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Cannabis & Mental Disorders

by
Dr. Prasenjit Ray
BHMS (Cal) PGT (PSYCH)

Introduction:
The purpose of the project was to review the recent evidence on the possible associations between cannabis & alcohol misuse & the development of mental disorders, particularly among young people. The objective was to relate the association between the substance abuse & linkage of the same with developing mental disorder, particularly in younger people. These relationships are complex & in all probability involve the mediation of a variety of additional factors. The emphasis on young people is particularly important, for a number of reasons. It’s found that prevalence of substance use by young people is much more than other age groups. Secondly, the impact of affection of such age group is wide. The list is long. It includes; psychiatric problems, risk of suicide, abnormal sexual behaviors leading to unwanted pregnancies, high risk of fatal accidents, STDs, AIDS, violence, homicides & above all high health care costs.

¤ Prevalence:
Research suggests that the prevalence of alcohol abuse in 15-18 yrs is highest in Europe. Among 11-18yrs olds in England in 2001, 12% has used drugs in past month &20% have used drugs in the past year. Cannabis is reported to be the most frequently used drug (13% reported in last year).

¤ Need For The Study:
In addition to above factors, the anxiety surrounding the increased & earlier usage of narcotic substances by young people, the possibility of secondary consequences of substance use have gained heightened policy & media attention. The issue of co-morbidity is to be considered with seriousness. The need was also to exclude the possible confounding factors which probably have relationships between substance misuse & development of mental disorders. It is to be considered that, if these confounding factors are controlled, the possibility of mental diseases reduces or not. The possibilities of these confounding factors are behavioral disorder; low IQ; place of upbringing; poor social integration; gender; age; ethnic background; level of education; unemployment; single marital status; previous psychotic symptoms; psychosexual behavior; parenting styles etc. So that, they provide the common causes of any mental disorders & also for substance abuse.
This is well understood that the necessity of future research in this area should be based on some degree of understanding of the conditions & impacts of social exclusion, particularly in terms of substance misuse & the development of mental disorder.

1. Alcohol & mental disorder:

A number of studies have suggested the co-relation between alcohol misuse & a variety of mental disorders. Drinkers may experience a blackout, an episode of temporary anterograde amnesia, in which the person forgets all or part of what occurred during a drinking evening. At the same time, alcohol diminishes rapid eye movement (REM) or dream sleep early in the evening, with resulting prominent and sometimes disturbing dreams later in the night.

1. Anxiety States:
There is high co-relation of alcohol misuse & Social Phobia. On the other hand, there is also evidence of pre-existing phobic states/ social phobia, acting as a precursor of chronic alcoholism. Long term use of alcohol is also seen to produce anxiety sates. An additional problem related to the acute effects of alcohol on most drinkers is the impairment in judgment, balance, and motor coordination that contributes to the high incidence and severity of accidents.

2. Depression, Bipolar Disorder, Suicidal Tendency, & Deliberate self harm:
Alcohol misuse has linked with an increased propensity for the development depression, Bipolar Disorder, Suicidal Tendency, & Deliberate self harm with early uses in males being a significant factor. These relationships are not clear. Gender could possibly be a mediating factor. As recent research shows that suicidal disposition leads to increased alcohol problems in women, & on the other side, alcohol-related problems are predictive of suicidal disposition in men.

3. Other Behavioral Disorders & Effects on CNS:
The effect of alcohol on the nervous system is even more pronounced among alcohol-dependent individuals. Chronic intake of high doses of ethanol causes peripheral neuropathy in 5 to 15% of alcoholics, which is possibly related to thiamine deficiency. Patients complain of bilateral limb numbness, tingling, and paresthesias; symptoms are more pronounced distally than proximally. The treatment is abstinence and thiamine supplementation.

Wernicke's syndrome (ophthalmoparesis, ataxia, and encephalopathy) and Korsakoff's syndrome (alcohol-induced persisting amnesic disorder), are seen in the United States at a rate of approximately 50 per million people per year. These disorders are the result of thiamine deficiency in vulnerable individuals, possibly owing to interaction with a genetic transketolase deficiency. Korsakoff's syndrome presents as profound and persistent anterograde amnesia (inability to learn new material) and a milder retrograde amnesia. Additional symptoms can include impairment in visual, abstract, and conceptual reasoning but with a normal intelligence quotient (IQ). Some patients demonstrate an acute onset of Korsakoff's syndrome in association with the neurological stigmata seen with Wernicke's syndrome (e.g., sixth nerve palsy and ataxia), whereas others have a more gradual onset.

