The bridge between classical and ‘synthetic’/chemical psychoses: towards a clinical, psychopathological and therapeutic perspective

© 2019 Orsolini, Chiappini, Papanti, De Berardis, Corkery and Schifano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.The critical spread and dissemination of novel psychoactive substances (NPS), particularly among the most vulnerable youngsters, may pose a further concern about the psychotic trajectories related to the intake of new synthetic drugs. The psychopathological pattern of the “new psychoses” appears to be extremely different from the classical presentation. Therefore, clinicians need more data on these new synthetic psychoses and recommendations on how to manage them. The present mini-review aims at deepening both the clinical, psychopathological features of synthetic/chemical NPS-induced psychoses and their therapeutic strategies, according to the different NPS classes implicated, by underlining the main differences with the “classical” psychoses. A comprehensive review was conducted using the PubMed/Medline database by combining the search strategy of free-text terms and exploding a range of MESH headings relating to the topics of novel psychoactive substances and synthetic/chemical psychoses as follows: {(Novel Psychoactive Substances[Title/Abstract]) AND Psychosis[Title/Abstract])} and for each NPS categories as well, focusing on synthetic cannabinoids and cathinones, without time and/or language restrictions. Finally, an overview of the main clinical and psychopathological features between classical versus NPS-induced chemical/synthetic psychoses is provided for clinicians working with dual disorders and addiction psychiatry. Further insight is given here on therapeutic strategies and practical guidelines for managing patients affected with synthetic/chemical NPS-induced psychoses.Peer reviewedFinal Published versio

An adolescent with an altered state of mind

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Use of Medicinal Cannabis and Synthetic Cannabinoids in Posttraumatic Stress Disorder (PTSD): a systematic review

Background and Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric disorder resulting from a traumatic event, is manifested through hyperarousal, anxiety, depressive symptoms, and sleep disturbances. Despite several therapeutic approaches being available, both pharmacological and psychological, recently a growing interest has developed in using cannabis and synthetic cannabinoids stems from their consideration as more efficient and better tolerated alternatives for the treatment of this condition. The present paper aims to evaluate the clinical and therapeutic potentials of medical cannabis and synthetic cannabinoids in treating PTSD patients. Methods: A systematic electronic search was performed, including all papers published up to May 2019, using the following keywords (((cannabis[Title/Abstract]) OR (synthetic cannabinoids [Title/Abstract])) AND ((PTSD[Title/Abstract]) OR (Posttraumatic stress disorder[Title/Abstract]))) for the topics ‘Cannabis’, ‘Synthetic Cannabinoids’, ‘PTSD’, and MESH terms, on the PubMed, Cochrane Library, and Web of Science online databases. For data gathering purposes, PRISMA guidelines were followed. Results were organized into two groups, considering cannabis and synthetic cannabinoids as different therapeutic approaches for PTSD. Results: Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory-related processes, and improving sleep. Conclusions: Even though the current literature suggests that cannabis and synthetic cannabinoids may have a role in the treatment of PTSD, there is currently limited evidence regarding their safety and efficacy. Therefore, additional research is needed in order to better understand the effectiveness and therapeutic usage of these drug classes and monitor their safety.Peer reviewe

Novel psychoactive substances of interest for psychiatry

Novel psychoactive substances include synthetic cannabinoids, cathinone derivatives, psychedelic phenethylamines, novel stimulants, synthetic opioids, tryptamine derivatives, phencyclidine-like dissociatives, piperazines, GABA-A/B receptor agonists, a range of prescribedmedications, psychoactive plants/herbs, and a large series of performance and image enhancing drugs. Users are typically attracted by these substances due to their intense psychoactive effects and likely lack of detection in routine drug screenings. This paper aims at providing psychiatrists with updated knowledge of the clinical pharmacology and psychopathological consequences of the use of these substances. Indeed, these drugs act on a range of neurotransmitter pathways/receptors whose imbalance has been associated with psychopathological conditions, including dopamine, cannabinoid CB1, GABA-A/B, 5-HT2A, glutamate, and k opioid receptors. An overall approach in terms of clinical management is briefly discussed.Peer reviewe

Cannabis; epidemiological, neurobiological and psychopathological issues: an update

This document is the Accepted Manuscript version of the following article: Maria Antonietta De Luca, Gaetano Di Chiara, Cristina Cadoni, Daniele Lecca, Laura Orsolini, Duccio Papanti, John Corkery, Fabrizio Schifano, 'Cannabis; Epidemiological, Neurobiological and Psychopathological Issues: An Update', CNS & Neurological Disorders - Drug Targets, Vol. 16, 2017. The published manuscript is available at EurekaSelect via https://doi.org/10.2174/1871527316666170413113246. Published by Bentham Science.Cannabis is the illicit drug with both the largest current levels of consumption and the highest reported lifetime prevalence levels in the world. Across different countries, the prevalence of cannabis use varies according to the individual income, with the highest use being reported in North America, Australia and Europe. Despite its ‘soft drug’ reputation, cannabis misuse may be associated with several acute and chronic adverse effects. The present article aims at reviewing several papers on epidemiological, neurobiological and psychopathological aspects of the use of cannabis. The PubMed database was here examined in order to collect and discuss a range of identified papers. Cannabis intake usually starts during late adolescence/early adulthood (15-24 years) and drastically decreases in adulthood with the acquisition of working, familiar and social responsibilities. Clinical evidence supports the current socio-epidemiological alarm concerning the increased consumption among youngsters and the risks related to the onset of psychotic disorders. The mechanism of action of cannabis presents some analogies with other abused drugs, e.g. opiates. Furthermore, it has been well demonstrated that cannabis intake in adolescence may facilitate the transition to the use and/or abuse of other psychotropic drugs, hence properly being considered a ‘gateway drug’. Some considerations on synthetic cannabimimetics are provided here as well. In conclusion, the highest prevalence of cannabis use and the social perception of a relatively low associated risk are in contrast with current knowledge based on biological and clinical evidence. Indeed, there are concerns relating to cannabis intake association with detrimental effects on both cognitive impairment and mental health.Peer reviewe

