Dissertations / Theses on the topic 'Cannabis use disorder'
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1
McCabe, Patrick J. "Cannabis Use and Bipolar Disorder: Bipolar Disorder Case Identification and Cannabis Use Risk Assessment: A Dissertation." eScholarship@UMMS, 2011. https://escholarship.umassmed.edu/gsbs_diss/584.
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Bipolar disorders (BD) are characterized by symptoms of grandiosity, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increased goal-directed activities, psychomotor agitation, and excessive involvement in pleasurable activities. Those with a bipolar disorder have a high degree of psychiatric comorbidity including substance use disorders, and they also experience increased mortality. Despite the widespread recognition of BD as an important psychiatric condition, available population-based estimates for BD prevalence differs across data sources.
Cannabis is one of the most widely-used illicit substances. Evidence supports it as a risk factor for psychotic symptoms and disorders. Because populations with psychotic disorders and populations with bipolar disorder share genetic characteristics, cannabis may increase risk for bipolar disorders through the same pathways as it does with psychotic disorders. Limited and conflicting evidence regarding the association of cannabis use and bipolar disorder is currently available. This dissertation investigates cannabis use as a risk factor for incident manic symptoms and bipolar disorders in a large nationally representative longitudinal cohort.
The first aim of this dissertation is to evaluate the implications for manic, hypomanic and major depressive episode prevalence estimates arising from the different approaches to assessing DSM-IV criterion between two national surveys. Differences in the assessment of impairment strongly influence manic or hypomanic classification within the NESARC. Compared to multiple imputation estimates (19.7% [95% CI: 19.3-20.1]) which treat depressed mood and anhedonia as separate symptoms, symptom assessment in the NESARC substantially underestimates major depressive episode prevalence (16.9% [95% CI: 16.1-17.6]).
The second research objective examined self-reported cannabis use as a risk factor for incident manic symptoms, bipolar spectrum disorders (including manic and hypomanic episodes) and SCID-based recalibrated BD I and II. Cannabis use risk was assessed in the population as a whole and in sub-populations defined by age, substance abuse/dependence status, and family history. Among those reporting no lifetime major depressive or manic symptoms at baseline, self-reported past-year cannabis use was associated with increased odds of an incident week of extremely elevated or irritable mood accompanied by at least two manic episode criterion B symptoms (adj. OR 1.69, 95% CI: 1.08-2.65, p=.02) over the three year follow-up period. Among adults (ages 26 to 45) >=1 reported use(s) of cannabis per week was associated with incident manic or hypomanic episodes (adjusted OR 2.52, 95% CI: 1.32-4.80, p=.006). Among those endorsing no major depressive symptoms, substance abuse/dependence, or anti-social traits in their first degree relatives, past year cannabis use is associated with increased risk for incident bipolar spectrum disorders (adjusted OR 2.27, 95% CI: 1.01-5.10, p=.05) and CIDI recalibrated BD I and II (adjusted OR 5.49, 95% CI: 1.38-21.9, p=.02). Past year cannabis use risk for DSM-IV manic or hypomanic episodes among those aged 26 to 45 is concentrated in those with a baseline history of a substance use disorder (adj. OR 2.00, 95% CI: 1.10-3.66, p=.02) as compared to those with no such history (adj. OR 1.87, 95% CI: 0.49-7.21, p=.36).
The third research objective of this dissertation was a sensitivity analysis using externally-predicted categorized exposures and continuous cannabis use propensities. The sensitivity analysis found evidence of exposure misclassification. Exposures defined by external propensity scores had improved cross-sectional association with bipolar spectrum disorders compared to reported use when both were compared to an external standard. No significant risk estimates were found for categorized predicted cannabis use among groups that were previously found to have significant risk from reported exposure. However, among adults 18 to 45 years of age with no manic or major depressive symptoms at baseline, past year cannabis use propensity (as a log transformed continuous measure) was associated with incident manic or hypomanic episodes (adj. OR 1.49, 95% CI: 1.10-2.03, p=.01). Elevated risk for high cannabis use propensity (>=1 use/week in the past year) was also found in this same group (adj. OR 1.33, 95% CI: 1.03-1.72, p=.03). Among those with no reported history of depression, substance abuse/dependence, or anti-social traits among their first-degree relatives, propensity for past year cannabis use (adj. OR 1.61, 95% CI: 1.11-2.32, p=.01) and propensity for >=1 use/week of cannabis in the past year (adj. OR 1.38, 95% CI: 1.03-1.85, p=.03) were associated with incident manic or hypomanic episodes. Among those without a substance use history at baseline, propensity for past year cannabis use (adj. OR 1.63, 95% CI: 1.33-1.55, p=1 use/week of cannabis in the past year (adj. OR 1.54, 95% CI: 1.26-1.88, p
The findings of the first aim support the conclusion that the AUDADIS substantially under-estimated lifetime major depressive episode prevalence compared to an imputed estimate that treated anhedonia and depressed mood as separate and concurrent MDE symptoms. The operationalization of impairment for manic disorders in both the AUDADIS and CIDI strongly influences case identification, with the CIDI having suppressed manic and hypomanic prevalence estimates. Evidence was found supporting the conclusion that self-reported cannabis use is a significant risk factor for incident bipolar spectrum outcomes within subpopulations in a nationally representative cohort. A sensitivity analysis finds evidence that supports the conclusion that increasing cannabis use propensity is associated with increased risk of bipolar spectrum outcomes within population subgroups, with the greatest increased risk among those with the lowest innate risk. Under-reporting of illicit substance use is a major limitation in this dissertation; further study is needed with improved exposure measures.
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Smolkina, Milana. "Epidemiological and genetic associations between Cannabis Use Disorder and Major Depressive Disorder." Thesis, King's College London (University of London), 2019. https://kclpure.kcl.ac.uk/portal/en/theses/epidemiological-and-genetic-associations-between-cannabis-use-disorder-and-major-depressive-disorder(aae240ea-e4b3-4c30-8fc0-fba14831b3a1).html.
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Background: Cannabis is the most commonly used illicit drug in the United Kingdom and worldwide. It is associated with a number of negative outcomes, which includes developing Cannabis Use Disorder (CUD). Individuals who meet criteria for CUD are at heightened risk for experiencing Major Depressive Disorder (MDD), the leading cause of disability worldwide. While this association has frequently been reported, the underlying mechanisms remain controversial. Aims of thesis: This thesis aims to investigate the degree of co-morbidity between lifetime rates of CUD and MDD, test whether this co-morbidity is accounted for by shared covariates, and test different twin models to investigate the sources (environmental or genetic) of and mechanisms underlying this co-morbidity. Methods: Data analysis was conducted on a sample of 3824 Australian twins and their non-twin siblings. Epidemiological analyses, using multivariable logistic regressions, tested whether CUD and MDD were significantly co-morbid in this sample, and to what extent covariates influenced this relationship. Twin models – bivariate correlated liabilities, discordant twin and co-morbidity models – examined whether the co-morbidity between the disorders could be explained by a) shared genetic and environmental factors, b) causal processes, and c) 13 different models of co-morbidity. Results: The epidemiological analyses found that MDD and CUD were significantly co-morbid in this sample: meeting diagnostic criteria for one disorder more than doubled the odds of meeting criteria for the other (odds ratio = 2.23, 95% confidence interval = 1.84–2.70). This co-morbidity could not be fully attributed to various psychiatric, trauma-related, parental, peer and demographic covariates. Bivariate twin analyses found that – when separated into genetic and environmental correlations – the only significant correlation between MDD and CUD was genetic (r =.41, 95% confidence interval = .24–.60). A possible causal relationship could not be excluded, because MDD and CUD were significantly associated (odds ratio = 2.83, 95% confidence interval = 1.12–7.19) in monozygotic twins discordant for both disorders. Co-morbidity model analyses indicated that the direction of influence was from CUD to MDD, and that CUD risk factors may cause MDD symptoms, particularly in individuals at high risk of CUD.
