Cannabinoid use in psychotic patients impacts inflammatory levels and their association with psychosis severity

Gibson, Claire; Nia, Anahita Bassir; Spriggs, Sharron; DeFrancisco, Daniel; Swift, Amy J.; Perkel, Charles; Zhong, Xiaobo; Mazumdar, Madhu; Fernandez, Nicolas; Patel, Manishkumar; Kim‐Schulze, Seunghee; Hurd, Yasmin L.

doi:10.1016/j.psychres.2020.113380

Cited by 12 publications

(15 citation statements)

References 47 publications

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“…A recent study looked into inflammatory profile differences between cannabinoid-positive and cannabinoid-negative participants with active psychosis. The findings suggested generally lower levels of inflammatory markers, especially interferon-γ and the proinflammatory cytokine interleukin-6 24 . However, NLR and MPV markers were not tested in the study.…”

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confidence: 77%

“…We retrospectively studied the NLR and MPV in 144 patients given a diagnosis of schizophrenia, 34 of whom were cannabis users. Relatively few studies have examined inflammation in cannabis-using individuals with psychosis, 10,24 high-lethality suicidality, 17 and other major psychiatric disorders 3,4 . Some studies have suggested that systemic inflammation occurs in these disorders 11,12 .…”

Section: Discussionmentioning

confidence: 99%

“…The findings suggested generally lower levels of inflammatory markers, especially interferon-γ and the proinflammatory cytokine interleukin-6. 24 However, NLR and MPV markers were not tested in the study. To the best of our knowledge, there is no published research reporting test results concerning the effect, if any, of cannabis use on NLR and MPV in schizophrenia patients.…”

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confidence: 99%

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Inflammation Markers Among Schizophrenia Patients Who Use Cannabis

Fridman,

Bloemhof-Bris,

Weizman

et al. 2023

Clin Neuropharm

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Objectives The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without. Methods In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use. Results No differences were found in the NLR and MPV values between the groups. Conclusion The results were contrary to our expectations. These results may be explained by the presentation of a “pseudo-balanced” picture created when multiple processes affect inflammatory indices.

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confidence: 77%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Inflammation Markers Among Schizophrenia Patients Who Use Cannabis

Fridman,

Bloemhof-Bris,

Weizman

et al. 2023

Clin Neuropharm

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“…Some of the biological research regarding the effects of cannabis on the brain in psychotic patients has focused on the role of IL-6, an inflammatory cytokine [16 ▪▪ ]. In one study conducted among 119 patients admitted to a psychiatric unit with acute psychosis, individuals who had toxicology positive for natural and/or synthetic cannabinoids were compared with patients with negative cannabinoid toxicology [16 ▪▪ ]. Although psychosis severity was similar between groups, cannabinoid-positive participants were more likely to receive as-needed medications for agitation in the psychiatric emergency room.…”

Section: Comorbidities: From Smoking Cigarettes and Cannabis To Acute...mentioning

confidence: 99%

Agitation in schizophrenia: origins and evidence-based treatment

Citrome

2020

Current Opinion in Psychiatry

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Purpose of reviewAgitation associated with schizophrenia remains an important clinical concern and if not managed effectively, can escalate into aggressive behavior. This is a review of the recent biomedical literature on agitation in individuals with schizophrenia. Recent findingsThemes in the recent literature include consideration of comorbidities such as cigarette smoking and cannabis use. Surveys reveal that pharmacological approaches to manage agitation have changed little, with haloperidol remaining in common use and intramuscular administration of antipsychotics and/or benzodiazepines being frequently administered to more severely agitated/aggressive individuals. Of note, ketamine has been recently adopted for use in severe agitation in medical emergency departments, but the risk of this medication for people with schizophrenia is unclear. At present, inhaled loxapine remains the only rapidly acting noninjectable FDA-approved treatment for agitation associated with schizophrenia. In development is an intranasal formulation for olanzapine (a well characterized atypical antipsychotic already approved to treat agitation) and a sublingual film for dexmedetomidine (an a2-adrenergic agonist used as an anesthetic and now being repurposed). SummaryComorbidities can contribute to agitation and can make an accurate differential diagnosis challenging. The ongoing development of rapidly acting novel formulations of antiagitation medications, if successful, may facilitate clinical treatment by providing additional options.