2. Cannabis & mental disorder:

The following features are observed to be associated with Cannabis misuse.
1. Psychosis
The possibility of an association between Cannabis use & developing psychosis is an area that has drawn serious attention (Batty D. in his article ‘Cannabis mental health risks “must be taught”’- The Guardian, 27th Jan’04). The reason of such relation is not clearly known though there are some hypotheses. Possible hypothesis include: the existence of a causal link between cannabis & psychosis. Cannabis usage increases the risk of developing psychosis in “vulnerable” populations i.e. those people who would have developed the condition anyway, lead to an earlier onset of psychosis. So it becomes clear that cannabis usage exacerbates the course of psychotic illness.

Furthermore, an analysis of the data collected by the Dunedin Multidisciplinary Health Development Study Contributed three key findings;
1) Cannabis use is associated with increased risk even after screening for pre- existing psychotic symptoms.
2) Early cannabis use confers the greatest risk of developing psychosis in later life.
3) The risk is specific to cannabis use & development of Schizophrenia.

2. Anxiety

Panic attacks & other forms of anxiety disorder have been associated with the misuse of cannabis & alcohol. Research now indicates that these associations are caused in greater part to the mediating effects of other factors such as childhood & family factors, co-morbid depression & Schizophrenia.

3. Depression

Research into possible association between cannabis use & developing depression is observed in cases of long term use of cannabis. Degenhardt et.al. (In” Exploring the association between cannabis use & depression, Addiction2003) reviewed evidence that regular cannabis use depression co-occur more often than normal. They saw that psychoactive ingredient of cannabis has regulation on the emotional experience & thus producing depression.

4. Suicide & deliberate self harm

The early use of cannabis has been cited as contributory factor for the possible increase in the risk of the later development of depression & increased risks of suicidal ideation & suicidal attempts (Kelly et.al; Drug alcohol Depend 2004). Other research has identified that there may be higher rates of cannabis use by people who seriously attempt suicide, depression. Severities of mood disorders have some direct effects on the suicide rates.

5. Social exclusion

Social exclusion has been described as a condition in which multiple risk factors are experienced as a consequence of socioeconomic deprivation. As by US Government ‘Social exclusion’ is “ A short – hand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low-incomes, poor housing, high crime environment, bad health, family breakdown”.

There is now an abundance of evidence that young people, who experience social exclusion are more likely to use/ misuse substances (Ref: Health Advisory Service; ‘The substance of young needs’ London, HMSO; 1996). This shows that the substance misuse in socially excluded persons are in high level.

On the other hand, the person who is socially accepted, has employment, & having chances of entertainment, is less likely to have such addiction. He may be educated properly against substance misuse.
A ‘sense of hopelessness’; has also been seen, as contributing factor to young people in urban setting, adopting risky behaviors. These ultimately turn into substance misuse & creating the rich soil for development of psychical disorders.

Research on excluded populations, i.e. the young homeless, has found that they are at more risk of using illicit drugs & experience worse mental & physical ill health than young people living in household.
¤ Conclusion:
The current global situation of substance misuse is frightening. Especially in cases of young people the use of both cannabis & alcohol are creating various problems, ranging from mental, physical, and social to economical. Those persons having superadded predisposing factors & vulnerability to mental disorder are prime sufferers.
More research is needed to understand the thorough mechanisms between substance misuse & development of psychiatric disorder.
It is to be considered that, unless the factors, especially social exclusion, that lead to substance misuse, are clarified; the tendency of young generation towards narcotics can not be corrected.
Lastly, it should be admitted that, if narcotics abuse is not controlled or restricted strictly, the progress of society would not be possible; only some mentally crippled people will rule the future days.
 
  homeo_psychiatrist on 2006-06-02
This is just a forum. Assume posts are not from medical professionals.
Good lecture, now start treating patients.
 
lopez last decade
disease state exist prior to use...self medication is motive behind substance abuse/use-----tet the ill desire is nulled---if before dependency has occurred --once dependency-now comes treating the medicinal/suppressed state of individual--with hope geting back to underlying cause..
 
John Stanton last decade
Yes Mr. Lopez
thanks for the delayed advice!
But I am on the way of curing lots of patients with mental disorders!
Including substance abuse.
It was one sample of that.
Hope I can get more friends to share there ideas & views regarding treatment of Mental illness
Thank u for reading my paper>
 
homeo_psychiatrist last decade
Dear Dr. Prasenjit,

I took cannabis sativa 200 (4time/day x 8 drops)for curing my stuttering problem. But after some days I started feeling fatigue in my lower limbs. Is it because that this medicine is not suitable for me.

How to know whether this medicine in not making adverse effect on me.

Pls. help me I am novice in using homeopath medicines.

Regards

Sanjay Gupta
 
kumar_prem25 last decade

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