Szejko Natalia, Fremer Carolin, Müller-Vahl Kirsten R
Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
Front Psychiatry. 2020 Jul 21;11:681. doi: 10.3389/fpsyt.2020.00681. eCollection 2020.
Although several lines of evidence support the hypothesis of a dysregulation of serotoninergic neurotransmission in the pathophysiology of obsessive-compulsive disorder (OCD), there is also evidence for an involvement of other pathways such as the GABAergic, glutamatergic, and dopaminergic systems. Only recently, data obtained from a small number of animal studies alternatively suggested an involvement of the endocannabinoid system in the pathophysiology of OCD reporting beneficial effects in OCD-like behavior after use of substances that stimulate the endocannabinoid system. In humans, until today, only two case reports are available reporting successful treatment with dronabinol (tetrahydrocannabinol, THC), an agonist at central cannabinoid CB1 receptors, in patients with otherwise treatment refractory OCD. In addition, data obtained from a small open uncontrolled trial using the THC analogue nabilone suggest that the combination of nabilone plus exposure-based psychotherapy is more effective than each treatment alone. These reports are in line with data from a limited number of case studies and small controlled trials in patients with Tourette syndrome (TS), a chronic motor and vocal tic disorder often associated with comorbid obsessive compulsive behavior (OCB), reporting not only an improvement of tics, but also of comorbid OCB after use of different kinds of cannabis-based medicines including THC, cannabis extracts, and flowers. Here we present the case of a 22-year-old male patient, who suffered from severe OCD since childhood and significantly improved after treatment with medicinal cannabis with markedly reduced OCD and depression resulting in a considerable improvement of quality of life. In addition, we give a review of current literature on the effects of cannabinoids in animal models and patients with OCD and suggest a cannabinoid hypothesis of OCD.
尽管有几条证据支持5-羟色胺能神经传递失调在强迫症（OCD）病理生理学中的假说，但也有证据表明其他途径如γ-氨基丁酸能、谷氨酸能和多巴胺能系统也参与其中。直到最近，少数动物研究获得的数据另表明内源性大麻素系统参与了OCD的病理生理学，这些研究报告称使用刺激内源性大麻素系统的物质后，OCD样行为有改善。在人类中，到目前为止，仅有两例病例报告称，对于其他治疗无效的OCD患者，使用中枢大麻素CB1受体激动剂屈大麻酚（四氢大麻酚，THC）治疗成功。此外，一项使用THC类似物纳布啡的小型开放非对照试验获得的数据表明，纳布啡与基于暴露的心理治疗联合使用比单独使用每种治疗更有效。这些报告与少数关于抽动秽语综合征（TS）患者的病例研究和小型对照试验的数据一致，TS是一种慢性运动和发声抽动障碍，常与共病的强迫行为（OCB）相关，这些研究报告称使用包括THC、大麻提取物和花朵在内的不同种类的大麻类药物后，不仅抽动症状有所改善，共病的OCB也有所改善。在此，我们报告一例22岁男性患者的病例，该患者自童年起患有严重的OCD，使用药用大麻治疗后有显著改善，OCD和抑郁症状明显减轻，生活质量有相当大的提高。此外，我们综述了关于大麻素在动物模型和OCD患者中的作用的当前文献，并提出了OCD的大麻素假说。
