scholarly journals Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives

10.2196/26562 ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. e26562
Author(s):  
Ovidiu Tatar ◽  
Amal Abdel-Baki ◽  
Christophe Tra ◽  
Violaine Mongeau-Pérusse ◽  
Nelson Arruda ◽  
...  
Keyword(s):  
Young Adults ◽  
Psychological Intervention ◽  
Cannabis Use ◽  
Early Psychosis ◽  
First Episode ◽  
General Interest ◽  
Psychological Interventions ◽  
Cannabis Use Disorder ◽  
Web Based ◽  
Clinician Perspectives

Background The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.

scholarly journals E-mental health interventions for young adults with early psychosis and cannabis use disorder: a qualitative study of patient and clinician perspectives (Preprint)

2020 ◽  
Author(s):  
Ovidiu Tatar ◽  
Amal Abdel-Baki ◽  
Christophe Tra ◽  
Violaine Mongeau-Perusse ◽  
Nelson Arruda ◽  
...  
Keyword(s):  
Young Adults ◽  
Psychological Intervention ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
Early Psychosis ◽  
First Episode ◽  
Psychological Interventions ◽  
Cannabis Use Disorder ◽  
Episode Psychosis ◽  
Clinician Perspectives

BACKGROUND Persistence of cannabis use disorder (CUD) in young adults with first episode psychosis is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EIS) for psychosis is inconsistent due to barriers including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. OBJECTIVE The purpose of this study was two-fold: 1) to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis, and 2) to explore factors related to the development and implementation of a technology-assisted psychological intervention. METHODS Ten patients undergoing treatment for first episode psychosis (FEP) and CUD in EIS participated in a focus group in June 2019. Semi-structured individual interviews were conducted with ten clinicians working in first episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyse data. For deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to online interventions for substance use (i.e., tailoring, reminders, delivery strategies, social support and incentives). For inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. RESULTS Data was synthesized in five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences of patient and clinician perspectives was produced. The categories included: attitudes and beliefs related to psychological intervention (e.g., behavioral stage of change), strategies for psychological interventions (e.g., motivational interviewing), incentives (e.g., financial), general interest in TBPIs (e.g., facilitators and barriers), and tailoring of TBPIs (e.g., outcome measures of interest for clinicians). CONCLUSIONS This study provides a comprehensive portrait of the multi-faceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. CLINICALTRIAL N/A

scholarly journals Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Melanie Blair Thies ◽  
Pamela DeRosse ◽  
Deepak K Sarpal ◽  
Miklos Argyelan ◽  
Christina L Fales ◽  
...  
Keyword(s):  
Treatment Response ◽  
Reward Processing ◽  
Cannabis Use ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Cannabis Use Disorder ◽  
Schizophrenia Spectrum Disorders ◽  
Double Blind ◽  
History Of ◽  
The Relationship

Abstract Antipsychotic (AP) medications are the mainstay for the treatment of schizophrenia spectrum disorders (SSD), but their efficacy is unpredictable and widely variable. Substantial efforts have been made to identify prognostic biomarkers that can be used to guide optimal prescription strategies for individual patients. Striatal regions involved in salience and reward processing are disrupted as a result of both SSD and cannabis use, and research demonstrates that striatal circuitry may be integral to response to AP drugs. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between a history of cannabis use disorder (CUD) and a striatal connectivity index (SCI), a previously developed neural biomarker for AP treatment response in SSD. Patients were part of a 12-week randomized, double-blind controlled treatment study of AP drugs. A sample of 48 first-episode SSD patients with no more than 2 weeks of lifetime exposure to AP medications, underwent a resting-state fMRI scan pretreatment. Treatment response was defined a priori as a binary (response/nonresponse) variable, and a SCI was calculated in each patient. We examined whether there was an interaction between lifetime CUD history and the SCI in relation to treatment response. We found that CUD history moderated the relationship between SCI and treatment response, such that it had little predictive value in SSD patients with a CUD history. In sum, our findings highlight that biomarker development can be critically impacted by patient behaviors that influence neurobiology, such as a history of CUD.

scholarly journals Persistent cannabis use among young adults with early psychosis receiving coordinated specialty care in the United States

2020 ◽  
Vol 222 ◽  
pp. 274-282
Author(s):  
Leslie Marino ◽  
Jennifer Scodes ◽  
Talia Richkin ◽  
Jean-Marie Alves-Bradford ◽  
Ilana Nossel ◽  
...  
Keyword(s):  
United States ◽  
Young Adults ◽  
The United States ◽  
Specialty Care ◽  
Cannabis Use ◽  
Early Psychosis

scholarly journals A pilot trial of text-delivered peer network counseling to treat young adults with cannabis use disorder

