Le potentiel thérapeutique du cannabidiol chez les sujets présentant un trouble du spectre psychotique : une revue systématique de la littérature sur les essais contrôlés randomisés

Abstract

ObjectivesPsychotic disorders, particularly schizophrenia, are frequent psychiatric disorders and are difficult to treat with current pharmacological treatments. There is therefore a need to find new medications. In this systematic review, we study the therapeutic potential of cannabidiol in randomized controlled trials in subjects with a psychotic spectrum disorder. MethodsWe conducted a systematic review following the PRISMA Guidelines, on the subject between the date of inception of the databases and June 25th 2022 on PubMed, Google Scholar and Cochrane Library. Only randomized controlled trials (RCT) meeting the inclusion criteria were selected. The research equation was: “(cannabidiol OR CBD) AND (schizophrenia OR psychotic disorders OR Schizophreniform Disorder OR Schizoaffective Disorders OR Brief Reactive Psychoses OR prodromal states OR clinical high risk OR schizoid personality disorder OR schizotypal personality disorder OR paranoid personality disorder) AND (randomized controlled trial) AND (therapeutics OR symptoms) NOT (dronabinol) NOT (child)”. ResultsTen studies were included. We synthesize data in subjects with schizophrenia, UHR or related psychotic disorder, of the antipsychotic action of cannabidiol on clinical symptoms (PANSS), the action of cannabidiol on cognition and global functioning, its tolerance and side effects, and finally the action of cannabidiol on cerebral areas or cortisol in subjects at Ultra high risk of psychotic transition during experimental tasks. We highlight heterogeneous results, due to the variability of doses and durations of treatments. The antipsychotic action of CBD is observed for doses higher than 600mg. Cannabidiol moderates the modifications of activations of the cerebral areas in subjects at ultra-high risk of psychotic transitions compared to healthy subjects. Concerning cognition, cannabidiol is inefficient for doses lower than 1000mg and in the short term. Regarding tolerance and side effects, cannabidiol was well tolerated with very few side effects (which seem to be limited to sedation and gastrointestinal disorders). ConclusionsThis work has highlighted heterogeneous results that indicate a limited effectiveness of cannabidiol in psychosis spectrum diseases and schizophrenia, requiring more randomized controlled trials to conclude.