Family Members of Young Adults with Psychosis: Intentions to Use Motivational Interviewing to Address Cannabis Use

Young adults experiencing a first episode of psychosis (FEP) have high rates of cannabis use and cannabis use disorder (CUD). No evidence-based practice effectively treats CUD for people with FEP, and little is known about factors that influence intentions to reduce or stop using. A critical inquiry was conducted to identify salient factors contributing to intentions of young adults with FEP to reduce or discontinue cannabis use, guided by theory of planned behavior (TPB). Online focus groups (n = 3) and individual interviews (n = 3) were conducted with 16 young adults with FEP (mean age of 23.7) and historical cannabis use (averaging 11.8 days of use in the previous 30). A content analysis was conducted to sort data into TPB constructs, and a thematic analysis was subsequently performed to identify the breadth of themes. Participants identified benefits of cannabis reduction and cessation for pursuing life goals, but most maintained regular use. Participants perceived cannabis as a facilitator of social interactions, enjoyable activities, and improved mental health (and reduced dysthymia). Many were concerned about reducing or discontinuing cannabis without replacement strategies to compensate for its benefits. In spite of life goals incompatible with cannabis use, cessation was not favored given the perceived benefits of cannabis and participants' lack of replacement strategies to facilitate social interactions, enjoyable activities, and euthymia. Interventions may be improved by addressing motivations for use and by teaching skills to build positive social support, schedule enjoyable activities, and ameliorate dysthymia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BackgroundDebate continues about how long maintenance treatment should be continued following a first episode of psychosis (FEP). Resolving this question requires an understanding of the risk of recurrence which would be expected to vary as a function of the underlying cause of the psychosis. The range of diagnoses that may present as a FEP include schizophrenia and related schizophrenia spectrum disorders, bipolar mania, bipolar and unipolar depression, substance-induced psychosis, and unspecified psychotic disorders. The majority of FEP patients will receive the diagnosis of schizophrenia or bipolar disorder for which the 1- year risk of illness recurrence is estimated at 77% and 41%, respectively. We reviewed the literature in order to estimate the risk of relapse and the risk of developing a primary psychotic disorder following a FEP due to other diagnoses.MethodsWe conducted a primary literature review using Medline and PubMed. We included the following search terms: first episode, relapse, recurrence, depression with psychosis, psychotic depression, mania with psychosis, substance induced psychosis and psychosis. We included prospective and retrospective studies including those that involved medication discontinuation or naturalistic follow-up to determine the risk of recurrence following a FEP. We also reviewed the literature to determine the likelihood that FEP with these diagnoses would transition to a primary psychotic disorder (schizophrenia spectrum disorder or major mood disorder) for which published rates of recurrence would apply.ResultsTwo studies were identified which reported on the recurrence rate following a first episode of psychotic depression. Recurrence rates ranged from 27% at eight months to 80.6% at a mean of 32 months. An additional study found that following a first episode of psychotic depression, 29.9% and 14.3% of patients were diagnosed with schizophrenia and bipolar disorder, respectively, at 10-year follow-up. The risk of developing a primary psychotic disorder following a first episode of substance-induced psychosis has been investigated in three studies which reported rates of conversion to a primary psychotic disorder of 25% at one year, 25% at 10 years and 32% at 20 years. The risk of developing a primary psychotic disorder following a cannabis-induced psychosis has been investigated in three studies which reported rates of conversion of 44.5% at three years, 46% at eight years, and 47.4% at 20 years. Patients with a first episode of unspecified psychosis have been reported in a single study to have a 73.7% risk of developing a primary psychotic disorder at 10 year follow-up.DiscussionThe risk of illness recurrence following a FEP not initially diagnosed as a schizophrenia spectrum or bipolar disorder was found to vary by both initial diagnosis and by follow-up duration. Psychotic depression, substance-induced psychosis and other unspecified psychoses were all associated with either substantial risks of illness recurrence or development of a primary psychotic disorder. The risk of illness recurrence following medication discontinuation has not been established for these disorders as many of these studies included patients whether they were on or off of their prescribed medications. Clinical recommendation should be informed by future research on recurrence rates with and without maintenance medication for the different causes of FEP. In the meantime, patients with a FEP and their family members should be fully informed about the risk of illness recurrence and development of a primary psychotic disorder when considering any trial of medication discontinuation.

