Les outils de repérage pour les troubles de l’usage du cannabis et leur adaptation au DSM-5 : une revue de littérature

ObjectivesCannabis use is widespread in France, particularly among adolescents and young adults, and can induce severe somatic, psychiatric and social consequences. Early identification and appropriate care of cannabis use disorders thus constitute a major public health issue. Standardized questionnaires based on patient self-reporting are recognized as the best option for identifying cannabis use disorders because of their reliability and simplicity.MethodsWe conducted a narrative literature review on cannabis use assessment tools on PubMed and selected cannabis-specific questionnaires, validated for adolescent and/or adult populations, from scientific articles in English or French between 1995 and 2010.ResultsSixteen questionnaires were found according to the inclusion criteria. The CAGE-cannabis, the CAST, the CUDIT and its revised version the CUDIT-R, the PUM and the SDS are the only ones that have good characteristics for a short screening tool adapted to daily clinical practice, namely to be brief (fewer than 10 questions) and quick handover (less than 10 minutes). Only the CAST has been validated in French, and the CUDIT-R is currently being validated. In the DSM-5, diagnoses of abuse or addiction have been grouped into a single diagnosis of cannabis use disorders with different levels of severity. It is relevant that tools used for screening take into account these new diagnostic concepts. The CUDIT-R is currently the only one to be validated based on DSM-5 diagnostic criteria.ConclusionAmong the many questionnaires available, few are suited for daily clinical practice in France because of their complexity, their long duration or the absence of a validated French translation. The CUDIT-R has good psychometric characteristics, is simple to use, and has been validated according to the criteria of DSM-5. These questionnaires are obviously not a substitute for a clinical diagnosis and must be followed by a specialist's evaluation. However, they remain an interesting mediation, encouraging a patient's awareness and commitment to care.     

Bipolar disorder and co-occurring cannabis use disorders: Characteristics,co-morbidities and clinical correlates

This study examines rates of co-morbid mental disorders and indicators of the course of illness among individuals with bipolar disorder and cannabis use disorders (CUD). Data were drawn from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC Wave 1, 2001–2002), a nationally representative sample of adults living in the United States. Among individuals with lifetime prevalence of bipolar disorder (N=1905) rates of CUD in the past 12 months were 7.2%, compared to 1.2% in the general population. Logistic regression models adjusting for sociodemographic variables indicated that individuals with bipolar disorder and co-occurring CUD were at increased risk for nicotine dependence (Adjusted Odds Ratio (AOR)=3.8), alcohol (AOR=6.6) and drug (AOR=11.9) use disorders, as well as antisocial personality disorder (AOR=2.8) compared to those without CUD. Among individuals with co-occurring CUD, age of onset of bipolar disorder was significantly lower and median number of manic, hypomanic and depressive episodes per year was significantly greater compared to individuals without CUD. Co-occurring CUD is associated with significant co-morbidities and a more severe course of illness among individuals with bipolar disorder. Comprehensive evaluation of patients with bipolar disorder should include a systematic assessment of CUD.     

Women are taking the hit: Examining the unique consequences of cannabis use across the female lifespan

Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.     

Cannabis

Zusammenfassung Die zunehmende Verbreitung von Cannabiserfahrung in der Bev?lkerung hat für die Psychiatrie erhebliche Auswirkungen. Die ?sterreichische Gesellschaft für Psychiatrie und Psychotherapie hat deshalb ein state of art-paper verfasst, in welchem der heutige Wissensstand über die akuten und chronischen Cannabiswirkungen zusammengefasst wird. Von psychiatrischer Relevanz sind insbesondere die Fragen, ob Cannabis Sensibilisierungsdroge sei, ob es sogenannte Amotivationssyndrome ausl?sen k?nne und welcher Zusammenhang zwischen Cannabiskonsum und Psychose besteht. Besonders diskutiert werden Indikationen und Verwendung von Cannabis und Cannabinoiden als Medikament. Abschlie?end werden eine Reihe von Empfehlungen für die rechtlichen Fragen und justizielle Reaktionen bei Cannabismissbrauch gegeben.      

Cannabis and schizophrenia: results of a follow-up study

A total of 39 schizophrenic patients with a history of current cannabis abuse at index admission was compared with a control group of schizophrenics without substance abuse matched for age, gender, and year of admission. At follow-up after 68.7 ± 28.3 months, 27/ 39 cases and 26/39 controls could be investigated. 8/27 cases (30%) had continued cannabis abuse, 6/27 (22%) had become alcohol abusers. Only one patient of the control group had started abusing alcohol. Patients with previous cannabis abuse had significantly more rehospitalizations, tended to worse psychosocial functioning, and scored significantly higher on the psychopathological syndromes “thought disturbance” (BPRS) and “hostility” (AMDP). These results confirm the major impact of cannabis abuse on the long-term outcome of schizophrenic patients. Received: 16 December 1997 / Accepted: 19 November 1998     

The psychotomimetic states inventory (PSI): measuring psychotic-type experiences from ketamine and cannabis

BACKGROUND: This study reports a new measure of psychotomimetic states in the context of cannabis and ketamine use. The Psychotomimetic States Inventory (PSI) has sub-scales of Delusory Thinking, Perceptual Distortions, Cognitive Disorganization, Anhedonia, Mania and Paranoia. METHODS: The PSI was administered in two independent group, repeated measures designs: an experimental study of ketamine and a naturalistic study of cannabis. RESULTS: Both cannabis and ketamine produced reliable increases in ratings of psychotomimetic state effects across several sub-scales. CONCLUSIONS: The PSI is a potentially useful measure of the nature and extent of the phenomenological effects of psychotropic drugs in schizophrenia-related research.     

