabis and mania: cannabis use may be linked with a younger age of mania onset, more frequent manic episodes and poorer outcome. 23 However, there is little data regarding the impact of cannabis use on mania in FEP. ...
Article
Objective: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode of psychosis (FEP) and the link with symptomatic course and outcome over 1 year post psychosis onset. Design and setting: One thousand twenty-seven FEP patients were recruited upon inception to specialized early intervention services (EIS) for psychosis in the United Kingdom. Participants completed assessments at baseline, 6 and 12 months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psychosocial functioning. Continued use of cannabis following the FEP was associated with poorer outcome at 1 year for Positive and Negative Syndrome Scale total score, negative psychotic symptoms, depression and psychosocial functioning, an effect not explained by age, gender, duration of untreated psychosis, age of psychosis onset, ethnicity or other substance use. Conclusion: This is the largest cohort study of FEP patients receiving care within EIS. Cannabis use, particularly "continued use," was associated with poorer symptomatic and functional outcome during the FEP. The results highlight the need for effective and early intervention for cannabis use in FEP.
... Consequently, there has been increasing focus on the nature of the relationship between BDand cannabis use and misuse. Firstly, it seems that cannabis use may be a risk factor for developing manic symptoms and BD (Bally et al., 2014;Feingold et al., 2014;Gibbs et al., 2014;Henquet et al., 2006;van Laar et al., 2007). Secondly, CUD has been associated with an earlier onset of BD (Etain et al., 2012;Lagerberg et al., 2014), increased frequency and duration of affective episodes (Lev-Ran et al., 2013;Strakowski et al., 2007), increased number of suicide attempts (Agrawal et al., 2011;Bellivier et al., 2011) and increased prevalence of psychotic symptoms (Braga et al., 2012). ...
Article
Objective: Cannabis use disorders (CUD) may influence the course of bipolar disorder (BD), but key confounding factors such as tobacco smoking have not been adequately addressed. This study examined whether CUD was associated with a more severe illness course in tobacco smoking BD patients. Methods: A sample of French and Norwegian tobacco smoking patients with BD I and II (N=642) was investigated. DSM-IV diagnoses and other characteristics were obtained through personal interviews using structured questionnaires. The association between CUD and illness course was assessed in regression analyses. Results: In bivariate analyses, CUD was associated with earlier BD onset, higher frequency of manic (in BD I) and depressive episodes and hospitalizations per illness year, and a higher occurrence of psychotic episodes. After controlling for potential confounders, the relationships with earlier BD onset (B=-5.60 95% CI=-7.65 to -3.64), and increased rates of manic episodes (OR=1.93, 95% CI: 1.15 to 3.23) and hospitalizations (OR=2.93, 95% CI: 1.85 to 4.64) remained statistically significant. Limitations: Despite the multivariate approach, differences between the two samples may lead to spurious findings related to hidden confounders. Substance use and mood episode information was collected retrospectively, and potential birth cohort effects could not be controlled for. Conclusion: Studies have found associations between tobacco smoking and poorer outcomes in BD. In this study on tobacco smoking BD patients we report an association between CUD and illness severity, suggesting that CUD exacerbates the disease evolution independently of tobacco smoking. Specific treatment and prevention programs addressing CUD in BD patients are warranted.
... For most psychiatric patients groups, there is an increased prevalence of substance use disorders, such as alcohol, cannabis, and nicotine use [62]. For instance, cannabis is considered to be the most commonly used illegal drug of abuse among patients with bipolar disorder and schizophrenia [63,64]. Although substance use disorder was an exclusion criterion in all studies, it cannot be excluded that patients had a higher recreational use of drugs of abuse. ...
Article
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Accumulating evidence from different lines of research suggests an involvement of the immune system in the pathophysiology of several psychiatric disorders. During recent years, a series of positron emission tomography (PET) studies have been published using radioligands for the translocator protein (TSPO) to study microglia activation in schizophrenia, bipolar I disorder, major depression, autism spectrum disorder, and drug abuse. The results have been somewhat conflicting, which could be due to differences both in patient sample characteristics and in PET methods. In particular, further work is needed to address both methodological and biological sources of variability in TSPO levels, a process in which the use of animal models and small animal PET systems can be a valuable tool. Given this development, PET studies of immune activation have the potential to further increase our understanding of disease mechanisms in psychiatric disorders, which is a requisite in the search for new treatment approaches. Furthermore, molecular imaging could become an important clinical tool for identifying specific subgroups of patients or disease stages that would benefit from treatment targeting the immune system.
... This study also found an earlier age at onset in both affective and non-affective psychotic disorders in individuals with a history of cannabis abuse and this is in contrast to other studies that have found that cannabis use is associated with an earlier age at onset in non-affective psychotic disorders or schizophrenia-spectrum disorders (Stefanis et al., 2014). However, the findings of this study that cannabis abuse is associated with an earlier age at onset across all FEP diagnoses has validity, as cannabis use is associated with an earlier age at onset of first mania (Bally et al., 2014). However, a possible explanation for our findings that contrasted to the previous literature is that we examined cannabis abuse, as opposed to cannabis use and therefore the 'dose' of cannabis is likely to be higher in abuse. ...
... The high comorbidity rates may also be due to cultural or social reasons such as increased access and opportunity to use illicit drugs in the community (Liang et al., 2011). Recent research indicates that cannabis use is highly prevalent in BD and may trigger or induce manic symptoms resulting in earlier age of onset of bipolar illness (Bally et al., 2014;Gibbs et al., 2015;Leweke and Koethe, 2008). Identification of those at risk of developing a SUD at an early age is important because the onset of BD often precedes the development of a SUD, thus, there is a narrow window of opportunity for prevention (Goldstein and Bukstein, 2010). ...
Article
Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
... Marijuana correlates with the onset of psychosis in patients with schizophrenia and perhaps bipolar disorder as well. [29][30][31][32] About half of patients with cannabis psychosis will later be diagnosed with a primary psychotic disorder. 8,33 This high rate may reflect high rates of marijuana use among patients with schizophrenia. ...
Article
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We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient's psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care.
... Furthermore, the risk of schizophrenia increased six times in people who used it at least 50 times [5]. Cannabis also induces mania inpatients with bipolar disorder [6,7]. As these reports show, psychiatric disorders and cannabis use may be involved, nevertheless, the number of cannabis use disorder patient is increasing annually [8]. ...
