Rates Of Cannabis Use Disorder Research Articles

Trends in cannabis use in New Jersey: Effects of COVID-19 and cannabis legalization.

With the legalization of cannabis in New Jersey on April 21, 2022, including the licensing of cannabis dispensaries, concerns have arisen about potential adverse events related to cannabis use. Here, we explore temporal trends and risk factors for cannabis-related harm in both adult and pediatric cannabis-related visits at a tertiary care academic institution. We performed a retrospective chart review and temporal trend analysis via the electronic health record from May 1, 2019 to October 31, 2022, covering 2 years before, and 6 months after, cannabis legalization in New Jersey. The pediatric charts identified were analyzed for root causes of adverse events, and changes in the frequency of specific unsafe practices since cannabis legalization were tracked. We found that adult cannabis ED-related visits significantly increased during the COVID-19 pandemic and remained higher than pre-pandemic levels for the remainder of the study periods, without a significant change upon legalization. Pediatric rates of cannabis-related ED visits did not vary significantly during the study period. The vast majority of visits for children aged 0-12 years were related to accidental cannabis exposures-often a household member's edibles-whereas most visits for older children stemmed from intentional cannabis use. This project highlights the unintended consequences of wider cannabis access in New Jersey. Notably, cannabis use increased even before its legalization, presumably in response to the COVID-19 pandemic and its attendant mental health effects. Rates of cannabis use disorder and its highlight of other concurrent psychiatric disorders are important topics for both clinicians and lawmakers to consider.

Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial.

African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730. DERR1-10.2196/52776.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies

ABSTRACT Background: People with schizophrenia have high rates of cannabis use disorder (CUD) as well as co-use of tobacco. Tobacco may be used to alleviate cannabis cravings. Objectives: We conducted a secondary analysis of 7 and 28 days of cannabis abstinence from two datasets of participants with CUD with and without schizophrenia to assess cannabis craving, cannabis use in grams per day (GPD) and cigarettes per day (CPD). Methods: We recruited 49 participants (schizophrenia n = 29; control n = 20; 2% female) with CUD. All participants received weekly behavioral support sessions to assist with cannabis abstinence/reduction. GPD and CPD were assessed with the 7-day Timeline Follow-back; the Marijuana Craving Questionnaire (MCQ) assessed compulsivity, emotionality, expectancy and purposefulness subscales. Effects of GPD and MCQ subscales on CPD at days 7 and 28 were assessed with analysis of covariance. Results: At day seven, participants with schizophrenia scored higher on compulsivity (t = 2.72, df = 46.8, p < .01), emotionality (t = 2.48, df = 45.2, p = .02), and purposefulness (t = 2.32, df = 39.41, p = .02) craving subscales than control participants. There was a significant interaction between high purposefulness craving and low GPD on high CPD at day seven (F1,23 = 4.76, p = .039) and day 28 (F1,13 = 7.02 p = .02) in schizophrenia participants but not control participants. Conclusion: We found preliminary evidence that due to cannabis craving intensity, people with schizophrenia and CUD may use more cigarettes when reducing cannabis use, as compared to CUD participants without schizophrenia. Strategies to manage cannabis craving and avoid increasing tobacco use will be useful to implement in intervention strategies. Clinical Trial Name Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in Schizophrenia URL: www.clinicaltrials.gov; Registration Number: NCT03189810;

Impact of early-life lead exposure on adult delta-9-tetrahydrocannabinol sensitivity in male and female C57BL6/J mice

Environmental exposure to lead (Pb) and cannabis use are two of the largest public health issues facing modern society in the United States and around the world. Exposure to Pb in early life has been unequivocally shown to have negative impacts on development, and recent research is mounting showing that it may also predispose individuals for risk of developing substance use disorders (SUD). At the same time, societal and legal attitudes towards cannabis (the main psychoactive component of which is delta-9-tetrahydrocannabinol) have been shifting, and many American states have legalized the recreational use of cannabis. It is also the 3rd most widely used drug of abuse in the US, and rates of cannabis use disorder are on the rise. Here we establish a link between early life Pb exposure and later THC-related behavior in C57BL6/J mice, as has been demonstrated for other drugs of abuse. The study seeks to answer whether Pb exposure affects physiological/behavioral THC sensitivity (as measured by the cannabinoid-induced tetrad). It was hypothesized that Pb exposure would decrease THC sensitivity and that sex-dependent effects of Pb-exposure and THC would be observed. Interestingly, results showed that THC sensitivity was increased by Pb exposure, but only in female mice. Future research will fully explore the implications of these findings, namely how these effects impact THC self-administration and the mechanism(s) by which developmental Pb exposure produces these effects.

Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health.

Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). Although recent increases in the legalization of cannabis have been linked to increases in cannabis use among the general population, few studies have examined if changes in cannabis use and CUD vary by sexual identity. The purpose of the current study was to examine sexual identity differences in trends for CUD and compare them to trends for AUD. We used data from 2015-2019 National Survey on Drug Use and Health to examine annual prevalence and year-specific disparities in cannabis use, CUD, heavy episodic drinking, and AUD. We also examined sex-specific sexual identity differences in linear trends for these substance use outcomes over this 5-year period. All groups except lesbian females experienced significant increases in cannabis use rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in heavy episodic drinking or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in cannabis use and CUD as well as the largest growth in disparities across time. The few changes in heavy episodic drinking and AUD alongside numerous changes in cannabis use and CUD suggest that changes in cannabis use may be attributable to legalization of cannabis use in many states during this period. Given profound disparities and increasing rates of CUD affecting bisexual females, further research is needed to identify factors that may explain their disproportionate burden.

Cannabis use for medical symptoms: Patterns over the first year of use

BackgroundAs greater numbers of states in the United States and countries in the world continue to legalize cannabis for medical use, it has become increasingly important to assess patterns of cannabis use in individuals using cannabis for medical symptoms over time. A public health concern is that, like recreational cannabis, some individuals using cannabis for medical reasons may develop detrimental patterns of use, leading to the development of a cannabis use disorder (CUD). MethodsIn a 9-month longitudinal cohort study following a 12-week randomized, waitlist-controlled trial in 149 adults who used cannabis to alleviate insomnia, pain, depressed mood, or anxiety (RCT: NCT03224468), we assessed whether patterns of cannabis use for the 9 months following the RCT were associated with the development of CUD. ResultsWe identified five unique trajectories of use; 31 participants (21%) had low stable or no use, 50 (34%) had medium stable use, 19 (13%) had high stable use, 26 (17%) showed de-escalating and 23 (15%) showed escalating use over 9 months following the RCT. Of 149 participants enrolled, 19 (13%) met diagnostic criteria for CUD at 12 months. Only the escalating cannabis use pattern predicted significantly higher rates of CUD compared to the low or no use category (OR = 4.29, 95% CI = 1.21 to 10.87, p = 0.02). ConclusionsThese data indicate that most individuals using cannabis for medical symptoms have a stable pattern of use over the first year. Escalation of use may be a detrimental pattern that warrants further concern.

Peripheral signature of altered synaptic integrity in young onset cannabis use disorder: A proteomic study of circulating extracellular vesicles

Background Rates of Cannabis Use Disorder (CUD) are highest amongst young adults. Paucity of brain tissue samples limits the ability to examine the molecular basis of cannabis related neuropathology. Proteomic studies of neuron-derived extracellular vesicles (NDEs) isolated from the biofluids may reveal markers of neuropathology in CUD. Methods NDEs were extracted using ExoSORT, an immunoaffinity method to enrich NDEs from plasma samples from patients with young onset CUD and matched controls. Differential proteomic profiles were explored with Label Free Quantification (LFQ) mass spectrometry. Selected proteins were validated using orthogonal methods. Results A total of 231 (±10) proteins were identified in NDE preparations from CUD and controls of which 28 were differentially abundant between groups. The difference in abundance of properdin (CFP gene) was statistically significant. SHANK1 (SHANK1 gene), an adapter protein at the post-synaptic density, was nominally depleted in the CUD NDE preparations. Conclusion In this pilot study, we noted a decrease in SHANK1 protein, involved in the structural and functional integrity of glutamatergic post-synapse, a potential peripheral signature of CUD neuropathology. The study shows that LFQ mass spectrometry proteomic analysis of NDEs derived from plasma may yield important insights into the synaptic pathology associated with CUD.

