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Chapter 20 - Cannabidiol as a Potential Antipsychotic

from Part VI - Cannabinoids and Schizophrenia: Aetiopathology and Treatment Implications

Published online by Cambridge University Press:  12 May 2023

Deepak Cyril D'Souza
Affiliation:
Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine
David Castle
Affiliation:
University of Tasmania, Australia
Sir Robin Murray
Affiliation:
Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
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Summary

Schizophrenia spectrum disorders are psychiatric conditions that express by a wide range of symptoms. Current treatments are effective in controlling so-called positive symptoms (e.g., delusions or hallucinations) but are often less effective for negative symptoms (e.g., blunted affect and passive social withdrawal) as well as for cognitive impairments. Further, current anti-psychotics may induce several side-effects that limit use and patient adherence. Therefore, mechanistically novel anti-psychotics are urgently needed. Cannabidiol, a major cannabinoid of Cannabis sativa, has been investigated in both animal models for aspects of schizophrenia, clinical studies, and controlled trials. Animal studies have raised substantial evidence for cannabidiol’s anti-psychotic effects. While controlled clinical trials have shown mixed results, studies using cannabidiol at higher dosages have demonstrated its ability to ameliorate psychotic symptoms while showing a relatively benign side-effect profile. Although the currently available data is short of any proof justifying the registration of cannabidiol as an anti-psychotic at present, the data from phase II clinical trials justify further study of cannabidiol’s antipsychotic properties in controlled clinical trials to clarify its therapeutic value and safety profile, notably in long-term treatment. In addition, more insight into its mechanisms of action may broaden our understanding of new targets for treatment.

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Marijuana and Madness , pp. 200 - 215
Publisher: Cambridge University Press
Print publication year: 2023

