Research Note: Adolescents’ Perception of Psychosis Risk Following Cannabis Consumption

Cannabis consumption during adolescence has been associated with the onset of psychosis. In 2010, we examined adolescents’ perception of this association. Adolescents (N = 583) from four Romanian urban high schools filled in psychosis proneness scales according to the risk they assigned to hypothetical adolescents described in vignettes. Target adolescent's frequency and age of first consumption were manipulated. Analysis of variance indicated a main effect of target's consumption frequency, but no effect of age of first consumption on psychosis risk perception. Participants’ own consumption status acted as moderator. Results highlight the discrepancy between clinical research results and adolescents’ perception of psychosis risk. The study's limitations are noted.     

Changes in the “Get-Off”: Social Process and Intervention in Risk Locales

Because of ongoing resistance in Florida's legislature to interventions involving exchanges of sterile syringes for contaminated ones, Miami/Dade County's population of injection drug users (IDUs) reduce risk of HIV and hepatitis C infection by buying illegal syringes, participating in illegal syringe exchanges, or decontaminating their paraphernalia. Although it is completely legal, wherewithal for decontamination of injection paraphernalia, including sodium hypochlorite (laundry bleach), water, and cotton for filtering drugs, only appears sporadically in Miami/Dade's risk locales (called “get-off” houses). To ensure consistent decontamination, our intervention instituted regular delivery of these goods to known risk locales. In addition, personnel in half of the locales received training in techniques for optimal decontamination. RNA polymerase chain reaction measured impact of this intervention in terms of viral load found on harvested paraphernalia. Regular delivery of cleansing paraphernalia provided opportunities for observation and characterization of adaptations among people who run risk locales. These people may lead highly stable lives or highly changeable ones, but in most cases their roles as regular hosts of injection activities continue with only brief hiatuses due to incarceration, eviction, or familial dissolution. Proprietors of risk locales maintain their roles as facilitators of self-injection because they use that role to make money or to obtain opportunities to inject drugs and also because their clientele demands they continue.     

Negative Prognostic Effect of Baseline Antipsychotic Exposure in Clinical High Risk for Psychosis (CHR-P): Is Pre-Test Risk Enrichment the Hidden Culprit?

IntroductionSample enrichment is a key factor in contemporary early-detection strategies aimed at the identification of help-seekers at increased risk of imminent transition to psychosis. We undertook a meta-analytic investigation to ascertain the role of sample enrichment in the recently highlighted negative prognostic effect of baseline antipsychotic (AP) exposure in clinical high-risk (CHR-P) of psychosis individuals.MethodsSystematic review and meta-analysis of all published studies on CHR-P were identified according to a validated diagnostic procedure. The outcome was the proportion of transition to psychosis, which was calculated according to the Freeman‐Tukey double arcsine transformation.ResultsThirty-three eligible studies were identified, including 16 samples with details on AP exposure at baseline and 17 samples with baseline AP exposure as exclusion criterion for enrollment. Those with baseline exposure to AP (n = 395) had higher transition rates (29.9%; 95% CI: 25.1%–34.8%) than those without baseline exposure to AP in the same study (n = 1289; 17.2%; 15.1%–19.4%) and those coming from samples that did not include people who were exposed to AP at baseline (n = 2073; 16.2%; 14.6%–17.8%; P < .05 in both the fixed-effects and the random-effects models). Heterogeneity within studies was substantial, with values above 75% in all comparisons.ConclusionsSample enrichment is not a plausible explanation for the higher risk of transition to psychosis of CHR-P individuals who were already exposed to AP at the enrollment in specialized early-detection programs. Baseline exposure to AP at CHR-P assessment is a major index of enhanced, imminent risk of psychosis.     

Carbohydrate Reward and Psychosis: An Explanation For Neuroleptic Induced Weight Gain and Path to Improved Mental Health?

Evidence links dopamine release in the mid-brain to the pathophysiology of psychosis, addiction and reward. Repeated ingestion of refined carbohydrate may stimulate the same mesolimbic dopaminergic pathway, rewarding such eating behaviour and resulting in excessive food intake along with obesity. In this paper, we explore the role of dopamine in reward and psychosis, and discuss how reward pathways may contribute to the weight gain that commonly follows antipsychotic drug use, in people with psychotic illness. Our theory also explains the frequent co-occurrence of substance abuse and psychosis. From our hypothesis, we discuss the use of carbohydrate modified diets as an adjunctive treatment for people with psychosis.     

