Scribd Logo
Upload

Welcome to Scribd!

  • 8 views

    Comment: Lancet Psychiatry 2019

    Uploaded by

    Alfredo Moreno
    Cannabis y psicosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Comment: Lancet Psychiatry 2019

    Uploaded by

    Alfredo Moreno
    8 views2 pages
    Cannabis y psicosis

    Original Title

    ComentarioPsicosisCanna

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Cannabis y psicosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    8 views2 pages

    Comment: Lancet Psychiatry 2019

    Uploaded by

    Alfredo Moreno
    Cannabis y psicosis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Comment

    Cannabis and psychosis: triangulating the evidence


    Disentangling causality where complex and confounded countries so could not be accounted for in this potency
    behaviours might be impacting on even more complex variable.

    Ted Kinsman/Science Source/SPL


    mental health outcomes is notoriously challenging, All study patients were diagnosed using the same
    and requires tackling the question in a number of ICD-10 criteria, meaning diagnoses were harmonised
    different ways to triangulate the evidence. Although and therefore directly comparable across sites. The
    observational epidemiology and experimental studies sample size was large, although when split across
    are broadly consistent in indicating a link between heavy the 11 sites it was reduced (15–201 cases per site),
    cannabis use and risk of psychosis,1 an often-mentioned meaning associations within individual sites might be Lancet Psychiatry 2019

    anomaly when considering the association is that while underpowered. The associations seen between cannabis Published Online
    March 19, 2019
    cannabis use has increased in some populations, the and psychosis were largely driven by daily cannabis http://dx.doi.org/10.1016/
    corresponding level of psychosis incidence has not. users, and particularly those daily users consuming high S2215-0366(19)30086-0
    See Online/Articles
    Marta Di Forti and colleagues2 explored this paradox in potency cannabis. In non-daily users, effect sizes did
    http://dx.doi.org/10.1016/
    more detail, examining detailed measures of cannabis not differ between the cannabis potency groups, and S2215-0366(19)30048-3
    use from 901 patients with first-episode psychosis and there was no evidence of an association between less-
    1237 controls across 11 sites in Europe. Additionally, than-weekly cannabis use and psychosis, regardless of
    they used cannabis data from their control sample to potency.
    assess the link between patterns of cannabis use in the As well as this individual level case-control study,
    region and data for psychosis incidence in that location Di Forti and colleagues also examined the relationship
    taken from the EU-GEI project. Their results suggest between incidence rates for psychotic disorder across 11
    that some of the variation in frequency of use and type of the different study sites, and cannabis use patterns in
    of cannabis used might be implicated in differing rates the control group sampled for their case-control study.
    of psychosis across the different locations, going against They found that for almost every site assessed in the
    the previously held notion. study, prevalence of daily cannabis use in the controls, or
    In recent years, attention has turned to the impact prevalence of high potency cannabis use, was correlated
    of various cannabinoids on risk of poor mental health. with incidence rates for psychosis in the location in
    In particular, there is some suggestion from short- question, although cannabis use sample sizes were very
    term experimental intoxication studies that ratios small (37–302 controls per site).
    of Δ⁹-tetrahydrocannabinol (THC) to cannabidiol Does this mean we can now be sure that (daily
    (CBD) could have an impact on risk of psychotic-like and high potency) cannabis use causes psychosis?
    experiences,3 with some emerging evidence even Unfortunately, not all the evidence utilising different
    suggesting that CBD might be anti-psychotic.4 Although methods is consistent about causality. For example,
    they were unable to directly measure cannabis potency, studies using genetic data have found evidence possibly
    Di Forti and colleagues created a cannabis potency consistent with shared genetic aetiology between risk of
    variable by using self-reported type of cannabis used psychosis and likelihood to use cannabis.6 Di Forti and
    combined with Europe-wide data published by the colleagues’ study asks participants about their cannabis
    European Monitoring Centre for Drugs and Drug use prior to their first episode psychosis diagnosis, but it
    Addiction on the concentration of THC in cannabis is possible that subclinical symptoms might have existed
    found in the countries under investigation. While this prior to cannabis initiation, meaning that associations
    approach is subject to some uncertainty, as levels of in the opposite direction cannot be ruled out.
    THC are not necessarily consistent within a country or It is perfectly possible that the association between
    even a region,5 and sample sizes were small, it is a novel cannabis and psychosis is bidirectional, as suggested
    and inventive way to account for levels of THC, and one by other work using genetic variables as proxies for the
    which is likely to be more accurate than only asking exposures of interest in a Mendelian randomisation
    participants to self-report the strength of their cannabis. design.7,8 Di Forti and colleagues’ study adds a new and
    Unfortunately, data for CBD were not available in most novel study design to the evidence available, which

    www.thelancet.com/psychiatry Published online March 19, 2019 http://dx.doi.org/10.1016/S2215-0366(19)30086-0 1


    Comment

    consistently indicates that for some individuals there 2 Di Forti M, Quattrone D, Freeman TP, et al, and the EU-GEI WP2 Group.
    The contribution of cannabis use to variation in the incidence of psychotic
    is an increased risk of psychosis resulting from daily disorder across Europe (EU-GEI): a multicentre case-control study.
    use of high potency cannabis. Given the changing legal Lancet Psychiatry 2019; published online March 19.
    http://dx.doi.org/10.1016/S2215-0366(19)30048-3.
    status of cannabis across the world, and the associated 3 Englund A, Morrison PD, Nottage J, et al. Cannabidiol inhibits THC-elicited
    paranoid symptoms and hippocampal-dependent memory impairment.
    potential for an increase in use, the next priority is to J Psychopharmacol 2013; 27: 19–27.
    identify which individuals are at risk from daily potent 4 McGuire P, Robson P, Cubala WJ, et al. Cannabidiol (CBD) as an adjunctive
    therapy in schizophrenia: a multicenter randomized controlled trial.
    cannabis use, and to develop educational strategies and Am J Psychiatry 2018; 175: 225–31.
    interventions to mitigate this. 5 Chandra S, Radwan MM, Majumdar CG, Church JC, Freeman TP, ElSohly MA.
    New trends in cannabis potency in USA and Europe during the last decade
    (2008–2017). Eur Arch Psychiatry Clin Neurosci 2019; published online Jan 22.
    Suzanne H Gage DOI:10.1007/s00406-019-00983-5.
    6 Verweij KJ, Abdellaoui A, Nivard MG, et al. Short communication:
    Department of Psychological Sciences, University of Liverpool, genetic association between schizophrenia and cannabis use.
    Liverpool L69 7ZA, UK Drug Alcohol Depend 2017; 171: 117–21.
    [email protected] 7 Gage SH, Jones HJ, Burgess S, et al. Assessing causality in associations
    between cannabis use and schizophrenia risk: a two-sample Mendelian
    I declare no competing interests. randomization study. Psychol Med 2017; 47: 971–80.
    Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open 8 Pasman JA, Verweij KJH, Gerring Z, et al. GWAS of lifetime cannabis use
    Access article under the CC BY 4.0 license. reveals new risk loci, genetic overlap with psychiatric traits, and a causal
    influence of schizophrenia. Nat Neurosci 2018; 21: 1161–70.
    1 Gage SH, Hickman M, Zammit S. Association between cannabis and
    psychosis: epidemiologic evidence. Biol Psychiatry 2016; 79: 549–56.

    2 www.thelancet.com/psychiatry Published online March 19, 2019 http://dx.doi.org/10.1016/S2215-0366(19)30086-0

    You might also like