ObjectiveTo investigate the trajectories of diminished expression and apathy over 10 years. Further, to explore the effects of baseline- and persistent cannabis use on the development of diminished expression and apathy during follow-up, while controlling other potential sources and predictors of secondary negative symptoms. Methods351 participants with a first episode of non-affective psychosis were examined at baseline and invited to follow-up at one year and 10 years. The trajectories of diminished expression and apathy were investigated using linear mixed models. Subsequently, cannabis use and other potential predictors and sources of secondary negative symptoms were added to the model to investigate the respective impact on their trajectories. ResultsThe severity of both diminished expression and apathy decreased during the follow-up period after the first episode of psychosis, with the most improvement observed from baseline to 1-year follow-up. Cannabis use at baseline was associated with a long-lasting higher symptom load for diminished expression, but not apathy. Introducing persistent cannabis use to the model further strengthened the association with diminished expression. ConclusionBoth cannabis use at baseline and persistent cannabis use after a first episode of psychosis were associated with more severe symptoms of diminished expression. Our results imply a causal relationship between cannabis use and diminished expression and suggest that measures to reduce cannabis use both before and after psychosis onset may reduce expressive negative symptoms.

The University of Minnesota (UMN) Dental Hygiene (DH) program devotes considerable time developing students' competency using motivational interviewing (MI). However, the extent to which graduates use MI in clinical practice and their perceptions of MI effectiveness in changing behavior is unknown. A cross-section of UMN dental hygiene classes from 2010-2019 were emailed an electronic survey using Qualtricsxm software (n=208). The survey instrument collected demographic information and queried respondents' current MI use and perceptions of its effectiveness in changing patients' behavior. Survey questions were aligned with the constructs of the Theory of Planned Behavior (TPB): attitudes, subjective norms, and perceived behavioral control. Data analyses included descriptive statistics, cross-tabulations, and one-way ANOVA tests. There were 73 responses for a 35% response rate and 58 surveys (28%) included in data analysis. Respondents (95%) used MI, held positive attitudes toward MI and perceived MI to be an effective behavior counseling method (98%). However, respondents expressed concerns about patients' abilities to change behaviors. The three TPB constructs were found to be predictors of MI use in the clinical environment. A significant association was found between age and the TPB construct: behavioral control (p=0.02). The majority of respondents reported using MI in clinical practice. According to the TPB, respondents exhibited strong behavioral intentions to use MI. Respondents held favorable attitudes toward MI and believed it to be effective in motivating positive behavior change. Respondents were confident in their MI skills and felt supported to use MI in their work environments.

BackgroundCannabis use disorder among young people with a first episode of psychosis contributes to relapse, hospitalization, and impaired functioning. However, few studies have examined what young people with early phase psychosis, particularly those from Black racialized communities, understand or appreciate about this relationship, even though they may be at risk. There are no formally tested knowledge translation strategies that disseminate these research findings for young people with emerging psychosis from Black racialized communities.ObjectiveThis study aims to conceptualize what young people with early phase psychosis/cannabis use disorder understand about the relationship between cannabis and psychosis, focusing on people from racialized backgrounds. This study also aims to assess whether the knowledge translation product, the “Back to Reality Series,” increases awareness of the impact of cannabis use on psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities.MethodsQualitative analysis will reveal themes from qualitative interviews about cannabis and psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Perceptions before and after exposure to the Back to Reality Series will be qualitatively analyzed. A control game will be used for comparison, and scores on a quiz after playing the Back to Reality Series will be quantitatively analyzed to establish whether the Back to Reality Series raises awareness of the effects of cannabis on psychosis. An advisory council involving young people from Black communities, family members, and clinicians will bring community perspectives to this research.ResultsWe began recruiting participants for this study in September 2021. We will complete data collection on demographic and clinical factors, qualitative interviews, and quantitative assessments of the Back to Reality Series.ConclusionsThe voices of young people from racialized backgrounds will generate preliminary data to inform early psychosis programs, addressing cannabis use in this population. The findings may advance the use of a new knowledge translation product that deals with gaps in knowledge about cannabis use for people experiencing early phase psychosis, particularly those from racialized communities.International Registered Report Identifier (IRRID)DERR1-10.2196/36758

Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data. This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and negative) in order to identify the different response trajectories. Diagnosis, cannabis use, duration of untreated psychosis (DUP), smoking and antipsychotic class were examined as possible predictive variables. Patients were classified in five groups according to the positive dimension, three groups according to the disorganized dimension and five groups according to the negative dimension. Longer DUPs and cannabis use were associated with higher scores and poorer responses in the positive dimension. Cannabis use was associated with higher scores and poorer responses in the disorganized dimension. Only schizophrenia diagnosis was associated with higher scores and poorer responses in the negative dimension. Our results illustrate the heterogeneity of short-term response to antipsychotics in patients with a first episode of psychosis and highlight markedly different patterns of response in the positive, disorganized and negative dimensions. DUP, cannabis use and diagnosis appeared to have a prognostic value in predicting treatment response with different implications for each dimension.

Cannabis use is high amongst young people who have recently had their first episode of psychosis, and is associated with worse outcomes. To date, interventions to reduce cannabis consumption have been largely ineffective, and it has been suggested that longer treatment periods are required. In a pragmatic single-blind randomized controlled trial 110 participants were randomly allocated to one of three conditions: a brief motivational interviewing and cognitive behavioural therapy (MI-CBT) intervention (up to 12 sessions over 4.5 months) with standard care from an early intervention service; a long MI-CBT intervention (up to 24 sessions over 9 months) with standard care; or standard care alone. The primary outcome was change in cannabis use as measured by Timeline Followback. Neither the extended nor the brief interventions conferred benefit over standard care in terms of reductions in frequency or amount of cannabis use. Also the interventions did not result in improvements in the assessed clinical outcomes, including symptoms, functioning, hospital admissions or relapse. Integrated MI and CBT for people with cannabis use and recent-onset psychosis does not reduce cannabis use or improve clinical outcomes. These findings are consistent with those in the published literature, and additionally demonstrate that offering a more extended intervention does not confer any advantage. Many participants were not at an action stage for change and for those not ready to reduce or quit cannabis, targeting associated problems rather than the cannabis use per se may be the best current strategy for mental health services to adopt.

Background:Mood disorders and psychosis has been reported among the patients with macrocytosis; however, its prevalence among the first episode of psychosis and depression is unknown. The purpose of the study was to establish the prevalence of macrocytosis among the patients with the first episode of depression and psychosis.Materials and Methods:In this cross-sectional study, three groups comprising patients with first episode of depression (n = 100), patients with the first episode of psychosis (n = 100), and healthy controls (n = 100) were included. Blood samples were collected from each participant and analyzed using the automated coulter counter. The hematological variables (e.g., macrocytosis, anemia) in the three groups were compared using the Chi-square and analysis of variance tests.Results:The prevalence of macrocytosis among patients with depression and psychosis was 2.6 (8%) and 3.3 times (11%) higher, respectively than that among the healthy controls (3%). In addition, the hemoglobin concentration, mean corpuscular volume and mean platelet volume in patients with first episodes of psychosis and depression significantly differed from those in healthy controls P < 0.001.Conclusion:This study showed that the prevalence of macrocytosis among the first episode of depression and psychosis was higher than healthy controls. Macrocytosis may have etiological and prognostic significance among these patients. Prospective studies are needed to explore the clinical significance of macrocytosis among the patients with depression and psychosis in the clinical practice.

