James Bonifant CPNP Presentation .pdf
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Introduce self and background (quick),
(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.
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
Photo is a PET brain scan of a normal brain (top row) and the brain of a marijuana
abuser (boRom row)
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
This is not an exhaus:ve list! (Trying to save :me)
(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
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.
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.
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
The CHDS, NEMESIS, and ALSPAC studies all aRempt to account for aRri:on.
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).