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Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis

BACKGROUND: Approximately 188 million people use cannabis yearly worldwide, and it has recently been legalised in 11 US states, Canada, and Uruguay for recreational use. The potential for increased cannabis use highlights the need to better understand its risks, including the acute induction of psyc...

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Autores principales: Hindley, Guy, Beck, Katherine, Borgan, Faith, Ginestet, Cedric E, McCutcheon, Robert, Kleinloog, Daniel, Ganesh, Suhas, Radhakrishnan, Rajiv, D'Souza, Deepak Cyril, Howes, Oliver D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738353/
https://www.ncbi.nlm.nih.gov/pubmed/32197092
http://dx.doi.org/10.1016/S2215-0366(20)30074-2
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author Hindley, Guy
Beck, Katherine
Borgan, Faith
Ginestet, Cedric E
McCutcheon, Robert
Kleinloog, Daniel
Ganesh, Suhas
Radhakrishnan, Rajiv
D'Souza, Deepak Cyril
Howes, Oliver D
author_facet Hindley, Guy
Beck, Katherine
Borgan, Faith
Ginestet, Cedric E
McCutcheon, Robert
Kleinloog, Daniel
Ganesh, Suhas
Radhakrishnan, Rajiv
D'Souza, Deepak Cyril
Howes, Oliver D
author_sort Hindley, Guy
collection PubMed
description BACKGROUND: Approximately 188 million people use cannabis yearly worldwide, and it has recently been legalised in 11 US states, Canada, and Uruguay for recreational use. The potential for increased cannabis use highlights the need to better understand its risks, including the acute induction of psychotic and other psychiatric symptoms. We aimed to investigate the effect of the cannabis constituent Δ(9)-tetrahydrocannabinol (THC) alone and in combination with cannabidiol (CBD) compared with placebo on psychiatric symptoms in healthy people. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published in English between database inception and May 21, 2019, with a within-person, crossover design. Inclusion criteria were studies reporting symptoms using psychiatric scales (the Brief Psychiatric Rating Scale [BPRS] and the Positive and Negative Syndrome Scale [PANSS]) following the acute administration of intravenous, oral, or nasal THC, CBD, and placebo in healthy participants, and presenting data that allowed calculation of standardised mean change (SMC) scores for positive (including delusions and hallucinations), negative (such as blunted affect and amotivation), and general (including depression and anxiety) symptoms. We did a random-effects meta-analysis to assess the main outcomes of the effect sizes for total, positive, and negative PANSS and BPRS scores measured in healthy participants following THC administration versus placebo. Because the number of studies to do a meta-analysis on CBD's moderating effects was insufficient, this outcome was only systematically reviewed. This study is registered with PROSPERO, CRD42019136674. FINDINGS: 15 eligible studies involving the acute administration of THC and four studies on CBD plus THC administration were identified. Compared with placebo, THC significantly increased total symptom severity with a large effect size (assessed in nine studies, with ten independent samples, involving 196 participants: SMC 1·10 [95% CI 0·92–1·28], p<0·0001); positive symptom severity (assessed in 14 studies, with 15 independent samples, involving 324 participants: SMC 0·91 [95% CI 0·68–1·14], p<0·0001); and negative symptom severity with a large effect size (assessed in 12 studies, with 13 independent samples, involving 267 participants: SMC 0·78 [95% CI 0·59–0·97], p<0·0001). In the systematic review, of the four studies evaluating CBD's effects on THC-induced symptoms, only one identified a significant reduction in symptoms. INTERPRETATION: A single THC administration induces psychotic, negative, and other psychiatric symptoms with large effect sizes. There is no consistent evidence that CBD induces symptoms or moderates the effects of THC. These findings highlight the potential risks associated with the use of cannabis and other cannabinoids that contain THC for recreational or therapeutic purposes. FUNDING: UK Medical Research Council, Maudsley Charity, Brain and Behavior Research Foundation, Wellcome Trust, and the UK National Institute for Health Research.
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spelling pubmed-77383532020-12-18 Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis Hindley, Guy Beck, Katherine Borgan, Faith Ginestet, Cedric E McCutcheon, Robert Kleinloog, Daniel Ganesh, Suhas Radhakrishnan, Rajiv D'Souza, Deepak Cyril Howes, Oliver D Lancet Psychiatry Articles BACKGROUND: Approximately 188 million people use cannabis yearly worldwide, and it has recently been legalised in 11 US states, Canada, and Uruguay for recreational use. The potential for increased cannabis use highlights the need to better understand its risks, including the acute induction of psychotic and other psychiatric symptoms. We aimed to investigate the effect of the cannabis constituent Δ(9)-tetrahydrocannabinol (THC) alone and in combination with cannabidiol (CBD) compared with placebo on psychiatric symptoms in healthy people. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published in English between database inception and May 21, 2019, with a within-person, crossover design. Inclusion criteria were studies reporting symptoms using psychiatric scales (the Brief Psychiatric Rating Scale [BPRS] and the Positive and Negative Syndrome Scale [PANSS]) following the acute administration of intravenous, oral, or nasal THC, CBD, and placebo in healthy participants, and presenting data that allowed calculation of standardised mean change (SMC) scores for positive (including delusions and hallucinations), negative (such as blunted affect and amotivation), and general (including depression and anxiety) symptoms. We did a random-effects meta-analysis to assess the main outcomes of the effect sizes for total, positive, and negative PANSS and BPRS scores measured in healthy participants following THC administration versus placebo. Because the number of studies to do a meta-analysis on CBD's moderating effects was insufficient, this outcome was only systematically reviewed. This study is registered with PROSPERO, CRD42019136674. FINDINGS: 15 eligible studies involving the acute administration of THC and four studies on CBD plus THC administration were identified. Compared with placebo, THC significantly increased total symptom severity with a large effect size (assessed in nine studies, with ten independent samples, involving 196 participants: SMC 1·10 [95% CI 0·92–1·28], p<0·0001); positive symptom severity (assessed in 14 studies, with 15 independent samples, involving 324 participants: SMC 0·91 [95% CI 0·68–1·14], p<0·0001); and negative symptom severity with a large effect size (assessed in 12 studies, with 13 independent samples, involving 267 participants: SMC 0·78 [95% CI 0·59–0·97], p<0·0001). In the systematic review, of the four studies evaluating CBD's effects on THC-induced symptoms, only one identified a significant reduction in symptoms. INTERPRETATION: A single THC administration induces psychotic, negative, and other psychiatric symptoms with large effect sizes. There is no consistent evidence that CBD induces symptoms or moderates the effects of THC. These findings highlight the potential risks associated with the use of cannabis and other cannabinoids that contain THC for recreational or therapeutic purposes. FUNDING: UK Medical Research Council, Maudsley Charity, Brain and Behavior Research Foundation, Wellcome Trust, and the UK National Institute for Health Research. Elsevier 2020-04 /pmc/articles/PMC7738353/ /pubmed/32197092 http://dx.doi.org/10.1016/S2215-0366(20)30074-2 Text en © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Hindley, Guy
Beck, Katherine
Borgan, Faith
Ginestet, Cedric E
McCutcheon, Robert
Kleinloog, Daniel
Ganesh, Suhas
Radhakrishnan, Rajiv
D'Souza, Deepak Cyril
Howes, Oliver D
Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title_full Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title_fullStr Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title_full_unstemmed Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title_short Psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
title_sort psychiatric symptoms caused by cannabis constituents: a systematic review and meta-analysis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738353/
https://www.ncbi.nlm.nih.gov/pubmed/32197092
http://dx.doi.org/10.1016/S2215-0366(20)30074-2
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