Lim Keane, See Yuen Mei, Lee Jimmy
Research Division, Institute of Mental Health, Singapore.
Department of General Psychiatry 1, Institute of Mental Health, Singapore.
Clin Psychopharmacol Neurosci. 2017 Nov 30;15(4):301-312. doi: 10.9758/cpn.2017.15.4.301.
The discovery of endocannabinoid's role within the central nervous system and its potential therapeutic benefits have brought forth rising interest in the use of cannabis for medical purposes. The present review aimed to synthesize and evaluate the available evidences on the efficacy of cannabis and its derivatives for psychiatric, neurodegenerative and movement disorders. A systematic search of randomized controlled trials of cannabis and its derivatives were conducted via databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials). A total of 24 reports that evaluated the use of medical cannabis for Alzheimer's disease, anorexia nervosa, anxiety, dementia, dystonia, Huntington's disease, Parkinson's disease, post-traumatic stress disorder (PTSD), psychosis and Tourette syndrome were included in this review. Trial quality was assessed with the Cochrane risk of bias tool. There is a lack of evidence on the therapeutic effects of cannabinoids for amyotrophic lateral sclerosis and dystonia. Although trials with positive findings were identified for anorexia nervosa, anxiety, PTSD, psychotic symptoms, agitation in Alzheimer's disease and dementia, Huntington's disease, and Tourette syndrome, and dyskinesia in Parkinson's disease, definitive conclusion on its efficacy could not be drawn. Evaluation of these low-quality trials, as rated on the Cochrane risk of bias tools, was challenged by methodological issues such as inadequate description of allocation concealment, blinding and underpowered sample size. More adequately powered controlled trials that examine the long and short term efficacy, safety and tolerability of cannabis for medical use, and the mechanisms underpinning the therapeutic potential are warranted.
内源性大麻素在中枢神经系统中的作用及其潜在治疗益处的发现，引发了人们对将大麻用于医疗目的的兴趣日益浓厚。本综述旨在综合和评估关于大麻及其衍生物对精神疾病、神经退行性疾病和运动障碍疗效的现有证据。通过数据库（PubMed、Embase和Cochrane对照试验中央注册库）对大麻及其衍生物的随机对照试验进行了系统检索。本综述共纳入了24份评估医用大麻用于治疗阿尔茨海默病、神经性厌食症、焦虑症、痴呆症、肌张力障碍、亨廷顿舞蹈症、帕金森病、创伤后应激障碍（PTSD）、精神病和妥瑞氏综合征的报告。使用Cochrane偏倚风险工具评估试验质量。目前缺乏关于大麻素对肌萎缩侧索硬化症和肌张力障碍治疗效果的证据。尽管在神经性厌食症、焦虑症、创伤后应激障碍、精神病症状、阿尔茨海默病和痴呆症中的激越、亨廷顿舞蹈症、妥瑞氏综合征以及帕金森病中的运动障碍方面发现了一些有阳性结果的试验，但无法就其疗效得出明确结论。根据Cochrane偏倚风险工具的评级，对这些低质量试验的评估受到了诸如分配隐藏、盲法描述不足以及样本量不足等方法学问题的挑战。有必要开展更具充分效力的对照试验，以研究大麻用于医疗的长期和短期疗效、安全性和耐受性，以及其治疗潜力背后的机制。