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Behrendt, Silke, Katja Beesdo-Baum, Michael Höfler, Axel Perkonigg, Gerhard Bühringer, Roselind Lieb, and Hans-Ulrich Wittchen. "The relevance of age at first alcohol and nicotine use for initiation of cannabis use and progression to cannabis use disorders." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120008.
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Background: A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder (SUD) related to that specific substance. However, the cross-substance relationship between a younger age at onset of alcohol use (AU) and nicotine use (NU) and the risk of cannabis use disorders (CUD) in adolescence and early adulthood remains unclear.
Aims: To identify the sequence of and latency between initial AU/NU and initial cannabis use (CU). To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD, taking into account externalizing disorders (ED) and parental substance use disorders as putative influential factors.
Methods: Prospective-longitudinal community study with N = 3021 subjects (baseline age 14–24) and up to four assessment waves over up to ten years with additional direct parental and family history information. Substance use and CUD were assessed with the DSM-IV/M-CIDI.
Results: Most subjects with CU reported AU (99%) and NU (94%). Among users of both substances, 93% reported AU prior to CU (87% for NU). After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU. Younger age at NU-onset was associated with earlier CU initiation. Younger age at AU- and NU-onset was not associated with a higher risk of CUD.
Conclusions: The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement.
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Behrendt, Silke, Katja Beesdo-Baum, Michael Höfler, Axel Perkonigg, Gerhard Bühringer, Roselind Lieb, and Hans-Ulrich Wittchen. "The relevance of age at first alcohol and nicotine use for initiation of cannabis use and progression to cannabis use disorders." Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27094.
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Background: A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder (SUD) related to that specific substance. However, the cross-substance relationship between a younger age at onset of alcohol use (AU) and nicotine use (NU) and the risk of cannabis use disorders (CUD) in adolescence and early adulthood remains unclear.
Aims: To identify the sequence of and latency between initial AU/NU and initial cannabis use (CU). To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD, taking into account externalizing disorders (ED) and parental substance use disorders as putative influential factors.
Methods: Prospective-longitudinal community study with N = 3021 subjects (baseline age 14–24) and up to four assessment waves over up to ten years with additional direct parental and family history information. Substance use and CUD were assessed with the DSM-IV/M-CIDI.
Results: Most subjects with CU reported AU (99%) and NU (94%). Among users of both substances, 93% reported AU prior to CU (87% for NU). After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU. Younger age at NU-onset was associated with earlier CU initiation. Younger age at AU- and NU-onset was not associated with a higher risk of CUD.
Conclusions: The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement.
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Tyler, Elizabeth. "An investigation of the relationship between bipolar disorder and cannabis use." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/an-investigation-of-the-relationship-between-bipolar-disorder-and-cannabis-use(e9aeb45d-d4f3-4d2b-b633-5a45d51aafd5).html.
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Substance abuse is very common in Bipolar Disorder (BD) and can lead an individual having an increased range of difficulties. Studies have indicated that cannabis is used very frequently, but most research into substance use and BD has focused on either alcohol use or substance use disorders generally. The relationship between BD and cannabis use specifically has received far less attention. This thesis specifically explored the co-occurring relationship between BD and cannabis use. In the first section the author examines and critically evaluates studies that have reported on the relationship between BD and cannabis use. The initial phase included a literature search of the area and the identification of relevant papers. A total of 13 research studies were identified and included in the final review. The studies varied considerably in terms of their research questions, design and methodological quality. The findings from the studies were synthesised in relation to a number of existing hypotheses for why BD and substance use in general co-occur. On the whole, the 13 studies contributed sufficient evidence both for and against the existing hypotheses. The findings suggest that there are a number of factors that contribute towards the high co-occurrence of BD and cannabis use (e.g. the use of cannabis to self-medicate symptoms).The second section was designed to investigate a number of the factors derived from the literature which might explain the high co-occurrence of BD and cannabis use. The Experience Sampling Methodology (ESM) was utilised to provide a close investigation of a number of factors over the course of daily life. Twenty-three participants with BD type I and type II completed diary entries for 6 days using ESM. The procedure allowed a close investigation into the associations between cannabis, mood, BD symptoms and Behavioural Activation System (BAS) sensitivity. Self-reported BAS was also measured to indicate the extent to which this predicted changes in mood, BD symptoms and cannabis use. The findings indicate that cannabis use is associated with a number of psychological effects, although no evidence for the self- medication of mood and BD symptoms was revealed in the daily life of the participants. An association between BAS sensitivity and positive affect and manic symptoms was revealed and this is consistent with the findings in current literature. The final section provides a critical reflection of the research process. This includes a rationale for the development of the literature review and the main research paper. This is followed by a description of the study context and then a reflection on the methodological and ethical issues which were faced. Finally it discusses theoretical, clinical and future implications for research in this area.
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Wittchen, Hans-Ulrich, Christine Fröhlich, Silke Behrendt, Agnes Günther, Jürgen Rehm, Petra Zimmermann, Roselind Lieb, and Axel Perkonigg. "Cannabis use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community study in adolescents." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110270.
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Background: Whereas the role of externalizing disorders is relatively well established in predicting the onset of cannabis use (CU) or cannabis use disorder (CUD), the status of anxiety and mood disorders in predicting CU and CUD remains controversial.
Objective: (1) To examine cross-sectional and prospective associations of CU and CUD with a range of mental disorders and whether anxiety and mood disorders are associated with CU/CUD after adjusting for externalizing disorders.
Methods: N = 1395 community subjects aged 14–17 at baseline were followed-up at three waves prospectively over 10 years. Substance use, substance disorders and mental disorders were assessed using the DSM-IV/M-CIDI.
Results: (1) The baseline prevalence rates where 19.3% at t0 for CU and 2.6% for CUD. Cumulative incidence rates at t3 were 54.3% for CU and 13.7% for CUD. (2) In cross-sectional and prospective analyses other substance use disorders, mood and anxiety disorders were associated with CU and CUD. (3) Associations of panic-anxiety with CU and of depressive and bipolar disorders with CU and CUD were significant after controlling for externalizing disorders.
Conclusion: A range of psychopathological conditions, including depressive, bipolar and less consistently anxiety disorders as well as the degree of their comorbidity are significantly associated with incident CU and progression to CUD, even when controlling for externalising disorders. A better understanding of this complex interplay may result in better aetiological models and intervention strategies.
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Wittchen, Hans-Ulrich, Christine Fröhlich, Silke Behrendt, Agnes Günther, Jürgen Rehm, Petra Zimmermann, Roselind Lieb, and Axel Perkonigg. "Cannabis use and cannabis use disorders and their relationship to mental disorders: A 10-year prospective-longitudinal community study in adolescents." Technische Universität Dresden, 2007. https://tud.qucosa.de/id/qucosa%3A26826.
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Background: Whereas the role of externalizing disorders is relatively well established in predicting the onset of cannabis use (CU) or cannabis use disorder (CUD), the status of anxiety and mood disorders in predicting CU and CUD remains controversial.
Objective: (1) To examine cross-sectional and prospective associations of CU and CUD with a range of mental disorders and whether anxiety and mood disorders are associated with CU/CUD after adjusting for externalizing disorders.
Methods: N = 1395 community subjects aged 14–17 at baseline were followed-up at three waves prospectively over 10 years. Substance use, substance disorders and mental disorders were assessed using the DSM-IV/M-CIDI.
