Therapeutic Effects of Prolonged Cannabidiol Treatment on Psychological Symptoms and Cognitive Function in Regular Cannabis Users: A Pragmatic Open-Label Clinical Trial.

Introduction: Chronic cannabis use has been associated with impaired cognition and elevated psychological symptoms, particularly psychotic-like experiences. While Δ9-tetrahydrocannabinol (THC) is thought to be primarily responsible for these deleterious effects, cannabidiol (CBD) is purported to have antipsychotic properties and to ameliorate cognitive, symptomatic, and brain harms in cannabis users. However, this has never been tested in a prolonged administration trial in otherwise healthy cannabis users. Here, we report the first study of prolonged CBD administration to a community sample of regular cannabis users in a pragmatic trial investigating potential restorative effects of CBD on psychological symptoms and cognition. Materials and Methods: Twenty frequent cannabis users (16 male, median age 25 years) underwent a 10-week open-label trial of 200 mg of daily oral CBD treatment, while continuing to use cannabis as usual. The majority of participants were daily cannabis users who had used cannabis for several years (median 5.5 years of regular use). Participants underwent psychological and cognitive assessments at baseline (BL) and post-treatment (PT) and were monitored weekly throughout the trial. Results: CBD was well tolerated with no reported side effects; however, participants retrospectively reported reduced euphoria when smoking cannabis. No impairments to cognition were found, nor were there deleterious effects on psychological function. Importantly, participants reported significantly fewer depressive and psychotic-like symptoms at PT relative to BL, and exhibited improvements in attentional switching, verbal learning, and memory. Increased plasma CBD concentrations were associated with improvements in attentional control and beneficial changes in psychological symptoms. Greater benefits were observed in dependent than in nondependent cannabis users. Conclusions: Prolonged CBD treatment appears to have promising therapeutic effects for improving psychological symptoms and cognition in regular cannabis users. Our findings require replication given the lack of a placebo control in this pragmatic trial, but suggest that CBD may be a useful adjunct treatment for cannabis dependence

Dyadic interventions for community-dwelling people with dementia and their family caregivers: a systematic review.

Background: In this review, we study the effects of dyadic psychosocial interventions focused on community-dwelling people with dementia and their family caregivers, and the relationship of the effects with intervention components of programs. Methods: A search from January 2005 to January 2012 led to 613 hits, which we reviewed against our inclusion criteria. We added studies from 1992 to 2005 reviewed by Smits et al. (Smits, C. H. M., De Lange, J., Droes, R.-M., Meiland, F., Vernooij-Dassen, M. and Pot, A. M. (2007). Effects of combined intervention programs for people with dementia living at home and their caregivers: a systematic review. International Journal of Geriatric Psychiatry, 22, 1181-1193). We assessed the methodological quality of 41 programs with the Cochrane criteria and two items of the Oxford Centre of Evidence-based Medicine guidelines. Results: Studies of moderate to high quality concerning 20 different dyadic psychosocial programs for people with dementia and caregivers were included. Nineteen of these programs show significant effects on the patient with dementia, the caregiver, or both. Due to differences in the programs and the studies, this study does not provide an unequivocal answer about which programs are most effective. Programs with intervention components that actively train one or more specific functional domains for the person with dementia and/or the caregiver seem to have a beneficial impact on that domain, although there are exceptions. Reasons can be found in the program itself, the implementation of the program, and the study design. Conclusions: Dyadic psychosocial programs are effective, but the outcomes for the person with dementia and the caregiver vary. More attention is needed for matching the targeted functional domains, intervention components, and delivery characteristics of a program with the needs of the person with dementia and the family caregiver. Copyright © International Psychogeriatric Association 2013

Leukemic iris infiltration as the only site of relapse in a child with acute lymphoblastic leukemia: temporary remission with high-dose chemotherapy

A 12-year-old Caucasian boy developed leukemic hyphema with iris infiltration as the only relapse site during the third complete remission of his acute lymphoblastic leukemia. With high-dose methotrexate, high-dose cytosine-arabinoside plus teniposide, and a 5-week course of vincristine, prednisolone, and L-asparaginase, a complete remission could be achieved. Maintenance treatment was reinstituted for 1 year. However, after stopping the treatment, the iris infiltrate reappeared, and this time the eye was irradiated after chemotherapeutic reinduction. Seven months later, the boy remains in complete remission. The pathogenesis of leukemic iris infiltration is discussed briefl

