Nabilone is a synthetic cannabinoid that has shown promise for the treatment of posttraumatic stress disorder (PTSD)–related insomnia and nightmares as well as efficacy in the management of chronic pain. It has also been proposed for harm reduction in cannabis dependence. Its effectiveness for management of concurrent disorders in seriously mentally ill correctional populations has not been evaluated. This retrospective study of 104 male inmates with serious mental illness prescribed nabilone analyzes the indications, efficacy, and safety of its use. Medications discontinued with the initiation of nabilone were also reviewed. The results showed nabilone targeting a mean of 3.5 indications per patient, thus likely reducing polypharmacy risk. The mean final dosage was 4.0 mg. Results indicated significant improvement in PTSD-associated insomnia, nightmares, PTSD symptoms, and Global Assessment of Functioning and subjective improvement in chronic pain. Medications associated with greater risk for adverse effects or abuse than nabilone were often able to be discontinued with the initiation of nabilone, most often antipsychotics and sedative/hypnotics. There was no evidence of abuse within this high-risk population or reduction of efficacy when nabilone was given in powder form with water rather than as a capsule. This study supports the promise of nabilone as a safe, effective treatment for concurrent disorders in seriously mentally ill correctional populations. Prospective, randomized controlled trials are required to confirm our preliminary results. Follow-up in the community will be required to confirm effectiveness in harm reduction.
The ability of developing rainbow trout Oncorhynchus mykiss embryos to compensate for elevated oocyte triiodothyronine (T 3 ) content and whether elevation of oocyte T 3 content within a physiologically meaningful range affects growth rates of the embryo or the expression of genes encoding for thyroid hormone receptors a (TRa) and b (TRb) were examined. Oocytes were immersed in ovarian fluid alone (control) or T 3 -enriched ovarian fluid prior to fertilization and water hardening, to induce a dose-dependant increase in oocyte T 3 content of c. 3 (control), c. 30 (LT 3 ) or c. 110 ng egg À1 (HT 3 ). To examine the interaction of embryo somatic growth with altered thyroid state more effectively, the embryos were reared at two ambient temperatures (8Á5 and 5Á5 C ) to induce different growth rates. A significant decline in whole embryo T 3 content was measured in the T 3 -treatment groups reared at both water temperatures by 3 weeks post-fertilization (dpf), and may have reflected the action of outer ring monodeiodinase, which was present in microsomes prepared from embryos 23 dpf. Whole embryo T 3 levels in the HT 3 group, however, remained higher than controls until phase 2 of development [the onset of endogenous thyroid hormone (TH) release]. This suggested that the embryos exerted some control over their response to exogenous TH, but that there was a limit to the level of control exerted by the embryonic tissues. Reverse transcriptase-polymerase chain reaction (RT-PCR) revealed the presence of mRNA encoding for the two TR isoforms as early as 26 dpf, and quantitative real-time RT-PCR (qPCR) was used to examine the effect of elevated oocyte T 3 content on the expression of these TR genes in embryos raised at 8Á5 and 5Á5 C, and sampled at similar developmental stages prior to the onset of embryonic TH synthesis, to ensure that the oocyte T 3 was the only source of TH exposure to the embryo. There was a suppression of the TRa gene expression in the control 5Á5 C group relative to the control 8Á5 C group. In addition, both TRa and TRb mRNA accumulation was lower, relative to the controls, in the LT 3 treatment group reared at 8Á5 C suggesting a suppressive effect of the lower level of T 3 treatment on the TR gene expression. Conversely, there were no differences from controls in the HT 3 treatment group, possibly indicating that this level of exposure overrides the downregulating capacity of the embryo. Similar patterns were seen for TRa and TRb mRNA accumulation in embryos reared at 5Á5 C, but because of the temperature suppressed level of TRa mRNA in the controls, significant affects of the LT 3 treatment were only found for TRb. There were no measurable effects of T 3 treatment on oocyte fertility or embryo somatic growth for either temperature treatment group, nor was somatic growth hormone content (measured only in the 8Á5 C treatment group) apparently related to in ovo T 3 levels. The results suggest †Author to whom correspondence should be addressed.
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