Results: (1) The baseline prevalence rates where 19.3% at t0 for CU and 2.6% for CUD. Cumulative incidence rates at t3 were 54.3% for CU and 13.7% for CUD. (2) In cross-sectional and prospective analyses other substance use disorders, mood and anxiety disorders were associated with CU and CUD. (3) Associations of panic-anxiety with CU and of depressive and bipolar disorders with CU and CUD were significant after controlling for externalizing disorders.
Conclusion: A range of psychopathological conditions, including depressive, bipolar and less consistently anxiety disorders as well as the degree of their comorbidity are significantly associated with incident CU and progression to CUD, even when controlling for externalising disorders. A better understanding of this complex interplay may result in better aetiological models and intervention strategies.
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Kosty, Derek. "Trajectories of Cannabis Use Disorder: Risk and Developmental Factors, Clinical Characteristics, and Outcomes." Thesis, University of Oregon, 2015. http://hdl.handle.net/1794/19200.
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Efforts to objectively inform cannabis discourses include research on the epidemiology of cannabis abuse and dependence disorders or, collectively, cannabis use disorder (CUD). For my dissertation I identified classes of individuals based on intraindividual CUD trajectory patterns and contrasted trajectory classes with respect to clinical characteristics of CUD, developmental risk factors, and psychosocial outcomes.
Identifying differences between trajectory classes provides evidence for the validity of trajectory-based CUD constructs and informs the development of comprehensive models of CUD epidemiology and trajectory-specific intervention approaches. My dissertation used data from the Oregon Adolescent Depression Project, a prospective epidemiological study of the psychiatric and psychosocial functioning of a representative community-based sample randomly selected from nine high schools across western Oregon. Four waves of data collection occurred between mid-adolescence and early adulthood and included diagnostic interviews and self-report questionnaires. Onset and offset ages of all CUD episodes were recorded. The reference sample included 816 participants who completed all diagnostic interviews.
A series of latent class growth models revealed three distinct CUD trajectory classes through age 30: (1) a persistent increasing risk class; (2) a maturing out class, marked by increasing risk through age 20 and then a decreasing risk through early adulthood; and (3) a stable low risk class. Rates of cannabis dependence were similar across the persistent increasing and the maturing out classes. Trajectory classes characterized by a history of CUD were associated with a variety of childhood risk factors and measures of psychosocial functioning during early adulthood. Participants who were male, had externalizing disorders, and had psychotic experiences during early adulthood discriminated between the persistent increasing and the maturing out classes.
Future research based on more diverse samples is indicated, as are well-controlled tests of associations between risk factors, trajectory class membership, and psychosocial outcomes. A better understanding of these relationships will inform etiological theories of CUD and the development of effective intervention programs that target problematic cannabis use at specific developmental stages. Designing targeted versus undifferentiated interventions for those at greatest risk for adult psychosocial impairment could be a cost-effective way to mitigate the consequences of CUD.
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Rebgetz, Shane E. "Natural recovery of people with cannabis use and psychosis." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101576/1/Shane_Rebgetz_Thesis.pdf.
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People with psychosis who use cannabis have much worse outcomes, but treatments typically have only limited effects that are poorly sustained. This program of research explored how people with psychosis cease using cannabis without substantial assistance, to see if this shed light on how treatments could be improved. The studies suggested that greater focus on employment, separate accommodation, and social and emotional support for cessation would result in stronger outcomes than at present. Similar reasons were found for strategies to maintain a reduction in use; while relapse was associated with substance using peers, and problems with relationships and negative emotions.
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Hicks, Terrell A. "A Longitudinal Investigation of Interpersonal Trauma Exposure, Posttraumatic Stress Disorder, and Cannabis Use Phenotypes among College Students." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/6066.
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College students have an increased risk for cannabis use, trauma exposure, and posttraumatic stress disorder (PTSD). Cannabis use disorder (CUD) and PTSD comorbidity is high, and given the negative consequences of the comorbidity (e.g., poor academic outcomes), there is a need to understand comorbid CUD-PTSD etiology. Two primary etiologic models exist: self-medication (i.e., PTSD à CUD) and high-risk (i.e., CUD à PTSD) hypotheses. This study 1) examined the prevalence and predictors of cannabis use and interpersonal trauma (IPT) exposure; 2) investigated the relationship between cannabis use and IPT; and 3) examined cannabis use, IPT, and PTSD through mediational self-medication and high-risk hypotheses lenses in a large (n = 9,889) longitudinal study of college students. Aim 1 found the prevalence of lifetime problematic (i.e., use ≥ 6 times) and experimental (i.e., use 1-5 times) cannabis use was 28.3% and 17.4%, respectively. Aim 1 results also estimated that the prevalence of lifetime IPT exposure was 35.9%. Aim 2 results supported the self-medication hypothesis, but not the high-risk hypothesis. Overall model fit from Aim 3 was poor. Nonetheless, Aim 3 results did not support the self-medication or high-risk hypotheses. Given the poor model fit of Aim 3, results should be interpreted with caution. However, as a whole, these findings provide preliminary support for the self-medication hypothesis, indicating that those reporting IPT exposure and probable PTSD may be at risk for cannabis use. Implications of these findings, in light of study limitations, are discussed.
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Neumann, Maria, Gerhard Bühringer, Michael Höfler, Hans-Ulrich Wittchen, and Eva Hoch. "Is Cannabis Use Treatment Also Indicated for Patients with Low to Moderate Polysubstance Use?" Karger, 2018. https://tud.qucosa.de/id/qucosa%3A70647.
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Background: Polysubstance use (PSU) is common among patients with cannabis use (CU) and is related to more severe CU problems. However, it is unclear how PSU predicts CU treatment outcomes beyond CU patterns. We examined the frequency, amount, and class of additionally used substances as predictors for primary and secondary outcomes. Methods: We conducted crude and adjusted regression analyses for PSU variables as predictors of remission, abstinence, reduction, and secondary outcomes in 166 help-seeking patients from a randomized clinical trial of CANDIS, a cognitive behavioral treatment program. Results: Patients with recent illegal PSU experienced more difficulties in reducing their CU (B = –1.22, p < 0.001). In contrast, remission rates were slightly higher in patients with a wide variety of last-year-PSU (RD = 0.04, p < 0.001). Amphetamine use predicted poorer outcomes regarding CU-related problems (B = –4.22, p = 0.019), and the use of opiates, inhalants, and dissociative substances predicted poorer physical health outcomes (B = –0.62, p = 0.009; B = –0.96, p = 0.039; B = –1.18, p = 0.007). Conclusions: CU treatment is also effective for patients with moderate PSU. However, treatment effects may be enhanced by addressing specific PSU characteristics as part of a modularized program.
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Sehl, Hannah. "Mapping brain function associated with cue-reactivity and changes pre-to-post a mindfulness-based intervention in cannabis use disorder." Phd thesis, Australian Catholic University, 2022. https://acuresearchbank.acu.edu.au/download/46b2078989c1269781fbd5dfb5d781c02bd65178d2458e18dfde3b52567f568a/4231107/Sehl_2022_Mapping_brain_function_associated_with_cue.pdf.
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Globally, cannabis is used by ~210 million people and 10-to-30% endorse symptoms consistent with a cannabis use disorder (CUD), which constitutes a substantial social burden including health and treatment services. CUD is characterised by a loss of control over cannabis consumption despite significant adverse outcomes including strong cravings when exposed to cannabis cues. Such outcomes have been (partly) ascribed to altered brain function in addiction related pathways.
