Köck Patrick, Badek Andrzej, Meyer Maximilian, Klaassen Arndt-Lukas, Walter Marc, Kindler Jochen
Department of Psychosomatics and Psychotherapy, Clinic Barmelweid, Barmelweid, Switzerland.
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Child Adolesc Psychiatry Ment Health. 2024 Dec 18;18(1):158. doi: 10.1186/s13034-024-00846-5.
Cannabinoids have been of increasing interest mainly due to their putative efficacy in a wide array of psychiatric, psychosomatic, and neurological conditions.
This systematic review aims to synthesize results from randomized placebo-controlled trials regarding the efficacy and the dosage of cannabinoids as therapeutics in psychiatric disorders in children, adolescents, and young adults.
All publications up to June 30th, 2024, were included from PubMed and Embase. Eligibility criteria in accordance with the PRISMA-guidelines was applied. RCTs providing pre- and post-treatment parameters on cannabinoid therapies for mental disorders in comparison to controls in an age range from 0 to 25 years were included. Effect sizes were calculated as Hedges' g for primary outcomes, and a multilevel random-effects meta-analysis was conducted to account for dependent outcomes from same study populations.
We identified 7603 records, of which 8 independent clinical trials (reported in 9 publications) met the pre-established eligibility criteria, comprising 474 unique participants (245 treatment, 229 control). Analysis of 13 primary outcomes (of 7 clinical trials) revealed a modest positive overall effect for symptom improvement or normalization of brain physiology (Hedges' g = 0.308, 95% CI: 0.167, 0.448). Autism spectrum disorder studies showed the most consistent evidence (g = 0.264, 95% CI: 0.107, 0.421), while other conditions showed wider confidence intervals. Age-stratified analysis showed that adult populations (mean age 23.3 years, n = 5 outcomes) demonstrated higher effect sizes (g = 0.463, SD = 0.402) compared to pediatric populations (mean age 11.8 years, n = 8 outcomes; g = 0.318, SD = 0.212). Whole plant preparations (g = 0.328, 95% CI: 0.083, 0.573) and pharmaceutical cannabinoids (g = 0.292, 95% CI: 0.069, 0.515) showed comparable effects. CBD dosages ranged from 17.5 mg to 600 mg per day, with no significant correlation between dosage and effect size (ρ = -0.014, p = 0.963). Mild to moderate side effects were reported, but no serious adverse events. Risk of bias assessment ranged from low (n = 3) to high (n = 5).
While meta-analysis of effect sizes for primary outcomes revealed modest positive effects, particularly for autism spectrum disorders, the current evidence remains insufficient to broadly recommend cannabinoids for treating mental disorders in youth populations. Larger, controlled studies with standardized outcomes are needed to establish definitive clinical recommendations.
大麻素越来越受到关注，主要是因为它们在一系列精神、心身和神经疾病中可能具有的疗效。
本系统评价旨在综合来自随机安慰剂对照试验的结果，这些试验涉及大麻素作为儿童、青少年和青年精神疾病治疗药物的疗效和剂量。
纳入截至2024年6月30日来自PubMed和Embase的所有出版物。应用符合PRISMA指南的纳入标准。纳入了在0至25岁年龄范围内比较大麻素治疗精神障碍与对照组的治疗前和治疗后参数的随机对照试验。计算主要结局的效应量为Hedges' g，并进行多水平随机效应荟萃分析以考虑来自同一研究人群的相关结局。
我们确定了7603条记录，其中8项独立临床试验（在9篇出版物中报道）符合预先设定的纳入标准，包括474名独特参与者（245名治疗组，229名对照组）。对7项临床试验的13项主要结局进行分析，结果显示症状改善或大脑生理功能正常化总体有适度的积极效果（Hedges' g = 0.308，95% CI：0.167，0.448）。自闭症谱系障碍研究显示出最一致的证据（g = 0.264，95% CI：0.107，0.421），而其他疾病的置信区间更宽。年龄分层分析显示，与儿科人群（平均年龄11.8岁，n = 8项结局；g = 0.318，SD = 0.212）相比，成人人群（平均年龄23.3岁，n = 5项结局）的效应量更高（g = 0.463，SD = 0.402）。全植物制剂（g = 0.328，95% CI：0.083，0.573）和药用大麻素（g = 0.292，95% CI：0.069，0.515）显示出相当的效果。CBD剂量范围为每天17.5毫克至600毫克，剂量与效应量之间无显著相关性（ρ = -0.014，p = 0.963）。报告了轻度至中度副作用，但无严重不良事件。偏倚风险评估范围从低（n = 3）到高（n = 5）。
虽然对主要结局效应量的荟萃分析显示有适度的积极效果，特别是对于自闭症谱系障碍，但目前的证据仍不足以广泛推荐大麻素用于治疗青年人群的精神疾病。需要进行更大规模、有对照且结局标准化的研究，以建立明确的临床建议。