BackgroundSubstance use may be a risk factor for the onset of schizophrenia. Almost 50 % of people with first episode psychosis (FEP) have a history of cannabis or alcohol use. Smaller but significant proportions of this population have a history of psychostimulants (PS) use. Cross-sectional studies have shown a link between recreational and regular use of PS and psychotic symptoms, particularly among individuals with PS dependence, that usually revert after drug withdrawal. Nevertheless, some PS users suffer not just spontaneous relapse of the symptoms but also persistent psychosis in the absence of the drug.European data are not available for a large sample of the prevalence of consumption and its relation to the severity of symptoms in FEP. For this purpose, we described the differences in patterns of use of PS current and lifetime between FEP and healthy controls (HC) and their impact on the severity of the clinical symptomatology.MethodsThis analysis is based on data from the case-control study work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI), which took part between 2010 and 2015 across six countries.901 FEP patients (M age=30.76, SD= 10.51; 38.1% females) and 1235 HC (M=36.15, SD=13.30; 53% females) were included in the present case-control study. Data related to amphetamine use were obtained through CEQEU-GEI. To assess psychopathology the OPerational CRITeria (OPCRIT) system was used.Group comparisons were made using t-test or Chi square, and ANCOVA or logistic regression controlling for age, sex and cannabis use when appropriate.ResultsFEP subjects displayed a trend for higher use of PS in the last year (B=-0.18, p= 0.055: 81 (9%) FEP and 56 (4.5%)) and a significant higher lifetime use (Chi2= 37.33, p<0.001: 196 (21.8%) FEP and 149 (12.1%) HC) than HC, but the frequency of PS use did not differ between groups.Lifetime FEP PS-users showed higher scores, thus is, more severe symptoms in the Mania (t= -3.69, p< 0.001) and the general (t= -3.47, p= 0.001) factors compared to FEP non-PS-users. Current FEP PS-users showed higher scores in the Mania factor (t= -2.52, p= 0.012) than FEP non-PS-users. However, these results were not significant when the comparisons were adjusted for age, sex and cannabis use. FEP PS-users displayed lower scores than the non-users in the negative factor both in the last year (t= 2.10, p= 0.038 and: F1,866= 4.27, p= 0.039 when adjusted for age, sex and cannabis use) and lifetime (t= 1.99, p= 0.046 and F1,869= 1.37, p= 0.243 when adjusted for age, sex and cannabis use).DiscussionAs previous studies, we confirmed the higher rates of PS use in FEP than HC in a European study with a big sample. PS use was related to severity of clinical symptomatology. PS-users presented more severe general symptoms and, specifically, in the mania factor. Otherwise, FEP non-PS-user showed higher scores in the negative factor which might be related to the usual course of the psychosis without exposure to PS use.

Age of onset of Cannabis use and cognitive function in first-episode non-affective psychosis patients: Outcome at three-year follow-up

Pre-morbid Conduct Disorder symptoms are associated with cannabis use among individuals with a first episode of psychosis

Apathy and Functioning in First-Episode Psychosis

Outcome of a first episode of psychosis in adolescence: a 2-year follow-up

Many studies have reported that cannabis use increases the risk of a first episode of psychosis (FEP). However, only a few studies have investigated the nature of cannabis-related experiences in FEP patients, and none has examined whether these experiences are similar in FEP and general populations. The aim of this study was to explore differences in self-reported cannabis experiences between FEP and non-psychotic populations. A total of 252 subjects, who met International Classification of Diseases (ICD)-10 criteria for FEP, and 217 controls who reported cannabis use were selected from the Genetics and Psychosis (GAP) study. The Medical Research Council Social Schedule and the Cannabis Experience Questionnaire were used to collect sociodemographic data and cannabis use information, respectively. Both 'bad' and 'enjoyable' experiences were more commonly reported by FEP subjects than controls. Principal components factor analysis identified four components which explained 62.3% of the variance. Linear regression analysis on the whole sample showed that the type of cannabis used and beliefs about the effect of cannabis on health all contributed to determining the intensity and frequency of experiences. Linear regression analysis on FEP subjects showed that the duration of cannabis use and amount of money spent on cannabis were strongly related to the intensity and frequency of enjoyable experiences in this population. These results suggest a higher sensitivity to cannabis effects among people who have suffered their first psychotic episode; this hypersensitivity results in them reporting both more 'bad' and 'enjoyable' experiences. The greater enjoyment experienced may provide an explanation of why FEP patients are more likely to use cannabis and to continue to use it despite experiencing an exacerbation of their psychotic symptoms.

First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol