Cannabis in Psychiatric Practice: A Practical Guide

Description

This book educates and familiarizes psychiatrists with the impact of cannabis beyond the scope of addiction and ways to effectively discuss the existing literature and knowledge with patients. Cannabis in Psychiatric Practice is organized by clinical setting to help tailor the literature to psychiatrists and other mental health clinicians working in all areas, whether traditional outpatient clinics, emergency departments, inpatient psychiatry or medical units. It helps readers, regardless of their training background, learn about the impact of cannabis on a variety of disorders in a manner adjusted to the unique needs and challenges of their particular treatment settings and patient populations. The book also includes clinical cases and practical tips integrating the current evidence, treatment approaches, and psychoeducation needed to effectively practice in the era of modern-day psychiatry and cannabis legalization. Chapters are written in a clear, easy-to-read style, allowing readers to reference specific portions of the book as needed, increasing its utility for the general psychiatrist and mental health clinician. With the increasing prevalence and availability of cannabis and CBD products, this book is an invaluable reference for psychiatrists who wish to explore the impact of cannabis in their clinical practice. Foreword References Series Editor Introduction References Preface Introduction and Acknowledgements Contents Contributors 1: Public Health Concerns of Cannabis Introduction Epidemiology and Review of Legalization in the U.S. Medical Impact: Special Populations Medical Impact: Emergency and Hospital Patients Legal Impact Economic Impact Conclusion References Part I: Pharmacology of Cannabis 2: Clinical Pharmacology of Cannabinoids Endocannabinoid System Review [3–7] Pharmacodynamics Cannabinoid Subtypes Endocannabinoids (ECs) Phytocannabinoids [10, 11] Synthetic Cannabinoids [14] Tolerance to Exogenous Cannabinoids [9, 15–18] Dosage Forms FDA-Approved Cannabinoids [10–12] Pharmacokinetics [3, 5–7, 9, 20] Absorption Distribution Metabolism Elimination Drug-Drug Interactions [5, 10–12, 22–25] CYP450 Properties of THC and CBD [5, 9, 25] Adverse Events Drug and Genetic Testing Drug Testing Summary References 3: Cannabidiol: Overview, Complexities, and Opportunities for Behavioral Health What Is Cannabidiol (CBD)? Is CBD Legal? How Does CBD Work? Unknowns and Concerns: Efficacy, Safety, and Quality Clinical Applications Conclusions References Part II: Cannabis in Child and Adolescent Mental Health Settings 4: Developmental Impact Introduction Neurodevelopment Neuromaturation: Neurogenesis, Synaptogenesis, and Myelination Neurotransmitter System Development Neurodevelopmental Impact of Cannabinoid Exposure Cannabinoid Potency and Timing of Exposure Mechanisms of Exogenous Cannabinoid Exposure Teratogenicity of Exogenous Cannabinoids Cognitive Effects of Prenatal Cannabis Exposure Infancy Early Through Late Childhood Adolescence Cognitive Effects of Adolescent Cannabis Exposure Neuroimaging Studies of Adolescent Cannabis Use Future Directions References 5: What Clinicians Need to Know About Adolescent Cannabis Use in Outpatient Mental Health Settings Case Introduction Substance Screening and Clinical Evaluation Treatment for Cannabis Use Disorder Integrated Treatment and Coordinated Care for Youth with Co-occurring Psychiatric and Substance Use Disorders Summary and Conclusion References 6: Cannabis in the Child and Adolescent Emergency and Inpatient Psychiatric Settings Clinical Case Introduction and Literature Reviewwe Psychotic Disorders Mood and Anxiety Disorders Management of Psychotic and Mood Disorders Associated with Cannabis Abuse Considerations with the Use of Second-Generation Antipsychotics Management of Mood Disorders Associated with Cannabis Use Conclusion References 7: Clinical Considerations for Cannabis in the Child and Adolescent Consultation-Liaison Setting Clinical Case Introduction Product Types and Concentrations Synthetic Cannabinoid Receptor Agonists (SCRAs) Pediatric Clinical Presentations Acute Intoxications Unintentional/Exploratory Intoxications Initial Evaluation for Intoxication Laboratory Studies Clinical Management Acute Intoxication Approach Management Conclusion References Part III: Cannabis in Adult Mental Health Settings: Outpatient Mental Health Setting 8: Disease Course and Prognosis Clinical Case Significance to Current Clinical Practice Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Trauma- and Stressor-Related Disorders ADHD and Cannabis Cannabinoids as Treatment Treatment Approach and Patient Psychoeducation Summary and Conclusions References 9: Evaluation of Co-occurring Psychiatric Disorders and Cannabis Use in the Outpatient Setting Clinical Case Introduction Review of Literature Opening the Conversation: Broaching the Topic of Cannabis While Building Rapport Gathering Details: Diagnosing Underlying Substance Use Disorder Chicken or Egg: Correlating Psychiatric History and Cannabis Use History Formal Screening Instruments Summary and Next Steps References 10: Treatment of Co-occurring Psychiatric Disorders and Cannabis Use in the Outpatient Setting Introduction Review of Literature Psychoeducation and Harm Reduction Psychosocial Interventions Pharmacologic Options Summary and Next Steps References 11: Acute Intoxication and Agitation/Violence Clinical Case Introduction and Literature Review Medical and Psychiatric Symptoms of Intoxication Managing Ongoing Violence Risk Treatment Approach Conclusion References 12: Cannabis and Psychosis Case Introduction Prevalence and Epidemiology Neurobiology Clinical Presentations, Diagnoses, and Treatments Acute Intoxication Substance Induced Psychotic Disorder Schizophrenia or Other Chronic Psychotic Disorder Synthetic Cannabinoid Intoxication Conclusion References 13: Self-Harm and Cannabis Use Treatment Approaches Summary References 14: Cannabis in the Adult Medical and Consultation-Liaison Settings Complications of Cannabis Use in the Medical Setting Case Introduction and Literature Review Delirium Catatonia Cannabis Hyperemesis Syndrome Cannabis Withdrawal Treatment Approaches Delirium Catatonia Cannabis Hyperemesis Syndrome Cannabis Withdrawal Conclusion References 15: Cannabis in the Perinatal Period Introduction A Note on CBD Epidemiology and Risk Factors Pregnancy-Specific Reasons for Use Obstetrical and Neonatal Outcomes Lactation Screening Legal Treatment Summary References 16: Cannabis in the Geriatric Population Geriatric Populations and Cannabis Case Introduction and Literature Review Trends in Use Metabolism of THC in the Elderly Falls, Cannabis, and the Elderly Driving, Cannabis, and the Elderly Dementia and Cannabis Insomnia, Cannabis, and the Elderly Chronic Pain, Cannabis, and the Elderly Other Cannabis Usage in the Elderly Treatment Approaches Conclusion References 17: Marijuana Use in Organ Transplantation Introduction Brief Overview of Organ Transplantation Unique Features of Transplant Patients Overview and Significance of Marijuana in Organ Transplantation Logistical, Legal, and Ethical Matters Marijuana Stigma and Idealization Brief Review of Existing Transplant-Specific Marijuana Literature Liver Heart and Lung Kidney Potential General Benefits of Marijuana Use in Transplant Patients Potential General Risks of Marijuana Use in Transplant Patients Evaluating and Treating Marijuana Use in Transplant Patients General Approach Psychiatric and SUD Comorbidities Psychometric Instruments Toxicology Transplant Policy Awareness and MH/SUD Treatment Adherence Summary References Index