Prospective Cohort Study

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.

The Self-medication Hypothesis of Substance Use Disorders: A Reconsideration and Recent Applications

Objective:Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Method:Electronic databases were searched up to June 2009 using variants of the key words “cognitive,” “training,” “remediation,” “clinical trial,” and “schizophrenia.” Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted th...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2010.10060855

A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes

Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies

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Beck Depression Inventory-IIについての一考察

Background. While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. 

Method. Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two.

Results. Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of 'important improvement' in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates.

Conclusions. Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.

/pdf/psychological-treatments-in-schizophrenia-i-meta-analysis-of-4uma3ynsqp.pdf

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

Aims Ketamine remains an important medicine in both specialist anaesthesia and aspects of pain management. At the same time, its use as a recreational drug has spread in many parts of the world during the past few years. There are now increasing concerns about the harmful physical and psychological consequences of repeated misuse of this drug. The aim of this review was to survey and integrate the research literature on physical, psychological and social harms of both acute and chronic ketamine use.

Method  The literature on ketamine was systematically searched and findings were classified into the matrix of Nutt et al.'s (2007) rational scale for assessing the harms of psychoactive substances.

Results  A major physical harm is ketamine induced ulcerative cystitis which, although its aetiology is unclear, seems particularly associated with chronic, frequent use of the drug. Frequent, daily use is also associated with neurocognitive impairment and, most robustly, deficits in working and episodic memory. Recent studies suggest certain neurological abnormalities which may underpin these cognitive effects. Many frequent users are concerned about addiction and report trying but failing to stop using ketamine.

Conclusions  The implications of these findings are drawn out for treatment of ketamine-induced ulcerative cystitis in which interventions from urologists and from addiction specialists should be coordinated. Neurocognitive impairment in frequent users can impact negatively upon achievement in education and at work, and also compound addiction problems. Prevention and harm minimization campaigns are needed to alert young people to these harmful and potentially chronic effects of ketamine.

Ketamine use: a review

Background. Social skills training and cognitive remediation are psychological techniques with considerable face validity for the treatment of negative symptoms of schizophrenia and their consequences. This paper provides a meta-analytical review of these treatments. It includes an appreciable number of randomized controlled trials, using comparisons against both standard care and other active interventions. However, the assessment of particular outcomes sometimes had to be based on single studies.Method. A detailed search strategy was used to identify randomized controlled trials of social skills training and cognitive remediation, primarily employing electronic databases. Randomized controlled trials (RCTs) that met predefined criteria were then subjected to meta-analysis on a variety of outcome measures.Results. There was no clear evidence for any benefits of social skills training on relapse rate, global adjustment, social functioning, quality of life or treatment compliance. Cognitive remediation had no benefit on attention, verbal memory, visual memory, planning, cognitive flexibility or mental state.Conclusions. Social skills training and cognitive remediation do not appear to confer reliable benefits for patients with schizophrenia and cannot be recommended for clinical practice.

/pdf/psychological-treatments-in-schizophrenia-ii-meta-analyses-464miqfure.pdf

Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation.

In an increasing number of states and countries, cannabis now stands poised to join alcohol and tobacco as a legal drug. Quantifying the relative adverse and beneficial effects of cannabis and its constituent cannabinoids should therefore be prioritized. Whereas newspaper headlines have focused on links between cannabis and psychosis, less attention has been paid to the much more common problem of cannabis addiction. Certain cognitive changes have also been attributed to cannabis use, although their causality and longevity are fiercely debated. Identifying why some individuals are more vulnerable than others to the adverse effects of cannabis is now of paramount importance to public health. Here, we review the current state of knowledge about such vulnerability factors, the variations in types of cannabis, and the relationship between these and cognition and addiction.

/pdf/keep-off-the-grass-cannabis-cognition-and-addiction-3sdfh2bwjp.pdf

Keep off the grass? Cannabis, cognition and addiction

Convergent evidence suggests a link between cannabis use and psychosis. 1 However, cannabis comprises a combination of cannabinoids and these different constituents may have distinct effects, not all of which are detrimental to mental health. The main component of smoked cannabis is D9-tetrahydrocannabinol (D9-THC), which is thought to be responsible for the majority of the psychotomimetic effects of the drug: it has been shown to elevate levels of anxiety and psychotic symptoms in healthy individuals. 2 In contrast, cannabidiol (CBD), another major constituent of some strains of cannabis, has been found to be anxiolytic and to have antipsychotic properties, 3,4 and may be neuroprotective in humans. 5 The ratio of these two compounds in smoked cannabis varies – there are higher levels of D9-THC in ‘skunk’ or genetically modified strains of the plant. 6 Cannabis users are often unaware of the ratio of CBD to D9-THC because CBD has no psychotomimetic effect in humans. 3 Elevated levels of psychosis proneness and delusions have been found in people who use cannabis regularly. 7 Despite suggestions about the different psychological properties of these two constituents of smoked cannabis, no prior research has examined the link between psychosis proneness and delusions and the CBD/D9-THC ratio in those who use cannabis. This study aimed to use hair analytic techniques to examine levels of D9-THC and CBD, and relate these objective indices of cannabis use to measures of psychosis proneness and delusional thinking.

/pdf/effects-of-cannabidiol-on-schizophrenia-like-symptoms-in-301ox515n8.pdf

Celia J. A. Morgan

Papers

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

Ketamine use: a review

Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation.

Keep off the grass? Cannabis, cognition and addiction

Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis