[Acute dystonia in a patient with an elevated clozapine level due to an infection]. / Acute dystonie bij een patiënte met een door infectie verhoogde clozapinespiegel.

Acute dystonia is a side-effect associated with the use of antipsychotics. We describe the case of a 75-year-old patient with late-onset schizophrenia who used clozapine. During a hospital admission due to pneumonia, she developed a form of acute dystonia consisting of a rotational torticollis, which disappeared rapidly after treatment with biperiden. Blood examination showed an increase of the clozapine level, probably due to the infection. This case report shows that acute dystonia, although very rare, can occur during treatment with clozapine; therefore awareness is needed of the circumstances that can alter clozapine levels.

Change in cannabis use in the general population: a longitudinal study on the impact on psychotic experiences.

OBJECTIVE: To prospectively assess the relationship between cannabis use and psychotic experiences over time. METHOD: In a longitudinal design, young adults aged 18-27years (N=705) gave online information on cannabis use and completed the Community Assessment of Psychic Experiences (CAPE). These measures were repeated after an interval ranging from six months to five years. RESULTS: A decrease in cannabis use was associated with a decrease in total psychotic experiences (ß=-0.096, p=0.01) after adjustment for a range of potential confounders. An increase in cannabis use was associated with increased positive symptoms at follow-up (ß=0.07, p=0.02), but was not significantly associated with increases in Negative and Depression symptom scores, nor with the total number of psychotic experiences. CONCLUSION: In the first study to the association of change in cannabis use and psychotic experiences over time in the general population, we found an association between changes in cannabis use and changes in the frequency of psychotic experiences. While this does not prove a causal relationship between cannabis use and psychosis, our findings are consistent with studies suggesting that cessation of cannabis use may be beneficial in terms of reducing psychotic experiences.

Transisthmian differentiation in the tree-climbing mangrove crab Aratus H. Milne Edwards, 1853 (Crustacea, Brachyura, Sesarmidae), with description of a new species from the tropical eastern Pacific.

The tree-climbing mangrove crab Aratus pisonii (H. Milne Edwards, 1837) (Brachyura, Sesarmidae) is considered to have a transisthmian distribution, due to its presence in mangroves of the Western Atlantic as well as the Eastern Pacific. We here present evidence, based on the morphologies of male gonopods and on genetic data, that populations from these two coastlines are morphologically and genetically distinct and require the description of a new species, Aratus pacificus n. sp., as the sister-species of Aratus pisonii. The corresponding speciation event can be regarded as the outcome of differentiation following the closure of the Isthmus of Panama. As these coastal brackish species were probably among the last ones to become separated, the speciation can thus be dated to a time frame of no more than 3.1 million years.

Cannabis use is a better indicator of poor mental health in women than in men: a cross-sectional study in young adults from the general population.

Cannabis use is a known risk factor for a range of mental health problems, but less is known on the association with general mental health. We aim to explore the relationship between cannabis use and general mental health. We did a cross-sectional online survey of 1,929 young adults aged 18-30 years. Participants reported socio-demographic data, substance use and the Symptom Checklist-90 (SCL-90). Monthly cannabis use was associated with a higher total score on the SCL-90, both in a crude (OR 1.94, 95% CI 1.57-2.38) and fully adjusted model (OR 1.48, 95% CI 1.07-2.03). The association between cannabis and mental health was stronger in women and weekly users, and was independent of age at first use of cannabis. We conclude that moderate cannabis use is associated with general mental health problems in young adulthood. This relationship is independent of age at first use and of other risk factors, and is strongest in women.

Cannabidiol as a potential treatment for psychosis.

Although cannabis use is associated with an increased risk of developing psychosis, the cannabis constituent cannabidiol (CBD) may have antipsychotic properties. This review concisely describes the role of the endocannabinoid system in the development of psychosis and provides an overview of currently available animal, human experimental, imaging, epidemiological and clinical studies that investigated the antipsychotic properties of CBD. In this targeted literature review we performed a search for English articles using Medline and EMBASE. Studies were selected if they described experiments with psychosis models, psychotic symptoms or psychotic disorders as outcome measure and involved the use of CBD as intervention. Evidence from several research domains suggests that CBD shows potential for antipsychotic treatment.

Cigarette smoking and cannabis use are equally strongly associated with psychotic-like experiences: a cross-sectional study in 1929 young adults.

