Adolescent Initiation of Cannabis Use and Early-Onset Psychosis.

BACKGROUND: It is important to evaluate the impact of cannabis use on onset and course of psychotic illness, as the increasing number of novice cannabis users may translate into a greater public health burden. This study aims to examine the relationship between adolescent onset of regular marijuana use and age of onset of prodromal symptoms, or first episode psychosis, and the manifestation of psychotic symptoms in those adolescents who use cannabis regularly. METHODS: A review was conducted of the current literature for youth who initiated cannabis use prior to the age of 18 and experienced psychotic symptoms at, or prior to, the age of 25. Seventeen studies met eligibility criteria and were included in this review. RESULTS: The current weight of evidence supports the hypothesis that early initiation of cannabis use increases the risk of early onset psychotic disorder, especially for those with a preexisting vulnerability and who have greater severity of use. There is also a dose-response association between cannabis use and symptoms, such that those who use more tend to experience greater number and severity of prodromal and diagnostic psychotic symptoms. Those with early-onset psychotic disorder and comorbid cannabis use show a poorer course of illness in regards to psychotic symptoms, treatment, and functional outcomes. However, those with early initiation of cannabis use appear to show a higher level of social functioning than non-cannabis users. CONCLUSIONS: Adolescent initiation of cannabis use is associated, in a dose-dependent fashion, with emergence and severity of psychotic symptoms and functional impairment such that those who initiate use earlier and use at higher frequencies demonstrate poorer illness and treatment outcomes. These associations appear more robust for adolescents at high risk for developing a psychotic disorder.

Restricting youth suicide: behavioral health patients in an urban pediatric emergency department.

BACKGROUND: Suicide is the third leading cause of death among individuals age 10 years to 19 years in the United States. Adolescents with suicidal behaviors are often cared for in emergency departments (EDs)/trauma centers and are at an increased risk for subsequent suicide. Many institutions do not have standard procedures to prevent future self-harm. Lethal means restriction (LMR) counseling is an evidence-based suicide prevention strategy that informs families to restrict access to potentially fatal items and has demonstrated efficacy in preventing suicide. The objectives of this study were to examine suicidal behavior among behavioral health patients in a pediatric ED and to assess the use of LMR by hospital staff. METHODS: A sample of 298 pediatric patients was randomly selected from the population of behavioral health patients treated at the ED from January 1 through December 31, 2012 (n = 2,294). Descriptive data include demographics (age, sex, race/ethnicity, etc,), chief complaint, current and past psychiatric history, primary diagnosis, disposition, alcohol/drug abuse, and documentation of any LMR counseling provided in the ED. RESULTS: Of the 298 patients, 52% were female, 47% were white, and 76% were in the custody of their parents. Behavior/out of control was the most common chief complaint (43%). The most common diagnoses were mood disorder (25%) and depression (20%). Thirty-four percent of the patients had suicidal ideation, 22% had a suicide plan, 32% had documented suicidal behavior, and 25% of the patients reported having access to lethal means. However, only 4% of the total patient population received any LMR counseling, and only 15% of those with access to lethal means had received LMR counseling. CONCLUSION: Providing a safe environment for adolescents at risk for suicidal behaviors should be a priority for all families/caretakers and should be encouraged by health care providers. The ED is a key point of entry into services for suicidal youth and presents an opportunity to implement effective secondary prevention strategies. The low rate of LMR counseling found in this study suggests a need for improved LMR counseling for all at-risk youth.

Psychometric characteristics of the Teen Addiction Severity Index-Two (T-ASI-2).

The Teen Addiction Severity Index-Two (T-ASI-2) was developed as an extension of the T-ASI to assess the severity of substance abuse and related problems among adolescents (N = 371) 12-19 years of age. The T-ASI-2 consists of 18 domains that assess current use of alcohol, tobacco, marijuana, and other drugs, as well as mental health service utilization, treatment satisfaction, school difficulties, social functioning with family members and peers, substance use by family members and peers, depression, anxiety, attention deficit, hyperactivity, defiant and risky behaviors, and readiness for change. Results show that all domains have adequate to excellent internal consistency (.54 to .88, median .80). New domains assessing psychological factors strongly correlated with gold standard assessments in the respective areas. The T-ASI-2 was designed to be a user friendly, cost-effective, viable assessment of substance use behavior and related factors.

Megadose intranasal methylphenidate (ritalin) abuse in adult attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is commonly co-occurring with other psychiatric disorders including substance use disorders. Stimulants have proven to be the pharmacological treatment of choice of ADHD along the life span. Contrary to media hype which compared the addictive potential of methylphenidate (MPD) to cocaine, only a handful of case studies on the abuse of prescription MPD by ADHD patients have been published. This case study centers on the treatment management and aftercare implications of an adult ADHD patient who abused 700 mg of prescribed MPD intranasally during a 3-day binge.