Temporal stability of neurophysiological drug cue reactivity before and after acute stress in cannabis users: A test of incentive sensitization

BackgroundGiven increasing rates of Cannabis Use Disorder (CUD), objective measures are needed that can reliably index risk and track cannabis use progression. Based on incentive sensitization models, neurophysiological reactivity to cannabis cues, measured with the electroencephalography-recorded late positive potential (LPP), may be a candidate biomarker. To serve as such, the cannabis cue-elicited LPP must demonstrate adequate retest reliability and sensitivity to cannabis use change. Moreover, incentive sensitization theory suggests that state-level contextual variables, such as acute stress, can impact drug cue reactivity. Therefore, the present study evaluated the three-month retest reliability of the cannabis cue-elicited LPP, recorded before and after a laboratory stress induction, as well as its sensitivity to cannabis use change. MethodCannabis and neutral cue-elicited LPPs were measured in 102 adults reporting frequent cannabis use (86 % with current CUD) before and after an acute stress induction at two lab visits three-months apart. Physiological and subjective stress reactivity were also measured. ResultsManipulation checks confirmed expected cannabis cue and acute stress effects. Cannabis cue-elicited LPP amplitudes showed significant three-month retest reliability of poor-to-fair through moderate-to-good size. Change in cannabis use frequency significantly predicted change in cannabis cue-elicited LPP amplitudes, particularly at post-stress. ConclusionConsistent with incentive sensitization models of addiction, the cannabis cue-elicited LPP demonstrated trait-like, moderate three-month stability and responsivity to change in cannabis use behavior. Greater predictive validity of the post-stress LPP may arise through kindling effects of acute stress on incentive salience-related neural activity, which should be explored in future studies.

Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders?

Rates of cannabis use disorder (CUD) are higher in people with schizophrenia than in the general population. Irrespective of psychiatric diagnosis, tobacco co-use is prevalent in those with CUD and leads to poor cannabis cessation outcomes. The cannabis withdrawal syndrome is well-established and increases cannabis relapse risk. We investigated whether cannabis withdrawal severity differed as a function of high versus no/low tobacco dependence and psychiatric diagnosis in individuals with CUD. Men with CUD (N = 55) were parsed into four groups according to schizophrenia diagnosis and tobacco dependence severity using the Fagerstrom Test for Nicotine Dependence (FTND): men with schizophrenia with high tobacco dependence (SCT+, n = 13; FTND ≥ 5) and no/low tobacco dependence (SCT-, n = 22; FTND ≤ 4), and nonpsychiatric controls with high (CCT+, n = 7; FTND ≥ 5) and no/low (CCT-, n = 13; FTND ≤ 4) tobacco dependence. Participants completed the Marijuana Withdrawal Checklist following 12-h of cannabis abstinence. There was a significant main effect of tobacco dependence on cannabis withdrawal severity (p < .001). Individuals with high tobacco dependence had significantly greater cannabis withdrawal severity (M = 13.85 [6.8]) compared to individuals with no/low tobacco dependence (M = 6.49, [4.9]). Psychiatric diagnosis and the interaction effects were not significant. Lastly, cannabis withdrawal severity positively correlated with FTND (r = .41, p = .002). Among individuals with CUD and high tobacco dependence, cannabis withdrawal severity was elevated twofold, irrespective of diagnosis, relative to individuals with CUD and no/low tobacco dependence. Findings from this study emphasize the importance of addressing tobacco co-use when treating CUD.

Comorbidity and Coaggregation of Major Depressive Disorder and Bipolar Disorder and Cannabis Use Disorder in a Controlled Family Study

