Schizophrenia and Cannabis

"El peor de todos los narcóticos, peor incluso que la morfina o la cocaína. Bajo su influencia los hombres se han vuelto bestias. La Marihuana les ha destruido sus vidas. No tengo ninguna simpatía por aquellos que venden esta cizaña" (Juez J. Symes, Denver 1937). Esta vez, he viajado en el tiempo, a un momento muy concreto en la historia. Allí pude observar unos hechos macabros de los que se culpó injustamente a la marijuana. Viajamos en nuestra nave del tiempo…

The researcher consulted literature concerning cognitive behavioral therapy (CBT), schizophrenia, and CBT in the treatment of schizophrenia. Consulting The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and the experience of researchers who have dealt with individuals diagnosed with schizophrenia, an examination is made of the etiology and symptomology of the mental disorder. This review of the available literature identifies the population of society that schizophrenia affects, as well as the ways that it influences the biological, psychological, socioeconomic, and spiritual aspects of the whole person. The researcher then gives a list of the instruments and tests used to measure for symptoms of schizophrenia, as well as psychosis in general, including their reported accuracy. The analysis then addresses antipsychotic medication and adjunctive CBT, two empirically supported treatments for schizophrenia. Results of the reviewed literature showed greater helpfulness of treatment with only antipsychotic medication rather than only CBT, however conjunctive use of medication with CBT shows to be the most beneficial. The paper then discusses the Christian view of CBT as a psychotherapy and schizophrenia as a mental disorder with the result being a selective acceptance of the psychological community’s claims about the therapy and the disorder, since some claims contradict God’s Word and are false to one degree or another.
Keywords: literature review, schizophrenia, cognitive behavioral therapy (CBT), antipsychotic medication, Christian integration

ABSTRACT
Background: Individuals suffering with psychiatric disorders are stigmatised and dehumanised, which leads to the maintenance of conditions. With stigma and dehumanisation, there is a probability that those with mental illness will suffer tremendously and eventually succumbing to adverse irreversible phases. Considering the significance of stigmatisation and dehumanisation in psychiatric populations, it becomes vital to assess their presence and degree in the psychology students’ community. The aim of this study was to examine psychology students' stigmatising and dehumanising attitudes toward two clinical populations (individuals with severe cannabis use disorder and schizophrenia), while taking gender into account.
Methods: Undergraduate psychology students (N=114) were presented with three vignettes portraying two psychiatric disorders (schizophrenia, and cannabis use disorder) and one with no psychiatric condition (control). They were then required to rate their perceptions of humanity on a scale of dehumanisation (Unique human/Human nature). The Social Distance Scale (SDS) and two subscales of the Attribution Questionnaire (AQ 27: Fear and Anger) were used to assess stigmatising attitudes. Two distinct surveys, one for each gender, were distributed on University`s SONA system.
Results: Psychology students reported considerably more psychiatric stigma and dehumanisation toward individuals with schizophrenia and cannabis use disorder (CUD) compared with control condition on all attitudinal variables. When investigating gender, this study found significant results for desire to social distance from males regardless of diagnosis. Individuals suffering from cannabis use disorder(CUD) scored higher in measures of psychiatric stigma and dehumanisation. Another significant result in this study was that the schizophrenia case vignette elicited greater fear in respondents than the CUD and no psychiatric condition (control) case. Additional research is needed to generalise and verify the current research's results about attitudes of stigma and dehumanisation associated with psychiatric conditions using broader societal samples and relevant demographic samples. Further research should consider examining the many variations (responsibility and morality) in respondents' attitudes in an attempt to inform solutions targeted directly at the stigma associated with mental illness.
Keywords: schizophrenia, cannabis use disorder, dehumanisation, stigma, students` attitudes, vignette study;

Given increasingly prevalent use of cannabinoids among Veterans to address such issues as pain and anxiety, it is incumbent upon providers to enhance their familiarity and clinical “comfort level” in working with Veterans who use these substances (Metrik et al., 2018).  With the majority of U.S. states having adopted legislation to medically and/or recreationally legalize cannabis, the already high prevalence of cannabis use (Hasin et al., 2015) is expected to further increase nationwide, especially among existing users (Hall & Lynskey, 2016; Pacula & Lundberg, 2014). States that allow the legal use of cannabis for medicinal purposes have higher rates of cannabis use and cannabis use disorder (CUD) in national survey data (Cerdá, Wall, Keyes, Galea, & Hasin, 2012) and specifically within the Veterans Health Administration (VHA; Bonn-Miller, Harris, & Trafton, 2012). Veteran advocacy groups have been created to further veterans’ rights to access cannabis for medical (MC) purposes and discuss its use with their VHA providers (for e.g., “http://www.vetscp.org/#,” 2017). There are also published reports that veterans perceive cannabis to be a low-risk or safe substance unlike other drugs of abuse (Wilkinson, van Schalkwyk, Davidson, & D’Souza, 2016) and expect cannabis to provide relief from symptoms of combat-related trauma (Earleywine & Bolles, 2014).

Bonn-Miller MO, Harris AHS, Trafton JA. Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Psychological Services. 2012;9(4):404–416. doi: 10.1037/a0027622

Cerdá M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence. 2012;120(1–3):22–27. doi: 10.1016/j.drugalcdep.2011.06.011.

Earleywine M, Bolles JR. Marijuana, expectancies, and post-traumatic stress symptoms: A preliminary investigation. Journal of Psychoactive Drugs. 2014;46(3):171–177. doi: 10.1080/02791072.2014.920118

Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction. 2016;111(10):1764–1773. doi: 10.1111/add.13428.

Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Grant BF. Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry. 2015;72(12):1235–1242. doi: 10.1001/jamapsychiatry.2015.1858.