Preliminary functional magnetic resonance imaging (fMRI) evidence in cannabis users, show different brain activity when exposed to cannabis (vs neutral) cues, in prefrontal, striatal and parietal regions. However, no study has examined cannabis users with a DSM-5 diagnosis of CUD, or tested if psychological interventions targeting cravings (e.g., mindfulness-based interventions [MBI]) reduce neural cue-reactivity in CUD. This thesis comprises three studies aimed to examine brain activity during cannabis cue-reactivity in cannabis users and CUD, and whether such activity can be reduced with a MBI.
Study 1 was a systematic review of the fMRI literature on brain function during cue-reactivity in cannabis users. It synthesised findings on brain function during fMRI cue-reactivity tasks (cannabis vs neutral stimuli) in regular cannabis users, and their association with behavioural variables (e.g., craving). Eighteen studies showed that cannabis users had greater activity in prefrontal, striatal, and parietal regions, some of which (orbitofrontal cortex [OFC]) correlated with and greater subjective craving. The literature was limited by the lack of assessment of CUD using the DSM-5 and the inclusion of a non-using control group.
Study 2 aimed to examine differences in brain activity during a cue-reactivity task (cannabis vs neutral images), i) between 49 adults with moderate-to-severe CUD and 30 controls; and ii) their association with craving, cannabis exposure and mental health. CUD vs controls had greater activity in the lingual gyrus (FWE-corrected p < .05, k > 10), and in the MFG, medial OFC, and cerebellum (uncorrected, p < .001, k > 10). Greater MFG activity correlated with more past month cannabis grams.
Overall, the findings from this thesis provide novel information on the current understanding of the neural correlates of cannabis cue-reactivity in CUD. The results of the first two studies suggest that CUD has a (partly) overlapping neurobiology with that of other SUDs as per prominent neuroscientific theories of addiction. Different brain function during cannabis cue-reactivity may reflect alterations in reward processing, including salience evaluation and attention pathways resulting from regular exposure to cannabis/related cues; or predating CUD. As such, interventions that target these regions may be effective at reducing cue-reactivity/craving in CUD.
Study 3 was a double-blind fMRI experiment. It aimed to investigate for the first time if a brief MBI compared to both an active relaxation and passive no intervention placebo controls, reduces neural cue-reactivity in the regions of interest (ROIs) functionally different in Study 2 (i.e., MFG, OFC, lingual gyrus and cerebellum), in the same sample with CUD (N = 40). It also explored if changes in brain activity pre-to-post MBI were associated with changes in behaviour. It was hypothesised that the greater activity in the ROIs would significantly decrease pre-to-post the MBI only. A significant decrease in the activity of the OFC was observed pre-to-post all three interventions, as well as in subjective craving and arousal rating of cannabis images. No correlations emerged.
Overall, the findings from the research in this thesis demonstrates that cannabis cue-reactivity in CUD is associated with different activity in selected brain pathway implicated in salience and reward processing; and the activity of some of these regions (e.g. OFC) can be reduced during a brief engagement with monitoring of daily cannabis use, cravings and mood. More research in larger samples is required to identify with precision the neurobiology of cannabis cue-reactivity in CUD and to reduce these with novel interventions. Such new knowledge is necessary to alleviate the harmful impacts of the increasing prevalence of CUD to both the individual and to society, particularly when cannabis products and related cues are increasingly accessible and visible to vulnerable members of the community.
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Altoft, Victoria Louise. "Negative symptons experienced by people with schizophrenia and schizoaffective disorder who use cannabis : a pilot study within assertive outreach services." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/1157/.
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This thesis is submitted in partial fulfilment of the requirements for the degree of Clinical Psychology Doctorate at the University of Birmingham. There are two volumes to the thesis, which illustrate research (Volume I) and clinical work (Volume II). Volume I contains a literature review, research paper, and public domain paper. The literature review summarises research that explored the impact of different psychological therapies on negative symptoms in schizophrenia and related disorders. The research paper describes an investigation into the negative symptoms experienced by people with schizophrenia or schizoaffective disorder who use cannabis, compared to those who do not. It is intended that both pieces of work will be submitted to ‘Schizophrenia Research’ for publication. The public domain paper summarises both the literature review and research paper. Volume II contains five clinical practice reports (CPRs). CPR1 is a case formation about a 21 year old man with a learning disability, an Autistic Spectrum disorder, and who experiences anxiety and shows aggression. CPR2 is a service evaluation about the effectiveness of a multidisciplinary team referral process in a learning disability service. CPR3 documents a single-case experimental design that assessed the effectiveness of a toileting intervention with a ten year boy with secondary encopresis. CPR4 depicts a case study of an 81 year old man with memory loss and depression. An abstract outlining CPR5, a clinical presentation about a 50 year old woman with mixed anxiety and depressive disorder, is also included.
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Blanco, Hinojo Laura 1981. "Functional connectivity anomalies in the neural networks mediating motivated behavior : assessong obsessive-compulsive disorder , chronic cannabis use, Prader-Willi syndrome and Down syndrome." Doctoral thesis, Universitat Pompeu Fabra, 2015. http://hdl.handle.net/10803/328419.
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Compulsive, impulsive, and addictive disorders display some behavioral commonalities associated with a dysfunction in the regulation of motivated, goal-directed behavior. Relevant to motivated behavior, there is a set of distributed large-scale neural networks connecting cortical areas, mainly frontal, with the basal ganglia. We have used MRI measurements of functional connectivity to assess the functional status of the cortico-basal ganglia circuits, as well as their interaction with other large-scale networks, in four medical conditions characteristically showing altered motivated behavior. The study samples included a group of 74 patients with obsessive-compulsive disorder, 28 chronic cannabis users, 24 Prader-Willi syndrome and 20 Down syndrome individuals. Structural MRI was additionally used to characterize gray matter volume correlations within these same networks in healthy subjects. Results showed both common and distinct functional connectivity across study groups, associated with the severity of their characteristic behavioral disturbances. All in all, the data suggest potential functional mechanisms by which flexible and adaptive behaviors may be compromised. In the specific context of frontal-basal ganglia physiology, the findings may provide new insights into the nature of obsessive compulsive behavior, its boundaries with impulsivity and the role of nonsatiated basic drives in the genesis of obsessions.Els trastorns compulsius, impulsius, i addictius, mostren trets comuns associats a una disfunció en la regulació de la conducta motivada. El conjunt de xarxes neuronals que connecten àrees corticals, principalment frontals, amb els ganglis basals, té un paper rellevant a la conducta motivada. Hem utilitzat mesures de RM per avaluar l’estat funcional dels circuits corticals-ganglis basals, així com la seva interacció amb altres xarxes cerebrals, en quatre trastorns que d’una manera característica presenten alteracions de la conducta motivada. Les mostres d’estudi van incloure un grup de 74 pacients amb trastorn obsessiu-compulsiu, 28 consumidors crònics de cànnabis, 24 persones amb síndrome de Prader-Willi i 20 persones amb síndrome de Down. A més, vam utilitzar RM estructural per caracteritzar les correlacions volumètriques de substància grisa dins d’aquests mateixos circuits en subjectes sans. Els resultats mostren alteracions comunes i diferents entre els grups d’estudi, associades a la gravetat dels seus símptomes més característics. En el context específic de la fisiologia frontal-ganglis basals, les troballes poden proporcionar nous coneixements sobre la naturalesa del comportament obsessiu compulsiu, els límits amb la impulsivitat i el paper de les motivacions bàsiques no satisfetes en la gènesi de les obsessions.
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Berard, Amanda Kay. "Giving Texas Veterans a Voice: Traumatic Experience and Marijuana Use." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1248452/.
