Sociodemographic and Clinical Predictors of the Length of Psychiatric Inpatient Stay of Immigrants in Switzerland

Immigrants with mental disorders have consistently been reported to spend shorter time in the psychiatric hospital compared to native patients. The aim of this study was to identify sociodemographic, clinical and migration-related predictors of a shorter length of psychiatric inpatient stay among immigrants in Switzerland. All patients of a foreign nationality admitted for inpatient treatment in the year 2016 (N = 279) were included in this study. The sample characteristics were drawn from the register of the psychiatric hospital. Within this sample, self-harm and substance use predicted a shorter inpatient treatment episode whereas disturbances of general psychosocial functioning were a predictor of a longer length of stay. As similar results were also reported for non-immigrant patients, the impact of these specific behavioral and social problems on the length of inpatient stay does not appear to be migrant-specific. Moreover, a country of origin outside Europe was a strong predictor of shorter length of stay pointing to inequalities of inpatient psychiatric treatment within the group of immigrants. Therefore, the cultural background and migrant history of immigrants in psychiatry need stronger consideration in order to eliminate disadvantages in mental health care

Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders

Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions

Simultaneous and Sensitive Analysis of THC, 11-OH-THC, THC-COOH, CBD, and CBN by GC-MS in Plasma after Oral Application of Small Doses of THC and Cannabis Extract

Besides the psychoactive Δ9-tetrahydrocannabinol (THC), hashish and marijuana as well as cannabis-based medicine extracts contain varying amounts of cannabidiol (CBD) and of the degradation product cannabinol (CBN). The additional determination of these compounds is interesting from forensic and medical points of view because it can be used for further proof of cannabis exposure and because CBD is known to modify the effects of THC. Therefore, a method for the simultaneous quantitative determination of THC, its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH), CBD and CBN from plasma was developed. The method was based on automatic solid-phase extraction with C18 ec columns, derivatization with N,O-bistrimethylsilyltrifluoroacetamide (BSTFA), and gas chromatography-electron impact ionization-mass spectrometry (GC-EI-MS) with deuterated standards. The limits of detection were between 0.15 and 0.29 ng/mL for THC, 11-OH-THC, THC-COOH, and CBD and 1.1 ng/mL for CBN. The method was applied in a prospective pharmacokinetic study after single oral administration of 10 mg THC alone or together with 5.4 mg CBD in cannabis extract. The maximum plasma concentrations after cannabis extract administration ranged between 1.2 and 10.3 ng/mL (mean 4.05 ng/mL) for THC, 1.8 and 12.3 ng/mL (mean 4.9 ng/mL) for 11-OH-THC, 19 and 71 ng/mL (mean 35 ng/mL) for THC-COOH, and 0.2 and 2.6 ng/mL (mean 0.95 ng/mg) for CBD. The peak concentrations (mean values) of THC, 11-OH-THC, THC-COOH, and CBD were observed at 56, 82, 115, and 60 min, respectively, after intake. CBN was not detected. Caused by the strong first-pass metabolism, the concentrations of the metabolites were increased during the first hours after drug administration when compared to literature data for smoking. Therefore, the concentration ratio 11-OH-THC/THC was discussed as a criterion for distinguishing oral from inhalative cannabis consumptio

Early Somatosensory Processing Over Time in Individuals at Risk to Develop Psychosis

Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has been demonstrated to influence SEP parameters in individuals at risk to develop psychosis. The aim of this study was to explore the course of SEP changes and the impact of concomitant cannabis use in individuals at risk to develop psychosis who sought medical help.Methods: Median nerve SEPs including high-frequency oscillations (HFOs) superimposed on the primary cortical response (N20) were investigated using multichannel EEG in individuals (n = 54 at baseline) remaining at risk to develop psychosis at follow-up after 1 year (high-risk: n = 19; ultra-high-risk: n = 27) vs. subjects with conversion to psychosis (n = 8) and a healthy control group (n = 35). Longitudinal and cross-sectional analyses of SEP components as estimated by dipole source analysis were performed.Results: The longitudinal development of the N20 strength depended on cannabis use. In cannabis non-users, a greater decrease of N20 strengths over time was associated with more negative symptoms at baseline. At baseline, converters did not differ from subjects remaining at risk. At follow-up, converters showed increased low- and high-frequency activity than at-risk subjects and did not differ from controls.Conclusion: The results of this study lead to the suggestion that the deficits in early somatosensory processing in individuals at risk to develop psychosis may not represent a marker for a genetic risk for psychosis but rather reflect state-dependent factors such as negative symptoms. On the other hand, the transition to psychosis seems to represent an interstage between reduced sensory registration from the at-risk state and gating deficits in the chronic state