BACKGROUND: Cannabis use is associated with increased risk for psychotic-like experiences (PLEs) and psychotic disorders. It remains unclear whether this relationship is causal or due to confounding. METHOD: A total of 1929 young adults aged 18-30 years participated in a nationwide internet-based survey in The Netherlands and gave information on demographics, substance use and parental psychiatric illness and completed the Community Assessment of Psychic Experiences (CAPE). RESULTS: Cigarette smoking and cannabis use were equally strongly associated with the frequency of PLEs in a fully adjusted model (ß = 0.098 and 0.079 respectively, p < 0.05). Cannabis use was associated with distress from PLEs in a model adjusted for an elaborate set of confounders excluding smoking (ß = 0.082, p < 0.05). However, when cigarette smoking was included in the model, cannabis use was not a significant predictor of distress from PLEs. Cigarette smoking remained associated with distress from PLEs in a fully adjusted model (ß = 0.107, p < 0.001). CONCLUSIONS: Smoking is an equally strong independent predictor of frequency of PLEs as monthly cannabis use. Our results suggest that the association between moderate cannabis use and PLEs is confounded by cigarette smoking.

Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools.

BACKGROUND: Although the association between cannabis use and a wide range of psychiatric symptoms is fairly well established, it is not clear whether cannabis use is also a risk factor for general mental health problems at secondary school. Method A total of 10 324 secondary school children aged 11-16 years, participating in an ongoing Public Health Service School Survey, gave information on demographics, substance use, school factors and stressful life events and completed the Strengths and Difficulties Questionnaire (SDQ). RESULTS: Cannabis use in the past month was associated with a clinically relevant score on the SDQ [unadjusted odds ratio (OR) 4.46, 95% confidence interval (CI) 3.46-5.76]. Other risk factors associated with poor psychosocial functioning were: a low level of education, alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation, feeling unsafe at school, being victimized, frequent absence due to illness, a mentally ill parent, molestation by a parent, financial problems and feeling distressed by an adverse event. In a full model adjusting for these risk factors, cannabis was not significantly associated with mental health problems, although an association at trend level was apparent. Of these risk factors, regular alcohol use, cigarette smoking, hard drug use, frequent truancy, an unfavourable school evaluation and frequent absence due to illness were also associated with cannabis use. CONCLUSIONS: The association between cannabis use and poor psychosocial functioning in adolescence is due, at least in part, to confounding by other risk factors. Thus, cannabis use can best be viewed as an indicator of risk for mental health problems in adolescence.

Association between cannabis and psychiatric hospitalization.

OBJECTIVE: To investigate the relationship between cannabis use and mental health. METHOD: A cross-sectional analysis in a sample of 17 698 individuals with a mean age of 22 years (SD: 4.2). Participants provided information on the amount and initial age of cannabis use and history of psychiatric hospitalizations through a web-based questionnaire. To quantify Δ(9) -tetrahydrocannabinol exposure, we operationalized cannabis use as the amount of money spent on cannabis per week over the last month. The odds ratio of having a history of psychiatric hospitalizations was the primary outcome measure. RESULTS: We found a dose-response relationship between the amount of cannabis use and the odds for psychiatric hospitalization. Adjusted odds ratios for hospitalization increased with the amount of cannabis consumed from 1.6 (95% CI: 1.1-2.3) in incidental users to 6.2 (95% CI: 4.3-8.9) in heavy users (>€25/week). Our data suggested that concomitant drug use was an intermediate factor. Exposure to cannabis before the age of 12 years was found to carry a 4.8 (95% CI: 2.9-7.8) times increased odds for past psychiatric hospitalizations. CONCLUSION: We conclude that early and heavy uses of cannabis are each and independently associated with poor mental health in its users.

Cannabis use at a young age is associated with psychotic experiences.

