1st Department of Psychiatry, Nyírő Gyula Hospital, Budapest, Hungary.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jan 15;35(1):212-7. doi: 10.1016/j.pnpbp.2010.11.007. Epub 2010 Nov 16.
Although incidence of schizophrenia is higher among cannabis users and marijuana is the most common abused drug by adolescents, etiological linkage between schizophrenia and cannabis use is still not clarified. Clinical experiences suggest that regular cannabis user can show similar psychotic episode to schizophrenic disorders but it is still unclear if chronic cannabis use with schizophreniform disorder is a distinct entity requiring special therapy or it can be treated as classical schizophrenia. There are no data available on the comparison of pharmacotherapy between schizophreniform patients with and without cannabis use.
Clinical data of 85 patients with schizophrenia spectrum disorder were analyzed retrospectively. Cannabis use was not reported by 43 persons (Cnbs0 subgroup) and 42 patients used regularly cannabis during at least 1 year (Cnbs1 subgroup). Comparison of anamnesis, family history, social-demographic condition, positive and negative symptoms, acute and long-term therapies recorded by clinical interviews was performed with chi square tests, logistic binary regression and t-tests using SPSS 13.0 for Windows software.
Men were over-represented in cannabis dependent group while mean age was lower among them compared to Cnbs0 subgroup. Prevalence of suicidal attempt was increased in men without cannabis use (OR = 5.25, p = 0.016). Patients without cannabis use spent more time in hospital (p = 0.026) and smoking was more frequent among them (OR = 1.36, p = 0.047). The chance to get olanzapine for acute therapy and aripiprazol for long term therapy was more than two fold in Cnbs1 subgroup (OR = 2.66, OR = 3.67, respectively). However, aripiprazol was used for acute therapy with significantly lower risk in Cnbs1 subgroup (OR = 0.47, p = 0.023). Olanzapine was administered for long term therapy in a higher dose to Cnbs0 patients (p = 0.040). Also higher dose of risperidon LAI was used in women without cannabis dependency compared to women of Cnbs1 subgroup (p=0.020). Positive and negative symptoms and family history did not differ significantly between the two subgroups.
Although symptom profile was similar, hospitalization time, suicidal anamnesis, smoking habit and also dosage, intensity and lasting of therapy were different between the two subgroups. Further prospective studies are required for the investigation of the clinical and molecular background of this discrepancy in order to determine a relevant protocol of prevention and treatment of the chronic cannabis use related psychotic disorder.
尽管精神分裂症患者中使用大麻的比例较高，大麻也是青少年最常滥用的药物，但精神分裂症与大麻使用之间的病因联系仍不清楚。临床经验表明，经常使用大麻的人可能会出现类似精神分裂症的精神病发作，但目前尚不清楚慢性大麻使用伴精神分裂样障碍是否是一种需要特殊治疗的独特实体，或者是否可以像经典的精神分裂症一样进行治疗。目前尚无关于有和没有大麻使用的精神分裂样患者之间药物治疗比较的资料。
回顾性分析 85 例精神分裂症谱系障碍患者的临床资料。43 人未报告大麻使用（Cnbs0 亚组），42 人至少 1 年内定期使用大麻（Cnbs1 亚组）。采用卡方检验、逻辑二元回归和 t 检验比较通过临床访谈记录的病史、家族史、社会人口状况、阳性和阴性症状、急性和长期治疗，使用 SPSS 13.0 for Windows 软件进行分析。
与 Cnbs0 亚组相比，依赖大麻的患者中男性比例过高，而平均年龄较低。无大麻使用的男性自杀企图发生率增加（OR=5.25，p=0.016）。无大麻使用的患者住院时间更长（p=0.026），吸烟更频繁（OR=1.36，p=0.047）。Cnbs1 亚组急性治疗使用奥氮平和长期治疗使用阿立哌唑的机会增加两倍以上（OR=2.66，OR=3.67）。然而，Cnbs1 亚组使用阿立哌唑进行急性治疗的风险显著降低（OR=0.47，p=0.023）。奥氮平在 Cnbs0 患者中用于长期治疗的剂量更高（p=0.040）。与 Cnbs1 亚组相比，无大麻依赖的女性使用利培酮长效注射剂的剂量也更高（p=0.020）。两组间阳性和阴性症状及家族史无显著差异。
尽管症状谱相似，但两组间住院时间、自杀病史、吸烟习惯以及治疗的剂量、强度和持续时间存在差异。为了确定预防和治疗慢性大麻使用相关精神病的相关方案，需要进一步进行前瞻性研究，以调查这种差异的临床和分子背景。