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Acute effects of Δ9-tetrahydrocannabinol and standardized cannabis extract on the auditory evoked mismatch negativity

GesamtdissertationSchizophrene Erkrankungen gehen häufig mit verminderten Amplituden der akustisch evozierten Mismatch Negativity (MMN) einher. Defizite in der Generierung der MMN zeigen Störungen der auditorischen Informationsverarbeitung und des auditorischen sensorischen Gedächtnisses an. Δ9-Tetrahydrocannabinol (Δ9-THC), der psychoaktive Hauptbestandteil der Cannabis sativa-Pflanze, induziert als Agonist am zentralen Cannabinoidrezeptor (CB1) akute Schizophrenie-ähnliche Symptome sowie kognitive Defizite. Cannabidiol (CBD), ein weiterer Bestandteil der Cannabis sativa-Pflanze ohne psychoaktive Wirkung, scheint als Antagonist am CB1-Rezeptor neuroprotektive und antipsychotische Eigenschaften zu besitzen. Die Rolle des endogenen Cannabinoidsystems bei der Pathogenese der Schizophrenie und der Entwicklung kognitiver Defizite wird zur Zeit viel diskutiert. In diesem Zusammenhang konnte gezeigt werden, dass das endogene Cannabinoidsystem eng mit dem dopaminergen System interagiert. Im Rahmen einer prospektiven, randomisierten, placebokontrollierten Doppelblindstudie mit doppeltem Crossover wurden die Auswirkungen von Δ9-THC und standardisiertem Cannabis-Extrakt, das neben Δ9-THC zusätzlich CBD enthält, auf die MMN bei 22 Normalprobanden (28 ± 6 Jahre, 11 männliche, 11 weibliche Probanden) untersucht. Die MMN wurde mit einem 32-Kanal-EEG abgeleitet. Insgesamt wurden 1000 akustische Stimuli präsentiert. Die Standardstimuli (1000 Hz, 80 dB, 100 ms) traten mit einer Wahrscheinlichkeit von 90% auf, die devianten Stimuli (1500 Hz, 80 dB, 100 ms) traten mit einer Wahrscheinlichkeit von 10% auf. Unter Cannabis-Extrakt zeigte sich im Vergleich zu Placebo ein signifikanter Anstieg der MMN-Amplitude an den zentralen Elektroden. An den frontalen Elektroden konnten keine signifikanten Unterschiede festgestellt werden. Desweiteren zeigte die MMN-Amplitude an den zentralen Elektroden eine signifikante Korrelation mit der Konzentration des 11-OH-THC, dem wichtigsten psychoaktiven Metaboliten des Δ9-THC. Durch Subtraktion der Effekte des Δ9-THC auf die MMN-Generierung von den Effekten des standardisierten Cannabis- Extraktes, welches neben Δ9-THC auch CBD beinhaltete, läßt sich die Vermutung aufstellen, dass die höhere MMN-Amplitude unter Cannabis-Extrakt auf die Effekte des CBD zurückgeführt werden kann. Ein Anstieg der MMN-Amplitude weist auf eine gesteigerte kortikale Aktivierung und damit einhergehend auf eine gesteigerte kognitive Leistungsfähigkeit hinsichtlich der auditorischen Informationsverarbeitung hin, die mit dem positiven Einfluss des CBD in Zusammenhang gebracht werden kann. Insbesondere scheint die Aktivität des auditorischen Kortex von diesem Effekt zu profitieren, da an den frontalen Elektroden keine signifikanten Veränderungen beobachtet wurden.Reduced amplitudes of auditory evoked mismatch negativity (MMN) have often been found in schizophrenic patients, indicating deficient auditory information processing and working memory. Cannabis-induced psychotic states may resemble schizophrenia. Currently, there are discussions focusing on the close relationship between cannabis, the endocannabinoid and dopaminergic system, and the onset of schizophrenic psychosis. This study investigated the effects of cannabis on MMN amplitude in 22 healthy volunteers (age 28 6 years, 11 male) by comparing Δ9-tetrahydrocannabinol (Δ9-THC) and standardized cannabis extract containing Δ9-THC and cannabidiol (CBD) in a prospective, double-blind, placebo-controlled cross-over design. The MMNs resulting from 1000 auditory stimuli were recorded by 32 channel EEG. The standard stimuli were 1000 Hz, 80 dB SPL, and 100 ms duration. The deviant stimuli differed in frequency (1500 Hz). Significantly greater MMN amplitude values at central electrodes were found under cannabis extract, but not under Δ9-THC. There were no significant differences between MMN amplitudes at frontal electrodes. MMN amplitudes at central electrodes were significantly correlated with 11-OH-THC concentration, the most important psychoactive metabolite of Δ9-THC. Since the main difference between Δ9-THC and standardized cannabis extract is CBD, which seems to have neuroprotective and antipsychotic properties, it can be speculated whether the greater MMN amplitude that may imply higher cortical activation and cognitive performance is related to the positive effects of CBD. This effect may be relevant for auditory cortex activity in particular because only MMN amplitudes at the central, but not at the frontal electrodes were enhanced under cannabis