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References

Almeida, V., Levin, R., Peres, F. F., et al. (2013). Cannabidiol exhibits anxiolytic but not antipsychotic property evaluated in the social interaction test. Prog Neuropsychopharmacol Biol Psychiatry, 41, 3035.Google Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Arlington: American Psychiatric Association.Google Scholar
Appiah-Kusi, E., Petros, N., Wilson, R., et al. (2020). Effects of short-term cannabidiol treatment on response to social stress in subjects at clinical high risk of developing psychosis. Psychopharmacology, 237, 11211130.Google Scholar
Bellack, A. S., Morrison, R. L., Wixted, J. T., et al. (1990). An analysis of social competence in schizophrenia. Br J Psychiatry, 156, 809818.CrossRefGoogle ScholarPubMed
Bhattacharyya, S., Wilson, R., Appiah-Kusi, E., et al. (2018). Effect of cannabidiol on medial temporal, midbrain, and striatal dysfunction in people at clinical high risk of psychosis: A randomized clinical trial. JAMA Psychiatry, 75, 11071117.Google Scholar
Boggs, D. L., Surti, T., Gupta, A., et al. (2018). The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia: A randomized placebo controlled trial. Psychopharmacology (Berl), 235, 19231932.Google Scholar
Bowie, C. R., Best, M. W., Depp, C., et al. (2018). Cognitive and functional deficits in bipolar disorder and schizophrenia as a function of the presence and history of psychosis. Bipolar Disord, 20, 604613.Google Scholar
Braff, D., Stone, C., Callaway, E., et al. (1978). Prestimulus effects on human startle reflex in normals and schizophrenics. Psychophysiology, 15, 339343.Google Scholar
Braff, D. L., Geyer, M. A., and Swerdlow, N. R. (2001). Human studies of prepulse inhibition of startle: Normal subjects, patient groups, and pharmacological studies. Psychopharmacology (Berl), 156, 234258.Google Scholar
Bucci, P., Galderisi, S., Mucci, A., et al. (2018). Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition. Acta Psychiatr Scand, 138, 253266.Google Scholar
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., et al. (2018). Global epidemiology and burden of schizophrenia: Findings from the global burden of disease study 2016. Schizophr Bull, 44, 11951203.Google Scholar
Deiana, S., Watanabe, A., Yamasaki, Y., et al. (2015). MK-801-induced deficits in social recognition in rats: Reversal by aripiprazole, but not olanzapine, risperidone, or cannabidiol. Behav Pharmacol, 26, 748765.CrossRefGoogle ScholarPubMed
Díaz-Caneja, C. M., Cervilla, J. A., Haro, J. M., et al. (2019). Cognition and functionality in delusional disorder. Eur Psychiatry, 55, 5260.CrossRefGoogle ScholarPubMed
Fadda, P., Robinson, L., Fratta, W., et al. (2004). Differential effects of THC- or CBD-rich cannabis extracts on working memory in rats. Neuropharmacology, 47, 11701179.Google Scholar
Fadda, P., Robinson, L., Fratta, W., et al. (2006). Scopolamine and MK801-induced working memory deficits in rats are not reversed by CBD-rich cannabis extracts. Behav Brain Res, 168, 307311.CrossRefGoogle Scholar
Ffytche, D. H., and Aarsland, D. (2017). Psychosis in Parkinson’s disease. Int Rev Neurobiol, 133, 585622.Google Scholar
Gomes, F. V., Issy, A. C., Ferreira, F. R., et al. (2015a). Cannabidiol attenuates sensorimotor gating disruption and molecular changes induced by chronic antagonism of NMDA receptors in mice. Int J Neuropsychopharmacol, 18, pyu041.Google Scholar
Gomes, F. V., Llorente, R., Del Bel, E. A., et al. (2015b). Decreased glial reactivity could be involved in the antipsychotic-like effect of cannabidiol. Schizophr Res, 164, 155163.Google Scholar
Gururajan, A., Taylor, D. A., and Malone, D. T. (2011). Effect of cannabidiol in a MK-801-rodent model of aspects of schizophrenia. Behav Brain Res, 222, 299308.Google Scholar
Gururajan, A., Taylor, D. A., and Malone, D. T. (2012). Cannabidiol and clozapine reverse MK-801-induced deficits in social interaction and hyperactivity in Sprague-Dawley rats. J Psychopharmacol, 26, 13171332.Google Scholar
Hallak, J. E., Machado-De-Sousa, J. P., Crippa, J. A., et al. (2010). Performance of schizophrenic patients in the Stroop Color Word Test and electrodermal responsiveness after acute administration of cannabidiol (CBD). Rev Bras Psiquiatr, 32, 5661.CrossRefGoogle ScholarPubMed
