Medical Treatment Options for Cannabis Use Disorder: An Updated Narrative Review

Background: Cannabis use disorder (CUD) is a common and growing condition in the United States and across the world. With the alteration of the legal landscape of the substance, normalization of the substance use in society, and a continual increase in frequency in recent years, more treatment options are desperately needed. CUD has been shown to be associated with various symptoms of mental illness. Most therapies to date have been psychotherapeutic in nature, involving theories such as cognitive-behavioral motivational-based methods. However, these are not always the most effective or accessible options for patients. Methods: Articles for this review were obtained by searching PubMed, Google Scholar, and the Cochrane Review database for key terms. All the studies included were human studies. Most of the included studies were randomized control trials (RCTs). Trials were prioritized for inclusion based on methodology, date, and outcome-based measures. Only papers after 2010 were considered for inclusion. Results: In recent years, many pharmacological agents have been studied, including antidepressants, mood stabilizers, GABA agents, THC-like compounds, and even some new novel agents such as N-Acetyl Cysteine (NAC), ketamine, and fatty acid amid hydrolase (FAAH) inhibitors. Of these drugs, research has found some more effective than others such as particular mood stabilizers, GABA agents, as well as THC agonists and antagonists. Newer drugs like ketamine, a FAAH inhibitor, and NAC have also been shown to be potential treatment candidates. Studies suggest other effective options may involve neuromodulation, as interventions such as transcranial magnetic stimulation (TMS) and transcranial direct-current stimulation (tDCS) have been shown to be relatively successful when targeting specific brain regions. Conclusions: While there is exciting research so far, much work must be done before there will be FDA-approved treatments on the market. Thus, we must work together to approach treatment in a multifactorial manner and prioritize the research of potential treatment options with more reliable and consistent evidence of safety and efficacy for CUD

Substance Abuse and Schizophrenia: Impediments to Optimal Care

ABSTRACT With lifetime prevalence estimates of substance abuse among schizophrenics as high as 47.01 %, there is an increasing awareness of the importance of this dual diagnosis and the global deficiencies in our knowledge about this comorbid condition. Patients with substance abuse disorders and schizophrenia are problematic from a clinical, economic, and health care systems perspective. The lack of systematic research into phenomenology, etiology, and treatment approaches (both psychotherapeutic and psychopharmacologic) has hindered the development of an adequate strategy to care for the needs of these patients. Thus, these patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations, and poor overall treatment compliance. The authors critically review the contemporary literature relevant to concurrent substance abuse and schizophrenia, highlight major deficiencies in our knowledge, and call for research to reduce the individual, economic, and social costs of this condition

PERSON-CENTERED CARE PLANNING AND SHARED DECISION MAKING FOR MENTAL AND COMORBID CONDITIONS

Developments in person-centered coordinated care are essential given the challenges of the growing epidemic of physical comorbidity in the mentally ill population. Excessive deaths due to comorbidity, especially cardiovascular disease, continue to contribute to the significant reduction in life expectancy in people with mental health problems. Contemporary and proposed models are now available to provide evidence for a way forward in this field. Practical guidance on implementation using person-centered care planning has now been developed to promote a more collaborative and integrated approach as a solution to the current single disease focused model of care, which is failing this patient group. The WHO perspective supports this strategy with the recent global objectives outlining proactive and preventative strategies and interventions to tackle comorbidity. The emphasis is on a transformation of current systems using evidence-based approaches for more integration to support the delivery of more effective and efficient care for those with mental disorders and other comorbid chronic diseases. Coordinated, collaborative, system-wide strategies encompass transparent shared decision making in prevention, early intervention, treatment options, lifestyle management and pharmacological rationalization. Hence urgent action is required to help create the conditions to enable the delivery of person-centered coordinated care in health care systems by involving commissioning bodies, clinicians, patient groups along with voluntary and other community providers. Contemporary models of care for comorbidity emphasize the importance of coordination in the management of physical well-being from the onset of treatment of people with mental health problems in order to ensure better outcomes, improved overall well-being, and a longer life expectancy. Illustratively, no further funds are available to implement this shift in the model of care in the United Kingdom, so redesign and redistribution of current resources will be key to promote this more seamless coordinated system of care to improve the quality of life and life expectancy for this population

Psychiatric diagnosis: challenges and prospects

Psychiatric diagnosis is one of the most important topics within the broad field of psychiatry. Clear, accurate definitions of the various disorders are essential for clinicians around the world to be confident that they are classifying patients in the same way, thereby enabling comparisons of treatment regimens and their outcomes. There are two major classification systems in use, one produced by the World Health Organization, the WHO International Classification of Diseases, Mental Disorders Chapter, and one by the American Psychiatric Association, the well known Diagnostic and Statistical Manual of Mental Disorders. Both of these are being revised so this book from the prestigious World Psychiatric Association is especially timely. In this book, leading experts in the field provide a broad and integrated coverage of the concepts, structure and context of psychiatric diagnosis. It begins by addressing mental health and illness around the world from historical, philosophical and cultural perspectives. Health is approached comprehensively, to include such aspects as resilience, resources and quality of life. The book then covers major specific psychopathology topics in Section II, including new categorizations and dimensional approaches. Section III concentrates on the complex problem of comorbidity, a primary challenge for modern diagnostic classifications in psychiatry. Finally, Section IV reviews emerging international diagnostic systems in psychiatry, considering innovative models and adaptations. This book will be essential reading for anyone involved in the diagnosis of psychiatric disorders

Comorbidity, Positive Health, and Integration of Services

This chapter contains sections titled: Introduction Comorbidity Essentials Comorbidity and Positive Health The Need for Integrated Care Reference

PERSON-CENTERED INTEGRATIVE DIAGNOSIS: CONCEPTS AND PROCEDURES

The person-centered integrative diagnosis (PID) is a model that aims at putting into practice the vision of person-centered medicine affirming the whole person of the patient in context as the center of clinical care and health promotion at the individual and community levels. The PID is a novel model of conceptualizing the process and formulation of clinical diagnosis. The PID presents a paradigm shift with a broader and deeper notion of diagnosis, beyond the restricted concept of nosological diagnoses. It involves a multilevel formulation of health status (both ill and positive aspects of health) through interactive participation and engagement of clinicians, patients, and families using all relevant descriptive tools (categorization, dimensions, and narratives). The current organizational schema of the PID comprises a multilevel standardized component model integrating three main domains. Each level or major domain addresses both ill health and positive aspects of health. The first level is the assessment of health status (ill health and positive aspects of health or well-being). The second level includes contributors to health, both risk factors and protective factors. The third major level includes health experience and values. Experience with the PID through a practical guide in Latin America supported the usefulness and adequacy of the PID model

Towards a Person‐Centred Integrative Diagnosis

This chapter contains sections titled: Introduction Historical and Conceptual Bases WPA's Institutional Programme on Psychiatry for the Person Conceptual Bases for Person‐Centred Integrative Diagnosis Precedence and Resources Basic Theoretical Model of Person‐Centred Integrative Diagnosis (PID) Next Steps In PID Development ConclusionS Reference