Cannabis use disorder (CUD) is increasing in the US. Clarification of the potential mechanisms underlying the comorbidity between mood disorders and CUD may help prevent CUD. To examine co-occurrence and familial aggregation of CUD and mood disorder subtypes. In this cross-sectional, community-based study in the Washington, DC, metropolitan area, semistructured diagnostic interviews and family history reports assessed lifetime DSM-IV disorders in probands and relatives. Familial aggregation and coaggregation of CUD with mood disorders were estimated via mixed-effects models, adjusting for age, sex, recruitment source, and comorbid mood, anxiety, and other substance use disorders. A total of 586 adult probands (186 with bipolar disorder; 55 with CUD) and 698 first-degree relatives (91 with bipolar disorder; 68 with CUD) were recruited from a community screening of the greater Washington, DC, metropolitan area from May 2004 to August 2020. Inclusion criteria were ability to speak English, and availability and consent to contact at least 2 living first-degree relatives. Lifetime CUD in first-degree relatives. Of 586 probands, 395 (67.4%) were female; among 698 relatives, 437 (62.6%) were female. The mean (SD) age was 47.5 (15.2) years for probands and 49.6 (18.0) years for relatives. In the proband group, 82 participants (14.0%) self-identified as African American or Black, 467 (79.7%) as White, and 37 (6.3%) as American Indian or Alaska Native, Asian, more than one race, or another race or ethnicity or declined to respond. In the relative group, 53 participants (7.6%) self-identified as African American or Black, 594 (85.1%) as White, and 51 (7.3%) as American Indian or Alaska Native, Asian, more than one race, or another race or ethnicity or declined to respond. These groups were combined to protect privacy owing to small numbers. CUD in probands (55 [9.4%]) was associated with an increase in CUD in relatives (adjusted odds ratio [aOR], 2.64; 95% CI, 1.20-5.79; P = .02). Bipolar disorder II (BP-II) in probands (72 [12.3%]) was also associated with increased risk of CUD in relatives (aOR, 2.57; 95% CI, 1.06-6.23; P = .04). However, bipolar disorder I (114 [19.5%]) and major depressive disorder (192 [32.8%]) in probands were not significantly associated with CUD in relatives. Among relatives, CUD was associated with BP-II (aOR, 4.50; 95% CI, 1.72-11.77; P = .002), major depressive disorder (aOR, 3.64; 95% CI, 1.78-7.45; P < .001), and mean (SD) age (42.7 [12.8] years with CUD vs 50.3 [18.3] years without CUD; aOR, 0.98; 95% CI, 0.96-1.00; P = .02). Familial coaggregation of BP-II with CUD was attenuated by the inclusion of comorbid anxiety disorders. Further, rates of CUD were highest in relatives with both a familial and individual history of BP-II (no familial or individual history of BP-II: 41 [7.2%]; familial history but no individual history of BP-II: 13 [19.1%]; individual history but no familial history of BP-II: 10 [22.2%]; familial and individual history of BP-II: 4 [28.6%]; Fisher exact test, P < .001). The onset of mood disorder subtypes preceded CUD in probands and relatives in most cases. The findings confirmed a familial aggregation of CUD. The increase in risk of CUD among relatives of probands with BP-II suggests that CUD may share a common underlying diathesis with BP-II. Taken together with the temporal precedence of depression and mania with respect to CUD onset, these findings highlight a potential role for BP-II intervention as CUD prevention.

Cannabis Use, Cannabis Use Disorder, and Comorbid Psychiatric Illness: A Narrative Review.

Background: The landscape of attitudes, legal status and patterns of use of cannabis is rapidly changing in the United States and elsewhere. Therefore, the primary aim of this narrative review is to provide a concise overview of the literature on the comorbidity of cannabis use and cannabis use disorder (CUD) with other substance use and psychiatric disorders, and to use this information to accurately guide future directions for the field. Methods: A literature review of PubMed was conducted for studies relating to cannabis use, CUD, and a co-occurring psychiatric disorder. To provide an overview of representative data, the literature review focused on national-level, population-based work from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and National Survey on Drug Use and Health (NSDUH) surveys. Considering rapidly changing cannabis laws, recent (past five-year) studies were addressed. Results: A strong body of literature shows associations between cannabis use and CUD with other drug use, psychosis, mood disorders, anxiety disorders, and personality disorders. The strongest evidence of a potential causal relationship exists between cannabis use and psychotic disorders. While some evidence shows potential directionality between cannabis use and mood and anxiety disorders, results are inconsistent. Studies have established higher rates of CUD among those with personality disorders, but little about the specifics of this relationship is understood. Conclusions: Although the general population in the United States increasingly perceives cannabis to be a harmless substance, empirical evidence shows that cannabis use is associated both with CUD and comorbid psychiatric illness. However, there is mixed evidence regarding the role of cannabis in the etiology, course, and prognosis of a co-occurring disorder across all categories of psychiatric disorders. Future research should expand on the existing body of literature with representative, longitudinal data, in order to better understand the acute and long-term effects of cannabis on comorbid psychiatric illness.

