Cannabis Use in Patients with a First Psychotic Episode and Subjects at Ultra High Risk of Psychosis: Impact on Psychotic- and Pre-Psychotic Symptoms

Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis. Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake. Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder. Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current sample, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.

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Ultra-high risk psychosis. A case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1335 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S730-S731

Author(s):

G. Pardo de Santayana ◽

R. Landera ◽

M. Juncal ◽

O. Porta ◽

M. Gómez ◽

...

Keyword(s):

High Risk ◽

Prophylactic Treatment ◽

Therapeutic Option ◽

Adjustment Disorder ◽

Borderline Personality ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Ultra High Risk ◽

Competing Interest ◽

Near Future

IntroductionThere is much debate on whether patients who are at high risk of developing a psychotic disorder in the near future (such as patients suffering of attenuated psychotic symptoms, brief limited intermittent psychotic symptoms or personality trait vulnerability) should be treated with antipsychotic drugs to prevent possible psychotic breaks from happening.AimTo review articles from the existing medical literature about treatment of patients in ultra-high risk of developing psychosis.MethodsWe describe the case of a 19-year-old male who was hospitalized after a suicide attempt in April 2015. He had been diagnosed of different psychiatric disorders such as mixed anxiety-depressive disorder, adjustment disorder and probable borderline personality disorder. During his stay at the hospital, we observed that he had schizoid personality traits. In the initial anamnesis, he denied ever having psychotic symptoms, but a few days later he admitted that the previous year he suffered throw a period of brief self-limiting psychotic symptoms.ResultsProphylactic treatment was started with oral aripiprazole 15 mg/day, which was well tolerated by the patient. He has been free of psychotic symptoms for the last 17 months (from April 2015 to September 2016). No relevant side effects were detected.ConclusionsOral aripiprazole 15 mg/day can be a good therapeutic option in patients at ultra-high risk of developing a psychotic episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Obstetric Complications and Transition to Psychosis in an ‘Ultra’ High Risk Sample

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2005.01604.x ◽

2005 ◽

Vol 39 (6) ◽

pp. 460-466 ◽

Cited By ~ 1

Author(s):

Yang Yun ◽

Lisa J. Phillips ◽

Sue Cotton ◽

Alison R. Yung ◽

Shona M. Francey ◽

...

Keyword(s):

Risk Factor ◽

High Risk ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Functional Decline ◽

Obstetric Complications ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Degree Relative ◽

Ultra High Risk

Objective: An association between birth and pregnancy complications and the later development of schizophrenia has been described for decades and obstetric complications (OCs) have been proposed as a vulnerability marker for psychosis in line with the neurodevelopmental hypothesis of psychotic disorders. Previous studies of OCs have focused on established schizophrenia. In this study, the association between OCs and the development of psychotic disorder was studied in a group of 74 young people identified as being at very high risk for the first onset of psychosis. Method: The ‘ultra’ high risk (UHR) cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-eight per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of OCs experienced by the UHR cohort was assessed at intake. Results: Obstetric complicationswere not associated with the later development of psychosis in the UHR group included in this study. Conclusions: This study does not suppor t a role for OCs as a risk factorfor the later development of psychosis; however, we cannot conclude that they should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study suggest that it may be premature to dismiss OCs as a risk factor for the development of psychosis and further research is urged in this area.

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Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective

Research in Psychotherapy Psychopathology Process and Outcome ◽

10.4081/ripppo.2020.455 ◽

2020 ◽

Vol 23 (1) ◽

Author(s):

Maria Pontillo ◽

Maria Cristina Tata ◽

Roberto Averna ◽

Prisca Gargiullo ◽

Silvia Guerrera ◽

...

Keyword(s):

Young Adults ◽

High Risk ◽

Children And Adolescents ◽

Conversion Rate ◽

Theoretical Perspective ◽

Clinical Profile ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Suicidal Thinking ◽

Ultra High Risk

Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (i.e., different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed

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Cannabis-induced attenuated psychotic symptoms: implications for prognosis in young people at ultra-high risk for psychosis

Psychological Medicine ◽

10.1017/s0033291716002671 ◽

2016 ◽

Vol 47 (4) ◽

pp. 616-626 ◽

Cited By ~ 20

Author(s):

M. J. McHugh ◽

P. D. McGorry ◽

A. R. Yung ◽

A. Lin ◽

S. J. Wood ◽

...

Keyword(s):

High Risk ◽

Psychotic Disorder ◽

Cannabis Use ◽

Psychotic Symptoms ◽

Cannabis Abuse ◽

Dependent Relationship ◽

Abuse Severity ◽

Ultra High Risk ◽

Prognostic Utility ◽

History Of

BackgroundCannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS).MethodParticipants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4–8.7 years).ResultsA history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93–12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS.ConclusionsFindings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.

