scholarly journals Cannabis Therapy Knowledge Study: Toward Establishing a Pedagogical Tool

2018 ◽  
Vol 8 (2) ◽  
pp. 19-22
Author(s):  
Ankur Shahi ◽  
Suzanne Allain ◽  
Shelley Turner ◽  
Kathleen Bailey
Keyword(s):  
Effective Treatment ◽  
Clinical Guidelines ◽  
Endocannabinoid System ◽  
Standard Of Care ◽  
Training Needs ◽  
Cannabis Use ◽  
Pedagogical Tool ◽  
Physician Knowledge ◽  
Treatment Plans

Upcoming legalization of cannabis calls for physicians to increase knowledge on medical and recreational cannabis use. We analyzed physician knowledge and opinions on i) mechanism of the endocannabinoid system, ii) current training with cannabis, iii) risks associated with cannabis use, iv) creating effective treatment plans using cannabis and v) future training needs. Physician knowledge and opinions on cannabis are limited and divided. Physicians support integration of cannabis training through webinars, in person training, peer reviewed literature and clinical guidelines. A curriculum must be developed for current and future physicians to create a standard of care as it relates to cannabis.

P.0171 The independent and joint effect of the endocannabinoid system and daily cannabis use on the risk of psychosis

2021 ◽  
Vol 53 ◽  
pp. S124
Author(s):  
D. Quattrone ◽  
E. Vassos ◽  
L. Ferraro ◽  
G. Tripoli ◽  
A. Quattrone ◽  
...  
Keyword(s):  
Endocannabinoid System ◽  
Joint Effect ◽  
Cannabis Use

The 2016 RANZCP Guidelines for the Management of Schizophrenia and Related Disorders – what’s next?

2017 ◽  
Vol 25 (6) ◽  
pp. 600-602 ◽  
Author(s):  
Assen Jablensky ◽  
David J Castle ◽  
Frances Dark ◽  
Verity Humberstone ◽  
Eoin Killackey ◽  
...  
Keyword(s):  
Mental Health ◽  
Scientific Evidence ◽  
Standard Of Care ◽  
Mental Health Research ◽  
Response To Treatment ◽  
Clinical Expertise ◽  
The Public ◽  
Measuring Outcomes ◽  
Treatment Plans ◽  
Personalised Treatment

Objectives: The recently published RANZCP guidelines for schizophrenia and related disorders reviewed recent scientific evidence, and, where lacking, referred to clinical expertise to supply a template for raising the standard of care. This paper builds on the guidelines and recommends how they might be used to improve outcomes. Methods: The guidelines call for evidence-based mental health policies, inclusive of mobilising affected families, communities and the public in support of policies that ensure better care and protect the wellbeing of people with severe mental disorders. The process of preparing the guidelines highlighted the limits of our scientific understanding of schizophrenia and shortcomings in the care currently provided. Results: Writing the guidelines evinced the need for a culture of measuring outcomes and response to treatment, and harnessing such data to monitoring and optimising patient care. Conclusions: We recommend creation of a national case cohort for mental health research involving a collaborative network of clinical research centres, using the guidelines and generating scientific evidence for translation into clinical practice protocols that enable personalised treatment plans for patients and criteria for the performance of clinical services.

scholarly journals Quantification of rhythm problems in disordered speech: a re-evaluation

2014 ◽  
Vol 369 (1658) ◽  
pp. 20130404 ◽  
Author(s):  
Anja Lowit
Keyword(s):  
Effective Treatment ◽  
Speech Disorders ◽  
Speech Impairment ◽  
Rhythm Perception ◽  
Speech Characteristics ◽  
Acoustic Characterization ◽  
Treatment Plans ◽  
Clinical Measures ◽  
Disordered Speech

Disordered speech can present with rhythmic problems, impacting on an individual's ability to communicate. Effective treatment relies on the availability of sensitive methods to characterize the problem. Rhythm metrics based on segmental durations originally designed for cross-linguistic research have the potential to provide such information. However, these measures may be associated with problems that impact on their clinical usefulness. This paper aims to address the perceptual validity of cross-linguistic metrics as indicators of rhythmic disorder. Speakers with dysarthria and matched healthy participants performed a range of tasks, including syllable and sentence repetition and a spontaneous monologue. A range of rhythm metrics as well as clinical measures were applied. Results showed that none of the metrics could differentiate disordered from healthy speakers, despite clear perceptual differences, suggesting that factors beyond segment duration impacted on rhythm perception. The investigation also highlighted a number of areas where caution needs to be exercised in the application of rhythm metrics to disordered speech. The paper concludes that the underlying speech impairment leading to the perceptual and acoustic characterization of rhythmic problems needs to be established through detailed analysis of speech characteristics in order to construct effective treatment plans for individuals with speech disorders.

