(The New York Times) – Nearly a century after the film “Reefer Madness” alarmed the nation, some policymakers and doctors are again becoming concerned about the dangers of marijuana, although the reefers are long gone.
Experts now distinguish between the “new cannabis” — legal, highly potent, available in tabs, edibles and vapes — and the old version, a far milder weed passed around in joints. Levels of T.H.C., the chemical that produces marijuana’s high, have been rising for at least three decades, and it’s now possible in some states to buy vape cartridges containing little but the active ingredient.
The concern is focused largely on the link between heavy usage and psychosis in young people. Doctors first suspected a link some 70 years ago, and the evidence has only accumulated since then. In a forthcoming book, “Tell Your Children,” Alex Berenson, a former Times reporter, argues that legalization is putting a generation at higher risk of schizophrenia and other psychotic syndromes. Critics, including leading researchers, have called the argument overblown, and unfaithful to the science.Read More
(The New Yorker Magazine) – A few years ago, the National Academy of Medicine convened a panel of sixteen leading medical experts to analyze the scientific literature on cannabis. The report they prepared, which came out in January of 2017, runs to four hundred and sixty-eight pages. It contains no bombshells or surprises, which perhaps explains why it went largely unnoticed. It simply stated, over and over again, that a drug North Americans have become enthusiastic about remains a mystery.Read More
The Foundation for Excellence in Mental Health Care, with the dedicated support of major donors, began funding pilot projects in 2012 for adapting the Finnish Open Dialogue model to the culture and system of care in the United States. Preliminary outcome data sets are too small to draw conclusions about the U.S. programs’ efficacy, but qualitative data on participant and clinician satisfaction with the practice methods argue for further investigation.
To that end, the Foundation is now reviewing RFP submissions for its competitive grant Expanding the Science and Practice of Open Dialogue: An international collaborative multicenter research project to evaluate the effectiveness of Open Dialogue in various mental health care contexts around the world.
Last week in Psychiatric Services, Kim Mueser asked Is More Rigorous Research on “Open Dialogue” a Priority?, to which we reply, unsurprisingly, “Yes.”
Dr. Mueser’s commentary highlights the need to move the science of Open Dialogue practice beyond the small, insular group of developers, advocates, and early adopters and into the mainstream.
Historically, this would have been done with federal dollars, resources which have typically been required to establish an Evidence Based Practice. Unfortunately, federal dollars aren’t available the way they were when the original EBPs were established.
That is why independent, competitive funding from the Foundation for Excellence in Mental Health Care is so important and timely. Seed funding for innovative thinkers is also often the catalyst for those thinkers acquiring other funding to advance science and practice.
Excellence board member and lead of the first U.S. pilot project, psychiatrist Chris Gordon, writes, “My own experience remains that the mode of care in Open Dialogue is vastly more humane, person-centered, and toxicity-minimizing than standard care. We have experienced great satisfaction and enthusiastic endorsement from most (but not all) individuals and families we have served, but we have seen less impact on psychosis, and more need for the use of medications, than were reported by the originators of Open Dialogue in Finland. This may in part be due to the fact that we rarely see people who are completely new to the mental health system; most people we serve come to us already on antipsychotic medications. Still, at times, psychosis can remit and Open Dialogue makes space and time and opportunity for such natural resolution, and helps people avoid getting stuck in an enervating mental health system. So it’s great for much, much better informed consent and collaborative treatment design, and it’s the process I’d want myself for someone I love – if the team includes a competent psychiatrist who appreciates that medicines sometimes can be very helpful.”
Introduction: Recent research in Western countries has indicated that family interventions in schizophrenia and other psychotic disorders can reduce patient relapse and improve medication compliance. Few studies have addressed Chinese and Asian populations. This study tested the long-term effects of a 9-month family-led mutual support group for Chinese people with schizophrenia in Hong Kong, compared with psycho-education and standard psychiatric care.
Methods: A randomized controlled trial of Chinese families of patients with recent-onset psychosis (≤5 years of illness) was conducted between August 2012 and January 2017, with a 4-year follow-up. Two hundred and one Chinese families of adult outpatients with recent-onset psychosis were randomly selected from the computerized patient lists and randomly assigned to either mutual support, psycho-education, or standard care group (n = 70 per group). Family caregivers were mainly the parent, spouse, or child of the patients. Mutual support and psycho-education group consisted of 16 two-hour group sessions and patients participated in three sessions. The standard care group and the two treatment groups received the routine psychiatric outpatient care.
Results: Patients and families in the mutual support group reported consistently greater improvements in overall functioning [family functioning, F(2, 203) = 8.13, p = 0.003; patient functioning, F(2, 203) = 6.01, p = 0.008] and reductions in duration of hospitalizations [F(2, 203) = 6.51, p = 0.005] over the 4-year follow-up. There were not any significant increases of medication dosages or service use by both the family support and psycho-education groups over time.
Conclusions: The peer-led family support group can be an effective psychosocial intervention in early psychosis indicating long-term benefits on both patient and family functioning and re-hospitalizations.
Clinical Trial Registration: NCT00940394: https://register.clinicaltrials.gov.
(Medscape) – A large Danish population-based study provides strong evidence of an association between childhood infection, antibiotic treatment, and subsequent neuropsychiatric disorders.