Article
Full-text available
The number of cannabis users is increasing in the world. However, the mechanisms involved in the psychiatric effects and addiction formation remain unclear. Medical treatments against cannabis addiction have not yet been established. Δ9-Tetrahydrocannabinol (THC), the main active substance in cannabis, binds and affects cannabinoid type 1 receptors (CB1R) in the brain. The mice were intraperitoneally (i.p.) administered arachidonylcyclopropylamide (ACPA), a CB1R-selective agonist, and then two behavioral experiments on anxiety and addiction were performed. Administration of ACPA caused anxiolytic-like behavior in the elevated plus maze test. In addition, ACPA increased place preference in a conditioned place preference (CPP) test. The basolateral amygdala (BLA), which is the focus of this study, is involved in anxiety-like behavior and reward and is reported to express high levels of CB1R. We aimed to reveal the role of CB1R in BLA for ACPA-induced behavior. AM251, a CB1R selective antagonist, was administered intra-BLA before i.p. administration of ACPA. Intra-BLA administration of AM251 inhibited ACPA-induced anxiolytic-like behavior and place preference. These results suggest that CB1R in the BLA contributes to behavior disorders caused by the acute or chronic use of cannabis.
... Dans l'étude NESARC (National epidemiologic survey on alcohol and related conditions), la fréquence de l'abus/dépendance au cannabis chez 1905 patients atteints de troubles bipolaires était de 7 % dans les 12 mois précédant l'étude, contre 1,2 % en population générale [14]. Une revue systématique a trouvé une prévalence de 30 % de l'abus/dépendance au cannabis chez des patients atteints de troubles bipolaires au cours de leur vie entière [15]. ...
Article
Le cannabis est la substance psychoactive illicite la plus consommée dans notre pays et dans le monde. Son impact négatif sur les troubles psychiatriques a été largement évoqué, mais peu d'études ont été réalisées dans notre contexte.฀ Objectifs : nous allons évaluer la prévalence de la consommation de cannabis chez des patients atteints de troubles psychotiques et bipolaires, et étudier son impact sur le nombre et la durée des hospitalisations.฀ Méthodologie : il s'agit d'une étude transversale rétrospective, menée sur 130 dossiers de patients hospitalisés au sein du service de psychiatrie d'un Hôpital général provincial, entre novembre 2018 et novembre 2020.฀ Résultats : L'âge moyen de notre population est de 28 ans ± 9,4, tous de sexe masculin, dont 58.9% sont atteints de troubles psychotiques et 41.1% sont atteints de troubles bipolaires. La prévalence de la consommation de cannabis est de 65,9 %, avec 65,8% pour les troubles psychotiques et 66% pour les troubles bipolaires. Le cannabis est associé à une hospitalisation plus longue de ces patients : 28,34 contre 19,43 jours (p=0,005), mais pas à un nombre plus important d'hospitalisations. Conclusion : la consommation de cannabis est très répandue parmi les patients atteints de troubles psychotiques et bipolaires. Nos résultats restent limités par le fait que nos patients sont généralement réhospitalisés dans d'autres structures de soins.
... Two other studies also support these findings and suggested that cannabis users are likely to experience longer periods of mania than non-users and are non-compliant in utilisation of their medication during not only the acute phase but also maintenance, and hence, alternative therapeutic approaches might be required for this patient population (Baethge et al., 2005;Gonzalez-Pinto et al., 2010). Finally, poorer treatment outcomes and a higher frequency of developing rapid cycling and mixed episodes were reported in BD patients who presented with the comorbidity of cannabis use (Strakowski et al., 2007;Agrawal et al., 2011;Bally et al., 2014). ...
Article
Full-text available
Objective Bipolar disorder (BD) is a debilitating, lifelong neuropsychiatric illness characterised by unsteady mood states which vacillate from (hypo)mania to depression. Despite the availability of pharmaceutical agents which can be effective in ameliorating the acute affective symptoms and prevent episodic relapse, BD is inadequately treated in a subset of patients. The endocannabinoid system (ECS) is known to exert neuromodulatory effects on other neurotransmitter systems critical in governing emotions. Several studies ranging from clinical to molecular, as well as anecdotal evidence, have placed a spotlight on the potential role of the ECS in the pathophysiology of BD. In this perspective, we present advantages and disadvantages of cannabis use in the management of illness course of BD and provide mechanistic insights into how this system might contribute to the pathophysiology of BD. Results We highlight the putative role of selective cannabinoid receptor 2 (CB 2 ) agonists in BD and briefly discuss findings which provide a rationale for targeting the ECS to assuage the symptoms of BD. Further, data encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB-based options as probable treatment approaches. Conclusion The probable role of the ECS has been almost neglected in BD; however, from data available which suggest a role of ECS in mood control, it is justified to support conducting comprehensive studies to determine whether ECS manipulation could positively affect BD. Based on the limited available data, we suggest that activation of CB 2 may stabilise mood in this disorder.
... While observational studies have suggested that heavy cannabis use may unveil depressive or psychotic episodes 12 , there are many biopsychosocial factors involved. 33,34 This discussion is further complicated by recent trends of cannabis and synthetic cannabinoids being used as self-medication or prescribed as experimental therapy for acute and chronic psychiatric disorders. While there is literature in support of its therapeutic value and safety for chronic pain, 35,36 multiple sclerosis, 37 cancer, 38 and inflammatory bowel disease, 39 the evidence for prescribing cannabis for the symptomatic treatment of psychotic, anxiety, or mood disorders is scarce and mixed. ...
Article
Full-text available
Objective: With the increasing prevalence of cannabis use, there is a growing concern about its association with depression and suicidality. The aim of this study was to examine the relationship between recent cannabis use and suicidal ideation using a nationally representative data set. Methods: A cross-sectional analysis of adults was undertaken using National Health and Nutrition Examination Survey data from 2005 to 2018. Participants were dichotomized by whether or not they had used cannabis in the past 30 days. The primary outcome was suicidal ideation, and secondary outcomes were depression and having recently seen a mental health professional. Multiple logistic regression was used to adjust for potential confounders, and survey sample weights were considered in the model. Results: Compared to those with no recent use (n = 18,599), recent users (n = 3,127) were more likely to have experienced suicidal ideation in the past 2 weeks (adjusted odds ratio [aOR] 1.54, 95% CI, 1.19 to 2.00, P = 0.001), be depressed (aOR 1.53, 95% CI, 1.29 to 1.82, P < 0.001), and to have seen a mental health professional in the past 12 months (aOR 1.28, 95% CI, 1.04 to 1.59, P = 0.023). Conclusions: Cannabis use in the past 30 days was associated with suicidal thinking and depression in adults. This relationship is likely multifactorial but highlights the need for specific guidelines and policies for the prescription of medical cannabis for psychiatric therapy. Future research should continue to characterize the health effects of cannabis use in the general population.
... Moreover, it has also been reported that THC increases glutamate level in PFC which in turn leads to psychoactive and behavioral effects of marijuana consumption (35). Since the results also indicated that harmful use of cannabis in schizophrenia is related to the lower intensity of negative symptoms, especially when cannabis is the only drug abused and the user just starts before the onset of schizophrenia, it can be presumed that cannabis use might be a major factor for schizophrenia (36). ...