Full textAbstract:
Disabled veterans with post-traumatic stress disorder (PTSD) exist in a category separate from many civilians and soldiers. Their experiences land them in a category distinctly marked as atypical. The standard protocol to manage this atypical subject position is prescription drugs- a mark of the ill. In a distorted, post-war American society, what happens when veterans with PTSD refuse to be labeled as ‘sick,' ‘different,' or even ‘disabled'? This thesis explores the actions and intricacies of a community of veterans who advocate for medical cannabis to manage associated symptoms of PTSD. This group of veterans campaigns for individuality, both in medical treatment and in personal experience. Collaboratively, their experiential evidence indicates that none can be treated in the same fashion. After a year of participant observation and field work, it becomes apparent that their work both individualizes and unifies the veterans. This thesis details their experiences and the results of their activist campaign to demarcate themselves.
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Modisane, L. N. "Relationship between cannabis use and psychiatric disorders in patients admitted at Dr George Mukhari Hospital Psychiatric Unit." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/442.
Full textAbstract:
Thesis (M Med (Psychiatry))--University of Limpopo, 2010.BACKGROUND Cannabis is the commonly used illicit drug of choice in South Africa and throughout the world. The majority of individuals who use cannabis do not report adverse reactions to it, however a minority of heavy users will develop problems. A substantial number of patients admitted at our psychiatry unit seem to be using cannabis. AIMS The aim of the study was to assess the relationship between cannabis use in psychiatric disorders in patients admitted in George Mukhari Hospital Psychiatry Unit, to determine the pattern of cannabis use, to identify the common psychiatric disorders in patients using cannabis, to determine the socio-economic factors that may lead to cannabis use. METHODS A total of 75 participants admitted at Doctor George Mukhari hospital and diagnosed with psychiatric disorders according to the diagnostic and statistical manual of mental disorders fourth edition text revised were interviewed using a structured questionnaire and had urine specimens collected for analysis. Out of 75 participants a control group of 34 participants who tested negative for urinary cannabinoids were interviewed. The participants had signed a written informed consent in their language of preference. The study had been approved by the Research Ethics and Publications Committee of the University of Limpopo (Medunsa Campus).Data was analysed with the help of the statistician and reported on graphs, pie-charts and tables. RESULTS 16(39%) of participants who tested positive were diagnosed with schizophrenia, 7 (17%) of those who tested positive were diagnosed with cannabis induced psychotic disorder, 5(12%) of those tested positive were diagnosed with psychosis due to GMC (HIV) and 6(15%) were diagnosed with psychosis due GMC (epilepsy). 8(24%) of those who tested negative were diagnosed with schizophrenia, 15(44%) of those tested negative were diagnosed with cannabis induced psychotic disorder, 2(6%) were diagnosed with psychosis due to GMC (HIV) and to 2(6%) of those who tested negative were diagnosed with psychosis due to GMC (epilepsy). Majority 24 (32%) smoked cannabis using pipes 4-5 times, 19 (25%) used zols 4-5 times, 12(16%) used pipes 2-3 times, 11(14%) used 1 zol in the 30 days prior to the interview. Most of the participants were of low socio-economic status and had started using cannabis early in their lives. CONCLUSION Cannabis use is related to a number of psychiatric disorders in patients admitted at Dr George Mukhari Hospital. Schizophrenia, cannabis induced psychotic disorder, psychosis due to GMC (HIV), psychosis due to epilepsy were the commonest identified disorders.
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Mallet, Jasmina. "Marqueurs neurodéveloppementaux, cognition et facteurs environnementaux précoces et tardifs dans le phénotype psychotique des pathologies mentales Heavy cannabis use prior psychosis in schizophrenia : clinical, cognitive and neurological evidences for a new endophenotype? Etude et apport de la latéralité comme marqueur neurodéveloppemental dans les troubles schizophréniques et bipolaires Cigarette smoking and schizophrenia : a specific clinical and therapeutic profile? Results from the Face-Schizophrenia cohort Tobacco smoking is associated with antipsychotic medication, physical aggressiveness and alcohol use disorder in schizophrenia : results from the Face-SZ national cohort Tabagisme et schizophrénie, impact sur la cognition Tobacco smoking and psychotic-like experiences in a general population sample Poster congrès français de psychiatrie 2018 : Expériences psychotiques chez 50 patients adolescents hospitalisés pour la 1ère fois : approche trans-diagnostique et prospective avec la PQ16." Thesis, Sorbonne Paris Cité, 2018. https://wo.app.u-paris.fr/cgi-bin/WebObjects/TheseWeb.woa/wa/show?t=2403&f=17360.
Full textAbstract:
Les maladies mentales représentent un ensemble catégoriel très hétérogène, même au sein d’une entité nosographique. L’approche multifactorielle rend compte de l’hétérogénéité clinique des troubles mentaux et du continuum entre certaines dimensions cliniques, voire entre le normal et le pathologique. Parmi ces dimensions, le phénotype psychotique constitue une dimension essentielle du trouble schizophrénique. L’approche dimensionnelle permet d’envisager la recherche d’expériences psychotiques dans la plupart des troubles mentaux ainsi qu’en population générale. Nous faisons l’hypothèse générale que certains troubles psychiatriques avec symptômes psychotiques pourraient être la résultante de l’interaction entre certains facteurs environnementaux précoces (traumatismes obstétricaux par exemple) et tardifs (consommation de toxiques, traumatismes) et le neurodéveloppement de l’individu. Un travail initial a été de rappeler les concepts de vulnérabilité en psychiatrie, et de prendre l’exemple du trouble schizophrénique pour réaliser une revue de la littérature sur les facteurs de risque en fonction de leur interaction précoce ou tardive avec le neurodéveloppement. Ensuite, dans le premier axe de recherche de la thèse, nous évaluons certains marqueurs neurodéveloppementaux précoces (signes neurologiques mineurs, latéralité, cognition). Notre premier travail, concerne la caractérisation clinique, neurologique et cognitive de 64 patients souffrant de trouble schizophrénique, en fonction de leur consommation de cannabis ou pas avant le début des troubles. Il apporte des éléments en faveur d’une charge neurodéveloppementale moins lourde chez les patients ayant consommé du cannabis, et de l’impact potentiel de cette substance chez des sujets vulnérables. Notre second travail, préliminaire, concerne l’impact clinique et cognitif de la latéralité chez les patients souffrant de schizophrénie (n=667) et de trouble bipolaire (n=2445). Nous apportons des arguments pour un poids neurodéveloppemental (mesuré avec cet indice) plus important dans la schizophrénie. Notre deuxième axe de recherche se concentre sur le tabagisme comme facteur environnemental tardif dans le trouble schizophrénique et le phénotype psychotique. Nous montrons dans deux travaux sur la cohorte FACE-SZ (n=361 ; n=474), que ces patients consomment presque deux fois plus qu’en population générale et qu’ils pourraient représenter un sous-groupe présentant des caractéristiques spécifiques d’un point de vue socio-démographique, clinique et thérapeutique. Dans un troisième travail préliminaire, nous comparons les fonctions cognitives de ces patients (n=785) et montrons que l’hypothèse d’automédication ne peut pas rendre compte à elle seule, de la forte prévalence du tabagisme chez ces patients. Dans un quatrième travail, nous étudions l’impact du tabagisme sur le phénotype psychotique dans une approche dimensionnelle, et montrons une association entre le tabagisme et certaines expériences de type psychotique dans un échantillon représentatif de la population générale américaine (NESARC, n=34653). Enfin dans un dernier axe de recherche nous nous intéressons au phénotype psychotique dans une population d’adolescents et jeunes adultes hospitalisés pour un premier épisode psychiatrique (n=50). Dans une étude préliminaire, nous montrons une forte prévalence des expériences de type psychotique chez ces jeunes adultes, quel que soit le diagnostic posé six mois à postériori, soulignant le caractère trans-nosographique du phénotype psychotique lors de l’émergence des troubles. L’ensemble de ce travail reflète l’hétérogénéité clinique des maladies mentales et l’importance de l’approche dimensionnelle et trajectorielle pour identifier des facteurs de risque (ou de protection). Les enjeux sont une meilleure compréhension étiopathogénique, des perspectives de prévention, et une prise en charge personnalisée des patientsMental diseases represent a very heterogeneous categorical group, even within a given nosographic entity. Multifactorial approaches allow accounting for the clinical heterogeneity of mental disorders, the continuum between certain clinical dimensions, and even between the normal and the pathological. Among