This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma.
A total of 24 high schools and 534 students in the regional area ...of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 "Healthy Living" courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes.
For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001).
This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted. Clinical trial registration information-Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780.
To prospectively identify and assess withdrawal symptoms in adolescents with cannabis dependence.
Twenty-one adolescents ages 13 to 19 years voluntarily entering residential and day/outpatient ...substance abuse programs, with cannabis dependence as their only current substance of dependence, were assessed using the Teen-Addiction Severity Index, Substance Use Survey, Cannabis Withdrawal Scale, and the Structured Clinical Interview for DSM-IV Childhood Diagnoses Substance Use Disorders Module. Weekly assessments continued for 4 weeks. Thirteen youths attained a minimum of 2 weeks of abstinence.
Cannabis withdrawal symptoms were present in adolescents. Cannabis withdrawal was greatest in the first 2 weeks of abstinence with evidence that it continued well into week 3. Most withdrawal symptoms were endorsed with a high degree of frequency. Those symptoms endorsed with the greatest severity were restlessness, appetite change, and thoughts of and cravings for cannabis, with the highest ratings occurring in week 1. Over the course of the study, participants reported fewer symptoms with decreasing levels of severity. Youth ratings of overall severity of withdrawal were significantly and positively correlated with withdrawal symptoms of irritability (r = 0.56), depression (r = 0.56), twitches and shakes (r = 0.57), perspiring (r = 0.57), thoughts of (r = 0.86), and cravings for (r = 0.69) cannabis.
Findings support the presence of clinically significant cannabis withdrawal symptoms in adolescents with cannabis dependence seeking substance abuse treatment. This study also provides supporting evidence suggesting a vulnerability of adolescents to physiological cannabis dependence. The study supports the addition of cannabis withdrawal as a distinct entity for inclusion in DSM-V.
Background and Objectives
Sleep disturbance is one of the hallmarks of cannabis withdrawal. Studies have indicated that treatment of this key symptom may facilitate abstinence. In the present paper ...we aim to provide a systematic review of the extant literature on pharmacological management of sleep disturbance associated with cannabis withdrawal.
Method
We conducted a systematic literature search across five electronic databases including PubMed, Psycinfo, MEDLINE, Cochrane review and Embase. Human studies using a pharmacological treatment for sleep disturbances associated with cannabis withdrawal were included. Review articles, case‐series, open trials, posters, and editorials were excluded.
Results
Seventeen publications, involving 562 participants, were included in this review. Major limitations involved small sample size, high dropout rate, methodological limitations, and heterogeneity of participants. Most of the studies were at high risk of bias, further downgrading the level of evidence. A meta‐analysis was not performed due to lack of quantitative data, marked heterogeneity and low quality of the included studies.
Conclusion
There is not sufficient evidence for any of the reviewed treatment options. Methodological limitations in a majority of the studies rendered their findings preliminary. Of the twelve investigated pharmacological agents, Gabapentin, Lofexidine, Mirtazapine, Quetiapine, and Zolpidem showed some primary benefits for treatment of sleep difficulties associated with cannabis withdrawal; however, future prospective studies are required to confirm such results.
Scientific Significance
This review examines the current evidence for potential pharmacological options for treatment of cannabis withdrawal and associated sleep disturbance. It furthers our knowledge and provides groundwork for future research. (Am J Addict 2018;27:453–464)
The purpose of the study was to determine the effectiveness and tolerability of quetiapine as a maintenance treatment preventing against relapse or recurrence of acute mood episodes in adolescent ...patients diagnosed with bipolar disorder.
Consenting patients meeting DSM-IV lifetime criteria for a bipolar disorder and clinically appropriate for maintenance treatment were enrolled in a 48-week open prospective study. After being acutely stabilized (CGI-S < or = 3 for 4 consecutive weeks), patients were started or continued on quetiapine and other medications were weaned off over an 8-week period. Quetiapine monotherapy was continued for 40-weeks and other mood stabilizers or antidepressants were added if clinically indicated. A neurocognitive test battery assessing the most reliable findings in adult patients was administered at fixed time points throughout the study to patients and matched controls.
Of the 21 enrolled patients, 18 completed the 48-week study. Thirteen patients were able to be maintained without relapse or recurrence in good quality remission on quetiapine monotherapy, while 5 patients required additional medication to treat impairing residual depressive and/or anxiety symptoms. According to symptom ratings and global functioning scores, the quality of remission for all patients was very good.Neurocognitive test performance over treatment was equivalent to that of a matched control group of never ill adolescents. Quetiapine was generally well tolerated with no serious adverse effects.
This study suggests that a proportion of adolescent patients diagnosed with bipolar disorder can be successfully maintained on quetiapine monotherapy. The good quality of clinical remission and preserved neurocognitive functioning underscores the importance of early diagnosis and effective stabilization.
D1441L00024.
Objective: A major aim of this longitudinal high‐risk study is to identify reliable early indicators of emerging bipolar disorder (BD) among offspring from well‐characterized parents.