Investigators found that the risk of developing a mental disorder increased by more than 80% after hospitalization for severe infection. The use of anti-infectives, specifically antibiotics, to treat the infection was associated with about a 40% increased risk for a subsequent mental disorder.
“Our findings linking infections with mental disorders in the developing brain, despite several limitations that make causal links impossible, add more knowledge to this growing field showing that there exists an intimate connection between the body and the brain,” first author Ole Kohler-Forsberg, MD, from the Psychosis Research Unit, Aarhus University Hospital, Denmark, told Medscape Medical News.
The study was published online December 5 in JAMA Psychiatry.Read More
(MadInAmerica.com) – New research recently published in JAMA Psychiatry examines the association between traumatic experiences and the development of psychosis. The authors of this large study suggest that trauma may have a causal association with psychotic experiences.
“The findings are consistent with the thesis that trauma could have a causal association with psychotic experiences,” the team of researchers, from the University of Bristol Medical School in the UK, write.
“This study indicates that, assuming the association is accurate and causal, a substantial proportion (25%-60%, consistent with previous estimates) of participants would not have developed psychotic experiences if they had not been exposed to traumatic experiences during childhood.”Read More
This paper discusses the current evidence from animal and human studies for a central role of inflammation in schizophrenia. In animal models, pre- or perinatal elicitation of the immune response may increase immune reactivity throughout life, and similar findings have been described in humans. Levels of pro-inflammatory markers, such as cytokines, have been found to be increased in the blood and cerebrospinal fluid of patients with schizophrenia. Numerous epidemiological and clinical studies have provided evidence that various infectious agents are risk factors for schizophrenia and other psychoses. For example, a large-scale epidemiological study performed in Denmark clearly showed that severe infections and autoimmune disorders are such risk factors. The vulnerability-stress-inflammation model may help to explain the role of inflammation in schizophrenia because stress can increase pro-inflammatory cytokines and may even contribute to a chronic pro-inflammatory state. Schizophrenia is characterized by risk genes that promote inflammation and by environmental stress factors and alterations of the immune system. Typical alterations of dopaminergic, serotonergic, noradrenergic, and glutamatergic neurotransmission described in schizophrenia have also been found in low-level neuroinflammation and consequently may be key factors in the generation of schizophrenia symptoms. Further support for the relevance of a low-level neuroinflammatory process in schizophrenia is provided by the loss of central nervous system volume and microglial activation demonstrated in neuroimaging studies. Last but not least, the benefit of anti-inflammatory medications found in some studies and the intrinsic anti-inflammatory and immunomodulatory effects of antipsychotics provide further support for the role of inflammation in this debilitating disease.Read More
(Medscape) – Young patients with recent-onset schizophrenia do not show signs of cognitive deterioration or disruption of ongoing brain development in the first years following illness onset, new research shows.
Results of a large longitudinal study show that young patients with schizophrenia experience cognitive impairment prior to the onset of psychotic symptoms, but the trajectory of their neurobehavioral development and performance is comparable to that of healthy control persons.
“The study results suggest that whatever effect cognition has in schizophrenia seems to happen before people develop clinical symptoms, the psychotic symptoms,” study investigator Cameron S. Carter, MD, professor of psychiatry and psychology, and director of the Schizophrenia Research and Education Program, Department of Psychiatry and Behavioural Sciences, University of California, Davis, told Medscape Medical News.
“So cognitive dysfunction is already there when people come in for treatment,” he said.
The findings are in line with the neurodevelopmental model of schizophrenia. This model hypothesizes that prenatal central nervous system insultsand/or genetic alterations during early brain developmentinteract with environmental risk factors and lead to the onset of psychosis in late adolescence or early adulthood.
“The study confirms our sense that schizophrenia is not a neurodegenerative disorder; the brain does not necessarily deteriorate after people become ill and develop these symptoms,” said Carter.
“In fact, these young people have the capacity to continue to improve and develop to the same degree as typical individuals,” he said.
The study was published online October 3 in JAMA Psychiatry.Read More
I recently received an email from Psychiatric Times highlighting current articles. Psychiatric Times is a newspaper that is distributed for free to psychiatrists in the US. To put this in context, the paper appears to be heavily subsidized by pharmaceutical company advertising, and its former editor, Ronald Pies, is a psychiatrist who has been critical of views expressed on Mad In America.
It caught my eye when the first article mentioned had the title, “Antipsychotic Discontinuation: When is it OK?” I clicked on the link to find a slide show authored by Brian Miller, M.D., P.D., M.P.H. which was titled, “Antipsychotics – To Respond or Not to Respond?”
This was intriguing but confusing. Dr. Miller’s slides reviewed a paper just published in Schizophrenia Bulletin titled, “How Many Patients With Schizophrenia Do Not Respond to Antipsychotic Drugs in the Short Term? An Analysis Based on Individual Patient Data From Randomized Controlled Trials.” As pointed out in the slide show, the paper reported on a meta-analysis of 16 randomized controlled studies of antipsychotic drugs over the first 4-6 weeks of treatment. The authors found that a significant number of people do not respond or have relatively poor responses and the majority do not experience a remission of psychotic symptoms. While important, this article addressed short-term rather than long-term care. It is, nevertheless, informative.Read More