such dimensions, the psychotic phenotype constitutes an essential dimension of schizophrenic disorder. The dimensional approach allows for the search of psychotic experiences in most mental disorders as well as in the general population. We make the general hypothesis that certain psychiatric disorders with psychotic symptoms could be the result of the interaction between early- (obstetric traumas for example) and late- environmental factors (toxics, traumatisms) and the neurodevelopment of the individual. The initial step in this thesis work was to better define the concepts of vulnerability in psychiatry, and, based on the example of schizophrenia, to conduct a review of the literature on risk factors according to their early or late interaction with neurodevelopment. Subsequently, the first axis of research of the present thesis was to evaluate early neurodevelopmental markers (neurological soft signs, laterality, cognition). Our first work concerned the clinical, neurological and cognitive characterization of 64 patients suffering from schizophrenia, according to their cannabis use (or not) prior to psychosis. It provided evidence for a lower burden of neurodevelopment in cannabis users, and the potential impact of this substance on vulnerable individuals. Our second work concerns the clinical and cognitive impact of lateralization in patients with schizophrenia (n = 667) and bipolar disorder (n = 2445). We bring arguments for a neurodevelopmental weight (measured with this lateralization index) that is more important in schizophrenia. Our second axis of research focused on tobacco smoking as a late environmental factor in schizophrenia and psychotic phenotype. We showed in two studies on the FACE-SZ cohort (n = 361, n = 474) that SZ patients consumed almost twice as much as the general population and that they could represent a SZ subgroup with specific socio-demographic and clinical characteristics. In a third study, we compare the cognitive functions of these patients (n = 785) and show that the self-medication hypothesis alone cannot account for the high prevalence of their smoking. In a fourth work, we studied the impact of smoking on the psychotic phenotype with a dimensional approach, and showed an association between smoking and certain psychotic-type experiences in a representative sample of the US general population (NESARC, n = 34653). Finally, in a last line of research, we evaluated the psychotic phenotype in a population of adolescents and young adults hospitalized for a first psychiatric episode (n = 50). In a preliminary study, we show a high prevalence of psychotic-like experiences in these young adults, regardless of the diagnosis made six months afterwards, highlighting the trans-nosographic character of the psychotic phenotype during the emergence of different mental disorders. Overall, the present thesis underscores the clinical heterogeneity of mental illnesses and the importance of dimensional and trajectory approaches in identifying risk (or protective) factors, towards a better etiopathogenic understanding, better prevention opportunities, and a personalized patient care
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Degenhardt, Louisa Psychology Faculty of Science UNSW. "Comorbidity between substance use and mental health in Australia: Relationships of alcohol, tobacco and cannabis use with other substance use and mental disorders." Awarded by:University of New South Wales. School of Psychology, 2001. http://handle.unsw.edu.au/1959.4/18247.
Full textAbstract:
Research into the comorbidity (or co-occurrence) of mental disorders is a relatively recent phenomenon. Much of this research has been conducted in clinical samples, which are prone to a range of biases that mean that the patterns observed are not representative of the general population. Although population-level research has previously been carried out, this thesis provides the first examination of comorbidity in the Australian population. This thesis examined the comorbidity of substance use and mental disorders among Australian adults. The major empirical work involved an examination of the patterns of homotypic comorbidity (other substance use disorders) and heterotypic comorbidity (mood disorders, anxiety disorders, and psychosis) of alcohol, tobacco and cannabis in the 1997 Australian National Survey of Mental Health and Well-Being (NSMHWB). These drugs were chosen as they are the most commonly used psychoactive substances in the Australian population. The NSMHWB involved a structured diagnostic interview of mental disorders with a representative sample of Australian adults. Three questions were addressed using this data: (1) What patterns of comorbidity exist between tobacco, alcohol and cannabis use, and other substance use and mental disorders?; (2) Are these patterns of comorbidity explained by common factors?; and (3) Does comorbidity affect the likelihood that mental health treatment has been sought? Similar patterns of homotypic comorbidity were observed for all three substances, and they were not explained by the other factors examined (gender, age, education, relationship status, employment and neuroticism). Cannabis dependence was the most strongly associated with other substance use disorders. Heterotypic comorbidity differed between alcohol, tobacco and cannabis use. Tobacco use predicted increased rates of all three groups of mental disorders (mood, anxiety and psychotic disorders). In the case of alcohol, only alcohol dependence was related to increased rates of all groups of mental disorders; alcohol use and abuse were not associated with heterotypic comorbidity. Any level of cannabis involvement was related to a similarly increased risk of mood and anxiety disorders. Cannabis use was linearly related to the risk of screening positively for psychosis. Common factors did not change the patterns of heterotypic comorbidity of tobacco and alcohol use. However, alcohol, tobacco and other drug use appeared to explain the higher rates of mood and anxiety disorders among cannabis users. Treatment seeking was much more likely among alcohol, tobacco and cannabis users when they had comorbid mental disorders. It was moderately increased when they had comorbid substance use disorders. The second piece of empirical work provided a more detailed examination of comorbid substance use problems among persons with psychosis. This topic was selected due to the limited epidemiological research on this issue, and the relatively large burden of disability that psychosis places upon the individual and the community. NSMHWB data were used to examine the prevalence of comorbid substance use disorders among persons who were likely to have met criteria for psychosis (as assessed by a screener used in the NSMHWB). Multiple regression analyses were used to test possible explanations for the higher rates of substance use disorders observed among persons reporting higher numbers of psychotic symptoms. The odds of alcohol dependence and regular tobacco use increased 1.5 times, and the odds of cannabis dependence increased twice, with each additional psychotic symptom reported, after adjusting for other substance use disorders, other mental disorders and demographic characteristics. Given the debate about the reasons for the association between cannabis use and psychosis, the final study used mathematical modelling to test four hypotheses about relationships between cannabis use and psychosis. Specifically, it examined trends in psychosis that would be predicted given the marked increases in the prevalence of cannabis use that have occurred in Australia over the past thirty years. The results suggested that a causal relationship - in which cannabis use caused psychosis among persons who would not otherwise have developed the disorder - is unlikely to explain the association. There was a better fit to the data provided by the other hypotheses examined, namely, that (a) cannabis use precipitates psychosis among vulnerable individuals; (b) cannabis use increases the risk of relapse among persons with psychosis; and (c) persons with psychosis are more likely to become regular cannabis users (without any effect upon the disorder). This thesis has demonstrated that in Australian adults there is significant comorbidity between alcohol, tobacco and cannabis use and other substance use and mental disorders. These patterns differ across the three substances. Some types of heterotypic comorbidity (e.g. between cannabis use and mood/anxiety disorders) are explained by common factors. The limited range of common factors tested here did not explain homotypic comorbidity. This thesis also suggested that mathematical modelling is a useful approach to consider when examining the plausibility of different relationships between risk factors and mental disorders. A number of hypotheses regarding comorbidity could not be tested using NSMHWB data, such as common genetic and other environmental factors. These can best be tested in research with samples of twins, and using longitudinal designs that assess a wide range of social and environmental factors. The findings of this thesis also have implications for treatment, because persons with comorbid disorders are more likely to seek treatment. There is an absence of validated treatments for persons with comorbid substance use and mental disorders, and more research is needed on this issue.