Diabetes and Cardiovascular Risk: Are Dipeptidyl Peptidase-4 Inhibitors Beneficial?

Cardiovascular (CV) disease is a major cause of morbidity and mortality in patients with diabetes. Whereas the link between glycemic control and reducing microvascular disease is firmly established, the evidence for macrovascular risk reduction remains unclear. Despite a host of available drugs for lowering serum glucose, none to date have been shown to substantially reduce CV risk and some have been associated with adverse effects. Recent trials have examined the CV effects of the dipeptidyl peptidase 4 (DPP-4) inhibitors or “gliptins.”Type 2 diabetes affects an estimated 25.8 million individuals in the United States.¹ Almost 2 million new cases were diagnosed in 2010 among adults 20 years of age and older. Data from the US Health and Nutritional Examination Survey (NHANES) indicate that the prevalence of diabetes increased dramatically from an estimated 6.2% for 1988-1994 to an estimated 9.9% for 2005-2010.²Diabetes is associated with accelerated atherosclerosis and is often considered to be a “coronary equivalent.” The overall risks of cardiovascular disease (CVD) and stroke are 2 to 4 times higher in individuals with diabetes compared to nondiabetics.¹ Despite the availability of numerous therapeutic agents with proven efficacy for lowering blood glucose, none have been shown to substantially reduce CV risk. Even more concerning is the fact that a number of these drugs have been associated with detrimental effects. For example, thiazolidinediones including rosiglitazone and pioglitazone, have been associated with an increased risk of heart failure resulting in a black box warning.³ Rosiglitazone has previously been associated with a potential increased risk of myocardial infarction and, although many of the restrictions on its use have now been removed, the US Food and Drug Administration (FDA) continues to monitor.^4,5Because CVD is a leading cause of death among diabetics, the development of additional antihyperglycemic drugs has provided an opportunity to determine the relative CV risk associated with these drugs. With this in mind, the FDA issued a 2008 guidance that manufacturers of new diabetes drugs should conduct studies to evaluate CV safety.⁶ The newest class of glucose-lowering drugs to undertake this assessment of CV risk is the dipeptidyl peptidase 4 (DPP-4) inhibitors. This article will discuss the findings from 2 recent clinical trials assessing the CV risk of these agents and the ongoing issues related to preventing macrovascular complications in patients with diabetes.     

How Is Substance Use Linked to Psychosis? A Study of the Course and Patterns of Substance Dependence in Psychosis

ABSTRACT

Substance use in mentally ill patients is now a major problem that influences the course and outcome of psychosis. With prevalence ranging up to 60%, several theories were postulated to explain the link. It would be interesting to know if substances have different effects in persons with psychosis than in those without. This study aimed to explore patterns of symptomatology of dependence and comorbid psychiatric illness by comparing and contrasting it with a group suffering from pure substance dependence. Consecutively admitted patients who were matched for age, sex, and tobacco use were divided into 3 groups. These were substance dependence without any comorbid psychiatric disorder (SD; n = 32), schizophrenia with substance dependence (SC; n = 31), and bipolar disorder with substance dependence (BD; n = 31). Patients were administered the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and Mini International Neuropsychiatric Inventory (MINI) to evaluate the chronology of criterion of International Classificiation of Diseases (ICD)-10 dependence. Results showed that cannabis was the most common substance used by both the SC (100%) and BD (80%) groups. This was followed by alcohol as the most common substance used, with prevalence of 87% in SC and 77% in BD groups. There was a significant difference in the pattern of use of cannabis in patients with psychosis, who developed tolerance much faster (P = .018) and had longer durations of cannabis use (P = .001) than the SD group. The presence of “loss of control” over drug use criterion seems to be a specific marker predicting development of dependence and psychosis. Cannabis use is more strongly associated with development of psychosis than any other substance.     

Social support and self-efficacy for abstinence: is peer identification an issue?