Cannabis use disorder and post-traumatic stress disorder: The prevalence of comorbidity in veterans of recent conflicts

AimsVeterans have high rates of cannabis use, and rates of cannabis use disorder (CUD) are rising among this population. These rising rates are particularly true for veterans with post-traumatic stress disorder (PTSD), which is common among veterans of recent conflicts, Operations Enduring Freedom, Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND). Although prior work has documented links between PTSD and cannabis use, a better understanding of the intersection among CUD, PTSD, and other disorders in real-world clinical practice can inform prevention and treatment efforts. This study examined the prevalence and comorbidities of CUD and PTSD in OFE/OIF/OND veterans. MethodThe study analyzed data from the Veterans Affairs Corporate Data Warehouse (2010–2016) for returning war veterans who were diagnosed with CUD (N = 46,268). The study determined prevalence of PTSD, and examined additional differences in comorbidities. ResultsThe prevalence of a comorbid PTSD diagnosis among OEF/OIF/OND veterans with a CUD diagnosis was 72.3%. Further analysis revealed additional co-occurring disorders. Veterans with a diagnosis of CUD and PTSD were more likely to have a comorbid diagnosis of depression (odds ratio, 1.69; 95% CI, 1.62–1.71), panic disorder (odds ratio; 1.58; 95% CI, 1.43–1.75), alcohol use disorder (odds ratio; 1.30; 95% CI, 1.24–1.35), opioid use disorder (odds ratio; 1.52; 95% CI, 1.43–1.62), and insomnia (odds ratio; 1.74; 95% CI, 1.65–1.84) than veterans without a PTSD diagnosis. ConclusionsFindings highlight that the majority of returning war veterans with CUD are highly complex. Our findings substantiate the need for urgent, comprehensive care for veterans with co-occurring CUD and PTSD, including integrated and transdiagnostic treatment approaches.

Characterizing symptoms of cannabis use disorder in a sample of college students.

Since legalization of marijuana in several U.S. states in 2012, there has been concern about increases in the development of cannabis use disorder (CUD). The current study examined rates of CUD in Colorado college students who reported regular marijuana use and assessed a range of factors associated with CUD symptoms, including coping motives, concentrate/dab use, mental health concerns (depression, anxiety), age of regular marijuana use, and alcohol use. College students were recruited from a mid-sized university and completed a baseline assessment that included a marijuana urine screen. Participants reported a median of five CUD symptoms and 90% met criteria for CUD. After adjusting for covariates, age of regular marijuana use was negatively associated with number of CUD symptoms, while average daily alcohol drinks was positively associated with number of symptoms. Prevention and intervention efforts at the university level should be increased to reduce negative outcomes associated with problem marijuana use.

Individual and combined effects of acute delta-9-tetrahydrocannabinol and cannabidiol on psychotomimetic symptoms and memory function

The main active ingredient in cannabis, delta-9-tetrahydrocannabinol (THC), can acutely induce psychotic symptoms and impair episodic and working memory. Another major constituent, cannabidiol (CBD), may attenuate these effects. This study aimed to determine the effects of THC and CBD, both alone and in combination on psychotic symptoms and memory function. A randomised, double-blind crossover design compared the effects of (i) placebo, (ii) THC 8 mg, (iii) CBD 16 mg and (iv) THC 8 mg + CBD 16 mg administered by inhalation through a vaporiser. Using an experimental medicine approach to predict treatment sensitivity, we selected 48 cannabis users from the community on the basis of (1) schizotypal personality questionnaire scores (low, high) and (2) frequency of cannabis use (light, heavy). The Brief Psychiatric Rating Scale (BPRS), Psychotomimetic States Inventory (PSI), immediate and delayed prose recall (episodic memory), 1- and 2-back (working memory) were assessed on each day. Results indicated that THC increased overall scores on the PSI, negative symptoms on BPRS, and robustly impaired episodic and working memory. Co-administration of CBD did not attenuate these effects. CBD alone reduced PSI scores in light users only. At a ratio of 2:1, CBD does not attenuate the acute psychotic and memory impairing effects of vaporised THC. Frequent cannabis users may show a blunted anti- psychotic response to CBD, which is of concern due to the high rates of cannabis use disorders in patients with schizophrenia.