Kahn, R. S., and Keefe, R. S. E. (2013). Schizophrenia is a cognitive illness: Time for a change in focus. JAMA Psychiatry, 70, 11071112.Google Scholar
Kirby, B. P. (2016). Animal models of psychotic disorders: Dimensional approach modeling negative symptoms. In Pletnikov, M. V., and Waddington, J. L. (eds.) Handbook of Behavioral Neuroscience (pp. 5567). London: Elsevier.Google Scholar
Klein, C., Karanges, E., Spiro, A., et al. (2011). Cannabidiol potentiates delta-tetrahydrocannabinol (THC) behavioural effects and alters THC pharmacokinetics during acute and chronic treatment in adolescent rats. Psychopharmacology (Berl), 218, 443457.Google Scholar
Kozela, E., Krawczyk, M., Kos, T., et al. (2019). Cannabidiol improves cognitive impairment and reverses cortical transcriptional changes induced by ketamine, in schizophrenia-like model in rats. Mol Neurobiol, 57, 17331747.Google Scholar
Leucht, S., Cipriani, A., Spineli, L., et al. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. Lancet, 382, 951962.Google Scholar
Levin, R., Peres, F. F., Almeida, V., et al. (2014). Effects of cannabinoid drugs on the deficit of prepulse inhibition of startle in an animal model of schizophrenia: The SHR strain. Front Pharmacol, 5, 10.CrossRefGoogle Scholar
Lewandowski, K. E., Cohen, B. M., and Ongur, D. (2011). Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder. Psychol Med, 41, 225241.Google Scholar
Leweke, F. M., Mueller, J. K., Lange, B., et al. (2016). Therapeutic potential of cannabinoids in psychosis. Biol Psychiatry, 79, 604612.Google Scholar
Leweke, F. M., Odorfer, T. M., and Bumb, J. M. (2012a). Medical needs in the treatment of psychotic disorders. Handb Exp Pharmacol, 212, 165185.Google Scholar
Leweke, F. M., Piomelli, D., Pahlisch, F., et al. (2012b). Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry, 2, e94.Google Scholar
Leweke, F. M., Rohleder, C., Gerth, C. W., et al. (2021). Cannabidiol and amisulpride improve cognition in acute schizophrenia in an explorative, double-blind, active-controlled, randomized clinical trial. Front Pharmacol, 12, 614811.CrossRefGoogle Scholar
Long, L. E., Chesworth, R., Huang, X. F., et al. (2010). A behavioural comparison of acute and chronic Delta9-tetrahydrocannabinol and cannabidiol in C57BL/6JArc mice. Int J Neuropsychopharmacol, 13, 861876.Google Scholar
Long, L. E., Chesworth, R., Huang, X. F., et al. (2012). Distinct neurobehavioural effects of cannabidiol in transmembrane domain neuregulin 1 mutant mice. PLoS ONE, 7, e34129.Google Scholar
Long, L. E., Malone, D. T., and Taylor, D. A. (2006). Cannabidiol reverses MK-801-induced disruption of prepulse inhibition in mice. Neuropsychopharmacology, 31, 795803.Google Scholar
Mack, J., Rabins, P., Anderson, K., et al. (2012). Prevalence of psychotic symptoms in a community-based Parkinson disease sample. Am J Geriatr Psychiatry, 20, 123132.Google Scholar
Makiol, C., and Kluge, M. (2019). Remission of severe, treatment-resistant schizophrenia following adjunctive cannabidiol. Aust NZ J Psychiatry, 53, 262.Google Scholar
Malone, D. T., Jongejan, D., and Taylor, D. A. (2009). Cannabidiol reverses the reduction in social interaction produced by low dose Delta(9)-tetrahydrocannabinol in rats. Pharmacol Biochem Behav, 93, 9196.Google Scholar
McGuire, P., Robson, P., Cubala, W. J., et al. (2018). Cannabidiol (CBD) as an adjunctive therapy in schizophrenia: A multicenter randomized controlled trial. Am J Psychiatry, 175, 225231.Google Scholar
Moreira, F. A., and Guimaraes, F. S. (2005). Cannabidiol inhibits the hyperlocomotion induced by psychotomimetic drugs in mice. Eur J Pharmacol, 512, 199205.Google Scholar
Moreno-Küstner, B., Martín, C., and Pastor, L. (2018). Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS ONE, 13, e0195687.CrossRefGoogle ScholarPubMed
Mueller, J. K., Rohleder, C., and Leweke, F. M. (2016). What is the promise of nicotinergic compounds in schizophrenia treatment? Future Med Chem, 8, 20092012.Google Scholar
