Nervenheilkunde 2023; 42(04): 215-221
DOI: 10.1055/a-1948-8800
Schwerpunkt

Medizinisches Cannabis

Einsatzmöglichkeiten in der PsychiatrieMedical cannabisUse in psychiatry
Johannes Kramer
1   Klinik für Psychiatrie und Psychotherapie, LMU Klinikum
,
Oliver Pogarell
1   Klinik für Psychiatrie und Psychotherapie, LMU Klinikum
› Institutsangaben

ZUSAMMENFASSUNG

Es liegen Untersuchungen zur Wirksamkeit von Cannabinoiden bei psychischen Störungen vor, jedoch fehlen ausreichende große, randomisiert-kontrollierte Studien mit Replikation. Der genaue Effekt von Cannabinoiden auf die Psychopathologie der jeweiligen Störungen konnte ebenfalls nicht mit hinreichender Evidenz belegt werden. Es ergaben sich jedoch keine Hinweise auf schwerwiegende Nebenwirkungen. Allgemeine Empfehlungen zum Einsatz von Cannabinoiden bei psychischen Störungen sind nicht möglich, dennoch kann in Einzelfällen bei fehlender Neigung zu Substanzgebrauchsstörungen der Einsatz von Cannabinoiden durchaus sinnvoll sein, insbesondere bei Patienten mit komorbiden Schmerzstörungen.

ABSTRACT

While multiple studies for the use of cannabinoids in treating mental illness exist, sufficient evidence from large randomized controlled trials is scarce. Their precise effect on the respective psychopathology of certain patient groups has not yet been investigated sufficiently. However, current evidence does not indicate a high likelihood of serious adverse events under cannabinoid therapy. In some cases, the use of cannabinoids in psychiatry may be warranted in absence of a propensity for substance use disorders, especially so in patients with comorbid pain disorders, but there is currently no basis for a general recommendation.



Publikationsverlauf

Artikel online veröffentlicht:
06. April 2023

© 2023. Thieme. All rights reserved.