T218. IDENTIFICATION OF FIRST-EPISODE PSYCHOSIS SUBGROUPS BASED ON POSITIVE SYMPTOM DOMAINS AND THEIR SOCIODEMOGRAPHIC AND CLINICAL CORRELATES

BackgroundAlthough the heterogeneous nature of psychosis is well established in the literature, genetics, neurophysiology, and neuroimaging have not yet succeeded in an unequivocal classification of the diverse clinical presentations. For the time being, the field relies mostly on a symptom-based, descriptive diagnostic system. The purpose of the current study was to use seven previously identified positive symptom domains to identify possible subgroups of first-episode psychosis (FEP), using cluster analysis. In addition, we tested whether possible subgroups differed across a number of sociodemographic and clinical variables.MethodsWe analyzed data from a large FEP sample (n=247) to identify possible clinical subgroups of psychosis based on positive symptoms; specifically, delusion and hallucination domains resulting from previous factor analyses of Scale for the Assessment of Positive Symptoms (SAPS) items in this sample. A rigorous methodology was applied to perform cluster analysis and identify FEP subgroups. Kruskal-Wallis tests with pairwise post-hoc comparisons were used to check the differences in each positive symptom domain between the subgroups. Bivariate analyses comparing subgroups on a number of sociodemographic and clinical characteristics were performed.ResultsFive FEP subgroups were identified based on the severity of seven domains of delusions and hallucinations. Three of them (Mild Positive Symptoms Subgroup, Moderate Positive Symptoms with Sin/Guilt and Jealousy Delusions Subgroup, Severe Positive Symptoms Subgroup) shared a similar psychopathological profile, with typical psychotic symptoms differing in severity. Another subgroup was characterized by high severity on typical and atypical symptoms (Severe Mixed Atypical Positive Symptoms Subgroup), and the other by high severity in somatic delusions (Somatic Delusions Subgroup). The five subgroups did not significantly differ in terms of gender, age at onset, family history, mode of onset of psychosis, premorbid functioning, and alcohol and non-cannabis drug use disorders, though some potential signals were identified, (but not reaching statistical significance due to small sample sizes in the subgroups). Significantly different prevalence rates of cannabis use disorder were found across the five subgroups.DiscussionIn our analysis, five possible FEP subgroups were identified based on the severity of seven domains of delusions and hallucinations: three of them shared a similar psychopathological profile differing in severity, and two were characterized by different atypical symptoms. Despite several acknowledged limitations, our results highlight the potential to identify clinical phenotypic subgroups of FEP, which may be helpful in future research aimed at filling the gaps between clinical, neuropathological, and genetic explanations of psychosis etiology. Such an approach may also lead to better targeted preventive interventions and more individualized and effective treatments.

Cannabinoid Hyperemesis Syndrome: An Update for Primary Care Providers

Cannabis is the most commonly used recreational drug worldwide. Crossbreeding and genetic modification techniques have dramatically increased the delta-9-tetrahydrocannabinol content, with resultant increased rates of cannabis use disorders and other toxic effects among users. Cannabinoid hyperemesis syndrome (CHS) is a recently identified disorder and should be considered as a differential diagnosis in patients exhibiting recurrent symptoms of abdominal pain, weight loss, intractable vomiting, and compulsive bathing. Treatment includes vigorous rehydration with intravenous fluids, antiemetics, proton pump inhibitor administration, weight monitoring, and cannabis use cessation. Awareness of CHS symptomology and clinical management strategies can prevent extensive diagnostic workups and unnecessary hospitalizations.

Preliminary Development of a Brief Cannabis Use Disorder Screening Tool: The Cannabis Use Disorder Identification Test Short-Form.

Introduction: Rates of cannabis use disorder (CUD) among vulnerable populations have increased in recent years, highlighting a need to equip providers with an efficient screening tool.Materials and Methods: A short form of the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) was developed by using item response theory and traditional statistical methods, with data from two community samples of cannabis users representing two countries. Four item selection methods (Rasch regression, test characteristic curve, logistic regression, discriminant function analysis) were employed to identify the optimal three-item shortened version. The diagnostic ability of the short form was evaluated by using receiver operating characteristic curves.Results: Using a cut score of 2, the 3-item CUDIT-Short Form (CUDIT-SF; reliability alpha=0.66, Sample 1; 0.80, Sample 2) identified 78.26% of participants in Sample 1 and 78.31% of participants in Sample 2 who met DSM-5 criteria for CUD, with 98% agreement in Sample 1 and 93% agreement in Sample 2 with the full CUDIT-R on CUD classifications using a cut score of 13. Specificity was 76.70 and 78.00 in Samples 1 and 2, respectively.Conclusions: The CUDIT-SF may be useful in busy clinical settings for a stepwise screening. Further validation of this shortened version with larger samples and in different settings is warranted.