Methods: ...High‐risk offspring were recruited from families in which one parent had BD diagnosed on the basis of the Schedule for Affective Disorders and Schizophrenia – Lifetime version (SADS‐L) interviews and DSM‐IV diagnostic criteria and the other parent was well. Bipolar parents were further subdivided on the basis of response or non‐response to long‐term lithium. A comparison group of offspring was recruited from well parents diagnosed on the basis of either SADS‐L interviews or the family history method. All consenting offspring from high‐risk and control families were assessed longitudinally with the Schedule for Affective Disorders and Schizophrenia for School‐aged Children – Present and Lifetime version (KSADS‐PL) interviews and DSM‐IV diagnoses were made on a blind consensus review. The offspring were reassessed on average annually, as well as at any time symptoms developed.
Results: Antecedent conditions to BD in both high‐risk groups included sleep and anxiety disorders, while attention‐deficit hyperactivity disorder and pre‐psychotic conditions were antecedents among the offspring of lithium non‐responders only. Among those offspring developing BD, the index mood episode was almost always depressive.
Conclusions: Despite a specific genetic risk, BD began with non‐specific psychopathology and/or depressive disorders in a majority of offspring. Therefore, diagnosis based only on cross‐sectional assessment of symptoms appears to be insufficient for the accurate early detection of emerging BD. Other parameters such as family history and associated antecedents should be taken into account.
It is important to evaluate the impact of cannabis use on onset and course of psychotic illness, as the increasing number of novice cannabis users may translate into a greater public health burden. ...This study aims to examine the relationship between adolescent onset of regular marijuana use and age of onset of prodromal symptoms, or first episode psychosis, and the manifestation of psychotic symptoms in those adolescents who use cannabis regularly.
A review was conducted of the current literature for youth who initiated cannabis use prior to the age of 18 and experienced psychotic symptoms at, or prior to, the age of 25. Seventeen studies met eligibility criteria and were included in this review.
The current weight of evidence supports the hypothesis that early initiation of cannabis use increases the risk of early onset psychotic disorder, especially for those with a preexisting vulnerability and who have greater severity of use. There is also a dose-response association between cannabis use and symptoms, such that those who use more tend to experience greater number and severity of prodromal and diagnostic psychotic symptoms. Those with early-onset psychotic disorder and comorbid cannabis use show a poorer course of illness in regards to psychotic symptoms, treatment, and functional outcomes. However, those with early initiation of cannabis use appear to show a higher level of social functioning than non-cannabis users.
Adolescent initiation of cannabis use is associated, in a dose-dependent fashion, with emergence and severity of psychotic symptoms and functional impairment such that those who initiate use earlier and use at higher frequencies demonstrate poorer illness and treatment outcomes. These associations appear more robust for adolescents at high risk for developing a psychotic disorder.
Abstract Background There is a paucity of longitudinal data characterizing the relationship between substance use disorder (SUD) and the early clinical course of bipolar disorder (BD). We studied ...this relationship in a prospectively assessed cohort of high-risk offspring. Methods Eligible families had one parent with confirmed BD based on SADS-L interviews and best estimate diagnostic procedure. Offspring completed KSADS-PL interviews at baseline and were reassessed prospectively. DSM-IV diagnoses were made on blind consensus review using all available information. This analysis included 211 offspring ≥12 years, and used GEE and linear mixed models to determine clinical characteristics differentiating those with compared to those without SUD, and CPH models to assess the relationship between SUD and the early stages of BD. Results Lifetime SUD was diagnosed in 24% of offspring; cannabis use being most common. The peak hazard of SUD was between 14 and 20 years of age. Male sex (HR 3.285; p =.0007), a prior mood disorder (HR 2.437; p =.0091) and parental history of SUD (HR 2.999; p =.0027) contributed to the risk of SUD in the offspring, while SUD predicted an increased risk of psychosis (HR 3.225; p =.0074). The estimated hazard of a major mood disorder in those offspring with compared to those without a prior SUD was almost 3-fold (HR 2.990 ( p ≤0.01). Limitations The novel clinical staging model requires independent replication. Conclusions SUD is a common comorbidity arising during the early course of BD, even before the first activated episode. Further research is needed to understand causative factors and to develop effective early intervention and prevention strategies.
Objective:
In adults with established bipolar disorder (BD), differential response to mood stabilizers has been associated with the clinical profile. Long-term treatment studies of youth with BD are ...lacking. This paper provides longitudinal observations of response to mood stabilizers early in the course of illness in youth with BD.
Method:
We report on 15 research patients who, as adolescents, met DSM-IV lifetime criteria for a bipolar spectrum disorder and required long-term treatment. These youths derived from families with one parent having BD whose course and long-term treatment response were determined in accordance with research criteria. The patients were offered lithium, and if they failed to respond or refused it, they were treated with either an anticonvulsant or an atypical antipsychotic. Using a validated scale, an independent rater retrospectively blindly scored the response to long-term treatment.
Results:
Those patients who stabilized on lithium derived from lithium-responsive families, whereas those who stabilized on an antipsychotic derived from lithium-nonresponsive families. The clinical course in the youths stabilized by lithium differed from that in the youths stabilized by an atypical antipsychotic.
Conclusions:
Our findings suggest that the clinical profile may help in selecting effective stabilizing treatment and that a proportion of youth can be stabilized on monotherapy. This is a small case series with nonrandom treatment assignment, and the findings should be considered tentative.
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