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Al’absi M, Allen AM. Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping. Front Psychol 2021
  • 2 Allsop DJ, Copeland J, Lintzeris N. et al Nabiximols as an Agonist Replacement Therapy During Cannabis Withdrawal. JAMA Psychiatry 2014
  • 3 Andries A, Frystyk J, Flyvbjerg A. et al Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. Int J Eat Disord 2014
  • 4 Andries A, Gram B, Støving RK. Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity 2015
  • 5 Aso E, Andrés-Benito P, Ferrer I. Delineating the Efficacy of a Cannabis-Based Medicine at Advanced Stages of Dementia in a Murine Model. Journal of Alzheimer’s Disease 2016
  • 6 Avraham Y, Latzer Y, Hasid D. et al The Impact of Delta9-THC on the Psychological Symptoms of Anorexia Nervosa: A Pilot Study. Isr J Psychiatry 2017: 44-51
  • 7 Bergamaschi MM, Queiroz RHC, Chagas MHN. et al Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients. Neuropsychopharmacology 2011
  • 8 Berner B. Kein Anspruch auf cannabinoidhaltige Arzneimittel. Dtsch Arztebl. 2007; 104(37): A-2536/B-2244/C-2176
  • 9 Bisaga A, Sullivan MA, Glass A. et al The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone. Drug and Alcohol Dependence 2015
  • 10 Bonn-Miller MO, Sisley S, Riggs P. et al The short-term impact of 3 smoked cannabis preparations versus placebo on PTSD symptoms: A randomized cross-over clinical trial. PLOS ONE. 2021; e0246990
  • 11 Bundesministerium Für Gesundheit. Bekanntmachung eines Beschlusses des Gemeinsamen Bundesausschusses über eine Änderung der Arzneimittel-Richtlinie (AM-RL): Anlage XII – Beschlüsse über die Nutzenbewertung von Arzneimitteln mit neuen Wirkstoffen nach § 35a des Fünften Buches Sozialgesetzbuch (SGB V) – Extrakt aus Cannabis Sativa (Wirkstoffkombination Delta-9-Tetrahydrocannabinol und Cannabidiol). Bundesanzeiger 2012; BAnz AT 11.07.2012 B2012
  • 12 Cooper RE, Williams E, Seegobin S. et al Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol 2017
  • 13 Cooper ZD, Haney M. Cannabis reinforcement and dependence: role of the cannabinoid CB1 receptor. Addiction Biology 2008
  • 14 Crippa JA, Derenusson GN, Ferrari TB. et al Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report. Journal of Psychopharmacology 2011
  • 15 D’souza DC, Sewell RA, Ranganathan M. Cannabis and psychosis/schizophrenia: human studies. European Archives of Psychiatry and Clinical Neuroscience 2009
  • 16 Elms L, Shannon S, Hughes S. et al Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. The Journal of Alternative and Complementary Medicine 2019
  • 17 Eubanks LM, Rogers CJ. Beuscher et al A Molecular Link between the Active Component of Marijuana and Alzheimer’s Disease Pathology. Molecular Pharmaceutics 2006
  • 18 Farkhondeh T, Khan H, Aschner M. et al Impact of Cannabis-Based Medicine on Alzheimer’s Disease by Focusing on the Amyloid beta-Modifications: A Systematic Study. CNS Neurol Disord Drug Targets 2020
  • 19 Filbey FM, Dunlop J, Ketcherside A. et al fMRI study of neural sensitization to hedonic stimuli in long-term, daily cannabis users. Human Brain Mapping 2016
  • 20 Hoch E, Friemel CM, Schneider M. (Hrsg.) Cannabis: Potenzial und Risiko: Eine wissenschaftliche Bestandsaufnahme. Heidelberg: Springer; 2019
  • 21 Jetly R, Heber A, Fraser G. et al The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology 2015
  • 22 Jicha CJ, Lofwall MR, Nuzzo PA. et al Safety of oral dronabinol during opioid withdrawal in humans. Drug and Alcohol Dependence 2015
  • 23 Kroon E, Kuhns L, Cousijn J. The short-term and long-term effects of cannabis on cognition: recent advances in the field. Curr Opin Psychol 2021
  • 24 Levin FR, Mariani JJ, Pavlicova M. et al Dronabinol and lofexidine for cannabis use disorder: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2016
  • 25 Leweke FM, Mueller JK, Lange B. et al Therapeutic Potential of Cannabinoids in Psychosis. Biol Psychiatry 2016
  • 26 Leweke FM, Piomelli D, Pahlisch F. et al Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Translational Psychiatry 2012
  • 27 Leweke FM, Rohleder C, Gerth CW. et al Cannabidiol and Amisulpride Improve Cognition in Acute Schizophrenia in an Explorative, Double-Blind, Active-Controlled, Randomized Clinical Trial. Front Pharmacol 2021
  • 28 Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. British Journal of Clinical Pharmacology 2018
  • 29 Lucas P, Reiman A, Earleywine M. et al Cannabis as a substitute for alcohol and other drugs: A dispensary-based survey of substitution effect in Canadian medical cannabis patients. Addiction Research & Theory 2013
  • 30 Macatee RJ, Okey SA, Albanese BJ. et al Distress intolerance moderation of motivated attention to cannabis and negative stimuli after induced stress among cannabis users: an ERP study. Addiction Biology 2019
  • 31 Mackenzie A, Cservenka A. Cannabis and emotion processing: A review of behavioral, physiological, and neural responses. Exp Clin Psychopharmacol 2021
  • 32 Mikulskaya E, Martin F. Visual attention to motion stimuli and its neural correlates in cannabis users. Eur J Neurosci 2018
  • 33 Mitchell JT, Sweitzer MM, Tunno AM. et al “I Use Weed for My ADHD”: A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PLOS ONE 2016
  • 34 Müller-Vahl K, Grotenhermen F. Medizinisches Cannabis: Die wichtigsten Änderungen. Dtsch Arztebl International 2017; 114: A 352-356
  • 35 Müller-Vahl K, Schneider U, Koblenz A. et al Treatment of Tourette’s Syndrome with Δ-9-Tetrahydrocannabinol (THC): A Randomized Crossover Trial. Pharmacopsychiatry 2002
  • 36 Muller-Vahl K, Schneider U, Prevedel H. et al Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry 2003
  • 37 Neumeister A, Normandin MD, Pietrzak RH. et al Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Mol Psychiatry 2013
  • 38 Petrucci AS, Lafrance EM, Cuttler C. A Comprehensive Examination of the Links between Cannabis Use and Motivation. Subst Use Misuse 2020
  • 39 Podda G, Constantinescu CS. Nabiximols in the treatment of spasticity, pain and urinary symptoms due to multiple sclerosis. Expert Opin Biol Ther 2012
  • 40 Portenoy RK, Ganae-Motan ED, Allende S. et al Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain 2012: 438-449
  • 41 Ranganathan M, Cortes-Briones J, Radhakrishnan R. et al Reduced Brain Cannabinoid Receptor Availability in Schizophrenia. Biol Psychiatry 2016
  • 42 Rapin L, Gamaoun R, El Hage C. et al Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic. Journal of Cannabis Research 2021
  • 43 Robinson T, Ali MU, Easterbrook B. et al Risk-thresholds for the association between frequency of cannabis use and the development of psychosis: a systematic review and meta-analysis. Psychological Medicine 2022
  • 44 Sachedina F, Chan C, Damji RS. et al Medical cannabis use in Canada and its impact on anxiety and depression: A retrospective study. Psychiatry Res 2022
  • 45 Sarris J, Sinclair J, Karamacoska D. et al Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review. BMC Psychiatry 2020
  • 46 Sexton M, Cuttler C, Finnell JS. et al A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy. Cannabis and Cannabinoid Research 2016
  • 47 Stueber A, Cuttler C. Self-Reported Effects of Cannabis on ADHD Symptoms, ADHD Medication Side Effects, and ADHD-Related Executive Dysfunction. Journal of Attention Disorders 2021
  • 48 Trigo JM, Soliman A, Quilty LC. et al Nabiximols combined with motivational enhancement/cognitive behavioral therapy for the treatment of cannabis dependence: A pilot randomized clinical trial. PLOS ONE 2018
  • 49 Van Den Elsen GA, Ahmed AIA, Verkes RJ. et al Tetrahydrocannabinol in Behavioral Disturbances in Dementia: A Crossover Randomized Controlled Trial. Am J Geriatr Psychiatry 2015
  • 50 Van Den Elsen GA, Ahmed AIA, Verkes RJ. et al Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled trial. Neurology 2015
  • 51 Volicer L, Stelly M, Morris J. et al Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 1997: 913-919
  • 52 Volkow ND, Swanson JM, Evins AE. et al Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry 2016
  • 53 Walsh JH, Maddison KJ, Rankin T. et al Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo. Sleep 2021
  • 54 Weizman L, Dayan L, Brill S. et al Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology 2018
  • 55 Wilcockson TDW, Sanal NEM. Heavy cannabis use and attentional avoidance of anxiety-related stimuli. Addict Behav Rep 2016
  • 56 Zuardi AW, Hallak JE, Dursun SM. et al Cannabidiol monotherapy for treatment-resistant schizophrenia. J Psychopharmacol 2006