PTSD in adults with Mild Intellectual Disabilities: investigating the applicability of the trauma-focused art therapy protocol

Background and purpose: During the period 2002-2018, there was a steady increase of the diagnosis post-traumatic stress disorder (PTSD) in the Netherlands. Research shows that people with mild intellectual disability (MID) are significantly more often diagnosed with PTSD. This comorbidity is related to challenges in coping, cognitive and adaptive skills which in turn may increase the risk of PTSD. The treatment protocol "Trauma-focused art therapy for adults with PTSD" developed by Schouten and colleagues (Schouten et al. 2018) shows that it has potential for treating PTSD in adults with MID. Therefore, the aim of this qualitative practice-based research was to investigate the extent to which this protocol-based treatment matches the abilities and needs of adults with MID.Method: Data was collected with multiple methods: from questionnaires (Delphi method), a focus group and from a single case study. The content was analyzed from the perspective of the client, the coordinating supervisor, and twelve professionals about the applicability of the Trauma-focused art therapy treatment protocol for adults with MID and PTSD.Results: Seven recommendations for applying the protocol in adults with MID and PTSD were derived from the thematic analysis. These recommendations focus on personalized treatment, network-oriented work, adjusting the diagnostics, (contra)indications and therapist attitude, as well as modifying the sessions and the work formats. Conclusion: The recommendations are consistent with national and international guidelines for trauma-focused interventions. The trauma-focused art therapy protocol therefore matches the needs of and can be applied to adults with MID and PTSD in clinical practice

Fusion loss as a result of long-standing unilateral traumatic cataract or uncorrected aphakia

Eight patients with secondary strabismus as a result of longstanding unilateral traumatic cataract or uncorrected aphakia were seen in the Orthoptic Department between April 1993 and September 1994. At the initial orthoptic examination three patients did not have any binocular vision and five patients demonstrated some form of binocularity although the fusional amplitude was seriously reduced. Three of these five patients showed just a small heterophoria and a better fusional amplitude within six months after a good optical correction and/or prescription of prisms with or without strabismus surgery. Orthoptic examination and therapy is mandatory in these patients because binocular functions can be restored in some of them, in spite of the long interval between trauma and optical correctio

The Peters' plus syndrome: a review

Peters' plus syndrome is an infrequently described entity that combines anomalies in the anterior chamber of the eye with other multiple congenital anomalies, and a developmental delay. Major symptoms are extremely variable anterior chamber anomalies, cupid bow of the upper lip, cleft lip and palate, short stature, broad hands and feet, and variable mental delay. The syndrome follows an autosomal recessive pattern of inheritance. The etiology is unknown, but may involve abnormal neural crest development. A review of the pertinent literature is provided. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserve

Effects of a music therapy and music listening intervention for nursing home residents with dementia:a randomized controlled trial

INTRODUCTION: The aim of the present study was to evaluate the effects of an individual music therapy intervention and an individual music listening intervention on neuropsychiatric symptoms and quality of life in people with dementia living in a nursing home and on professional caregiver's burden to be able to make statements about their specific value of application in clinical practice.METHODS: A multicenter single blind randomized controlled trial with three groups was performed: an individual music therapy intervention (IMTI) group ( n  = 49), an individual music listening intervention (IMLI) group ( n  = 56) and a control group ( n  = 53) receiving usual care. The interventions were given during three weeks, three times a week on non-consecutive days during 30-45 minutes for in total nine sessions. The endpoint of the study is the difference from baseline to interim (1,5 week), post-intervention (3 weeks) and follow-up (6 weeks) in reported scores of problem behaviour (NPI-NH) and quality of life (Qualidem) in people with dementia and occupational disruptiveness (NPI-NH) in care professionals. RESULTS: In total 158 people with dementia were randomized to one of the two intervention groups or the control group. Multilevel analyses demonstrated that hyperactive behaviour assessed by the NPI-NH was significantly more reduced for the IMLI group at follow up and that restless behaviour assessed by the Qualidem was significantly more reduced for the IMTI group at post and follow-up measurement compared to the control group. No significant effects between groups were found in other NPI-NH clusters or Qualidem subscales.CONCLUSION: In conclusion, because we found no convincing evidence that the IMTI or IMLI is more effective than the other both interventions should be considered in clinical practice. For the future, we advise further research into the sustainability of the effects with alternative designs, like a single case experimental design.</p