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Sensory gating in subjects at ultra high risk for developing a psychosis before and after a first psychotic episode

The World Journal of Biological Psychiatry ◽

10.3109/15622975.2012.680911 ◽

2012 ◽

Vol 16 (1) ◽

pp. 12-21 ◽

Cited By ~ 19

Author(s):

Mirjam J. van Tricht ◽

Dorien H. Nieman ◽

Johannes T. M. Koelman ◽

Arianne J. M. Mensink ◽

Lo J. Bour ◽

...

Keyword(s):

High Risk ◽

Sensory Gating ◽

Psychotic Episode ◽

First Psychotic Episode ◽

Before And After ◽

Ultra High Risk

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Effects of cannabis use on event related potentials in subjects at ultra high risk for psychosis and healthy controls

International Journal of Psychophysiology ◽

10.1016/j.ijpsycho.2013.03.012 ◽

2013 ◽

Vol 88 (2) ◽

pp. 149-156 ◽

Cited By ~ 10

Author(s):

Mirjam J. van Tricht ◽

Emma C. Harmsen ◽

Johannes H.T.M. Koelman ◽

Lo J. Bour ◽

Thérèse A. van Amelsvoort ◽

...

Keyword(s):

High Risk ◽

Event Related Potentials ◽

Cannabis Use ◽

Healthy Controls ◽

Ultra High Risk ◽

Related Potentials

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Brief psychotic disorder associated with quarantine and mild COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240088 ◽

2020 ◽

Vol 13 (12) ◽

pp. e240088

Author(s):

Peter M Haddad ◽

Majid Al Abdulla ◽

Javed Latoo ◽

Yousaf Iqbal

Keyword(s):

Psychotic Disorder ◽

Physical Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Psychiatric Medication ◽

Diagnostic And Statistical Manual ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

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Effects of Cannabis Use in Those at Ultra-High Risk for Psychosis

The Complex Connection Between Cannabis and Schizophrenia ◽

10.1016/b978-0-12-804791-0.00007-0 ◽

2018 ◽

pp. 167-181 ◽

Cited By ~ 3

Author(s):

Brian O'Donoghue ◽

Meredith McHugh ◽

Barnaby Nelson ◽

Patrick McGorry

Keyword(s):

High Risk ◽

Cannabis Use ◽

Ultra High Risk

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Early Diagnosis and Counseling in Adolescents With Subclinical Psychotic Symptoms

The Global Psychotherapist ◽

10.52982/lkj160 ◽

2022 ◽

Vol 2 (1) ◽

pp. 62-68

Author(s):

Veronika Ivanova

Keyword(s):

Early Diagnosis ◽

Medical Model ◽

Psychotic Symptoms ◽

Clinical Psychologist ◽

Psychotic Episode ◽

Clinical Approach ◽

First Psychotic Episode ◽

Psychotherapeutic Techniques ◽

Sexual Identification ◽

Subclinical Psychotic Symptoms

Psychosis is a condition characterized on current diagnostic tests by impairment and may include severe disturbances of cognition, thinking, behaviour, and emotion. The need for early diagnosis and prevention of psychotic episodes in adolescents challenges traditional models of counselling, diagnosis, and treatment. The aim of the present study is to derive the main themes and psychological manifestations in the first psychotic episode in adolescents and to deepen knowledge and raise questions around the specific experiences of psychotic adolescents in order to help the clinical psychologist and psychotherapist in diagnostic and therapeutic counselling. This thus goes beyond the visible behaviour and the medical model that pays little attention to the causal relationships in psychosis and its unconscious components. Thirty-six adolescents (27 girls) with subclinical and clinical psychotic symptoms and 30 adolescents (16 girls) with neurotic symptoms were interviewed. A clinical approach was used – clinical psychological interview followed by psychotherapeutic work. Findings and statements can be found showing that early psychotic signs may change into a more severe adolescent crisis, as well as indications of the nature of anger towards parents, unstable mood and aggressivity. Leading themes in interviews and psychotherapeutic sessions may relate to feelings of insignificance in the world around them, unclear sexual identification, too close a relationship with their mothers, and anxiety about real or symbolic absence such as their mothers’ working away from home for long periods of time. In 79% of the interviews with adolescents with psychotic symptoms, we see a lack of real symbolic play in childhood. suitable for non-psychotic adolescents, in this case to change in the first psychotic episode.****What does this last sentence mean? The importance of early diagnosis is recognized and the known psychotherapeutic techniques must be used. Keywords: early psychosis, adolescent, positive psychotherapy, counselling

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