Metrik, J., Bassett, S. S., Aston, E. R., Jackson, K. M., & Borsari, B. (2018). Medicinal versus recreational cannabis use among returning veterans. Translational issues in psychological science, 4(1), 6.

Pacula RL, Lundberg R. Why changes in price matter when thinking about marijuana policy: A review of the literature on the elasticity of demand. Public Health Reviews. 2014;35(2):1–18.

Wilkinson ST, van Schalkwyk GI, Davidson L, D’Souza DC. The formation of marijuana risk perception in a population of substance abusing patients. The Psychiatric Quarterly. 2016;87(1):177–187. doi: 10.1007/s11126-015-9369-z.

Target Audience

The primary target for this presentation is mental health clinicians at VA health care facilities (VHA), and this includes psychiatrists, clinical social workers, psychologists, LPCs, LMFTs, and psychiatric NPs.
Outcome/Objectives
At the conclusion of this educational program, learners will be able to:

1. Identify indications for cannabinoid use in the Veteran population, as well as evaluate claims not currently supported.
2. Identify the common pharmacological targets of cannabinoids, endo/phytocannabinoids
3. Discuss common formulations utilized by patients (e.g., edibles, vapor, tincture, whole flower) and risk-benefits associated with their use
4. Understand the evolution of cannabinoids from recreational to medical use

We conducted a systematic review to assess the evidence for specific effects of cannabis on impulsivity, disinhibition and motor control. The review had a specific focus on neuroimaging findings associated with acute and chronic use of the drug and covers literature published up until May 2012. Seventeen studies were identified, of which 13 met the inclusion criteria; three studies investigated acute effects of cannabis (1 fMRI, 2 PET), while six studies investigated non-acute functional effects (4 fMRI, 2 PET), and four studies investigated structural alterations. Functional imaging studies of impulsivity studies suggest that prefrontal blood flow is lower in chronic cannabis users than in controls. Studies of acute administration of THC or marijuana report increased brain metabolism in several brain regions during impulsivity tasks. Structural imaging studies of cannabis users found differences in reduced prefrontal volumes and white matter integrity that might mediate the abnormal impulsivity and mood observed in marijuana users. To address the question whether impulsivity as a trait precedes cannabis consumption or whether cannabis aggravates impulsivity and discontinuation of usage more longitudinal study designs are warranted.

El trabajo, publicado en las plataformas Kindle y Amazon, describe las principales características de 42 estudios clínicos que valoran el uso terapéutico de cannabinoides naturales y sintéticos. Ello incluye, en la primera parte, la introducción de conceptos básicos. En la segunda parte se describe el marco regulatorio en el contexto de la US Food and Drugs Administration (FDA) y se caracteriza a los estudios clínicos. En la tercera parte se hace referencia a los países y órganos reguladores involucrados, las instituciones o empresas que los patrocinan, las locaciones, la información de seguimiento, el tipo de estudio, edad, género e intervenciones. En la cuarta parte se describen los cuarenta y un estudios, conforme utilizan cannabinoides naturales o sintéticos. En la quinta parte se hacen algunas observaciones finales en torno a la modificación de los bloques de legalidad aplicables, especialmente en América Latina. El trabajo tiene como propósito servir de orientación básica sobre el tema y de referencia para estudios posteriores. Los estudios fueron tomados del Clinical Trials del US National Institutes of Health (NIH). Más de 130 enlaces conducen a las fuentes directas. Nueve cuadros resumen la información.

Background: Voice hearing (VH) is considered a major symptom of schizophrenia. This is despite estimates that ten times more people experience VH than receive treatment for psychotic disorder. Conventionally psychotic VH is distinguished from dissociative VH on the basis of topography, with voices heard outside the head regarded as more pathological than internally located ones. However, while location is accorded with diagnostic and prognostic value, there is no compelling evidence that any characteristic of VH is allayed with diagnostic specificity or treatment outcome. The fact that no qualities reliably distinguish VH in persons deemed psychotic from those with dissociative conditions, or even from those never designated mentally ill, raises profound questions about our understanding of VH.
Methods: A review and comparison of relevant historical, clinical, and phenomenological evidence was conducted. Particular attention was paid in relation to (1) VH in the general population, (2) the relationship between VH and traumatic life events, (3) the relationship between VH and dissociative experiences, (4) voice location, and (5) voice phenomenology.
Results: Assessment and evaluation of this literature strongly indicates that no qualities consistently differentiate VH in persons deemed psychotic from those with dissociative conditions, or even
those in the non-clinical population. Furthermore, there is compelling evidence that VH can be most appropriately understood as a dissociative phenomena which develops as a defensive strategy to interpersonal trauma.
Discussion: On the basis of our findings, we argue that  assumptions of VH as a core psychotic symptom be re-evaluated. Instead, we posit that VH be conceptualized as dissociative experiences, which under some circumstances may have psychopathological effects. The therapeutic implications of this position and avenues for future research are discussed.
doi:10.1016/j.schres.2010.02.234

SUMMARY In an attempt to detect electroencephalographic (EEG) changes associated with characteristic clinical signs and symptoms of schizophrenia, power spectra were derived from scalp EEGs of schizophrenic patients recorded by telemetry during free behaviour on their psychiatric wards. Power spectra from EEG epochs coincident with psychomotor blocking, stereotyped automatism or hallucinations were compared with spectra derived during periods of relatively normal behaviour, during performance of specific tasks, and with spectra from control subjects. Ramp spectra, characterised by a smooth decline in power from lowest to highest frequencies, previously found in conjunction with subcortical spike activity of epilepsy were not found in any control subject, but appeared in spectra from schizophrenic patients during catatonic episodes, hallucinatory periods and visual checking. Schizophrenic patients also had more slow activity and less alpha activity in their EEGs than normal control subjects.