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Helbig, Friederike, Anja Pixa, Gerhard Bühringer, and Jürgen Hoyer. "Wirksamkeit ambulanter Verhaltenstherapie bei Substanzstörungen und abhängigen Verhaltensweisen - Evaluation einer Spezialambulanz." Karger, 2017. https://tud.qucosa.de/id/qucosa%3A71680.
Full textAbstract:
Hintergrund: Die Psychotherapierichtlinien ermöglichen erst seit 2011 unter bestimmten Bedingungen eine ambulante psychotherapeutische Behandlung bei Substanzstörungen. Empirische Ergebnisse zu diagnostischen Charakteristika der auf dieser Grundlage behandelten Patienten und zu Erfolgsraten fehlen weitgehend. Methoden: Wir untersuchten N = 59 konsekutive Patienten einer Spezialambulanz, von denen n = 34 eine Behandlung begannen (Intent-to-Treat(ITT)-Stichprobe) und n = 28 sie abschlossen (Completer), mit standardisierten diagnostischen Interviews und ermittelten die Erfolgsraten nach ambulanter Kognitiver Verhaltenstherapie (Einzeltherapie) auf der Basis von Symptomskalen (Brief Symptom Inventory (BSI); Beck Depression Inventory (BDI)) sowie Patienten- und Therapeuten-Ratings, einschließlich einer klinischen Beurteilung der Abstinenz. Ergebnisse: 40% aller anfragenden Patienten nahmen keine Psychotherapie auf. Bei den behandelten Patienten kam es zu signifikanten Veränderungen (ITTAnalysen: d = 0,8 (BSI) bis d = 1,2 (BDI)). Mehr als zwei Drittel der Patienten erreichten eine klinisch relevante Verbesserung der Symptomatik gemäß Patienten- oder Therapeutenbeurteilungen (zwischen 68 und 76%, ITTStichprobe). Alle Completer mit Abhängigkeitssyndrom (n = 11) sowie 86% der diesbezüglichen ITT-Stichprobe erreichten zumindest unter der Behandlung eine Abstinenz. Schlussfolgerungen: Die Erfolgsraten bei Patienten, die die Therapie abschließen, sind gut. Sie sprechen für den Nutzen des ambulanten Settings.Effectiveness of Outpatient Cognitive-Behavioral Therapy for Substance Use Disorders – Evaluation of a Specialized Outpatient Clinic Background/Aim: Given a number of conditions, the revision of the German psychotherapy guidelines in 2011 facilitates treating substance use disorders in outpatient psychotherapy. Empirical results on the diagnostic characteristics of the patients treated within this setting and about the effectiveness of the treatment are lacking. Material and Methods: We examined N = 59 consecutive patients, diagnosed with standardized diagnostic interviews, of a specialized outpatient clinic for cognitivebehavioral therapy. Of these, n = 34 started the treatment (intent-to-treat (ITT) sample) and n = 28 completed it. The outcome (including clinical judgement of abstinence) was assessed with established symptom scales (Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI)) as well as therapist and patient ratings. Results: About 40% of the patients who contacted the clinic did not start the therapy. In therapy completers, clinically relevant improvement was reached. Based on ITT analyses, effect sizes ranged from d = 0.8 (BSI) to d = 1.2 (BDI). Based on therapist and patient ratings, the percentage of successful therapies was high (between 68 and 76%, ITT analyses). All therapy completers diagnosed with a dependence syndrome reached abstinence at least temporarily. Conclusion: Effectiveness rates are high in completers. These results show that treatment can be efficient in an outpatient setting.
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Sagar, Kelly A. "Cognition and cannabis use disorder in recreational cannabis users and medical cannabis patients." Thesis, 2020. https://hdl.handle.net/2144/41117.
Full textAbstract:
As legalization of cannabis continues to spread across the United States, many question the public health implications. The term “cannabis” is often used to refer to anything that comes from the plant and can be used recreationally (to get high or alter one’s current state) or medically (to treat a medical condition). While previous research has primarily focused on the impact of recreational cannabis use, few studies have examined cognitive outcomes associated with medical cannabis (MC) use and the potential for development of problematic use in MC patients. Given important distinctions among recreational users and MC patients, it is likely that these distinct populations of cannabis consumers will experience differential cognitive effects and potential for problematic cannabis use.
This dissertation is comprised of three studies. The first is a cross-sectional study that explores executive function and verbal learning and memory in recreational cannabis users relative to healthy controls who do not use cannabis, while also assessing whether cannabis use patterns (e.g., age of onset, urinary THC levels) influence findings. The second study is an observational, longitudinal study which examines executive function and memory, as well as changes in mood, anxiety, sleep, and quality of life in MC patients over 12 months of MC treatment relative to pre-MC treatment. In the third study, symptoms and behaviors associated with problematic cannabis use are examined in cohorts from study 1 and study 2. Specifically, scores on the Cannabis Use Disorder Identification Test – Revised (CUDIT-R) are assessed in MC patients over the course of treatment and also compared to a previously recruited cohort of recreational cannabis users; the validity of the CUDIT-R is also explored.
Despite previous research, in the current study recreational users did not exhibit cognitive decrements relative to healthy controls. In MC patents, cognitive performance was stable over the course of 12 months of MC treatment relative to pre-MC treatment performance, and overall they reported improved ratings of mood, anxiety, sleep, and some aspects of quality of life. Although the CUDIT-R suggests MC patients’ average scores do not meet the threshold for possible cannabis use disorder, analyses revealed this measure is not valid and therefore not appropriate in MC patients.
Although changes in cognition were not detected in recreational users or MC patients in the current studies, a number of methodological limitations (e.g., sample size and limited ability to adjust for confounding variables) must be considered as these factors likely affected study results. Future studies evaluating the impact of cannabis use will benefit from carefully considering the definition of cannabis itself, goal of use, product choice, and age of onset of use. Researchers and clinicians will also benefit from the development of screening tools specifically designed to assess cannabis use disorder in those who use cannabis for medical purposes.
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Marshall, SE. "The Cannabis use disorder identification test - revised (CUDIT-R) : categorisation and interpretation." Thesis, 2013. https://eprints.utas.edu.au/20793/1/whole_MarshallSophieElizabeth2013_thesis.pdf.
Full textAbstract:
The Cannabis Use Identification Test-Revised (CUDIT-R) is a brief cannabis misuse-screening tool, which is widely used to identify cannabis use problems. The CUDIT-R is widely accepted and psychometrically reliable within a clinical population. However, it is unclear if these same cut-offs are applicable in a community population. Additionally, the proposed changes in the DSM-5 introduce a new classification system and severity threshold system for identifying the severity of cannabis use disorder. Accordingly, the current CUD1T-R cut-off scores will no longer mirror the DSM severity thresholds. Consequently, the current study aims to identify community based cut-off scores that are consistent with the DSM-5 cannabis use disorder severity thresholds, as well as an indication of possible psychosocial difficulties experienced at these levels of cannabis use severity.
Method and Results.
The sample for analysis consisted of 310 Australian cannabis users. Receiver operating characteristics (ROCs) was the statistical procedure used to determine cut-off scores that produced maximum sensitivity and specificity, when calibrated against the DSM-IV and DSM-5 cannabis use severity thresholds, and the Severity of Dependence Scale. The results identified that a CUD1T-R cut-off of 13 was the optimal threshold for cannabis dependence (DSM-1V); a cut-off score of 9 was the optimal threshold for mild cannabis use disorder (DSM-5), a cut-off score of 13 was identified for moderate and severe cannabis use disorder (DSM-5), and finally, a SDS cut-off score of 10 was identified.
