Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA.
The Permanente Medical Group, Oakland, CA.
Perm J. 2021 May 12;25:20.179. doi: 10.7812/TPP/20.179.
Amidst a rapidly changing legal landscape, cannabis use in the United States has become increasingly common in the past several years. There is strong evidence to suggest that chronic and early cannabis use increases the risk of developing a psychotic disorder, and there is at least moderate evidence that suggests ongoing cannabis use among individuals with a psychotic disorder worsens clinical outcomes (eg, decreased psychiatric medication adherence, more frequent psychiatric hospitalizations). In this Review Article, we provide a focused, clinically oriented overview of the epidemiology and characteristics of cannabis use among individuals with first-episode psychosis; evaluation of cannabis use; and treatment modalities, focusing on behavioral interventions suitable for outpatient primary care settings. We discuss the limited data supporting pharmacologic interventions for cannabis use disorder, specifically among individuals with first-episode psychosis, and the unique potential of cannabidiol to serve as a harm-reduction strategy for individuals who are not able or willing to achieve abstinence for cannabis.
在快速变化的法律环境下，美国的大麻使用在过去几年中变得越来越普遍。有强有力的证据表明，慢性和早期大麻使用会增加患精神病的风险，至少有中等程度的证据表明，在患有精神病的个体中持续使用大麻会恶化临床结果（例如，减少精神药物的依从性，更频繁的精神科住院治疗）。在这篇综述文章中，我们提供了一个集中的、以临床为导向的概述，介绍了首次出现精神病发作的个体中大麻使用的流行病学和特征；大麻使用的评估；以及治疗方式，重点是适合门诊初级保健环境的行为干预。我们讨论了支持大麻使用障碍药物干预的有限数据，特别是在首次出现精神病发作的个体中，以及大麻二酚作为一种减少伤害的策略的独特潜力，适用于那些无法或不愿意戒除大麻的个体。