P.3.005 Is diagnosis indeed prognosis? 12 months outcome for schizophrenia, schizophreniform and schizoaffective disorder

With the recent federal mandate that all U.S. health care settings transition to ICD-10 billing codes, empirical evidence is necessary to determine if the DSM-5 designations map to their respective ICD-10 diagnostic categories/billing codes. The present study examined the concordance between DSM-5 and ICD-10 cannabis use disorder diagnoses.Data were derived from routine clinical assessments of 6871 male and 801 female inmates recently admitted to a state prison system from 2000 to 2003. DSM-5 and ICD-10 diagnostic determinations were made from algorithms corresponding to the respective diagnostic formulations.Past 12-month prevalence rates of cannabis use disorders were comparable across classification systems. The vast majority of inmates with no DSM-5 diagnosis continued to have no diagnosis per the ICD-10, and a similar proportion with a DSM-5 severe diagnosis received an ICD-10 dependence diagnosis. Most of the variation in diagnostic classifications was accounted for by those with a DSM-5 moderate diagnosis in that approximately half of these cases received an ICD-10 dependence diagnosis while the remaining cases received a harmful use diagnosis.Although there appears to be a generally high level of agreement between diagnostic classification systems for those with no diagnosis or those evincing symptoms of a more severe condition, concordance between DSM-5 moderate and ICD-10 dependence diagnoses was poor. Additional research is warranted to determine the appropriateness and implications of the current DSM-5 coding guidelines regarding the assignment of an ICD-10 dependence code for those with a DSM-5 moderate diagnosis.

Diagnostic Concordance between DSM-5 and ICD-10 Cannabis Use Disorders

ObjectivesWith the recent federal mandate that all U.S. health care settings transition to ICD-10 billing codes, empirical evidence is necessary to determine if the DSM-5 designations map to their respective ICD-10 diagnostic categories/billing codes. The present study examined the concordance between DSM-5 and ICD-10 cannabis use disorder diagnoses. MethodData were derived from routine clinical assessments of 6871 male and 801 female inmates recently admitted to a state prison system from 2000 to 2003. DSM-5 and ICD-10 diagnostic determinations were made from algorithms corresponding to the respective diagnostic formulations. ResultsPast 12-month prevalence rates of cannabis use disorders were comparable across classification systems. The vast majority of inmates with no DSM-5 diagnosis continued to have no diagnosis per the ICD-10, and a similar proportion with a DSM-5 severe diagnosis received an ICD-10 dependence diagnosis. Most of the variation in diagnostic classifications was accounted for by those with a DSM-5 moderate diagnosis in that approximately half of these cases received an ICD-10 dependence diagnosis while the remaining cases received a harmful use diagnosis. ConclusionsAlthough there appears to be a generally high level of agreement between diagnostic classification systems for those with no diagnosis or those evincing symptoms of a more severe condition, concordance between DSM-5 moderate and ICD-10 dependence diagnoses was poor. Additional research is warranted to determine the appropriateness and implications of the current DSM-5 coding guidelines regarding the assignment of an ICD-10 dependence code for those with a DSM-5 moderate diagnosis.

Cannabis use disorder treatment barriers and facilitators among veterans with PTSD.

In light of recent data demonstrating large variability in the diagnosis of cannabis use disorders (CUDs) within the Veterans Affairs Health Care System (VA), it is important to elucidate VA-specific barriers and facilitators to CUD diagnosis and treatment engagement. This issue is particularly salient among veterans with posttraumatic stress disorder (PTSD), given that PTSD is the most common co-occurring psychiatric disorder among veterans with CUD and is associated with poorer treatment outcomes. The goal of the current study was to evaluate the potential role of system-, clinician-, and patient-level factors associated with both CUD diagnosis and treatment engagement. Key personnel were interviewed from PTSD programs with both low and high rates of CUD and substance use disorder (SUD) programs with both low and high rates of SUD treatment engagement. Common themes emerged across clinics that may represent barriers to CUD diagnosis and treatment engagement and included, for example, clinician's concerns about negative consequences associated with CUD diagnosis (e.g., service connection). Potential facilitators to CUD diagnosis and treatment also emerged and included the use of formal assessment approaches when evaluating veterans for SUDs. Together, findings suggest opportunities, such as CUD-specific education and training for clinicians, to improve VA care.