Article
Full-text available
Cannabis abuse is a common public health issue and may lead to considerable adverse effects. Along with other effects, the dependence on cannabis consumption is a serious problem which has significant consequences on biochemical and clinical symptoms. This study intends to evaluate the harmful effects of the use of cannabis on thyroid hormonal levels, cardiovascular indicators, and psychotic symptoms in the included patients. This prospective multicenter study was conducted on cannabis-dependent patients with psychotic symptoms (n = 40) vs. healthy control subjects (n = 40). All participants were evaluated for psychiatric, biochemical, and cardiovascular physiological effects. Patients were selected through Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria and urine samples, exclusively for the evaluation of cannabis presence. Serum thyroid stimulating hormone (TSH), T3, and T4 levels were measured using the immunoassay technique. Patients were assessed for severity of depressive, schizophrenic, and manic symptoms using international ranking scales. Various quantifiable factors were also measured for the development of tolerance by cannabis. Among the patients of cannabis abuse, 47.5% were found with schizophrenia, 20% with schizoaffective symptoms, 10% with manic symptoms, and 22.5% with both manic and psychotic symptoms. In the group-group and within-group statistical analysis, the results of thyroid hormones and cardiovascular parameters were non-significant. The psychiatric assessment has shown highly significant (p < 0.001) difference of positive, negative, general psychopathology, and total scores [through Positive and Negative Syndrome Scale (PANSS) rating scales] in patients vs. the healthy control subjects. The study revealed that cannabis abuse did not significantly alter thyroid hormones and Muzaffar et al. Cannabis Altering Thyroid, Psychotic Symptoms cardiovascular parameters due to the development of tolerance. However, the cannabis abuse might have a significant contributing role in the positive, negative, and manic symptoms in different psychiatric disorders.
... As for cannabis, a three-fold increased risk for mania development has been reported by a recent meta-analysis, a risk interpreted as a "moderate association" by the authors (Gibbs et al., 2015). However, the role of cannabis in triggering first episodes of mania is still debated (Bally et al., 2014;Etyemez et al., 2020;Gibbs et al., 2015), and there are no valid indications for its use in COVID-19. ...
Article
Full-text available
Sars-CoV-2 is a respiratory virus that can access the central nervous system (CNS), as indicated by the presence of the virus in patients’ cerebrospinal fluid and the occurrence of several neurological syndromes during and after COVID-19. Growing evidence indicates that Sars-CoV-2 can also trigger the acute onset of mood disorders or psychotic symptoms. COVID-19-related first episodes of mania, in subjects with no known history of bipolar disorder, have never been systematically analyzed. Thus, the present study assesses a potential link between the two conditions. This systematic review analyzes cases of first appearance of manic episodes associated with COVID-19. Clinical features, pharmacological therapies, and relationships with pre-existing medical conditions are also appraised. Medical records of twenty-three patients fulfilling the current DSM-5 criteria for manic episode were included. Manic episodes started, on average, after 12.71±6.65 days from the infection onset. Psychotic symptoms were frequently reported. 82.61% of patients exhibited delusions, whereas 39.13% of patients presented hallucinations. A large discrepancy in the diagnostic workups was observed. Mania represents an underestimated clinical presentation of COVID-19. Further studies should focus on the pathophysiological substrates of COVID-19-related mania and pursue appropriate and specific diagnostic and therapeutic workups.
... Moreover, it has also been reported that THC increases glutamate level in PFC which in turn leads to psychoactive and behavioral effects of marijuana consumption (35). Since the results also indicated that harmful use of cannabis in schizophrenia is related to the lower intensity of negative symptoms, especially when cannabis is the only drug abused and the user just starts before the onset of schizophrenia, it can be presumed that cannabis use might be a major factor for schizophrenia (36). ...
Article
Full-text available
Cannabis abuse is a common public health issue and may lead to considerable adverse effects. Along with other effects, the dependence on cannabis consumption is a serious problem which has significant consequences on biochemical and clinical symptoms. This study intends to evaluate the harmful effects of the use of cannabis on thyroid hormonal levels, cardiovascular indicators, and psychotic symptoms in the included patients. This prospective multicenter study was conducted on cannabis-dependent patients with psychotic symptoms (n = 40) vs. healthy control subjects (n = 40). All participants were evaluated for psychiatric, biochemical, and cardiovascular physiological effects. Patients were selected through Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria and urine samples, exclusively for the evaluation of cannabis presence. Serum thyroid stimulating hormone (TSH), T3, and T4 levels were measured using the immunoassay technique. Patients were assessed for severity of depressive, schizophrenic, and manic symptoms using international ranking scales. Various quantifiable factors were also measured for the development of tolerance by cannabis. Among the patients of cannabis abuse, 47.5% were found with schizophrenia, 20% with schizoaffective symptoms, 10% with manic symptoms, and 22.5% with both manic and psychotic symptoms. In the group-group and within-group statistical analysis, the results of thyroid hormones and cardiovascular parameters were non-significant. The psychiatric assessment has shown highly significant (p < 0.001) difference of positive, negative, general psychopathology, and total scores [through Positive and Negative Syndrome Scale (PANSS) rating scales] in patients vs. the healthy control subjects. The study revealed that cannabis abuse did not significantly alter thyroid hormones and Muzaffar et al. Cannabis Altering Thyroid, Psychotic Symptoms cardiovascular parameters due to the development of tolerance. However, the cannabis abuse might have a significant contributing role in the positive, negative, and manic symptoms in different psychiatric disorders.
... [37]. Cannabis use is also related to poor prognosis with higher chance of rapid cycling and mixed episodes in bipolar patients [38]. There are no studies regarding CBD use for BPD treatment. ...
Article
Full-text available
Introduction: Cannabis use to treat various diseases or symptoms is not clearly defined. The purpose of this review is to explore the existing evidence regarding the harms and benefits of cannabis use across multiple illnesses. Material and Methods: Search for articles for this review was performed in PubMed, Google Scholar and PsycINFO. We summarize and discuss recent evidence regarding cannabis use in multiple neurological (including seizures, neurodegenerative disorders, multiple sclerosis), psychiatric (including depression, bipolar disorder, anxiety and psychotic illness) and other diseases (including chronic pain, cancer, vomiting, cardiovascular diseases, COVID-19). Results: The collated body of evidence shows that the benefit of its use (medicinal or recreational) mostly lacks adequate evidence warranting for further study. In pretext of already available better options (with better efficacy and safety), the consideration of this agent is seriously debatable. Conclusion: Harms or adverse effects of cannabis use clearly are evidence based and are at times serious (e.g. psychosis association), mainly from mental health perspective. Hence, its use should not be suggested and needs serious consideration before using it.
... 19 The age of onset of manic symptoms coincides with the bimodal distribution on the incidence of mania, between 15 and 24 years and 45 and54 years, and cannabis use being a trigger. [19][20][21][22] Following positive tetrahydrocannabinol (THC) in urine, and no other component in the regimen can induce mania; the diagnosis of cannabis-induced mania was made given presence of cannabis intoxication symptoms (increased appetite, tachycardia, and euphoria) during the early symptom presentation and withdraw symptoms (irritability, sleep difficulties, restlessness, tremorous, sweating, fever, and headache) during the admission period. 1 Thus, this was considered to be unlikely late-onset Bipolar Affective disorder (BAD) because of no previous risk factors for BAD, such as mood episodes, family history, or cluster B personality traits. Other differential diagnosis included a hyperactive type of delirium, from possible COVID-19 infection or CNS manifestation of COVID-19 because the patient had COVID-19 like symptoms. ...
