Cannabis Contributes to 15% of Case of Schizophrenia

A study in Psychological Medicine (May 2, 2023) reported on ” Danish registry data spanning five decades and representing more than 6.9 million people in Denmark to estimate the population-level percentage of schizophrenia cases attributable to (cannabis use disorder) CUD. A total of 60,563 participants were diagnosed with CUD. Three quarters of cases were in men; there were 45,327 incident cases of schizophrenia during the study period. The researchers estimate that in 2021, about 15% of schizophrenia cases among males aged 16 to 49 could have been avoided by preventing CUD, compared with 4% among females in this age range. For young men aged 21 to 30, the proportion of preventable schizophrenia cases related to CUD may be as high as 30%, the authors report.

Editors Note: Other data also support an increased risk for bipolar disorder in those abusing cannabis. The notion that cannabis use carries few risks is baloney. Making pot legal does not make it safe.

Assets of Exercise

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

Ben Goldstein of the University of Toronto gave a plenary talk on the benefits of exercise.

He found poor aerobic fitness in 19 of 20 young bipolar patients. They had low cerebral blood flow in proportion to the severity of their exhaustion after exercise. He noted the importance of stressing an endpoint of fitness for exercise rather than weight loss. Using an exercise coach and running with family and friends was helpful in motivating patients for consistent exercise.

Pediatric Bipolar Disorder is Associated with Neurocognitive Deficits

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

Maria Paula Maziero of The University of Texas Health Science Center At Houston reported that while euthymic youths with BD (bipolar disorder) exhibited significant dysfunction in working memory (WM), verbal learning, and memory domains, fluctuation between the mood states affected the type of cognitive dysfunction. They concluded: “Pediatric bipolar disorder patients have marked cognitive dysfunction involving multiple domains, especially executive measures. The severity of mood symptoms influences cognitive performance, but even euthymic persons perform lower than matched controls.

Childhood Bullying and Maltreatment Yield A Worse Course of Bipolar Illness

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

Georgina Hosang of Bart’s & The London, Queen Mary’s School of Medicine reported that bullying and maltreatment together were associated with more suicidal behaviors than either childhood experience alone.

Both Obesity and Bipolar Disorders in 2249 Individuals Show White Matter Microstructure Abnormalities

Lorielle Dietze of Dalhousie University “obtained body mass index (BMI) and diffusion tensor imaging derived fractional anisotropy (FA) values from 930 individuals with bipolar disorders (BD), and 1319 control individuals from 20 cohorts in the ENIGMA-BD Working Group.”

They “found that lower FA was associated with both BD and BMI, in five white matter tracts, including the corpus callosum and thalamic radiation. Nine ROIs were correlated with only BD, while higher BMI was uniquely correlated with lower FA in four white matter ROIs.”

They concluded: “For the first time we showed that both obesity and BD demonstrated lower FA in some of the same regions. The impact of obesity may be greater in some tracts in BD individuals.”

Greater Severity of Depression in Youth With Bipolar Disorder versus Unipolar Depression

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

Aaron Silverman of the University of Toronto, CAMH found that “youth (age 13-21) with [Bipolar Disorders] compared to those with [unipolar] depression had significantly higher (more severe) ratings on depressed mood (p = .001), irritability (p = .037), anhedonia (p = .004), negative self-image (p < .001), hopelessness (p = .04), fatigue (p = .001), hypersomnia (p = .001), suicidal ideation (p = .04), and recurrent thoughts of death (p < .001).”

The Systematic Treatment Optimization Program for Early Mania

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

A. Rathseesh and L. Yatham reported on the importance of systematic vigorous treatment of a first manic episode. If more episodes occurred, losses in cognition did not fully recover. All patients remitted within 1 year of their first mania. Recurrence occurred in 58% by year 1 and 74% by year 4. Predictors of functional recovery included sustained euthymia, especially absence of depressive symptoms, good cognitive functioning, and maintaining a normal weight. More aggressive treatment to prevent relapses in years 1-4 after a first manic episode appears needed and how exactly to achieve this requires further study.

Disrupted Circadian Temperature Rhythm in Skin Temperature in Bipolar Mania

Highlights from the International Society for Bipolar Disorders Conference Posters and Presentations, Chicago, June 22-25, 2023

Andrea Stautland of University of Bergen studied the nocturnal temperature of sleeping participants in mania and during remission between 3:00am and 6:00am (n=12). In mania, but not in remission there were “highly significant mean changes (lack of night time decreases) between baseline and 4:30am and 6:00am, with p=0.012 and p=0.037, respectively.”

Editors Note: This data is of interest in light of the new subtype of unspecified bipolar disorder called Temperature and Sleep Dysregulation Disorder (TSDD) characterized by profound behavioral dyscontrol, marked sleep disturbance, and temperature dysregulation (red face and ears, being too hot, going out in the cold underdressed). This extremely dysfunctional syndrome responds to high dose lithium; melatonin, clonidine, and other cooling techniques; and ascending and then repeated doses of intranasal ketamine (as described by Papolos et al 2013; 2018).

Early Antidepressant Use is Associated with Rapid Cycling Bipolar Disorder

Highlights from Posters Presented at the Society of Biological Psychiatry Meeting, April 27-29, 2023 in San Diego

A.C. Courtes and Jair Soares reported that “Antidepressants were prescribed as the first psychiatry medication in 74/114 (65%) of BD patients.” This and alcohol use disorder were independent predictors of rapid cycling.

Cannabis Use Disorder Increases Risk of Subsequent Unipolar Depression and Bipolar Disorder

Jefsen et al report in JAMA Psychiatry. that in “[6,651,765] individuals in Demark, cannabis use disorder was associated with an increased risk of (subsequent) both psychotic and nonpsychotic unipolar depression and bipolar disorder….Associations between CUD and subsequent affective disorders were estimated as hazard ratios (HRs) using Cox proportional hazards regression with time-varying information on CUD, adjusting for sex; alcohol use disorder; substance use disorder; having been born in Denmark; calendar year; parental educational level (highest attained); parental cannabis, alcohol, or substance use disorders; and parental affective disorders….Cannabis use was associated with an increased risk of bipolar disorder in men (HR, 2.96; ) and women (HR, 2.54; )”, and was highest for psychotic bipolar disorder (HR, 4.05; 95% CI, 3.52-4.65).

Editors Note: Marijuana is not a benign substance. “In all, 60,?696 individuals received a diagnosis of (cannabis use disorder) during follow-up, and 260,?746 (3.9%) developed an affective disorder.”

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