The Legal System of the Military Sovereign Order of Malta in Modern Age

The Military Sovereign Order of Malta celebrates 900 years of historical existence and enters in the Third Millenium Age true to its originary mission of defense of the Christian Faith and help, essentially trough sanitary strutures to the ill, the needy or the people caught by natual disasters or wars. The paper, presenting the features of the Order of Malta’s legal system, establishes a comparation with the legal concepts of International Law and Constitutional Law.A Ordem Soberana Militar de Malta acaba de celebrar 900 anos de existência histórica e ingressa na Era do Terceiro Milênio fiel às suas missões originárias de defesa da fé cristã e ajuda, sobretudo mediante estruturas sanitárias aos doentes, aos necessitados ou às pessoas atingidas por desastres naturais como, também, por guerras. O trabalho, ao apresentar as características do ordenamento da Ordem de Malta, faz um paralelo com as noções jurídicas de Direito Internacional e Direito Constitucional

Novel psychoactive substances: the pharmacology of stimulants and hallucinogens

There are increasing levels of concern relating to the rapidly evolving novel psychoactive substances/NPS and web markets' scenarios. The paper aims at providing an overview of the clinical pharmacological issues related to some of the most popular NPS categories, e.g. stimulants and hallucinogens. NPS intake is typically associated with the imbalance of a complex range of neurotransmitter pathways/receptors, namely: dopamine; cannabinoid/CB1; and 5-HT2A. The intake is almost invariably undetectable with standard screening tests. Hence, it may frequently occur that the acute management of NPS misusers will need to focus on decreasing levels of both self/outward-directed aggression and agitation. Benzodiazepines may be considered as first line treatment. Alternatively, propofol and/or antipsychotics can be administered. Focus will be as well on treatment of possible rhabdomyolysis and hyperthermia. Indeed, future studies should inform better tailored management/treatment strategies

An investigation into the relationship(s) between the different chemical classes of synthetic cathinones and their effects: desired, adverse and toxic

Final Published versio

Synthetic Cannabinoids : psychopharmacology, clinical aspects, and psy-chotic onset

This document is the Accepted Manuscript version of the following article: Giovanni Martinotti, Rita Santacroce, Duccio Papanti, Yasmine Elgharably, Mariya Prilutskaya, Ornella Corazza, ‘Synthetic Cannabinoids: Psychopharmacology, Clinical Aspects, and Psychotic Onset’, CNS & Neurological Disorders – Drug Targets, Vol. 16, 2017. Under embargo. Embargo end date: 13 April 2018. The published manuscript is available at EurekaSelect via: https://doi.org/10.2174/1871527316666170413101839. Published by Bentham Science.Synthetic Cannabinoids (SC) are the widest and most diffused class of Novel Psychoactive Substances. SC are chemically heterogeneous and structurally dissimilar from delta-9-tetrahydrocannabinol, being full agonists of the endocannabinoid system receptors CB1 and CB2. Desired effects include euphoria, talkativeness, feelings of joy and laughter, relaxation. With respect to cannabis, SC intake may also be associated with quicker arise of the effects, shorter duration of action, and larger levels of hangover. SC are more psychoactive than cannabis: symptoms may include a wide range of clinically relevant posi-tive, negative and cognitive psychopathological symptoms that mimic symptoms of schizophrenia. The risk of two widespread symptoms of SC intoxication, namely agitation and cardiotoxicity, exceeds this of traditional cannabis of 3.8 and 9.2 times respectively. A number of deaths have been related to SC ingestion, either on their own or in combination with other recreational drugs. Prompt and reliable in-formation available for health professionals, more specific analytic techniques, and designed preventive strategies are all required to face this unprecedented challenge.Peer reviewedFinal Accepted Versio

Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders : A multicenter-observational study

© 2017 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Acciavatti, T, Lupi, M, Santacroce, R, et al. Novel psychoactive substance consumption is more represented in bipolar disorder than in psychotic disorders: A multicenter‐observational study. Hum Psychopharmacol Clin Exp. 2017; 32:e2578. which has been published in final form at https://doi.org/10.1002/hup.2578. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.OBJECTIVE: Comorbidities between psychiatric diseases and use of traditional substances of abuse are common. Nevertheless, there are few data regarding the use of novel psychoactive substances (NPS) among psychiatric patients. Aim of this multicentre survey is to investigate the consumption of a number of psychoactive substances in a young psychiatric sample. METHODS: Between December 2013 and September 2015, a questionnaire was administered in 10 Italian psychiatric care facilities to a sample of 671 patients, aged 18-26 (mean age 22.24; SD 2.87). RESULTS: About 8.2% of the sample declared to have used NPS at least once, and 2.2% had consumed NPS in the previous 3 months. The three psychiatric diagnoses most frequently associated with NPS use were bipolar disorder (23.1%), personality disorders (11.8%), and schizophrenia and related disorders (11.6%). In univariate regression analysis, bipolar disorder was positively associated with NPS consumption, an association that did not reach statistical significance in the multivariate analysis. CONCLUSIONS: The use of NPS in a young psychiatric population appears to be frequent, and probably still underestimated. Bipolar disorder shows an association with NPS use. Careful and constant monitoring and an accurate evaluation of possible clinical effects related to NPS use are necessary.Peer reviewedFinal Accepted Versio