Article
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Context: Self-medication is becoming common during the coronavirus disease −2019 (COVID-19) pandemic due to the increasing popularity of home-based management of asymptomatic and mild cases. In this case report, we describe a patient who developed manic symptoms as a result of self-medication with a regimen containing cannabis to manage COVID-19 symptoms.Case Details: A 52-year-old man with no prior history of a mental disorder, presented with a one-week history of talking more than usual, poor sleep, destructiveness, irritability, and altered mental status, following use of homemade remedies containing oranges, garlic, ginger, onions, honey, lemon, and cannabis to treat COVID-19 related symptoms over a 2-week period. This was his index presentation with such symptoms in his life. He had never used any substance of addiction before, did not have any known chronic medical condition, and had no family member with a history of any known mental illness. He was a suspect because his father had tested positive for COVID-19 and was undergoing treatment. He tested negative for COVID-19 after 3-weeks of initial COVID-19 like symptoms, urine sample was positive for tetrahydrocannabinol (THC), and he had normal investigations. He was managed with a mood stabilizer (oral carbamazepine at a dose of 200mg three times daily), antipsychotic (chlorpromazine 200mg twice daily), a sedative (diazepam 10mg at before bedtime), and occupational therapy. All manic symptoms resolved in a period of two weeks.Conclusion: Cannabis induced mental illness following self-medication for COVID-19 like symptoms is on the rise in the population. Due to increasing COVID-19 cases globally, hospital congestion, the popularity of home-based care guidelines for asymptomatic and mild COVID-19 to reduce hospital burden in many countries, and easy access to cannabis. With no approved cure for COVID-19, patients are turning to natural remedies to relieve symp-toms of COVID-19. Emphasis on prevention of this insalubrious self-medication among the COVID-19 patients is needed to stop complication related to cannabis use (PDF) Cannabis-Induced Mania Following COVID-19 Self-Medication: A Wake-Up Call to Improve Community Awareness. Available from: https://www.researchgate.net/publication/349574167_Cannabis-Induced_Mania_Following_COVID-19_Self-Medication_A_Wake-Up_Call_to_Improve_Community_Awareness [accessed Feb 25 2021].
... However, as shown by the present study such patterns of use are not specific to bipolar homeless patients as shown by other studies that difference between alcohol, sedatives, cannabis, inhalants and hallucinogens use between BDH and UDH (Hasin et al., 1985). Lifetime use of cannabis among bipolar patients appears to be around 70% and approximately 30% of patients with bipolar disorder report comorbid cannabis abuse or dependence (Agrawal et al., 2011;Bally et al., 2014). There is a lack of data in literature regarding inhalant and hallucinogen use with respect to unipolar and bipolar depression. ...
... Cannabis is the most widely used illicit drug in the world (Degenhardt & Hall, 2012). Epidemiologic studies have shown that patients with bipolar disorder (BD) are 6.8 times more likely to report a history of lifetime cannabis use (LCU) (Agrawal et al., 2011), reporting rates between 36% and 70% (Bally et al., 2014;Cerullo and Strakowski, 2007). Furthermore, LCU was associated with a more severe course of illness regardless of sex, including more recurrent and prolonged affective episodes (Lev-Ran et al., 2013), increased occurrence of manic and mixed episodes (Gibbs et al., 2015;Weinstock et al., 2016), greater risk of attempted suicide (Ostergaard et al., 2017), higher prevalence of psychotic symptoms (Braga et al., 2012;van Rossum, Boomsma, Tenback, Reed, and van Os, 2009;Weinstock et al., 2016), and decreased compliance with treatment (van Rossum et al., 2009). ...
Article
Background: Cannabis use is markedly prevalent among patients with bipolar disorder (BD). However, to date, there have been no studies on this issue with a sex-based approach. This study examines if lifetime cannabis use (LCU) is differently associated with clinical course, functioning, and quality of life (QoL) in patients with BD by sex. Methods: Secondary analysis of a cross-sectional, naturalistic, multicentre study. LCU was defined as having had at least one day of use per month for at least 12 consecutive months in a patient's life. Results: A total of 224 patients with BD were included (65.2% women). Patients with LCU were younger (p = 0.001) and had their first hospitalization earlier (p<0.005) than those without LCU, regardless of sex. Among women, LCU was associated with being single (p = 0.006), worse sexual functioning (p = 0.006), financial functioning (p = 0.009), QoL [bodily pain (p = 0.009), vitality (p = 0.027), social functioning (p = 0.037), emotional role (p = 0.038), mental health (p = 0.001), and mental summary component (p = 0.012)]. After controlling for confounders, among women, LCU was associated with worse QoL, specifically on bodily pain (p = 0.049) and mental health (p = 0.016) subscales. Among males, no statistically significant differences were found between LCU and no LCU (NLCU) in any of the variables of the study. Limitations: This study was a secondary analysis not powered specifically to analyze cannabis use. Conclusions: LCU was associated with a younger age at first hospitalization in both women and men, while only women reported worse QoL on bodily pain and mental health subscales. Clinicians and public health providers should be aware of this and inform their patients and the general population of these detrimental effects.
Chapter
Prenatal and early cannabis exposure result in measurable brain changes. Cannabis use is currently increasing among adolescents and the perception of its risk is diminished among this vulnerable cohort and pregnant women. Cannabis exposure during vulnerable periods is linked to permanent brain and behavioral changes. Since greater neuromaturation takes place during adolescence, there is evidence that the adolescent brain is at great deleterious risk, compared to the adult brain. The deleterious effects of weekly cannabis use by teenagers are evident, which include lower IQ scores, decreased verbal memory, poorer executive function, decreased sustained attention, neurocognitive abnormalities, and abnormalities in brain morphometry.
Article
Objective: Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants and anxiolytics. Methods: Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. Results: Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 - 18.87), mood-stabilizers (OR = 5.36, 95 % CI 1.99 - 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 - 3.25), after accounting for socio-demographic variables, conduct problems, additional drug use, mental distress and prescriptions the year before cannabis use was measured. Conclusions: In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood-stabilizers and antidepressants.
