Cannabis & Psychosis: The Interface Emerging Frontiers for Research

INTRODUCTION: CANNABIS CONTINUES TO AFFECT MENTAL HEALTH. ITS ABUSE IS ON RISE GLOBALLY. IN CANADA A RISE BY 30% IN LAST TEN YEARS HAS BEEN OBSERVED IN HIGH SCHOOL STUDENTS. INTERRELATIONSHIP OF CANNABIS WITH PSYCHOSIS AND SCHIZOPHRENIA IS A COMPLEX ONE. CANNABIS IS HIGHLY COMORBID WITH PSYCHOSIS, & RELATED TO FUNCTIONAL DISABILITY AND OUTCOME. IT POSES SEVERAL CHALLENGES IN UNDERSTANDING CAUSAL RELATIONSHIP FOR COMORBIDITY, UNDERLYING NEUROCHEMICAL BASIS AND SPECIFICS OF SERVICE DEVELOPMENT. PREVALENCE OF CANNABIS VARIES FROM 20 TO 50% EARLY PSYCHOSIS. OBJECTIVE OF THIS PAPER IS TO REVIEW AVAILABLE LITERATURE TO IDENTIFY CHALLENGES FOR NEWER TARGETS OF RESEARCH AND PREVENTIVE MEASURES. METHOD: RECENT LITERATURE FROM ELECTRONIC DATA BASE SEARCH IDENTIFIES ROLE AND RELATIONSHIP OF CANNABIS AND PSYCHOSIS. RESULTS. CANNABIS IS A RISK FACTOR FOR BOTH PSYCHOSIS AND SCHIZOPHRENIA & APPEARS TO HAVE CAUSAL RELATIONSHIP FOR EARLY AND LATERAGE PSYCHOSIS. MOOD SYMPTOMS ARE ALSO SIGNIFICANT BUT LESS RECOGNIZED. UNDERSTANDINGS OF THE PROCESS AND CAUSES HAVE SIGNIFICANTLY ADVANCED WITH DISCOVERY OF CANNABINOID RECEPTORS AND ENDOGENOUS CANNABINOIDS. IT IS CLEAR THAT CANNABIS INCREASES BRAIN VULNERABILITY, CAUSES POORER OUTCOME AND MORE SIDE EFFECTS. CANNABIS CAUSES COGNITIVE DYSFUNCTION THAT PERHAPS WORKS AS A COMMON DENOMINATOR FOR THE RISK-VULNERABILITY. IT APPEARS TO HAVE INDEPENDENT GENETIC COMPONENT RELATED TO DISRUPTION IN NEUROTRANSMISSION AFFECTING NEURONAL PLASTICITY. MUCH LESS ATTENTION HAS BEEN PAID IN DEVELOPING SERVICES TARGETED TOWARDS HARM REDUCTION AND DEVELOPING THERAPEUTICS. CONCLUSION. CANNABIS IS POTENTIAL RISK FACTOR FOR POORER OUTCOME IN PSYCHOSIS. NEW BIOLOGICAL AND SOCIAL SERVICE INITIATIVES WILL ADD VALUE TO EARLY PSYCHOSIS PROGRAMS

Current Understanding and Pharmacological Management of Suicide Behavior in Clinical Setting

This presentation addresses these issues: • Nature of problem in clinical settings • Current understanding about suicide behavior (neurobiology) • What can be done to deal with suicide in clinical settings • Pharmacological managemen

Response, Remission & Recovery: Need to Review Outcome Measures for Schizophrenia

Schizophrenia is a complex neurobehavioral disorder known to be associated with poor outcome. It causes significant disability in patients and burden of care amongst relatives. Outcome in developing countries has been reported to be far better than western world, which has come into scientific scanner recently. Wide gap exists between expectations of outcome amongst patients, relatives, caregivers and professionals, which is possibly because of limitations in measurements tools. Significant number of patients remain marginalized without improvement in social & occupational functioning preventing their integration into mainstream of society despite \u27clinically reported good outcome\u27 and significant advancement in treatments. The contemporary outcome measure does not capture real-life situations. The concept of response, remission and recovery is being revisited scientifically. There is a strong need to develop culture specific, comprehensive and reliable outcome measures for schizophrenia, which reflects clinical and social outcome in multidimensional measures

Perception of medical interns and residents about specialty of microbiology and the role of microbiologists during COVID-19 pandemic

Background: The speciality of microbiology is closely associated with keeping people healthy and disease free by accurate diagnosis of infectious diseases. In spite of this, awareness about the speciality seems to be scarce. In the present scenario, public perception about microbiology has been changed a lot. The SARS-CoV-2 pandemic has highlighted the crucial role of microbiologists in the health care system. The aim of this survey was to determine the perceptions of medical interns and residents regarding the specialty of microbiology and the role of microbiologists in maintaining and promoting health of people.Methods: On-line survey using google form to identify perception of medical interns and residents about the speciality of microbiology.Results: A total 298 valid responses were obtained response rate 26.02% from the participants among them 167 (56.0%) were male and 131 (44.0%) females. Though, the attitude of medical interns and residents were found positive for the speciality of microbiology, they even recognize the importance of medical microbiology in their future role as medical practitioners, but only few (3.48%) wished to opt it as their career.Conclusions: The risks and responsibilities of a microbiologist involved in managing patients seldom get due acknowledgement. Adequate measures need to be taken to enlighten the authorities about microbiology and various responsibilities of microbiologists. The health care providers and medical teachers needed to appreciate the perception of young medical students regarding current and future trends in specialty choice and take concrete steps to meet the unmet need of health care

Predictors and Characteristics of Response and Nonresponse: A Ten Year Follow-Up of First Episode Schizophrenia in Mumbai

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, using the SAS system of statistical analysis ▪ 61 of 101 patients showed good outcome on the CGIS after ten years ▪ Predictors of good recovery were high baseline positive symptoms and low negative symptoms, higher anxiety-depressive symptoms, lower level of depressive symptoms, lower level of aggression, higher work performance and ability to live independently. ▪ Characteristics of non-recovered patients showed higher extra pyramidal symptoms, severe aggressive symptoms, higher frequency of disorganization symptoms at baseline and higher level of family burden at the end of the term ▪ Our study shows reasonably good outcome [61.7%] in first episode-hospitalized patients ▪ Good outcome correlated with severity of positive symptoms, level of work function and ability to live independently at baselin

Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension

BACKGROUND: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India. METHOD: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality. RESULTS: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up. CONCLUSION: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment

Staging of Schizophrenia with the Use of PANSS: An International Multi-Center Study

Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.<br /