Treatment of cannabis use among people with psychotic disorders: a critical review of randomised controlled trials.
There is growing and converging evidence that cannabis may be a major risk factor in people with psychotic disorders and prodromal psychotic symptoms. The lack of available pharmacological treatments for cannabis use indicates that psychological interventions should be a high priority, especially among people with psychotic disorders. However, there have been few randomised controlled trials (RCTs) of psychological interventions among this group. In the present study we critically overview RCTs of psychological and pharmacologic interventions among people with psychotic disorders, giving particular attention to those studies which report cannabis use outcomes. We then review data regarding treatment preferences among this group. RCTs of interventions within "real world" mental health systems among adults with severe mental disorders suggest that cannabis use is amenable to treatment in real world settings among people with psychotic disorders. RCTs of manual guided interventions among cannabis users indicate that while brief interventions are associated with reductions in cannabis use, longer interventions may be more effective. Additionally, RCTs reviewed suggest treatment with antipsychotic medication is not associated with a worsening of cannabis cravings or use and may be beneficial. The development of cannabinoid agonist medication may be an effective strategy for cannabis dependence and suitable for people with psychotic disorders. The development of cannabis use interventions for people with psychotic disorders should also consider patients' treatment preferences. Initial results indicate face-to-face interventions focussed on cannabis use may be preferred. Further research investigating the treatment preferences of people with psychotic disorders using cannabis is needed.
Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, Australia 2308. amanda.baker@newcastle.edu.au
Amanda L
AL
Baker
Louise K
LK
Thornton
Leanne
L
Hides
Adrian
A
Dunlop
D014150:Antipsychotic Agents / Q000627:therapeutic use; D006801:Humans; D002189:Marijuana Abuse / Q000150:complications / Q000188:drug therapy*; D008605:Mental Health Services / Q000458:organization & administration; D057240:Patient Preference; D011618:Psychotic Disorders / Q000150:complications* / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
D014150:Antipsychotic Agents