Article
Background: An association between first-episode presentation of bipolar mania and concurrent cannabis use disorder has been well established in the current literature (Bally et al., 2014, Baethge et al., 2008). Previous studies have shown that 30-70% of patients admitted for a first manic episode had concurrent cannabis use (Bally et al., 2014). The exact mechanism of this association has yet to be confirmed. Aims: We aim to evaluate the prevalence of cannabis use in patients with bipolar disorder (BD) admitted to UTHealth Harris County Psychiatric Center (HCPC) for a first manic episode. Methods: In this retrospective cohort study, 15,969 inpatient records of patients admitted to HCPC between 2012-2013 were examined to identify patients admitted with a first manic episode according to ICD-9 criteria (single episode mania). The prevalence of multiple sociodemographic and clinical variables including cannabis positivity in urine drug screening (UDS) were examined. Results: Twenty patients were admitted for a first manic episode. Half of the patients were females; mean age was 28.65 ± 10.56 years and mean length of stay (LOS) was 7.15 ± 3.72 days. Fifteen patients received a UDS. Of these fifteen, seven were positive for cannabinoids (47%). One patient was positive for phencyclidine (in addition to cannabis) and one patient was positive for amphetamine (but not cannabis). Conclusions: The prevalence of cannabis use was higher in first-episode mania patients compared to the general population. The influence of cannabis on the first episode of mania requires additional study.
Chapter
Authorizing and monitoring Cannabinoid-Based Medicines in advanced cancer and palliative care is not as difficult as it seems. Clinicians with a basic knowledge of the endocannabinoid system and cannabinoid pharmacology can surmise the appropriate settings where it can be introduced and, within a structured goal-setting environment, can safely initiate and monitor the use of Cannabinoid-Based Medicines, even in advanced cancer patients. Starting with a trial of approved pharmaceutical cannabinoids is recommended before attempting natural cannabis products. Cannabis comes in two main product types: dried flowers meant for inhalation and extracts meant for inhalation, oral ingestion, and other applications. The former is primarily inhaled through combustion or vaporization, while the latter is usually further transformed into other products, including edibles, oils, capsules, topical salves, suppositories, etc. Most patients will benefit from oral or oromucosal administration for baseline administration, while inhaled cannabis is reserved for breakthrough or episodic symptoms in specific clinical settings.The main active ingredients of cannabis are THC and CBD, which have their own indications, contraindications, drug interactions, and titration regimens. The three main types of cannabis product formulations include THC dominant, CBD dominant, and products with mixed THC/CBD ratios. Cannabinoid-Based Medicines is an individualized treatment, and slow titration is key in order to reduce adverse effects, particularly in frail or cannabis-naive patients. Risks of cannabis use disorder must always be kept in mind if long-term survival is expected.KeywordsDosing Microgram dosing Product Formulation Inhalation Edibles Cannabis concentrate Titration Monitoring Tolerance
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While research continues to determine the efficacy of lower-dose cannabis use for pain, nausea, and other symptoms, the therapeutic potential of higher-dose cannabis psychoactivity in cancer and palliative care remains unclear for most clinicians. However, non-ordinary states of consciousness, whether induced by meditative and religious practices or psychactive compounds, are beginning to be recognized as having therapeutic potential in multiple clinical settings, including end-of-life anxiety. With the resurgence of psychedelic-assisted psychotherapy (PAP) in medicine, it is now becoming clear that a thorough understanding of the neurocognitive effects of cannabis and other psychedelics are required if patients are to be counseled appropriately on their use. Although low-to-moderate doses of cannabis are not generally considered to produce psychedelic effects, reports dating back to the mid-nineteenth century suggest that cannabis-induced altered states of consciousness can be encountered at higher doses and are similar in nature to the effects produced by LSD or psilocybin. It has been hypothesized that traditional psychedelic compounds disrupt neural networks as a result of interactions with the 5HT2A receptor. With cannabis, this seems to also occur, likely by way of CB1-5HT2A receptor dimerization. The loosening of normal thinking processes which cannabis and psychedelics give rise to may explain why these experiences have been commonly associated with a reduction in rigid mental patterns encountered in mental health disorders such as refractory depression, PTSD, or death anxiety. Since high doses of THC-rich cannabis products are usually required to achieve these states, its use may be limited by dose-related psychiatric or cardiovascular side effects, such as hypotension and tachycardia. While proper knowledge of major cannabinoid pharmacology is required for dealing with low-dose cannabis dosage ranges, higher-dose cannabis use requires additional preparation with an appropriate set, setting, and effective integration for patients who wish to explore the possible benefits of these effects.KeywordsPsychoactivityPsychedelic5HT2A receptorNeuroplasticityDefault mode networkSalience networkCentral executive networkOceanic boundlessnessMystical experiencePeak experiencePsychedelic-assisted psychotherapy (PAP)
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Cannabis is not for everyone. Cannabinoids interact with nearly every tissue, organ, and system in the human body which may provide benefits in some but can also produce undesirable effects and reduced global functioning in others. To determine which patient can safely begin a trial of medical cannabis requires a thorough evaluation and close monitoring once initiated. Patients should first optimize approved therapeutic options before trying cannabis. Most contraindications to using cannabis depend on the predominant type of cannabinoid which will be used. Patients who are pregnant, lactating, or undergoing treatment with checkpoint inhibitors should avoid all cannabis products that contain either THC or CBD. The use of any significant amount of THC requires a careful medical evaluation to rule out potential cardiovascular and psychiatric contraindications. Otherwise, moderate doses of CBD-rich products, which may also include microgram doses of THC, can be safely used in most other settings. THC-drug interactions are mostly pharmacodynamic and related to exacerbation of CNS side effects. CBD-drug interactions are mostly CYP450 related and pharmacokinetic in nature. Current or past use can determine the level of patient knowledge and risk of abuse. Patient expectations vary and may or may not be realistic.KeywordsExperienceExpectationsPolypharmacyPsychosisTrauma sensitivityCardiovascularSafety-sensitive tasksDrivingTravelFinancial
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Background: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. Objective: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. Design: An integrative review was conducted using standard criteria for evaluating research articles. Results: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. Conclusions: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
Thesis
Se fondant sur le modèle biopsychosocial de la santé, la littérature internationale s'intéresse depuis quelques années à l'évaluation du fonctionnement social et au niveau de handicap dans la schizophrénie (SCZ) et le trouble bipolaire (TB). En dépit de la rémission des symptômes après l'instauration d'un traitement médicamenteux, il a été constaté chez les populations concernées un affaiblissement de leur fonctionnement socio-professionnel et affectif, ainsi qu'une altération de leur qualité de vie.Nous avons mené une étude longitudinale rétrospective descriptive et analytique d'unepopulation comportant 100 patients souffrant de schizophrénie et 50 patients souffrant de trouble bipolaire. Il s'agit de patients entre 35 et 40 ans, cliniquement stabilisés, dont le suivi ambulatoire a été effectué au Centre Psychothérapique de Nancy entre 2003 et 2013. La première partie décrit les caractéristiques démographiques, le fonctionnement psychosocial, les caractéristiques cliniques intriquées et le fonctionnement global de ces deux populations, mesurés selon une échelle standardisée (Échelle Globale de Fonctionnement). En second lieu, les résultats de notre étude ont été confrontés aux données récentes de la littérature afin d'analyser l'impact négatif de la maladie sur la vie sociale et professionnelle des patients.Notre conclusion souligne l'intérêt d'une prise en charge spécifique qui viendrait compléter le traitement symptomatique
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Major Depressive Disorder (MDT)) is a heterogeneous, complex and debilitating disorder that increases the burden of patients, families and society. The response to the antidepressant treatment varies largely, but literature reported several correlations of age, patient's characteristics and duration of depression with the response to antidepressant treatment. The objective of this observational study was to evaluate the daily functionality in MDD patients under AD treatment, who were prospectively followed. The secondary objectives included the improvement of MDE severity and symptoms and the adherence to the AD treatment. 1194 patients were included with a first MDE or a recurrent MDE according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), age between 18 and 75 years, treated with agomelatine before the inclusion in the study. The prospective observation of the patients lasted for 10 weeks and included 4 visits: VO- baseline, Vl- after 2 weeks, V 2- after 6 weeks and V 3 - after 10 weeks. For the evaluation of the MDE we used the CGI scale and the Quick Inventory of Depressive Symptomatology scale (QIDS-16). The statistical analysis was done using Kynos Modalisa software with a confidence level of 9500. Age, recurrent MDD and duration of depression were, and diagnosis delay were found to predict the negative course of the disorder. In conclusion, we noticed a concordance of the results of this study with the data from the literature regarding the results: age, MDD duration, number of MDE and time from diagnostics to treatment are the main clinical predictors of the antidepressant treatment response. Keywords: depression, antidepressants, predictors.
