Combined immunomodulating properties of 3,4-methylenedioxymethamphetamine (MDMA) and cannabis in humans

AIMS: Cell-mediated immune function and the occurrence of mild infectious diseases was investigated. Participants Polydrug consumers of 3,4-methylenedioxymethamphetamine (MDMA) and cannabis (n = 37) compared to cannabis users only (n = 23) and control group (n = 34). DESIGN: A longitudinal prospective study with three cross-sectional evaluations at time 0 and at 6 months and 1 year was performed. FINDINGS: At baseline, a significant decrease in interleukin (IL)-2 and an increase in anti-inflammatory transforming growth factor (TGF)-beta1, together with a decrease in the number of total lymphocytes, CD4 and natural killer (NK) cells were observed in the MDMA-cannabis group, with intermediate alterations in the cannabis group. Immune alterations observed at baseline were sustained over time. No differences were found between regular and occasional MDMA users. A significantly higher rate of mild infections in regular MDMA-cannabis users compared with occasional MDMA-cannabis users and the remaining groups was observed. CONCLUSIONS: The present data confirm that long-term alterations in immunological homeostasis may result in general health status impairment and subsequent increased susceptibility to infection and immune-related disorders.     

Motivational interviewing for cannabis users with psychotic disorders

BACKGROUND: People suffering from psychiatric disorders abuse alcohol or illicit substances twice as frequently as the general population. This problem is even more frequent in the early phase of psychotic disorders where prevalence of substance abuse ranges, according to various studies, from 35 to 65% during first psychotic episode. Cannabis is currently the most frequently used substance, and although its impact is often minimised, many data suggest it constitutes a risk for psychosis at three levels: (a) possible toxic psychosis in healthy individuals, (b) relapse of positive symptoms in schizophrenia and (c) raises the risk of schizophrenia when used early during adolescence. Despite a persistent controversy regarding some of these findings, they have constituted a sufficient body of evidence to support the development of specific interventions for psychotic patients. Various authors have described the fundamental elements of such dual diagnosis treatments, and some intervention programs have recently been developed. However, their relative complexity and the long duration of such interventions are often not well adapted to patients with limited motivation and low level of insight. Moreover, many obstacles arise that complicate their application to early psychotic disorders: minimisation of deleterious effect of cannabis by young people, distrust linked to psychotic symptoms, cognitive disturbances, stigmatisation of psychiatry, and use of cannabis as a means to socialise with peers. It is therefore important to adapt interventions to the specific needs of such patients and particularly to adopt a realistic attitude, aiming at increasing motivation to change habits and minimising associated risks rather than total abstinence. Our objective is to develop a pragmatic, non-judgemental approach, based on motivational interviewing techniques that is adapted to early psychosis with comorbid cannabis abuse, aimed at reducing the risks associated with abuse. In this article, we describe the basic principles and various stages of a brief motivational intervention developed for the treatment of cannabis abusers, going through the early phase of a psychotic disorder. The conceptualisation of the intervention was based on an extensive literature review and our experience in the treatment of such patients, as well as in the treatment of alcohol abuse through motivational interview. METHODS: Our intervention uses motivational interviewing techniques (empathic, non-judgemental approach, aimed at developing insight regarding potential consequences of cannabis abuse through the exploration of both its positive and negative aspects) and can be adapted to the patient's stage of motivation for change. Its basic principles are: (a) to address questions related to psychosis and cannabis simultaneously; (b) to take into account cognitive dysfunction related to illness and treatment; (c) to adapt techniques of reflective listening; and (d) to structure the interview through frequent summaries and by considering successively the positive and negative aspects of cannabis. The intervention is composed of four sessions: (1) creation of an alliance and evaluation of the level of cannabis abuse; (2) development of motivation to change by increasing contradictions between patient's affirmations; (3) definition of objectives according to the level of motivation to change; and (4) adaptation of the subsequent intervention according to the degree of motivation to change. RESULTS: A pilot study showed that this intervention can be implemented in the target population. It revealed that it facilitated the establishment of a trustful relationship, in the frame of which ambivalence regarding cannabis abuse could be explored. The fact that the therapist makes the first step, shows empathy and tries to understand patient's motivations to use cannabis, leads patients to expose their ambivalence with less reluctance and to become more aware of the possible links between cannabis and psychotic disorders. CONCLUSION: This method is particularly well adapted to patients who are in a precontemplative stage. Additional studies are needed in order to evaluate its efficacy in terms of decrease in the risks related to cannabis abuse.     

