Teens Who Regularly Use Marijuana May Be at Greater Risk of Paranoia, Hallucinations

Adolescents who regularly use marijuana may be more likely to experience subclinical paranoia and hallucinations, even after sustained abstinence from the drug, a study published this week in AJP in Advance reports.

Several studies have suggested that marijuana use, particularly during adolescence, is related to acute psychotic episodes and future psychotic disorders, but little is known about whether adolescents who regularly use the drug over several years exhibit a systematic increase in their subclinical psychotic symptoms that persists during periods of sustained abstinence.

Researchers from University of Pittsburgh Medical Center and Arizona State University, Phoenix, analyzed data from a sample of 1,009 adolescent boys from Pittsburgh who self-reported annually on the number of days they used marijuana in the past year and experiences of subclinical psychotic symptoms (e.g., feelings of paranoia, hallucinations, bizarre thinking) from age 13 to 18. The teens also annually reported on the number of days they used alcohol, tobacco, and other illicit drugs.

As expected, substance use increased from age 13 to 18. By the last assessment, 270 participants reported having used marijuana weekly, 325 had used alcohol weekly, 377 had used tobacco daily, and 134 had used other illicit drugs at least once. For each year the participants engaged in weekly marijuana use, their expected level of subsequent subclinical psychotic symptoms rose by 21% and their expected odds of experiencing subsequent subclinical paranoia or hallucinations rose by 133% and 92%, respectively.

Additional analysis revealed that even when adolescents stopped using marijuana for one year, the effect of prior weekly marijuana use on total subclinical psychotic symptoms, paranoia, and hallucinations persisted. For each additional year adolescents engaged in weekly marijuana use, their expected number of total subclinical psychotic symptoms rose by 29% during subsequent periods of year-long abstinence, and their expected odds of experiencing paranoia and hallucinations rose by 112% and 158%, respectively.

“[T]he most concerning finding is that the effect of prior weekly marijuana use persists even after adolescents have stopped using for one year,” the researchers wrote.

While the authors acknowledged future studies are needed to determine whether the findings hold for girls and adults living in geographically diverse locales and whether the effect of regular adolescent marijuana use on subclinical psychotic symptoms persists into adulthood, they concluded, “Given the recent proliferation of marijuana legalization across the country, it will be important to enact preventive policies and programs to keep adolescents from engaging in regular marijuana use, as chronic use seem to increase their risk of developing persistent subclinical psychotic symptoms.”

For related information, see the Psychiatric News article “Research Identifies Gene Linked to Cannabis-Induced Psychosis.”

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FDA Approves First Medication for Psychosis Associated With Parkinson’s Disease

The Food and Drug Administration (FDA) on Friday approved Nuplazid (pimavanserin) tablets, the first medication approved in the United States to treat psychosis in patients with Parkinson’s disease.

Although Parkinson’s disease is recognized as a movement disorder, the disease is sometimes preceded and frequently accompanied by other cognitive and psychiatric features. Some studies suggest that up to 50% of all patients with Parkinson’s disease will experience hallucinations or delusions at some time during the course of their illness—believed to be in part due to the elevated dopamine levels produced by common Parkinson’s disease medications.

Efforts to treat PDP with antipsychotics commonly prescribed for schizophrenia to date have proven mostly futile (PDP patients taking clozapine experienced worsening Parkinson’s disease symptoms; PDP patients taking quetiapine experienced fewer side effects, but the medication has yet to be proven to be more effective than placebo in these patients). However, pimavanserin is a selective-serotonin inverse agonist that preferentially targets 5-HT2A receptors, while avoiding activity at dopamine and other receptors commonly targeted by antipsychotics.

The FDA’s decision to approve pimavanserin was based on the results of a trial in which adults with PDP were randomly assigned to take 40 mg of pimavanserin or placebo daily for six weeks. Patients taking pimavanserin experienced fewer and less severe hallucinations and delusions without worsening the primary motor symptoms of Parkinson’s disease. The most common adverse effects reported by patients taking pimavanserin included peripheral edema, nausea, and confusional state, according to Acadia Pharmaceuticals Inc., the manufacturer of the medication.

As with other atypical antipsychotic drugs, the FDA noted that Nuplazid will feature a boxed warning indicating the increased risk of death associated with the use of antipsychotics in patients with dementia-related psychosis. Additionally, Nuplazid is not recommended in patients with severe renal impairment.

“[The] approval of Nuplazid represents a major paradigm shift in the treatment of Parkinson’s disease psychosis,” Michael S. Okun, M.D., medical director of the National Parkinson Foundation, said in a press release. “Through its novel and selective mechanism of action, Nuplazid is a breakthrough treatment that works in a whole new way—treating hallucinations and delusions without blocking dopamine receptors and, therefore, not impairing motor function in Parkinson’s psychosis patients.”

According to Acadia, Nuplazid will be commercially available next month.

For related information, see the Psychiatric News article “Will Nuplazid Offer a ‘New’ Choice for Treating Parkinson’s Disease Psychosis?”

High Stress Plus Caffeine: A Recipe for Psychosis Risk?

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Add stress to high daily caffeine intake, and what do you get? Hallucinatory symptoms possibly, according to Australian researchers. They grouped 92 community-recruited individuals free of psychiatric or neurological history, psychotropic medication use, and auditory impairment by self-reported stress levels and caffeine intake. Participants were asked to listen to white noise and to report each time they heard the song “White Christmas” during the white noise. Since the song was never played, each time a participant indicated they heard the song was recorded as a “false alarm.” All of the participants thought they heard the song being played, but those in the high stress-high caffeine group had the most false alarms.

The researchers concluded that increased caffeine consumption, in the presence of high levels of stress, has the potential to increase the experience of psychotic symptoms, specifically auditory hallucinations. The report was published in Personality and Individual Differences.

For more information about predictions of who may or may not be at a high risk for psychosis, see Psychiatric News at http://pn.psychiatryonline.org/content/46/10/18.1.full.