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1.
Eur Psychiatry ; 30(1): 152-9, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25541346

ABSTRACT

BACKGROUND: Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. METHODS: FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. RESULTS: Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. CONCLUSIONS: Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use.


Subject(s)
Marijuana Abuse/psychology , Marijuana Smoking/psychology , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Adaptation, Psychological , Adult , Aged , England/epidemiology , Female , Humans , Male , Middle Aged , Motivation , Social Behavior
2.
Eur Psychiatry ; 29(1): 32-5, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23764407

ABSTRACT

This study investigated the relationship between severe childhood abuse and cognitive functions in first-episode psychosis patients and geographically-matched controls. Reports of any abuse were associated with lower scores in the executive function domain in the control group. However, in contrast with our hypothesis, no relationships were found amongst cases.


Subject(s)
Child Abuse/psychology , Cognition Disorders/physiopathology , Executive Function/physiology , Psychotic Disorders/physiopathology , Adolescent , Adult , Aged , Case-Control Studies , Child , Cognition Disorders/etiology , Female , Humans , Male , Middle Aged , Young Adult
3.
Psychol Med ; 41(3): 463-76, 2011 Mar.
Article in English | MEDLINE | ID: mdl-20529412

ABSTRACT

BACKGROUND: Cognitive impairment, particularly in memory and executive function, is a core feature of psychosis. Moreover, psychosis is characterized by a more prominent history of stress exposure, and by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. In turn, stress exposure and abnormal levels of the main HPA axis hormone cortisol are associated with cognitive impairments in a variety of clinical and experimental samples; however, this association has never been examined in first-episode psychosis (FEP). METHOD: In this study, 30 FEP patients and 26 controls completed assessment of the HPA axis (cortisol awakening response and cortisol levels during the day), perceived stress, recent life events, history of childhood trauma, and cognitive function. The neuropsychological battery comprised general cognitive function, verbal and non-verbal memory, executive function, perception, visuospatial abilities, processing speed, and general knowledge. RESULTS: Patients performed significantly worse on all cognitive domains compared to controls. In patients only, a more blunted cortisol awakening response (that is, more abnormal) was associated with a more severe deficit in verbal memory and processing speed. In controls only, higher levels of perceived stress and more recent life events were associated with a worse performance in executive function and perception and visuospatial abilities. CONCLUSIONS: These data support a role for the HPA axis, as measured by cortisol awakening response, in modulating cognitive function in patients with psychosis; however, this association does not seem to be related to the increased exposure to psychosocial stressors described in these patients.


Subject(s)
Cognition/physiology , Hydrocortisone/physiology , Psychotic Disorders/psychology , Adult , Case-Control Studies , Female , Humans , Hydrocortisone/blood , Hydrocortisone/chemistry , Hypothalamo-Hypophyseal System/physiopathology , Linear Models , Male , Marijuana Abuse/physiopathology , Marijuana Abuse/psychology , Memory/physiology , Neuropsychological Tests , Pituitary-Adrenal System/physiopathology , Psychomotor Performance/physiology , Psychotic Disorders/physiopathology , Saliva/chemistry , Socioeconomic Factors , Stress, Psychological/physiopathology , Stress, Psychological/psychology , Wakefulness/physiology
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