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James Bonifant CPNP Presentation .pdf



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Introduce  self  and  background  (quick),    

1  

(Read  the  ques:on,  then  describe  the  two  warning  labels.  Le>  –  medical,  right  
recrea:onal)  So,  a  correla:on  between  cannabis  and  psychosis  is  a  public  health  
concern  that  should  not  be  taken  lightly.  These  findings  have  a  wide  range  of  
implica:ons  on  our  country’s  people.  

2  

Briefly  define  cohort  study:  Defined  by  medicinenet.com  as  a  study  in  which  a  
par:cular  outcome  is  compared  in  groups  of  people  who  are  alike  in  most  ways  but  
differ  by  a  certain  characteris:c.  
 
The  nature  of  studying  cannabis  use  and  psychosis  does  not  allow  I  believe  for  more  
homogeny  in  individuals.  Many  factors  that  make  par:cipants  unique  must  be  taken  
into  account.  
 
Photo  is  a  PET  brain  scan  of  a  normal  brain  (top  row)  and  the  brain  of  a  marijuana  
abuser  (boRom  row)  

3  

This  review  towards  the  end  breaks  down  these  high  risk  groups,  and  in  my  opinion  
the  best  two  examples  of  these  groups  are  cannabis  users  under  18  and  vic:ms  of  
childhood  trauma.  
 
This  is  not  an  exhaus:ve  list!  (Trying  to  save  :me)  

4  

(Say  the  name  of  the  table,  explain  the  table)  
 
I  no:ced  that  in  many  of  these  cohort  studies,  the  sample  size  is  small  and  this  
creates  a  limita:on.  Should  laws  con:nue  to  trend  towards  legaliza:on  of  medical  
and/or  recrea:onal  marijuana,  psychiatrists  and  clinicians  will  have  a  much  greater  
pool  of  poten:al  individuals  for  these  studies  regardless  of  what  strength  of  
limita:on  it  possesses.  
 
I  personally  like  the  one  study  by  NEMESIS  (Dutch  Netherlands  Mental  Health  Survey  
and  Incidence  Study)  because  they  took  an  extra  step  in  assessing  risk  of  psychosis  in  
ex-­‐users  of  cannabis.  This  was  only  men:oned  in  the  ar:cle  and  is  not  reflected  on  
this  table.  

5  

The  ar:cle  divided  these  studies  into  two  categories:  
 
(1)  Black  box  –  study  inves:gated  psycho:c  disorder.  
(2)  Orange  triangle  –  study  inves:gated  psycho:c  experience.  
 
Gale  Encyclopedia  of  Medicine  defines  (1)  as  a  mental  disorder  characterized  by  
delusions,  hallucina:ons,  or  other  symptoms  of  lack  of  contact  with  reality.  The  
schizophrenias  are  psycho:c  disorders.  
(2),  according  to  mind.org.uk,  is  a  term  that  is  interchangeable  with  psychosis  
(perceiving  events  differently  than  those  around  you),  so  to  me  this  means  that  it  is  
slightly  more  general  as  it  refers  to  any  experience  involving  hallucina:ons,  delusions,  
and  flight  of  ideas.  
   
Although  the  ar:cle  doesn’t  provide  much  of  a  dis:nc:on  of  these  terms  or  why  they  
grouped  these  cohorts  into  these  categories,  where  I  think  the  difference  lies  is  in  the  
dura%on  of  episode.    

6  

So  as  you  can  see,  nearly  all  of  these  studies  have  outcomes  that  point  to  a  causal  
associa:on  between  cannabis  and  psychosis  (it  con:nues  down  the  outcome  
column).  Despite  this,  certain  overes:ma:ng  and  underes:ma:ng  factors  must  be  
taken  into  considera:on  when  we  interpret  these  findings.  These  factors  can  be  
enough  to  render  these  studies  inconclusive.  

7  

Confounding  usually  leads  to  overes:ma:on.  
 
A  great  example  of  bias  is  when  dealing  with  heavy  users  of  cannabis.  As  they  are  
rarely  unintoxicated,  they  are  misclassified  as  psycho:c  (not  due  to  exogenous  
cannabinoids)  and  bias  is  introduced.  Bias  can  cause  both  over/under.  
 
Reverse  caus:on  also  leads  to  overes:ma:on.  
 
Self-­‐repor:ng  will  o>en  lead  to  underes:ma:on  (people  don’t  want  to  think  they’re  
crazy).  
 
The  CHDS,  NEMESIS,  and  ALSPAC  studies  all  aRempt  to  account  for  aRri:on.  

8  

Age  of  use  is  s:ll  a  huge  area  of  concern!  Rela:ng  back  to  the  new  legality  of  
cannabis,  just  as  some  adolescence  have  an  affinity  for  the  liquor  cabinet,  the  danger  
of  easier  access  among  younger  people  now  exists.  
 
Childhood  trauma  –  confounding  
 
Strains  –  There  is  also  increasing  concern  of  similar  psycho:c  outcomes  in  “legal”  
synthe:c  cannabinoids.  Seizures  have  also  been  reported  a>er  using  these  synthe:cs  
(AAPCC  Poison  Center).  
 
 

9  


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