This study investigated levels of abstinence social support and abstinence self-efficacy in relation to characteristics among recovering substance abusers (57 men, 43 women) residing in Oxford Houses. Significant relationships between treatment and sociodemographic variables were observed on measures of abstinence social support and abstinence self-efficacy. Residence time in an Oxford House and 12-step participation were related to increased levels of abstinence social support and abstinence self-efficacy. However, residents who reported that their veteran status or prior incarceration experiences were issues they perceived as making identification with other recovering peers difficult reported lower levels of abstinence social support. In addition, residents who reported having at least one identification issue (57%) and residents who reported being a parent (73%) also reported lower levels of abstinence self-efficacy. Results of this study have important treatment implications for our understanding of social support and self-efficacy within ongoing recovery.     

Risk assessment of toxaphene and its breakdown products: time for a change?

Technical toxaphene (TT) was last used in commerce in about 1982. Any environmental exposure to toxaphene in this century is to environmentally degraded forms of toxaphene, termed weathered toxaphene. Several hundred chlorinated bornane congeners have been identified in technical toxaphene. The degradation of technical toxaphene to weathered toxaphene can result in various congener mixtures, but the primary mode of degradation is dechlorination. The U.S. Environmental Protection Agency (EPA) presently estimates the risk of exposure to toxaphene by relying upon rat and mouse toxicology studies performed on technical toxaphene. No adjustment is made for the dechlorination of toxaphene in the environment. The European Union (EU), however, has modeled toxaphene risks from eating fish with chlorinated bornane residues through a series of studies on toxaphene degraded by either ultraviolet light, or biodegradation in fish. The EU risk assessment relies upon rat liver studies in vivo and mouse in vitro studies on the inhibition of gap junction intercellular communication (GJIC). This article reviews the current state of knowledge of technical and weathered toxaphene toxicology. We discuss the various current methods and opportunities to advance the risk assessment of weathered toxaphene beyond the existing U.S. EPA assessment of technical toxaphene.     

Risk Assessment of Toxaphene and its Breakdown Products: Time for a Change?

Technical toxaphene (TT) was last used in commerce in about 1982. Any environmental exposure to toxaphene in this century is to environmentally degraded forms of toxaphene, termed weathered toxaphene. Several hundred chlorinated bornane congeners have been identified in technical toxaphene. The degradation of technical toxaphene to weathered toxaphene can result in various congener mixtures, but the primary mode of degradation is dechlorination. The U.S. Environmental Protection Agency (EPA) presently estimates the risk of exposure to toxaphene by relying upon rat and mouse toxicology studies performed on technical toxaphene. No adjustment is made for the dechlorination of toxaphene in the environment. The European Union (EU), however, has modeled toxaphene risks from eating fish with chlorinated bornane residues through a series of studies on toxaphene degraded by either ultraviolet light, or biodegradation in fish. The EU risk assessment relies upon rat liver studies in vivo and mouse in vitro studies on the inhibition of gap junction intercellular communication (GJIC). This article reviews the current state of knowledge of technical and weathered toxaphene toxicology. We discuss the various current methods and opportunities to advance the risk assessment of weathered toxaphene beyond the existing U.S. EPA assessment of technical toxaphene.     

The Genomic Revolution: What Does it Mean for Human and Ecological Risk Assessment?

The first sequencing of a complete organism genome occurred in 1995. Since then there has been an explosion of information, with a new organism being sequenced nearly every week. This rapid development of genomics is providing unparalleled opportunities in toxicology, ecology, and risk assessment. This paper provides an overview of some possible applications of this new information in ecological and human risk assessment.     

Early Adolescents’ Substance Use and Life Stress: Concurrent and Prospective Relationships

Life stress during early adolescence has been linked to substance use. Few studies have investigated whether the amount of control the child has over stress moderates this relationship even though the role of personal control is of increasing theoretical importance. Relationships between controllable and uncontrollable life stress and substance use were investigated in 303 urban, African-American fourth and fifth graders (152 males, 151 females). Controllable life stress contributed to six regression equations predicting children's substance use both cross-sectionally and longitudinally, even when selected demographic and personal variables were controlled. Evidence supporting a similar role for uncontrollable life stress was not found.

Existen investigaciones que demuestran la relación eatre el estré. de vida durante la adolescencia y el consumo de sustancias adictivas. Son escasos los estudios que han explorado si la cantidad de control que el niño tiene sobre el estrés modera esta relación, si bien el papel del control personal está adquiriendo importancia teórica.