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The use of substances that modify the psychic functioning involved in the search for pleasure, relief of discomfort, and ritual/religious activities and also with the potential to cause harm to users and people around them has been reported for a long time in the history of mankind. Eventually it is possible to characterize pathologies related to the consumption of alcohol and other drugs called substance use disorders. These disorders often coexist with other pathological conditions in the same individual which increases the potential for damage and treatment difficulties. The concepts of comorbidity and multimorbidity can be applied in these situations. The recognition of comorbidities and multimorbidities and the development of strategies for their management are fundamental for individual therapeutic projects or the elaboration of public health policies. This chapter deals with this subject with the description of concepts and addresses issues associated with multimorbidity in the presence of a substance use disorder.
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This review summarizes evidence on the effects of cannabis use on the development of adolescents and young adults. It draws on epidemiological studies, neuroimaging studies, case-control studies, and twin and Mendelian randomization studies. The acute risks include psychiatric symptoms associated with the use of high THC (tetrahydrocannabinol) products and motor vehicle accidents. Daily cannabis use during adolescence is associated with cannabis dependence and poor cognitive function, which may affect educational attainment and occupational choice. Daily use of highly potent cannabis is associated with more severe psychological symptoms, such as psychoses, mania, and suicidality. There are more mixed findings on depressive symptoms, anxiety, and violence and debates about the interpretation of these associations. Legalization of adult cannabis use may increase cannabis use and dependence among adolescents and young adults. The regulation of cannabis after legalization needs to minimize adolescent uptake and cannabis-related adverse developmental outcomes. Expected final online publication date for the Annual Review of Developmental Psychology, Volume 2 is December 15, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Resumen En los pacientes con trastorno bipolar existe una elevada prevalencia de consumo de drogas, siendo el cannabis una de las principales. El consumo puede modificar las manifestaciones clínicas y la evolución del trastorno. El objetivo del presente trabajo es estudiar la influencia del consumo de cannabis sobre la evolución del trastorno bipolar. Se ha realizado una revisión sistemática realizando una búsqueda de artículos en Medline. Se han obtenido 5 artículos sobre cohortes de sujetos bipolares que estudian el efecto de dicho consumo. El consumo de cannabis se presenta como un factor pronóstico negativo, con menor recuperación clínica, peor funcionamiento global, más tiempo en episodios afectivos y, posiblemente, mayor frecuencia de ciclos rápidos y episodios maníacos o mixtos. El cese del consumo mejora la evolución. El consumo de otras drogas es frecuente entre los consumidores de cannabis y se asocia a una evolución negativa.
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Medical cannabis, or cannabinoid-based products, continues to grow in popularity globally, driving the evolution of regulatory access frameworks; cancer patients and caregivers often rely on guidance from their physicians regarding cannabinoid-based treatments. But the majority of healthcare practitioners still feel unprepared and insufficiently informed to make reasonable, evidence-based recommendations about medical cannabis. More than 30 countries worldwide have now legalized access to medical cannabis; yet various nations still face arduous regulatory challenges to fulfill the needs of patients, healthcare practitioners, and other medical stakeholders. This has affected the deployment of comprehensive medical cannabis access programs adapted to cultural and social realities. With a 20-year history of legal medical cannabis access and nearly 400,000 registered patients under its federal access program, Canada serves as a model for countries which are developing their regulatory frameworks. The Canadian clinical experience in cannabinoid-based treatments is also a valuable source of lessons for healthcare professionals who wish to better understand the current evidence examining medical cannabis for oncology patients.
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Este trabajo describe las habilidades que el entrenador debe desarrollar a nivel de comunicación educativa y la pedagogía de su desempeño ante grupo.
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Background: The use of cannabis has garnered more attention recently with ongoing efforts at marijuana legalization. The consequences of cannabis use are not clearly understood and remain a concern. Objectives: To review the acute and persistent effects of cannabis use and associations with psychiatric disorders. Methods: Using Pubmed and PsychInfo, we conducted a narrative review of the literature on cannabis and psychiatric comorbidity using the keywords cannab*, marijuana, schizo*, psychosis, mood, depression, mania, bipolar, and anxiety. Results: There is substantial evidence of cannabis use leading to other illicit drug use and of an association between cannabis use and psychosis. A few reports suggest an association with bipolar disorder while the association with depression and anxiety disorders is mixed. Conclusions: Whenever an association is observed between cannabis use and psychiatric disorders, the relationship is generally an adverse one. Age at the time of cannabis use appears to be an important factor with stronger associations observed between adolescent onset cannabis use and later onset of psychiatric disorders. Additional studies taking into account potential confounds (such as withdrawal symptoms, periods of abstinence, and other substance use) and moderators (such as age of initiation of cannabis use, the amount and frequency of drug use, prior history of childhood maltreatment, and gender) are needed to better understand the psychiatric consequences of cannabis use.