Cannabis in patients with Parkinson's disease in Argentina. A cross sectional study

We made an observational cross-sectional study to evaluate the prevalence of cannabis use, characteristics and results perceived by a group of PD patients. Semi-structured questionnaire was applied to patients. Until obtaining more information we suggest to incorporate into regular medical practice the question about the use of cannabis.     

Bad trip due to anticholinergic effect of cannabis

Cannabis in its various forms has been known since time immemorial, the use of which has been rising steadily in India. ‘Bad trips’ have been documented after cannabis use, manifestations ranging from vague anxiety and fear to profoundly disturbing states of terror and psychosis. Cannabis is known to affect various neurotransmitters, but ‘bad trip’ due to its anticholinergic effect has never been described in literature to the best of author's knowledge. Hereby, the author describes a case of a young adult male experiencing profound anticholinergic effects after being exposed for the first time in his life to bhang, a local oral preparation of cannabis.     

Psychiatric effects of cannabis use

That cannabis use may provoke mental disturbances is well known to Scandinavian psychiatrists today. A review of the psychiatric aspects of cannabis use is given, and the clinical signs of 70 cases of cannabis psychoses collected in Sweden are described. The bluntness and "amotivation" following chronic cannabis use are discussed. Anxiety reactions, flashbacks, dysphoric reactions and an abstinence syndrome are all sequels of cannabis use. Three risk groups begin to emerge: a) Young teenage cannabis users who lose some of their capacity to learn complex functions and who flee from reality to a world of dreams. With its sedative effect, cannabis could modify such emotions as anger and anxiety and slow down the liberation process of adolescence. b) Heavy daily users, often persons who cannot cope with depression or their life circumstances. c) Psychiatric patients whose resistance to relapses into psychotic reactions might be diminished according to the psychotropic effects of cannabis.     

Flattened cortisol awakening response in chronic patients with schizophrenia onset after cannabis exposure

Cannabis may play a causal role in the onset of some schizophrenia cases; however, the biological vulnerability that predisposes some individuals to develop schizophrenia after exposure to cannabis is not known. According to the diathesis-stress pathogenetic model, it is likely that the endogenous stress response system, including the hypothalamus–pituitary–adrenal (HPA) axis, could be involved. Therefore, we investigated the saliva cortisol awakening response (CAR) of 16 patients with schizophrenia onset after the exposure to cannabis (Can+) as compared to 12 patients with schizophrenia onset without cannabis exposure (Can−) and to 15 healthy controls. The CAR was assessed by collecting saliva samples at awakening and after 15, 30 and 60 min. As compared to healthy controls, Can+ schizophrenia patients exhibited significantly enhanced baseline saliva cortisol levels and a flattened CAR. No significant abnormality in both baseline cortisol levels and CAR was detected in Can− schizophrenia patients. These findings demonstrate a dysregulation of the HPA axis in chronic schizophrenic patients whose illness started after cannabis exposure but not in those with an illness onset without cannabis exposure. Further studies need to clarify whether this HPA dysregulation is a part of the biological background underlying the increased risk to schizophrenia after exposure to cannabis.     

Mindfulness-based relapse prevention for cannabis regular users: Preliminary outcomes of a randomized clinical trial

Mindfulness-based approaches have shown their effectiveness in caring for patients with substance use disorders (SUD). Mindfulness-based relapse prevention (MBRP) integrates practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. This article presents the preliminary results of a study that measures the effectiveness of an MBRP protocol for volunteer cannabis users willing to reduce or stop their consumptions. Twenty cannabis users were randomly assigned to either receive an eight-week outpatient MBRP program or treatment as usual (TAU). Cannabis use was assessed weekly through the timeline follow back (TLFB). Eighty percent of individuals received MBRP treatment and 60% of individuals received TAU completed treatment. Preliminary results did not find significant difference at the end of treatment (week 8) regarding the number of joints smoked. Despite the absence of any significant difference between the two groups, the contribution of mindfulness in the caring of SUD seems encouraging and promising. Many MBRP group participants reported qualitative changes in the way they consumed. This study will be continued in order to evaluate the effectiveness of MBRP on a larger number of subjects.     

Associations Between Past Alcohol,Cannabis, and Cocaine Use and Current Schizotypy Among First-Degree Relatives of Patients With Schizophrenia and Non-Psychiatric Controls

Associations between past use of alcohol, cannabis, and cocaine and various domains of schizotypy were examined in first-degree relatives of patients with schizophrenia and non-psychiatric controls. Substance use was operationalized in three ways: (1) having ever used the substance, (2) age at first use, and (3) past frequency/amount of use during three time periods in late adolescence/early adulthood. Schizotypy was assessed using the Schizotypal Personality Questionnaire (SPQ). Participants who had ever used cannabis had significantly higher cognitive-perceptual, interpersonal, and total schizotypy scores compared to those who had not. Younger age of alcohol use onset was associated with more schizotypy in adulthood, and younger age of first cannabis use was related to more interpersonal schizotypy. More frequent/heavier use of alcohol in the 25–29 age-range, and cannabis in early adulthood, were associated with more schizotypy. The use of addictive substances, particularly cannabis, is related to schizotypy in complex ways.