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“…Inflammatory disturbances are also evident with chronic psychotic disorders and CB2 receptors are expressed on immune cells. A recent study found lower levels pro-inflammatory cytokine (IL-6) in cannabis-using patients that correlated with higher psychopathology scores ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Changes in Expression of DNA-Methyltransferase and Cannabinoid Receptor mRNAs in Blood Lymphocytes After Acute Cannabis Smoking

et al. 2022

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BackgroundCannabis use is a component risk factor for the manifestation of schizophrenia. The biological effects of cannabis include effects on epigenetic systems, immunological parameters, in addition to changes in cannabinoid receptors 1 and 2, that may be associated with this risk. However, there has been limited study of the effects of smoked cannabis on these biological effects in human peripheral blood cells. We analyzed the effects of two concentrations of tetrahydrocannabinol (THC) vs. placebo in lymphocytes of a subset of participants who enrolled in a double-blind study of the effects of cannabis on driving performance (outcome not the focus of this study).MethodsTwenty four participants who regularly use cannabis participated in an experiment in which they smoked cannabis cigarettes (5.9 or 13.4% THC) or placebo (0.02%) ad libitum. Blood samples were drawn at baseline and several times after smoking. Lymphocytes were separated and stored at –80°C for further analysis. Samples were analyzed for mRNA content for cannabinoid receptors 1 (CB1) and 2 (CB2), methylation and demethylating enzymes (DNMT, TET), glucocorticoid receptor (NRC3) and immunological markers (IL1B, TNFα) by qPCR using TaqMan probes. The results were correlated with THC whole blood levels during the course of the day, as well as THCCOOH baseline levels. Statistical analyses used analysis of variance and covariance and t-tests, or non-parametric equivalents for those values which were not normally distributed.ResultsThere were no differences in background baseline characteristics of the participants except that the higher concentration THC group was older than the low concentration and placebo groups, and the low concentration THC group had higher baseline CB2 mRNA levels. Both the 5.9 and 13.4% THC groups showed increased THC blood levels that then decreased toward baseline within the first hour. However, there were no significant differences between THC blood levels between the 5.9 and 13.4% groups at any time point. At the 4-h time point after drug administration the 13.4% THC group had higher CB2 (P = 0.021) and DNMT3A (P = 0.027) mRNA levels than the placebo group. DNMT1 mRNA levels showed a trend in the same direction (P = 0.056). The higher 13.4% THC group had significantly increased CB2 mRNA levels than the 5.9% concentration group at several post drug administration time points and showed trends for difference in effects for between 5.9 and 13.4% THC groups for other mRNAs. TET3 mRNA levels were higher in the 13.4% THC group at 55 min post-cannabis ingestion. When the high and lower concentration THC groups were combined, none of the differences in mRNA levels from placebo remained statistically significant. Changes in THC blood levels were not related to changes in mRNA levels.ConclusionOver the time course of this study, CB2 mRNA increased in blood lymphocytes in the high concentration THC group but were not accompanied by changes in immunological markers. The changes in DNMT and TET mRNAs suggest potential epigenetic effects of THC in human lymphocytes. Increases in DNMT methylating enzymes have been linked to some of the pathophysiological processes in schizophrenia and, therefore, should be further explored in a larger sample population, as one of the potential mechanisms linking cannabis use as a trigger for schizophrenia in vulnerable individuals. Since the two THC groups did not differ in post-smoking blood THC concentrations, the relationship between lymphocytic changes and the THC content of the cigarettes remains to be determined.

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Cannabinoid use in psychotic patients impacts inflammatory levels and their association with psychosis severity

Cited by 12 publications

References 47 publications

Inflammation Markers Among Schizophrenia Patients Who Use Cannabis

Inflammation Markers Among Schizophrenia Patients Who Use Cannabis

Agitation in schizophrenia: origins and evidence-based treatment

Changes in Expression of DNA-Methyltransferase and Cannabinoid Receptor mRNAs in Blood Lymphocytes After Acute Cannabis Smoking

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