Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a “pluripotent” approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
BackgroundThere has been an increased trend towards the legalisation of medicinal and recreational cannabis use worldwide. This has been controversial as the long-term effects of frequent cannabis use on the brain are still poorly understood.MethodsIn this study, we investigated whether the legal status of cannabis in the United States of America (USA) is associated with problematic cannabis use and impulsivity in 329 frequent cannabis users. The data were collected in 2015 and were analysed in 2017. Ethical approval for this study was obtained from Monash University in 2015.ResultsThe results indicated that participants’ problematic cannabis use and impulsivity was not different whether they resided in states where cannabis is legal for medical and/or recreational use or prohibited.LimitationsThe present study is a cross-sectional design, making it difficult to infer causality and establish whether cannabis use is a cause, consequence, or correlate of altered impulsivity.ConclusionOur study supports the notion that frequent cannabis use is associated with impulsive behaviours, whilst, conversely, we did not find an association between US state legalisation and problematic cannabis use or impulsivity.
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