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To explore whether cannabis has a potential role in actually causing bipolar disorder, a general population cohort study design is informative. Cahill et al. reviewed the interactions between chronic cannabis use and cognitive compromise in bipolar disorder. In trying to understand the interaction between the cannabis and bipolar disorder, attention has been given to the endocannabinoid system. Ashton et al. have detailed the mechanisms of the endocannabinoid system that have been implicated in brain reward pathways, pain, sleep, mood and anxiety. The authors have acknowledged the difficulties with studying the cannabinoids, including issues with doses, mode of administration and tolerance. There is no doubt a great deal of comorbidity between bipolar disorder and cannabis use. There is also a growing body of evidence regarding the deleterious effects of cannabis use in patients with bipolar disorder.
A recent study by Morgan and colleagues found that cannabidiol attenuates the acute cognitive effects of delta-9-tetrahydrocannabinol (THC). This is of interest as THC has been associated with the detrimental effects of cannabis on mental health in at-risk users, and the potency of cannabis is increasing across Europe.
Little is known about the experiential dynamics of the interaction between cannabis and vulnerability to psychosis.
To examine the effects of cannabis on psychotic symptoms and mood in patients with psychosis and healthy controls.
Patients with a psychotic disorder (η = 42) and healthy controls (η = 38) were followed in their daily lives using a structured time-sampling technique.
Daily life cannabis use predicted subsequent increases in positive affect and in patients, but not in controls, decreases in negative affect. In patients, but not in controls, cannabis use predicted increased levels of hallucinatory experiences. Mood-enhancing properties of cannabis were acute, whereas psychosis-inducing effects were sub-acute. There was no direct evidence for self-medication effects in daily life.
Patients with psychosis are more sensitive to both the psychosis-inducing and mood-enhancing effects of cannabis. The temporal dissociation between acute rewarding effects and sub-acute toxic influences may be instrumental in explaining the vicious circle of deleterious use in these patients.
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