BACKGROUND: Cannabis use is associated with psychosis and a range of subclinical psychiatric symptoms. The strength of this association depends on dosage and age at first use. The current study investigates whether level of cannabis exposure and starting age are associated with specific profiles of subclinical symptoms. METHOD: We collected cross-sectional data from a young adult population sample by administering an online version of the Community Assessment of Psychic Experiences (CAPE). Cannabis exposure was quantified as the amount of Euros spent on cannabis per week and the age of initial cannabis use. The primary outcome measure was the odds ratio (OR) to belong to the highest 10% of scores on the total CAPE and the positive-, negative- and depressive symptom dimensions. RESULTS: In 17 698 adolescents (mean age 21.6, s.d.=4.2 years), cannabis use at age 12 years or younger was strongly associated with a top 10% score on psychotic experiences [OR 3.1, 95% confidence interval (CI) 2.1-4.3] and to a lesser degree with negative symptoms (OR 1.7, 95% CI 1.1-2.5). The OR of heavy users (>€25/week) for negative symptoms was 3.4 (95% CI 2.9-4.1), for psychotic experiences 3.0 (95% CI 2.4-3.6), and for depressive symptoms 2.8 (95% CI 2.3-3.3). CONCLUSIONS: Early start of cannabis use is strongly associated with subclinical psychotic symptoms and to a lesser degree with negative symptoms, while smoking high amounts of cannabis is associated with increased levels of all three symptom dimensions: psychotic, negative and depressive. These results support the hypothesis that the impact of cannabis use is age specific.

Investigating gene environment interaction in complex diseases: increasing power by selective sampling for environmental exposure.

BACKGROUND: The often limited influence of disease associated alleles on the vulnerability to complex diseases has lead to increased interest in environmental interaction with genotype. However, gene environmental interactions (GEIs) are not easily studied, since high numbers of subjects are required to detect GEI. METHODS AND RESULTS: This study provides a potential useful method to increase the power of such studies through selective sampling for environmental exposure. We show that selecting the top and bottom 10% regarding environmental exposure can lead to a 70% reduction in the required number of subjects for genotyping. CONCLUSION: This study demonstrates the potential usefulness of selective sampling in the study of the interplay between genes and environment. The reduction of required subjects can be particularly advantageous in studies where genotyping is extensive, such as in whole genome screens or in studies where phenotyping is expensive.

Genetic, ecological, and behavioural divergence between two sibling snapping shrimp species (Crustacea: Decapoda: Alpheus).

Examination of genetic and ecological relationships within sibling species complexes can provide insights into species diversity and speciation processes. Alpheus angulatus and A. armillatus, two snapping shrimp species with overlapping ranges in the north-western Atlantic, are similar in morphology, exploit similar ecological niches and appear to represent recently diverged sibling species. We examined phylogenetic and ecological relationships between these two species with: (i) sequence data from two mitochondrial genes (16S rRNA and COI); (ii) data on potential differences in microhabitat distribution for A. armillatus and A. angulatus; and (iii) data from laboratory experiments on the level of reproductive isolation between the two species. DNA sequence data suggest A. armillatus and A. angulatus are sister species that diverged subsequent to the close of the Isthmus of Panama, and that haplotype diversity is lower in A. armillatus than in A. angulatus. Both species are distantly related to A. heterochaelis and A. estuariensis, two species with which A. angulatus shares some similarities in coloration. Ecological data on the distribution of A. angulatus and A. armillatus from two locations revealed differences in distribution of the two species between habitat patches, with each patch dominated by one or the other species. However, there was no apparent difference in distribution of the two species within habitat patches with respect to microhabitat location. Ecological data also revealed that heterospecific individuals often occur in close proximity (i.e. within metres or centimetres) where sympatric. Behavioural data indicated that these species are reproductively isolated, which is consistent with speciation in transient allopatry followed by post-divergence secondary contact. Our data further resolve taxonomic confusion between the sibling species, A. armillatus and A. angulatus, and suggest that sympatry in areas of range overlap and exploitation of similar ecological niches by these two recently diverged species have selected for high levels of behavioural incompatibility.

Molecular phylogeny, taxonomy, and evolution of nonmarine lineages within the American grapsoid crabs (Crustacea: brachyura).

Grapsoid crabs are best known from the marine intertidal and supratidal. However, some species also inhabit shallow subtidal and freshwater habitats. In the tropics and subtropics, their distribution even includes mountain streams and tree tops. At present, the Grapsoidea consists of the families Grapsidae, Gecarcinidae, and Mictyridae, the first being subdivided into four subfamilies (Grapsinae, Plagusiinae, Sesarminae, and Varuninae). To help resolve phylogenetic relationships among these highly adaptive crabs, portions of the mitochondrial genome corresponding to the 16S rRNA gene were sequenced for all grapsoid genera occurring in America. The resulting phylogeny confirms most of the present grapsid subfamilies but suggests reclassification of some of the genera and recognition of new taxonomic units. The two American gecarcinid genera might not represent a sister group to the Grapsidae but rather appear to have evolved within the latter. Colonization of inland habitats evolved in several lineages of the grapsoids, resulting in various forms of nonmarine life and different degrees of independence from the sea.