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Objective: The clinical presentation, course and comorbidities of bipolar disorder type I (BD1) are highly heterogeneous and this variability remains poorly predictable. Certain onset characteristics (e.g. age and polarity at onset) may delineate subgroups differing in clinical expression and outcome. Method: We investigated the association between both polarity and age at onset and the clinical characteristics of BD1 (DSM-IV), in two independent samples (480 French patients assessed in 1992- 2006 and 714 American patients assessed in 1991-2003). Results: Polarity at onset correlated with subsequent predominance (p<0.001). Most patients experienced a depressive onset (France: 57.9% and US: 71%; p<0.001) associated with a higher density of depressive episodes, suicidal behavior and alcohol misuse. A manic onset was associated with a higher density of manic episodes. Early onset was frequent in both countries (68% in the US versus 42% in France; p<0.001) and was associated suicidal behavior, cannabis and cocaine/opiate misuse. Sensitivity for the prediction of clinical characteristics was 1-35% for age at onset and 26-47 % for polarity at onset. Conclusion: Onset characteristics are associated with subsequent predominant polarity, suicidal behavior and substance misuse in BD1. These findings may facilitate personalized treatment strategies based on type of onset and early focused strategies for preventing comorbidity. Given their relatively low sensitivity and specificity for predicting clinical variables, the relevance of onset characteristics as specifiers in nosographical classifications will require further studies. However, onset polarity may be the more relevant specifier, further investigations being required for age at onset.
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The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20,291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.
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Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption.
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Unlabelled: Cannabis use is associated with an earlier age of onset of psychosis (AOP). However, the reasons for this remain debated. Methods: We applied a Cox proportional hazards model to 410 first-episode psychosis patients to investigate the association between gender, patterns of cannabis use, and AOP. Results: Patients with a history of cannabis use presented with their first episode of psychosis at a younger age (mean years = 28.2, SD = 8.0; median years = 27.1) than those who never used cannabis (mean years = 31.4, SD = 9.9; median years = 30.0; hazard ratio [HR] = 1.42; 95% CI: 1.16-1.74; P < .001). This association remained significant after controlling for gender (HR = 1.39; 95% CI: 1.11-1.68; P < .001). Those who had started cannabis at age 15 or younger had an earlier onset of psychosis (mean years = 27.0, SD = 6.2; median years = 26.9) than those who had started after 15 years (mean years = 29.1, SD = 8.5; median years = 27.8; HR = 1.40; 95% CI: 1.06-1.84; P = .050). Importantly, subjects who had been using high-potency cannabis (skunk-type) every day had the earliest onset (mean years = 25.2, SD = 6.3; median years = 24.6) compared to never users among all the groups tested (HR = 1.99; 95% CI: 1.50- 2.65; P < .0001); these daily users of high-potency cannabis had an onset an average of 6 years earlier than that of non-cannabis users. Conclusions: Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users.
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Estimate the prevalence of cannabis dependence and its contribution to the global burden of disease. Systematic reviews of epidemiological data on cannabis dependence (1990-2008) were conducted in line with PRISMA and meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Culling and data extraction followed protocols, with cross-checking and consistency checks. DisMod-MR, the latest version of generic disease modelling system, redesigned as a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. The disability weight associated with cannabis dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs) and disability-adjusted life years (DALYs). YLDs and DALYs attributed to regular cannabis use as a risk factor for schizophrenia were also estimated. There were an estimated 13.1 million cannabis dependent people globally in 2010 (point prevalence0.19% (95% uncertainty: 0.17-0.21%)). Prevalence peaked between 20-24 yrs, was higher in males (0.23% (0.2-0.27%)) than females (0.14% (0.12-0.16%)) and in high income regions. Cannabis dependence accounted for 2 million DALYs globally (0.08%; 0.05-0.12%) in 2010; a 22% increase in crude DALYs since 1990 largely due to population growth. Countries with statistically higher age-standardised DALY rates included the United States, Canada, Australia, New Zealand and Western European countries such as the United Kingdom; those with lower DALY rates were from Sub-Saharan Africa-West and Latin America. Regular cannabis use as a risk factor for schizophrenia accounted for an estimated 7,000 DALYs globally. Cannabis dependence is a disorder primarily experienced by young adults, especially in higher income countries. It has not been shown to increase mortality as opioid and other forms of illicit drug dependence do. Our estimates suggest that cannabis use as a risk factor for schizophrenia is not a major contributor to population-level disease burden.
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The nature of the relationship between cannabis use (CU) and psychosis is complex and remains unclear. Researchers and clinicians remain divided regarding key issues such as whether or not cannabis is an independent cause of psychosis and schizophrenia. This paper reviews the field in detail, examining questions of causality, the neurobiological basis for such causality and for differential inter-individual risk, the clinical and cognitive features of psychosis in cannabis users, and patterns of course and outcome of psychosis in the context of CU. The author proposes two major pathways from cannabis to psychosis based on a differentiation between early-initiated lifelong CU and a scenario where vulnerable individuals without a lifelong pattern of use consume cannabis over a relatively brief period of time just prior to psychosis onset. Additional key factors determining the clinical and neurobiological manifestation of psychosis as well as course and outcome in cannabis users include: underlying genetic and developmental vulnerability to schizophrenia-spectrum disorders; and whether or not CU ceases or continues after the onset of psychosis. Finally, methodological guidelines are presented for future research aimed at both elucidating the pathways that lead from cannabis to psychosis and clarifying the long-term outcome of the disorder in those who have a history of using cannabis.
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Background: Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms. Method: Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points--at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded. Results: Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up. Conclusions: Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.
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Background The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients. Methods Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures. Results Males with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge. Conclusions Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.
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Cannabidiol (CBD), the main non-psychotomimetic component of the plant Cannabis sativa, exerts therapeutically promising effects on human mental health such as inhibition of psychosis, anxiety and depression. However, the mechanistic bases of CBD action are unclear. Here we investigate the potential involvement of hippocampal neurogenesis in the anxiolytic effect of CBD in mice subjected to 14 d chronic unpredictable stress (CUS). Repeated administration of CBD (30 mg/kg i.p., 2 h after each daily stressor) increased hippocampal progenitor proliferation and neurogenesis in wild-type mice. Ganciclovir administration to GFAP-thymidine kinase (GFAP-TK) transgenic mice, which express thymidine kinase in adult neural progenitor cells, abrogated CBD-induced hippocampal neurogenesis. CBD administration prevented the anxiogenic effect of CUS in wild type but not in GFAP-TK mice as evidenced in the novelty suppressed feeding test and the elevated plus maze. This anxiolytic effect of CBD involved the participation of the CB1 cannabinoid receptor, as CBD administration increased hippocampal anandamide levels and administration of the CB1-selective antagonist AM251 prevented CBD actions. Studies conducted with hippocampal progenitor cells in culture showed that CBD promotes progenitor proliferation and cell cycle progression and mimics the proliferative effect of CB1 and CB2 cannabinoid receptor activation. Moreover, antagonists of these two receptors or endocannabinoid depletion by fatty acid amide hydrolase overexpression prevented CBD-induced cell proliferation. These findings support that the anxiolytic effect of chronic CBD administration in stressed mice depends on its proneurogenic action in the adult hippocampus by facilitating endocannabinoid-mediated signalling.