En el presente trabajo se investigaron las relaciones entre el estrés de vida controlable e incontrolable y el consumo de sustancias adictivas en 303 estudiantes afro-americanos de cuarto y quinto curso de enseñanza elemental en una zona urbana (152 niños, 151 niñas). El estrés de vida controlable contribuyó a la obtención de seis ecuaciones de regresión que predicen el uso infantil de sustancias adictivas tanto a través de las distintas secciones como longitudinalmente, incluso cuando se tuvieron en cuenta determinadas variables demogràficas y personales. No se halló evidencia que apoye un papel similar en el caso del stress de vida incontrolable.

II a été établi un rapport entre la pression de la vie et l'abus occasionel de substances au début de l'adolescence. Alors que le rôle du contrôle personnel devient de plus en plus important théoriquement, peu d'études ont examiné si le contrôle qu'un enfant exerce sur la pression de la vie diminue ce rapport. Les rapports entre la pression de la vie contrôlable et la pression de la vie incontrôlable avec l'abus occasionel de substances ont été étudiés chex 303 Africains Américains, citadins, écoliers de quartriéme et cinquiéme grade (152 garcons, 152 filles). La pression de la vie contrôlable contribue á six éequations de régression prévoyant un abus occasionel de substance des enfants aussi bien sur un énchantillon que longitudinalement maˇme quand les variables démographique et personnelles sont controlées. II n'a pas été trouvé de preuves en faveur d'un rôle identique de la pression de la vie incontrôlable.     

What Is Diversion of Supervised Buprenorphine and How Common Is It?

ABSTRACT

This study aimed to identify the practices of community pharmacists regarding the provision of buprenorphine for opioid dependence and explore behaviors pharmacists considered indicative of buprenorphine diversion. A cross-sectional survey of 669 community pharmacists authorized to dispense buprenorphine or methadone was conducted in New South Wales and Victoria, Australia. There was wide variation between pharmacies in the level of supervision provided during supervised buprenorphine dosing and a lack of clarity between pharmacists regarding what behaviors are examples of buprenorphine diversion. Compared to New South Wales, a higher proportion of Victorian pharmacists detected 1 or more episodes of buprenorphine diversion in the past year (65% vs. 28%; p < .001) and in the past month (20% vs. 7%; p < .001). Detection of buprenorphine diversion was associated with the administration of crushed tablets (odds ratio = 2.77), broken tablets (odds ratio = 2.69), and having more buprenorphine clients (odds ratio = 1.24). Future research investigating the prevalence of buprenorphine diversion should include a clear definition of what behaviors constitute diversion.     

Young Urban Adolescents' Activity Spaces,Close Peers,and the Risk of Cannabis Use: A Social–Spatial Longitudinal Analysis

Background: An understudied, yet important area of youth development research is the examination of how place affects critical psychosocial processes such as identity formation, problem solving, emotional regulation, and in particular with adolescents, belongingness, autonomy, social competency, and behavioral health. A growing spatially informed literature indicates that youth interact with meaningful places as environmental strategies, shaping developmental trajectories related to behavioral health. Objectives: The objective is to investigate the relationship between place preference and health behavior among adolescents, with a focus on substance use behavior, specifically, cannabis use. We theorize that cannabis use is associated with place preference for urban, city types of places, and that this particular place preference interacts with close peer network behaviors. Methods: To understand the role of preferred locations, close peer relations, and mental health on cannabis use, 248 adolescents (ages 13 to 14) were studied longitudinally. Logistic regression models tested the moderating effects of peer network health (sum of close friends risk and protective behaviors) on selecting city locations (urban stress/neighborhoods) as preferred places, and subsequent cannabis use. Results: Results indicated that peer network health moderated the effects of choosing city locations as favorite, increasing the odds of cannabis use more than eight-fold at 24 months. Conclusions: Favorite places located in city environments appear to interact with peer risk behaviors influencing the cannabis use of young urban adolescents, even after controlling for the influence of baseline cannabis use, neighborhood disorder the home neighborhood, age, gender, and mental health effects.     