Predictors of acute treatment response in patients with a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables

Approximately 60% of patients with a first episode of psychosis will significantly reduce the severity of their positive symptomatology with antipsychotic drugs. The aim of this study was to investigate predictors of response to antipsychotic treatment during the first episode of non-affective psychosis. 172 patients (107 male) with a diagnosis of schizophreniform, schizophrenia, schizoaffective, brief reactive psychosis, schizotypal personality disorder or psychosis non-otherwise specified entered the study. Sociodemographic, premorbid and clinical data at baseline were evaluated. Unpaired t-test for continuous and chi2 for categorical data, respectively, were used to compare responders and non-responders selected variables. Multivariate logistic regression was used to establish a prediction model. 57.6% of study subjects (99 of 172) responded to antipsychotic treatment. The following variables were significantly associated with less likelihood of response: 1.--lower severity of general psychopathology, positive symptoms and disorganized symptoms at baseline; 2.--earlier age of onset; 3.--diagnosis of schizophrenia; 4.--longer DUP; 5.--poorer premorbid adjustment during adolescence, and 6.--hospitalization. Multivariate logistic regression demonstrated that differences between responders and non-responders were largely accounted for by BPRS total score, age of onset, premorbid adjustment at early adolescence, and diagnosis. Patients with an early age of onset of schizophrenia, a poor premorbid adolescent functioning, and with a lower severity of psychopathology at intake seem to have a decrease likelihood of responding to antipsychotic treatment. Helping clinicians to identify non-responders is meant as a first step to optimise therapeutic effort to benefit individuals in this vulnerable group.     

A comparison of the latent class structure of cannabis problems among adult men and women who have used cannabis repeatedly

BACKGROUND: Little empirical evidence exists to determine if there are alternative classification schemes for cannabis abuse and dependence beyond the definitions provided by Diagnostic and Statistical Manual (DSM) criteria. Current evidence is not conclusive regarding gender differences for cannabis use, abuse and dependence. It is not known if symptom profiles differ by gender. METHODS: Latent class analysis (LCA) was used to assess whether cannabis abuse and dependence symptom patterns suggest a severity spectrum or distinct subtypes and to test whether symptom patterns differ by gender. Data from 3312 men and 2509 women in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) who had used cannabis 12 + times life-time were included in the present analyses. The comparability of the solutions for men and women was examined through likelihood ratio chi(2) tests. RESULTS: Based on the Bayesian information criterion and interpretability, a four-class solution was selected, and the classes were labeled as 'unaffected/mild hazardous use', 'hazardous use/abuse', 'abuse/moderate dependence' and 'severe abuse/dependence'. The solutions were generally suggestive of a severity spectrum. Compared to men, women were more likely to be in the 'unaffected/mild hazardous use' class and less likely to be in the 'abuse/moderate dependence' or 'severe abuse/dependence' classes. The results were generally similar for men and women. However, men had consistently and substantially higher endorsements of hazardous use than women, women in the 'abuse/moderate dependence' class had moderately higher rates for four dependence symptoms, and women in two of the classes were more likely to endorse withdrawal. CONCLUSION: Our findings generally support the severity dimension for DSM-IV cannabis abuse and dependence symptomatology for both men and women. While our results indicate that public health messages may have generic and not gender-specific content, treatment providers should focus more effort on reducing hazardous use in men and alleviating withdrawal in women.     