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OBJECTIVE: The aim of this report was to examine the accuracy of diagnosing substance use disorders in manic adolescents with bipolar disorder. METHODS: The substance use disorder modules of the KSADS-PL were administered to a sample of 80 manic adolescents (12-21 years old) with co-occurring bipolar and substance use disorders. Initial substance use disorder diagnoses obtained from the KSADS-PL were then compared to a best-estimate diagnosis derived from all available information, including a second diagnostic interview, the Child Semi-Structured Assessment for the Genetics of Alcoholism, Adolescent version (C-SSAGA-A). RESULTS: Relatively low diagnostic agreement was achieved across the initial and the best estimate diagnoses for both alcohol and cannabis use disorders. Age, race, and sex did not predict diagnostic agreement between the two evaluations. CONCLUSIONS: Results of this study call for more research on diagnosing substance use disorders and suggest that a single interview alone may not be accurate for diagnosing substance use disorders in manic adolescents with bipolar disorder.
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Increases in mesolimbic dopamine transmission are observed when animals are treated with all known drugs of abuse, including cannabis, and to conditioned stimuli predicting their availability. In contrast, decreases in mesolimbic dopamine function are observed during drug withdrawal, including cannabis-withdrawal syndrome. Thus, despite general misconceptions that cannabis is unique from other drugs of abuse, cannabis exerts identical effects on the mesolimbic dopamine system. The recent discovery that endogenous cannabinoids modulate the mesolimbic dopamine system, however, might be exploited for the development of potential pharmacotherapies designed to treat disorders of motivation. Indeed, disrupting endocannabinoid signaling decreases drug-induced increases in dopamine release in addition to dopamine concentrations evoked by conditioned stimuli during reward seeking.
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The psychoactive constituent in cannabis, Δ(9)-tetrahydrocannabinol (THC), was isolated in the mid-1960s, but the cannabinoid receptors, CB1 and CB2, and the major endogenous cannabinoids (anandamide and 2-arachidonoyl glycerol) were identified only 20 to 25 years later. The cannabinoid system affects both central nervous system (CNS) and peripheral processes. In this review, we have tried to summarize research-with an emphasis on recent publications-on the actions of the endocannabinoid system on anxiety, depression, neurogenesis, reward, cognition, learning, and memory. The effects are at times biphasic-lower doses causing effects opposite to those seen at high doses. Recently, numerous endocannabinoid-like compounds have been identified in the brain. Only a few have been investigated for their CNS activity, and future investigations on their action may throw light on a wide spectrum of brain functions. Expected final online publication date for the Annual Review of Psychology Volume 64 is November 30, 2012. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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General population data from the National Comorbidity Survey are presented on co-occurring DSM-III-R addictive and mental disorders. Co-occurrence is highly prevalent in the general population and usually due to the association of a primary mental disorder with a secondary addictive disorder. It is associated with a significantly increased probability of treatment, although the finding that fewer than half of cases with 12-month co-occurrence received any treatment in the year prior to interview suggests the need for greater outreach efforts.
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Lithium has been used extensively for mood stabilization, and it is particularly efficacious in the treatment of bipolar mania. Like other drugs used in the treatment of psychiatric diseases, it has little effect on the mood of healthy individuals. Our previous studies found that mice with a mutation in the Clock gene (ClockΔ19) have a complete behavioral profile that is very similar to human mania, which can be reversed with chronic lithium treatment. However, the cellular and physiological effects that underlie its targeted therapeutic efficacy remain unknown. Here we find that ClockΔ19 mice have an increase in dopaminergic activity in the ventral tegmental area (VTA), and that lithium treatment selectively reduces the firing rate in the mutant mice with no effect on activity in wild-type mice. Furthermore, lithium treatment reduces nucleus accumbens (NAc) dopamine levels selectively in the mutant mice. The increased dopaminergic activity in the Clock mutants is associated with cell volume changes in dopamine neurons, which are also rescued by lithium treatment. To determine the role of dopaminergic activity and morphological changes in dopamine neurons in manic-like behavior, we manipulated the excitability of these neurons by overexpressing an inwardly rectifying potassium channel subunit (Kir2.1) selectively in the VTA of ClockΔ19 mice and wild-type mice using viral-mediated gene transfer. Introduction of this channel mimics the effects of lithium treatment on the firing rate of dopamine neurons in ClockΔ19 mice and leads to a similar change in dopamine cell volume. Furthermore, reduction of dopaminergic firing rates in ClockΔ19 animals results in a normalization of locomotor- and anxiety-related behavior that is very similar to lithium treatment; however, it is not sufficient to reverse depression-related behavior. These results suggest that abnormalities in dopamine cell firing and associated morphology underlie alterations in anxiety-related behavior in bipolar mania, and that the therapeutic effects of lithium come from a reversal of these abnormal phenotypes.
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A number of studies have found that the use of cannabis and other psychoactive substances is associated with an earlier onset of psychotic illness. To establish the extent to which use of cannabis, alcohol, and other psychoactive substances affects the age at onset of psychosis by meta-analysis. Peer-reviewed publications in English reporting age at onset of psychotic illness in substance-using and non-substance-using groups were located using searches of CINAHL, EMBASE, MEDLINE, PsycINFO, and ISI Web of Science. Studies in English comparing the age at onset of psychosis in cohorts of patients who use substances with age at onset of psychosis in non-substance-using patients. The searches yielded 443 articles, from which 83 studies met the inclusion criteria. Information on study design, study population, and effect size were extracted independently by 2 of us. Meta-analysis found that the age at onset of psychosis for cannabis users was 2.70 years younger (standardized mean difference = -0.414) than for nonusers; for those with broadly defined substance use, the age at onset of psychosis was 2.00 years younger (standardized mean difference = -0.315) than for nonusers. Alcohol use was not associated with a significantly earlier age at onset of psychosis. Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, confirming an association between cannabis use and earlier mean age at onset of psychotic illness. The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness, and they support the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients. The results suggest the need for renewed warnings about the potentially harmful effects of cannabis.
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The aim of the study was to investigate which factors are associated with age at onset in bipolar disorder with a specific focus on excessive alcohol and cannabis use, and the sequence of the onsets of excessive substance use and bipolar disorder. We investigated a naturalistic sample of 151 patients with bipolar I and II disorder receiving psychiatric treatment. Whether the presence of excessive substance use prior to bipolar disorder onset or the type of substance used (alcohol or cannabis) was associated with differences in age at onset was investigated using hierarchical and multiple linear regression analyses, adjusting for potential confounders. Patients with excessive alcohol use had a significantly later onset compared with patients with excessive cannabis use. Excessive general substance use prior to bipolar disorder onset was associated with a later onset. However, excessive cannabis use was associated with an earlier onset whether it preceded or followed bipolar disorder onset, also after adjusting for possible confounders. Excessive use of alcohol or other substances was not independently associated with age at onset in multivariate analyses. Alcohol use was associated with a later onset compared with cannabis use, suggesting different relationships to the onset of bipolar disorder. Lifetime use of cannabis predicted an earlier onset, independent of the sequence of onsets. This indicates that an early onset may increase the risk of cannabis use and that cannabis use may trigger bipolar disorder in vulnerable individuals.
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