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psychopathology (co-morbidity data: Llopis 2006 review of diseases (12…
psychopathology
co-morbidity data: Llopis 2006 review of diseases
huge samples
16-65 y/o
Western world
12 month prevalence estimates
anx
per dis
SUD
alc dep
depression
drug dep
nicotine dep
data not comp compatible
12% of drug dep pp had 2+ other dis
people with a psych dis
nic dep 22%
alc dep 30%
SUD 88%
drug dep 45%
smoking and mental illness: self medication?
nicotine has stimulant functions: alerting, arousing
smokers report smoking in part to enhance alertness / cog function
evidence that they do perform faster / more efficiently
might just reflect dependance rather then normal benefit, little evidence of non-smokers show improvement with strips
Leon and Diaz 2005
meta anal of studies comparing smoking in healthy adults vs mental illness patients
Sz much more likely to smoke
other mental disorders also very likely
general pop relatively low
mental illness patients
smoke more heavily
extract more nic from cig
less likely to successfully quit
enhance cog functioning in Sz and in ADHD
Sz
visuo spatial WM
smooth persuit eye movements/
inhib control of anti-saccadic eye movements
Kumari et al., 2005
nicotine may be self med for
emotional responding
environ engagement
attention
what might account for co morbidity
SUD
self med
situational risk
other disease
intrapersonal risk
vulnerability factor
cannabis use and psychosis
hypothesis of relationship
cannabis use causes / makes Sz worse
canna functions as self med for those with psych disorders
cannabis use causes psychotic disorder that wouldn't have occurred otherwise
to establish causality
specifity
association
cause must precede effect
strength
cannabis can lead to derealisation, paranoia and depersonalisation in lab cond
some cannabis users report hallucinations and or delusions
persistent toxic psychosis very rare
across the lifetime
up to 50% of people with alc disorders have conduct problem history / anti social personality
35% of epople with drug dependance also hav a mood dis
nearly 1/3 of pp with alc dis also have mood dis
45% anxiety
50% anti soc
cannabis use and Sz
50,000 conscripts
increase risk for Sz in those who tried cannabis
Zammit et al., 2002
dose dependant (increase dose increase risk)
Gurpegui et al., 2007
Sz vs non Sz
smokers
asked benefits
all higher in Sz
alertness
concentration
cheerfulness
agility
calmness
sociability (not much diff)
causality
specifity
strength
association
temp prio
Moore et al., 2007
cannabis increases risk of psychoticism
causal not determined
increases likelihood
14% of psych ep would not have happened w/ out cannabis
stimulant use
huge prescription of stims for dep and weight loss UK US 60s
Connell 1958
prescribed users got psychosis
over time
stims can induce Sz like symptoms
Angriest et al., 1970
9 healthy volunteers
gave them 50mg of amphetamine
all became psychotic
40% of amphetamine dep patients report Sz like symptoms at some point
stim induced psychosis recovery within a few days - month w/ abstinence
case study: operating table "realised" hidden part, tearful
60% of Sz have a history of stim dep use
most common psychotic like symptoms
ideas of reference
auditory hallucinations
paranoid delusion
overview
relationship between sub use and psychop
cannabis use and psychosis
smoking
stimulant use and psychosis
mechanisms of co-morbidity
co-morbidity data
psychometric models of comorbidity
Caspi et al., 2005: dunedin
examined the moderating effect of the COMT gene on cannabis use as a risk factor for psychosis
COMT gene: degrades drugs / substances
found
COMT gene can predict onset
earlier usage + COMT means higher risk
Arseneault et al., 2002: dunedin
examined Sz and depression
controls
cannabis users from 15
cannabis users from 18
found
15 higher risk
not sure if due to earlier or more sensitive time to start
Dunedin longitudinal study
assessed every few years
measured on psych and phys range
New Zealand
pp: 1,000, born 72/3
Burns 2013
low vulnerability - recent canna use
asymptomatic
high vulnerability - recent canna use
neuro dev disrupt
acute psychosis
CU stop
good outcome
ongoing cannabis use
poor outcome
co-morbidity between SUDs and other psychiatric disorders
people who have SUDs are more likely to also suffer form psychiatric disorders
person dis
Sz
anxiety
maj dep
link between cannabis and psychosis is bidirectional (2 ways)
Griffith et al., 2013
assessed
pas year can use
psychosis related probs
found:
can use at 16 pred psycho aged 19
psycho aged 13, 16 predicted canna use 16, 19 resp
sig related at every time point
2,000 adoles at 13, 16, 19