Does cannabidiol reduce the adverse effects of cannabis in schizophrenia? A randomised, double-blind, cross-over trial.
Chesney et al.·NeuropsychopharmacologyImpact 4.4
SchadenGRADEModerat11 Zitate
Stichproben = 30 Pat.
Dauerunklar
KontrollePlacebo vor vaporisiertem Cannabis
EndpunktHVLT-R
Verblindungdoppelblind
DesignRCT
Cannabinoidkombination
Max. Dosis1060.0 mg
Applikationoral
”Kernaussage
CBD-Vorbehandlung verschlechterte statt verbesserte die kognitiven und psychotischen Effekte von Cannabis: verbal recall war schlechter (-1,3 Wörter) und PANSS-Positiv-Symptome waren höher (+2,2 Punkte) im Vergleich zu Placebo.
Zusammenfassung
RCT (n=30) bei Schizophrenie-Patienten mit Cannabis-Gebrauchsstörung; randomisiert, doppelblind, cross-over Design. CBD-Prämedikation 1000 mg vs. Placebo vor vaporisiertem Cannabis (THC 20-60 mg). Verzögerter verbaler Abruf nach CBD-Prämedikation schlechter als nach Placebo (3.5 vs. 4.8 Wörter, MD=-1.3, 95% CI: -2.0 bis -0.6, p=0.001). PANSS-P-Anstieg nach CBD größer als nach Placebo (+5.0 vs. +2.9, MD=2.2, 95% CI: 0.6-3.7, p=0.01). CBD attenuierte Cannabis-Effekte nicht, sondern verstärkte sie paradoxerweise.
P
PopulationErwachsene mit Schizophrenie oder schizoaffektiver Störung und komorbider Cannabisgebrauchsstörung, n=30
I
InterventionOrales CBD 1000 mg, 3 Stunden vor Inhalation von vaporisiertem Cannabis (THC 20–60 mg)
C
KontrollePlacebo (oral) vor vaporisiertem Cannabis
O
OutcomeVerzögerter verbaler Abruf nach CBD-Vorbehandlung 3,5 Wörter vs. 4,8 Wörter nach Placebo (MD = −1,3; 95%-KI: −2,0 bis −0,6; p=0,001); PANSS-P-Anstieg nach CBD +5,0 vs. +2,9 nach Placebo (MD = 2,2; 95%-KI: 0,6–3,7; p=0,01)
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
Moderat
Dritte von vier GRADE-Stufen, die Effektschätzung ist wahrscheinlich verlässlich.
Herabgestuft wegen
Ungenauigkeit
Qualitätsprofil
Größe★★★★★
VerblindungDoppelblind
EffektstärkeSchaden
Zitate / Jahr★★★★★
Autoren
Chesney E, Oliver D, Sarma A, Lamper AD, Slimani I, Lloyd M, Dickens AM, Welds M, Krakstrom M, Gasparini-Andre I
In patients with schizophrenia, cannabis use exacerbates symptoms and can lead to a relapse of psychosis. Some experimental studies in healthy volunteers suggest that pre-treatment with cannabidiol (CBD) may reduce these effects, but others do not. Here, we investigated whether pre-treatment with CBD ameliorates the acute adverse effects of cannabis in patients with schizophrenia. Participants (n = 30) had schizophrenia or schizoaffective disorder plus a comorbid cannabis use disorder. In a double-blind, randomised, placebo-controlled, crossover trial, participants received oral CBD 1000 mg or placebo three hours before inhaling vaporised cannabis (containing Delta(9)-tetrahydrocannabinol (THC) 20-60 mg). The primary outcome was delayed verbal recall measured with the Hopkins Verbal Learning Test-Revised. We also measured psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS) - positive subscale. Delayed verbal recall after cannabis administration was 3.5 words (95% confidence interval [CI]: 2.5-4.5) following pre-treatment with CBD, compared to 4.8 words (95% CI: 3.9 to 5.8) following pre-treatment with placebo (mean difference [MD] = -1.3 [95% CI: -2.0 to -0.6]; p = 0.001). After CBD pre-treatment, inhalation of cannabis was associated with an increase in PANSS-P score of 5.0 (95% CI: 3.6 to 6.5), compared to 2.9 (95% CI: 1.5 to 4.3) following pre-treatment with placebo (MD = 2.2 [95% CI: 0.6 to 3.7]; p = 0.01). Administration of CBD did not have a significant effect on plasma concentration of THC or its active metabolite, 11-hydroxy-THC. In patients with schizophrenia and a comorbid cannabis use disorder, pre-treatment with CBD did not attenuate the acute effects of cannabis on memory impairment or psychotic symptoms, but appeared to exacerbate them. The study was registered on Clinicaltrials.gov (NCT04605393).