Amygdala–Hippocampal Connectivity Changes During Acute Psychosocial Stress: Joint Effect of Early Life Stress and Oxytocin

Previous evidence shows that acute stress changes both amygdala activity and its connectivity with a distributed brain network. Early life stress (ELS), especially emotional abuse (EA), is associated with altered reactivity to psychosocial stress in adulthood and moderates or even reverses the stress-attenuating effect of oxytocin (OXT). The neural underpinnings of the interaction between ELS and OXT remain unclear, though. Therefore, we here investigate the joint effect of ELS and OXT on transient changes in amygdala-centered functional connectivity induced by acute psychosocial stress, using a double-blind, randomized, placebo-controlled, within-subject crossover design. Psychophysiological interaction analysis in the placebo session revealed stress-induced increases in functional connectivity between amygdala and medial prefrontal cortex, posterior cingulate cortex, putamen, caudate and thalamus. Regression analysis showed that EA was positively associated with stress-induced changes in connectivity between amygdala and hippocampus. Moreover, hierarchical linear regression showed that this positive association between EA and stress-induced amygdala–hippocampal connectivity was moderated after the administration of intranasal OXT. Amygdala–hippocampal connectivity in the OXT session correlated negatively with cortisol stress responses. Our findings suggest that altered amygdala-hippocampal functional connectivity during psychosocial stress may have a crucial role in the altered sensitivity to OXT effects in individuals who have experienced EA in their childhood.     

Spiritual Struggles and Problem Drinking: Are Younger Adults at Greater Risk than Older Adults?

Background: Although a good deal of research has assessed the positive effects that involvement in religion has on alcohol use, there is relatively little research on the negative aspects of religious life and alcohol problems. Objectives: This study has two objectives. The first is to see if spiritual struggles are associated with problem drinking. The second is to see if the relationship between spiritual struggles and problem drinking is stronger for younger than for older adults. Methods: The data come from a recent nationwide survey of adults of all ages who reside in the United States (N = 2142).The study was conducted in 2014. Problem drinking is assessed with the CAGE questionnaire. Results: The findings indicate that people who encounter more spiritual struggles are more likely to experience problem drinking. The relationship between spiritual struggles and problem drinking was stronger than the relationship between three other frequently used measures of religion and problem drinking (i.e., attendance at worship services, private prayer, and affiliation with Evangelical denominations). The results further reveal that spiritual struggles are associated with a greater risk of drinking problems among younger than among older individuals. Conclusions/Importance: Although many studies show that various facets of religion are associated with a lower risk of experiencing problems with alcohol the findings from the current study show that there are negative aspects of religious life that may be associated with a greater risk of having problems with alcohol.     

Uruguayan Cannabis Social Clubs: From activism to dispensaries?

BackgroundIn 2013 Uruguay regulated three models for the supply of cannabis for recreational use (Law 19.172), including Cannabis Social Clubs (CSCs). According to the Cannabis Regulation and Control Institute, 110 CSCs are active at the time of writing.ObjectivesThis paper has a twofold goal. Firstly, it aims to take stock of how the CSC model has continued to be implemented in practice, drawing on the first-hand accounts of those involved in its management. Secondly, our analysis seeks to contribute to the understanding of the CSC model by considering the different variants of the model that have emerged in Uruguay.MethodologyOur analysis draws on qualitative research conducted in Uruguay between June and October of 2018. We conducted 15 semi-structured and face-to-face interviews with representatives of registered Uruguayan CSCs and with 13 other stakeholders.Results/conclusionsCSCs’ role as cannabis suppliers is perceived positively in terms of the type of cannabis produced and the means of distribution. We found that truly social CSCs co-exist with, and may be losing ground to, quasi-dispensary clubs. A number of factors may have contributed to this, including the Uruguayan regulatory framework, institutional context, and disengagement of members and/or CSC managers. This raises potential new challenges as to the contribution of the CSC model from a harm reduction perspective.     

Common noncompartmental pharmacokinetic variables: are they normally or log-normally distributed?

We investigated the hypothesis that distributions of continuous pharmacokinetic variables are positively skewed in nature and that logarithmic transformation of these variables restores normality. The distributions of conmion continuous noncompartmental pharmacokinetic variables were investigated for four different Glaxo Wellcome compounds, administered by three different routes of administration: ranitidine (po), sumatriptan (sc), ondansetron (iv), and bismuth, from ranitidine bismuth citrate (po). The distributions of all the investigated noncompartmental pharmacokinetic variables were adequately described by a log-normal distribution, whereas statistically significant departures from normality occurred in the majority of cases. Thus, unless there is strong and consistent evidence for a departure from log-normality, the parametric statistical analysis of common noncompartmental pharmacokinetic variables should be carried out a priori log transformation.