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review.

The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk-benefit assessments of the role of cannabis on users' health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes

Pure delta-9-tetrahydrocannabinol and its combination with cannabidiol in treatment-resistant Tourette syndrome: A case report

OBJECTIVES Anecdotal reports and preliminary studies suggest a therapeutic potential of cannabis in Tourette syndrome. We report the case of a female patient suffering from treatment-resistant Tourette syndrome. METHODS Guideline-directed antipsychotic treatment with risperidone and aripiprazole as well as pure delta-9-tetrahydrocannabinol had no significant effect on Tourette syndrome symptomatology. RESULTS Following administration of a daily dosage of 10 mg delta-9-tetrahydrocannabinol combined with 20 mg cannabidiol (CBD), the patient showed a rapid and highly significant improvement in the Yale Global Tic Severity Scale. CONCLUSIONS It can be speculated whether the beneficial effects may rely on the pharmacological properties of cannabidiol

Knowledge, experiences and views of German university students toward neuroenhancement: an empirical-ethical analysis

Across normative and empirical disciplines, considerable attention has been devoted to the prevalence and ethics of the non-medical use of prescription and illegal stimulants for neuroenhancement among students. A predominant assumption is that neuroenhancement is prevalent, in demand, and calls for appropriate policy action. In this paper, we present data on the prevalence, views and knowledge from a large sample of German students in three different universities (n = 1,026) and analyze the findings from a moral pragmatics perspective. The results of our study indicate that neuroenhancement is a well-known phenomenon among German students, but not prevalent. 2.2 % of our sample reported having used a prescription medication for neuroenhancement. Exams and competitive situations were predominant motivators of use. Students were unenthusiastic and critical about neuroenhancement in the academic context and disapproved of neuroenhancement for professionals. The majority of respondents agreed that neuroenhancing substances should be regulated by the state. These stances were based on strong beliefs in resisting peer pressure, avoiding the creation of injustice and valuing of hard work. From a moral pragmatics standpoint, these results challenge the assumption that policy on neuroenhancement is necessary in academic environments

Detecting Cannabis Use on the Human Skin Surface via an Electronic Nose System

The most commonly used drug testing methods are based on the analysis of hair and urine using gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry or immunoassay screening. These methods are time-consuming and partly expensive. One alternative method could be the application of an “electronic nose” (eNose). We have developed an eNose to detect directly on the human skin surface metabolic changes in the human body odor caused by cannabis consumption. Twenty cannabis-smoking and 20 tobacco-smoking volunteers were enrolled in this study. For the sensor signal data processing, two different methods were applied: Principle component analysis (PCA) with discriminant analysis, and the method of pattern recognition with subsequent support vector machines (SVM) processing. The PCA analysis achieved a correct classification of 70%, whereas the SVM obtained an accuracy of 92.5% (sensitivity 95%, specificity 90%) between cannabis-consuming volunteers and tobacco-smoking subjects. This study shows evidence that a low-cost, portable and fast-working eNose system could be useful for health protection, security agencies and for forensic investigations. The ability to analyze human body odor with an eNose opens up a wide field for diagnosing other drugs and also various diseases