Murphy, M., Mills, S., Winstone, J., et al. (2017). Chronic adolescent delta(9)-tetrahydrocannabinol treatment of male mice leads to long-term cognitive and behavioral dysfunction, which are prevented by concurrent cannabidiol treatment. Cannabis Cannabinoid Res, 2, 235246.Google Scholar
Nikolaides, A., Miess, S., Auvera, I., et al. (2016). Restricted attention to social cues in schizophrenia patients. Eur Arch Psychiatry Clin Neurosci, 266, 649661.CrossRefGoogle ScholarPubMed
Osborne, A. L., Solowij, N., Babic, I., et al. (2017). Improved social interaction, recognition and working memory with cannabidiol treatment in a prenatal infection (poly I:C) rat model. Neuropsychopharmacology, 42, 14471457.Google Scholar
Osborne, A. L., Solowij, N., Babic, I., et al. (2019). Cannabidiol improves behavioural and neurochemical deficits in adult female offspring of the maternal immune activation (poly I:C) model of neurodevelopmental disorders. Brain Behav Immun, 81, 574587.Google Scholar
Pedrazzi, J. F., Issy, A. C., Gomes, F. V., et al. (2015). Cannabidiol effects in the prepulse inhibition disruption induced by amphetamine. Psychopharmacology (Berl), 232, 30573065.CrossRefGoogle ScholarPubMed
Peres, F. F., Diana, M. C., Levin, R., et al. (2018). Cannabidiol administered during peri-adolescence prevents behavioral abnormalities in an animal model of schizophrenia. Front Pharmacol, 9, 901.Google Scholar
Peres, F. F., Diana, M. C., Suiama, M. A., et al. (2016). Peripubertal treatment with cannabidiol prevents the emergence of psychosis in an animal model of schizophrenia. Schizophr Res, 172, 220221.Google Scholar
Rohleder, C., Muller, J. K., Lange, B., et al. (2016a). Cannabidiol as a potential new type of an antipsychotic. A critical review of the evidence. Front Pharmacol, 7, 422.Google Scholar
Rohleder, C., Wiedermann, D., Neumaier, B., et al. (2016b). The functional networks of prepulse inhibition: Neuronal connectivity analysis based on FDG-PET in awake and unrestrained rats. Front Behav Neurosci, 10, 148.CrossRefGoogle ScholarPubMed
Samara, M. T., Nikolakopoulou, A., Salanti, G., et al. (2019). How many patients with schizophrenia do not respond to antipsychotic drugs in the short term? An analysis based on individual patient data from randomized controlled trials. Schizophr Bull, 45, 639646.Google Scholar
Seidman, L. J., Shapiro, D. I., Stone, W. S., et al. (2016). Association of neurocognition with transition to psychosis: Baseline functioning in the second phase of the North American prodrome longitudinal study. JAMA Psychiatry, 73, 12391248.Google Scholar
Sheffield, J. M., Karcher, N. R., and Barch, D. M. (2018). Cognitive deficits in psychotic disorders: A lifespan perspective. Neuropsychol Rev, 28, 509533.CrossRefGoogle ScholarPubMed
Stark, T., Ruda-Kucerova, J., Iannotti, F. A., et al. (2019). Peripubertal cannabidiol treatment rescues behavioral and neurochemical abnormalities in the MAM model of schizophrenia. Neuropharmacology, 146, 212221.Google Scholar
Swerdlow, N. R., Light, G. A., Thomas, M. L., et al. (2018). Deficient prepulse inhibition in schizophrenia in a multi-site cohort: Internal replication and extension. Schizophr Res, 198, 615.Google Scholar
Wong, A. H. C., and Van Tol, H. H. M. (2003). Schizophrenia: From phenomenology to neurobiology. Neurosci Biobehav Rev, 27, 269306.Google Scholar
Wright, M. J., Jr., Vandewater, S. A., and Taffe, M. A. (2013). Cannabidiol attenuates deficits of visuospatial associative memory induced by Delta(9) tetrahydrocannabinol. Br J Pharmacol, 170, 13651373.CrossRefGoogle ScholarPubMed
Zuardi, A. W., Crippa, J. A., Hallak, J. E., et al. (2009). Cannabidiol for the treatment of psychosis in Parkinson’s disease. J Psychopharmacol, 23, 979983.Google Scholar
Zuardi, A. W., Hallak, J. E., Dursun, S. M., et al. (2006). Cannabidiol monotherapy for treatment-resistant schizophrenia. J Psychopharmacol, 20, 683686.Google Scholar
Zuardi, A. W., Morais, S. L., Guimarães, F. S., et al. (1995). Antipsychotic effect of cannabidiol. J Clin Psychiatry, 56, 485486.Google Scholar
Zuardi, A. W., Rodrigues, J. A., and Cunha, J. M. (1991). Effects of cannabidiol in animal models predictive of antipsychotic activity. Psychopharmacology (Berl), 104, 260264.Google Scholar

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