2018 ◽  
Vol 89 ◽  
pp. 1-10 ◽  
Author(s):  
Michael J. Mason ◽  
Nikola M. Zaharakis ◽  
Michael Russell ◽  
Victoria Childress
Keyword(s):  
Young Adults ◽  
Pilot Trial ◽  
Cannabis Use ◽  
Cannabis Use Disorder ◽  
Peer Network ◽  
Peer Network Counseling

scholarly journals Deep Cerebellar Transcranial Electrical Stimulation: Hypothesis and Theory for Cannabis Use Disorder

2020 ◽  
Author(s):  
Anirban Dutta ◽  
Abhishek Ghosh ◽  
Shubhmohan Singh
Keyword(s):  
Young Adults ◽  
Electrical Stimulation ◽  
Information Processing ◽  
Molecular Layer ◽  
Cannabis Use ◽  
Transcranial Electrical Stimulation ◽  
Cannabis Use Disorder ◽  
Cannabis Dependence ◽  
Cerebellar Function ◽  
Home Based

Cannabis is the most widely cultivated, trafficked and abused illicit drug (“WHO | Cannabis,” n.d.; “World Drug Report 2020,” n.d.). In 2018, an estimated 192 million people aged 15-64 years used cannabis for nonmedical purposes globally (Degenhardt et al., 2013). The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated that, across the globe, there were more than 22·1 million people with cannabis dependence (Degenhardt et al., 2018). Moreover, the same study calculated that cannabis dependence could be accounted for 646 thousand Disability Adjusted Life Years, globally. Importantly, cannabis dependence mostly affects young adults (20-24 years), and thus has significant negative impact on the growth and productivity of not only these individuals but also to the societies and nations (Degenhardt et al., 2013). In addition to the dependence syndrome, cannabis use is associated with increased risk of psychosis, cognitive dysfunction, academic problems, and road side accidents (Volkow et al., 2014). A review showed a fairly consistent associations between cannabis use and both lower educational attainment and increased reported use of other illicit drugs (Macleod et al., 2004). In the United States, Cannabis Use Disorder (CUD) is an escalating problem in young adults by legalization (Cerdá et al., 2020) where National Survey on Drug Use and Health reported increased prevalence from 5.1% in 2015 to 5.9% in 2018 in 18-25 year olds (“2019 NSDUH Detailed Tables | CBHSQ Data,” n.d.). The psychoactive effects are due to type 1 cannabinoid receptor (CB1), the cannabinoid binding protein, that are highly expressed in the cerebellar cortex (Marcaggi, 2015). CB1 is primarily found in the molecular layer at the most abundant synapse type in the cerebellum (Marcaggi, 2015) that can shape the spike activity of cerebellar Purkinje cell (Brown et al., 2019). Moreover, granule cell to Purkinje cell synaptic transmission can trigger endocannabinoid release (Alger and Kim, 2011), which may be important for information processing by cerebellar molecular layer interneurons (Dorgans et al., 2019). This suggests that endocannabinoids could be essential to neurocognitive aspects of cerebellar function (Di Marzo et al., 2015),(Marcaggi, 2015),(Alger and Kim, 2011). Accumulating evidence also suggests cerebellar modulation of the reward circuitry and social behaviour, via direct cerebellar innervation of the ventral tegmental area (VTA) including dopamine cell bodies (A1) in the VTA (Carta et al., 2019). The VTA-dopamine (DA) signalling in the nucleus accumbens (NAc) and the medial prefrontal cortex (mPFC) (Lohani et al., 2019) play a key role in motivatedbehaviours and cognition. Cerebellar neuropathological changes can result in aberrant dopaminergic activity in the NAc and mPFC (ROGERS et al., 2011),(Lohani et al., 2019). Therefore, there is a critical need to determine how cerebellum modulate limbic VTA-DA signalling. Cerebellar Non-Invasive Brain Stimulation (NIBS) is postulated to be most relevant in CUD since endocannabinoids are essential to cerebellar function that includes reward-related behaviours, information processing, and cognitive control. (Di Marzo et al., 2015),(Marcaggi, 2015),(Alger and Kim, 2011). Furthermore, cerebellar NIBS can facilitate training of cognitive control in CUD during a during visual cue reactivity paradigm using a mobile virtual reality (VR) interface that can also allow remote delivery of cerebellar NIBS in conjunction with VR-based cognitive training for home-based intervention. Specifically, transcranial electrical stimulation (tES) can be translatable to low-cost (<$150) mobile devices that can be used in a low resource home-based setting (Carvalho et al., 2018).

Who responds best to text-delivered cannabis use disorder treatment? A randomized clinical trial with young adults.

2018 ◽  
Vol 32 (7) ◽  
pp. 699-709 ◽  
Author(s):  
Michael J. Mason ◽  
Nikola M. Zaharakis ◽  
Matthew Moore ◽  
Aaron Brown ◽  
Claudia Garcia ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Young Adults ◽  
Randomized Clinical Trial ◽  
Cannabis Use ◽  
Cannabis Use Disorder ◽  
Disorder Treatment
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