Quantification of the influence of friends and antisocial behaviour in adolescent consumption of cannabis using the ZINB model and data mining

Cannabis is the most consumed illegal drug in Europe and its repercussions are more important when taken up at an early age. The aim of this study is to analyse and quantify the predictive value of different personal, family and environmental variables on the consumption of cannabis in adolescence. The sample is made up of 9284 adolescents (47.1% boys and 52.9% girls) with an average age of 15.59 years (SE=1.17). The ZINB model highlights, as factors that increase the number of joints consumed per week, consumption by the peer group, nights out during the week, gender, the production of forbidden behaviour and the use of other substances, whereas the risk factors for the consumption of cannabis are consumption by friends, ease of access, production of forbidden behaviour and the use of other substances. Association rules highlight the relationship between cannabis consumption, ease of access, production of forbidden behaviour and tobacco consumption. Finally, decision trees enable us to predict cannabis consumption as well as the number of joints an adolescent will consume per week based on the production of forbidden behaviour, consumption of other substances and number of friends who consume cannabis. The results of this work have practical implications concerning the prevention of cannabis consumption in an adolescent population.     

Comparison of clinical trial recruitment populations: treatment-seeking characteristics of opioid-, cocaine-, and cannabis-using participants

This study examined the treatment history and intention to seek treatment among 489 individuals interested in substance use disorder clinical trial participation. Opioid and cocaine users were more likely than cannabis users to report having received treatment for substance use in the past and more likely than cannabis users to report planning to seek treatment for substance use before exposure to recruitment advertising. Free cost was the aspect of clinical trial participation that most influenced the decision to make an intake evaluation appointment for opioid-dependent patients as compared with cocaine- and cannabis-dependent participants, and the availability of individual psychotherapy most influenced those who were cannabis dependent. Cannabis-dependent individuals evaluated for clinical trial participation reported that recruitment advertising was an important factor in leading them to seek treatment. These results have implications for clinical trial recruitment and public health efforts directed at encouraging cannabis-dependent individuals to seek treatment.     

Recessions and the participation of youth in the selling and use of illicit drugs

Background

There has been limited research on how recessions (or more generally, the strength of the economy) affect drug use and the related outcome of drug selling. This is especially important, given the current economic crisis. This paper aims to use a conceptual framework, previous research, and new research to predict how the current economic crisis may be affecting youth drug selling and drug use.

Methods

A conceptual framework to understand how a recession could affect youth drug selling and drug use is presented, along with a review of the literature on empirical investigations on how the strength of the economy affects these behaviours among teenagers. In addition, new analyses for young adults are presented.

Results

The conceptual framework postulates that a recession would have direct positive effects on the prevalence of youth drug selling but ambiguous direct effects on youth drug use. The conceptual framework also postulates that drug selling and drug use are inter-connected at the individual level and the aggregate level. Thus, any effect of a recession on one would likely affect the other in the same direction. The limited empirical evidence indicates that both drug selling and drug use among youth are higher when the economy is weaker.

Conclusions

The current economic crisis will likely increase both youth drug selling and drug use relative to what they would have otherwise been.     

麻仁软胶囊药理和临床研究进展

麻仁软胶囊具有润肠通便的功效,疗效确切。最新的临床研究证实麻仁软胶囊不仅能够改善功能性便秘患者肠道动力障碍,还能够软化粪便并促进结肠蠕动。肛肠科术后应用麻仁软胶囊可减少病人术后并发症的发生以及麻仁软胶囊与其他通便药联合应用还能治疗老年顽固性便秘,扩大了临床应用范围。现代药理学研究也证实火麻仁油具有抗氧化和延缓衰老的作用,研究麻仁软胶囊润肠通便是否对促进老年人新陈代谢、延缓衰老有积极作用将有助于实现通便药在抗衰老领域新突破。     

Reasons for substance use among people with mental disorders

Background

Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders.

Methods

Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression.

Results

Participants had a mean age of 38 (SD = 12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons.

Conclusions

It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.