The metabolic implications of long term cannabis use in patients with psychosis

2008 ◽  
Vol 17 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Farrah Mushtaq ◽  
Valeria Mondelli ◽  
Carmine M. Pariante
Keyword(s):  
Body Weight ◽  
General Population ◽  
Endocannabinoid System ◽  
Cannabis Use ◽  
Long Term Effects ◽  
Glucose Levels ◽  
High Prevalence ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

SummaryAimsThe aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported.Methods– A narrative review based on the recent literature regarding cannabis use in the gen-eral population and patients with psychosis.Results– The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the general population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is currently observed in this vulnerable patient group.Conclusions– It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.Declaration of Interest: None.

scholarly journals Cerebrospinal fluid anandamide levels, cannabis use and psychotic-like symptoms

2013 ◽  
Vol 202 (5) ◽  
pp. 381-382 ◽  
Author(s):  
Celia J. A. Morgan ◽  
Emma Page ◽  
Carola Schaefer ◽  
Katharine Chatten ◽  
Amod Manocha ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Lower Risk ◽  
Endocannabinoid System ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
Csf Levels ◽  
Drug Free

SummaryAnandamide is a ligand of the endocannabinoid system. Animals show a depletion following repeated Δ9-tetrahydrocannabinol (THC) administration but the effect of cannabis use on central nervous system levels of endocannabinoids has not been previously examined in humans. Cerebrospinal fluid (CSF) levels of the endocannabinoids anandamide, 2-arachidonoylglycerol (2-AG) and related lipids were tested in 33 volunteers (20 cannabis users). Lower levels of CSF anandamide and higher levels of 2-AG in serum were observed in frequent compared with infrequent cannabis users. Levels of CSF anandamide were negatively correlated with persisting psychotic symptoms when drug-free. Higher levels of anandamide are associated with a lower risk of psychotic symptoms following cannabis use.

The impact of multidisciplinary cancer conferences (MCC) on the treatment of metastatic rectal cancer (MRC) at the Ottawa Hospital Cancer Centre (TOHCC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14686-e14686
Author(s):  
Tanya Di Valentin ◽  
Timothy R. Asmis ◽  
Rebecca Ann C. Auer
Keyword(s):  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Ottawa Hospital ◽  
Patient Demographics ◽  
Relative Risks ◽  
Included Patient ◽  
Treatment Plans ◽  
The Impact

e14686 Background: There is significant controversy surrounding the management of surgically resectable MRC. The use and timing of neoadjuvant chemotherapy, pelvic radiation, and relative risks and benefits of a combined surgical resection are areas of debate among surgeons, medical, and radiation oncologists. The TOHCC multidisciplinary Cancer Conferences (MCC) provide an opportunity to discuss these cases and propose treatment plans for these patients. Methods: We conducted a retrospective chart review of all the cases of MRC which were discussed at MCC at the TOHCC from November 2007 until October 2009. Information collected included patient demographics, site of metastases, the treatment they received prior to their case being discussed at MCC (past surgeries, chemotherapy, radiotherapy), the treatment plan discussed at MCC, treatment actually administered post MCC discussion, and patient outcome at 6 months. Results: Forty-two patients with MRC were reviewed. The most common sites of metastases were liver (45.2%) and lung (31%). Once diagnosed with metastatic disease, prior to the MCC, patients had received the following treatments alone or in combination: chemotherapy (33.3%), radiotherapy (21.4%), surgery (19.0%), no treatment (n=57.1%). After their case was presented, 38 patients (90.5%) received the treatment recommended at the MCC , while 4 (9.5%) did not. Treatment post MCC included: chemotherapy (neoadjuvant: 38.1%; adjuvant: 23.8%; palliative: 28.6%), radiotherapy (neoadjuvant: 14.3%; adjuvant: 7.1%; palliative: 7.1%) and surgery (31.0%). Conclusions: There is no standardized approach to the management of MRC. Given its complexity, many cases are reviewed at MCC, which allow coordination for multidisciplinary care of these patients. The results of this study suggest that in a majority of cases, the recommendations brought forth at MCC are indeed acted upon. Given that these meetings have a significant impact on the treatment plan and outcome of patients with MRC, they should represent the standard of care when treating this disease.

Professional Standards, Clinical Guidelines and Medical Liability: A Chance for Significant Improvement in Determining the Standard of Care?

2018 ◽  
Vol 25 (2) ◽  
pp. 157-176
Author(s):  
Athanasios Panagiotou
Keyword(s):  
Clinical Guidelines ◽  
Medical Malpractice ◽  
Standard Of Care ◽  
Medical Liability ◽  
Quality And Safety ◽  
European Level ◽  
Safety Standards ◽  
The Core ◽  
Cross Border

Abstract Despite the proposals to jettison fault/negligence as the fundamental criterion of imputation of medical liability, it remains at the core of most legal systems. At European level, the rise of cross-border healthcare has brought the issue of redress for medical malpractice and the need to enhance quality of care through the adoption of quality and safety standards to the fore. Furthermore, the necessity of best available external evidence to inform approaches to individual patient care is gradually acknowledged. In addition, clinical guidelines become an increasingly familiar part of clinical practice. Hence, the debate on their usefulness in medical malpractice cases has attracted significant scholarly attention. Despite their superficial attractiveness, clinical guidelines present core problems, which currently make them unsuitable as a determinant of the standard of care. The article concludes that, unless these issues are resolved, the usefulness of clinical guidelines in medical liability will be debatable.

scholarly journals Endocannabinoid Modulation Using Monoacylglycerol Lipase Inhibition in Tourette Syndrome: A Phase 1 Randomized, Placebo-Controlled Study

2021 ◽  
Author(s):  
Kirsten R. Müller-Vahl ◽  
Carolin Fremer ◽  
Chan Beals ◽  
Jelena Ivkovic ◽  
Henrik Loft ◽  
...  
Keyword(s):  
Single Dose ◽  
Tourette Syndrome ◽  
Phase 1 ◽  
Neurodevelopmental Disorder ◽  
Endocannabinoid System ◽  
Standard Of Care ◽  
Controlled Study ◽  
Monoacylglycerol Lipase ◽  
Positive Effects ◽  
Before And After

Abstract Introduction Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by chronic motor and vocal tics. While consistently effective treatment is lacking, evidence indicates that the modulation of endocannabinoid system is potentially beneficial. Lu AG06466 (previously ABX-1431) is a highly selective inhibitor of monoacylglycerol lipase, the primary enzyme responsible for the degradation of the endocannabinoid ligand 2-arachidonoylglycerol. This exploratory study aimed to determine the effect of Lu AG06466 versus placebo on tics and other symptoms in patients with TS. Methods In this phase 1b cross-over study, 20 adult patients with TS on standard-of-care medications were randomized to a single fasted dose of Lu AG06466 (40 mg) or placebo in period 1, followed by the other treatment in period 2. The effects on tics, premonitory urges, and psychiatric comorbidities were evaluated using a variety of scaled approaches at different time points before and after treatment. Results All scales showed an overall trend of tic reduction, with two out of three tic scales (including the Total Tic Score of the Yale Global Tic Severity Score) showing a significant effect of a single dose of Lu AG06466 versus placebo at various timepoints. Treatment with Lu AG06466 resulted in a significant reduction in premonitory urges versus placebo. Single doses of Lu AG06466 were generally well-tolerated, and the most common adverse events were headache, somnolence, and fatigue. Conclusion In this exploratory trial, a single dose of Lu AG06466 showed statistically significant positive effects on key measures of TS symptoms.

scholarly journals CNR2 GENE AND CANNABIS USE INTERPLAY MODULATES MANIPULATIVE ABILITIES IN FIRST-EPISODE OF PSYCHOSIS

2021 ◽  
Author(s):  
Maitane Oscoz Irurozqui ◽  
Maria Guardiola-Ripoll ◽  
Carmen Almodóvar-Payá ◽  
Amalia Guerrero-Pedraza ◽  
Edith Pomarol-Clotet ◽  
...  
Keyword(s):  
Cannabinoid Receptor ◽  
Clinical Symptoms ◽  
Endocannabinoid System ◽  
Cognitive Outcomes ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
First Episode ◽  
The Matrix ◽  
General Functioning ◽  
Matrix Reasoning

1. Objectives: While endocannabinoid system seems to be involved in processes underlying psychosis, research about Cannabinoid Receptor 2 gene (CNR2) is scarce and inconclusive. Some few reports indicate that CNR2 plays a role in psychiatric conditions, including depression or drug addiction (Onaivi et al., 2009). We aimed to evaluate the role of CNR2 and its interplay with cannabis on cognition and clinical symptoms in patients with a first-episode of psychosis (FEP). 2. Materials and Methods: the sample comprised 50 Caucasian individuals with a FEP (mean age(sd)=26.14(6.55) years, 76% males, 58% cannabis users). There were no differences in age, sex, premorbid IQ and antipsychotic dose between cannabis users (CU) and non-users (CNU). Neuropsychological (premorbid IQ - TAP-E, current IQ - WAIS, memory - WMS, executive function - BADS) and clinical (psychotic symptoms - PANSS, general functioning - GAF) scales were administered. Genetic variability was assessed by genotyping one Single Nucleotide Polymorphism (SNP) in CNR2 gene (rs2501431) (qPCR, TaqMan). 3. Results and conclusions: genotypic frequencies did not differ between cannabis users and non-users. CNR2 was not associated with PANSS scores.; however, it showed a differential effect on the performance IQ (measured by the matrix reasoning test - WAIS), conditional to the cannabis use (beta=0.73, p=0.02),. In particular, cannabis non-users with the AA genotype (23.53%) showed higher scores (mean(sd)=10.25 (1.87)) than those with at least one copy of the G allele (76.47%, mean(sd)=6.05(0.99); while cannabis users showed scores in the opposite direction (AA (42.31%): 8.21(1.09) and GG/GA (57.69%): 10.28(0.92)). Our results align with previous studies reporting the association of the CNR2 gene with psychiatric diseases (Ishiguro et al. 2007; Onaivi et al., 2008) adding evidence on the interplay of this gene with cannabis use on cognitive outcomes in first-episode psychosis. However, evidence is still scant, and further investigation in larger samples is needed.

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