Discussion.
The current study has identified community based CUDIT-R cut-off points that are consistent with the DSM-5 cannabis use disorder severity thresholds and has provided an indication of possible psychosocial difficulties experienced by cannabis users at varying CUDIT-R cut-off points, which may inform clinical intervention.
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Bashford, Janet Lorraine. "The Cannabis Use Problems Identification Test (CUPIT) : development and psychometrics : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand." 2007. http://hdl.handle.net/10179/705.
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Lack of a brief empirically-verified screener for problematic and potentially problematic cannabis use has hampered implementation of a proactive opportunistic cannabis screening and early intervention (SEI) initiative in New Zealand. Addressing this instrumentation need was the primary aim of this thesis. This thesis also investigated the nature, prevalence, severity, and natural history of cannabis-related problems among a heterogeneous sample of 212 ‘at risk’ adolescent and adult users recruited from the community. In a 3-phase developmental design the CUPIT question candidates were first generated employing an Expert Panels methodology. The CUPIT structure, crosssectional, and longitudinal psychometric properties were then systematically tested, incorporating measures of cannabis-related pathology and DSM-IV/ICD-10 diagnoses of cannabis use disorders as criterion standard. High levels of cannabis consumption and related health and psychosocial problems reported portrayed a highly-disordered sample, most marked among adolescents. DSMIV/ICD-10 diagnoses were almost universal with no significant adolescent/adult differences in dependence symptoms count or severity. The two CUPIT subscales (Impaired Control, Problems) derived from principal components analyses exhibited good test-retest and internal consistency reliability and highly significant ability to discriminate diagnostic subgroups along the severity continuum (nonproblematic, risky, problematic use). At the 12-month follow-up, 194 adolescents and adults reported significantly increased cannabis consumption (adolescents), symptoms, and dependence severity. Baseline CUPIT subscale scores demonstrated highly significant longitudinal predictive utility for respondents’ diagnostic group membership, health and psychosocial problems, and significantly improved prediction of other measured outcomes in conjunction with age and gender. ROC analyses identified a CUPIT score of 12 to be the optimal cut-point for maximum sensitivity for both currently diagnosable cannabis use disorder and those ‘at risk’ in this sample. The empirical findings of this thesis research provide a compelling rationale for systematic implementation of opportunistic SEI among consumers of publicly-funded health and social services in New Zealand. Data confirmed that the vast majority of those needing help are unaware, or do not perceive, they need help. This thesis argues that, facilitated by the CUPIT, reliable proactive detection and appropriate intervention for early-stage cannabis use problems has potential for enormous cumulative impact on public health gains and the individual’s quality of life.
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Cordelier, Noémie. "Consommation de cannabis, impulsivité et comportements routiers à risque chez les jeunes conducteurs." Thesis, 2020. http://hdl.handle.net/1866/25255.
Full textAbstract:
Malgré de nombreux efforts de prévention, les jeunes conducteurs sont surreprésentés dans les accidents routiers. Certaines études ont visé à mettre en évidence les facteurs pouvant influencer les jeunes conducteurs à adopter des comportements risqués. La consommation de cannabis et l’impulsivité ont été identifiées comme des facteurs importants. L’objectif de cette thèse vise à mieux comprendre les liens entre la consommation de cannabis et les comportements routiers risqués, tout en tenant compte de l’impulsivité. Pour ce faire, cette thèse se divise en deux articles.
Le premier article vise à vérifier si la fréquence de consommation de cannabis prédit la prise de risque des jeunes conducteurs au-delà de l’effet de leur impulsivité. 209 participants âgés de 17 à 25 ans ont rempli des questionnaires sur leurs comportements routiers, leur impulsivité, et leur fréquence de consommation de cannabis. Les résultats montrent que la fréquence de consommation de cannabis prédit la prise de risque des jeunes conducteurs au-delà de l’effet de l’impulsivité. De plus, l’urgence positive est la seule facette de l’impulsivité qui prédit la prise de risque, indépendamment des habitudes de consommation. Plusieurs hypothèses pouvant expliquer ces résultats ont été proposées dont une qui nous semblait particulièrement pertinente : la probabilité de prendre le volant après avoir consommé est plus élevée dans le cas d’une consommation plus fréquente, ainsi l’effet direct de la substance pourrait expliquer les comportements risqués. C’est pourquoi dans notre deuxième étude, nous avons voulu vérifier si la consommation de cannabis était associée aux comportements risqués même lorsque le consommateur n’est pas sous l’effet du cannabis. Comme une consommation fréquente peut être symptomatique d’un trouble d’utilisation du cannabis (TUC), nous avons voulu vérifier son impact sur les comportements risqués.
Le deuxième article compare donc un groupe de consommateurs ayant un TUC avec un groupe n’en ayant pas sur des comportements risqués tout en tenant compte de leur impulsivité. Pour ce faire, 76 participants masculins, consommateurs de cannabis, âgés de 18 à 25 ans, ont complété une tâche de simulation de conduite ainsi qu’une tâche stop-signal, s’étant abstenus de
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consommer du cannabis dans les 12 heures précédant l’expérimentation. Ils ont aussi rempli des questionnaires sur les habitudes de consommation de cannabis, les traits d’impulsivité et la prise de risque. Les consommateurs ayant un TUC ont manifesté plus de comportements risqués dans le simulateur que ceux n’en ayant pas, quel que soit leur niveau d’impulsivité et sans être sous l’effet de la substance. Plusieurs explications ont été proposées : difficulté d’adaptation à la conduite sans l’effet de la substance; présence d’une autre variable confondante que l’impulsivité sous-jacente à la consommation et aux comportements risqués; effet résiduel de la substance, non détecté par la tâche stop-signal, qui influencerait les comportements routiers.
En résumé, il ressort de cette thèse que la consommation de cannabis est un facteur contribuant aux comportements risqués des jeunes conducteurs, et ce indépendamment de l’impulsivité. De plus, les consommateurs ne constituent pas un groupe homogène, d’où la pertinence de cibler particulièrement les consommateurs problématiques dans les campagnes de prévention.Despite many prevention efforts, young drivers are overrepresented in road crashes. Some studies show that cannabis use and impulsivity are significant predictors of risky driving behaviour among young drivers. The aim of this thesis is to better understand the association between cannabis use and risky driving behaviour, while considering the driver’s impulsivity. For this purpose, this thesis is divided into two articles. The first article aims to verify whether the frequency of cannabis use predicts risk-taking over and above the impulsivity traits of young drivers. 209 participants aged between 17 and 25 completed questionnaires on their driving behaviours, impulsivity, and frequency of cannabis use. Results show that the frequency of cannabis use is a significant predictor of risky driving over and above the five impulsivity traits. Furthermore, positive urgency is the only impulsivity trait which predicts risky driving, regardless of the frequency of cannabis use. Several explanations of these results are proposed, including one we found particularly relevant: the probability of driving under the influence is higher with more frequent use, so the substance effects could explain risky driving behaviour. Therefore, in our second study, we wanted to test whether cannabis use was associated with risky driving behaviour even if the user was not driving under the influence. Moreover, since frequent use can be symptomatic of a cannabis use disorder (CUD), we wanted to verify its impact on risky behaviours. The second article, therefore, compares two groups of cannabis users (with or without CUD) on several driving behaviours, while considering their impulsivity. A sample of 76 male participants, cannabis users, aged 18 to 25, completed a driving simulation task and a stop-signal task, abstaining from cannabis use in the 12 hours preceding the experiment. They also completed questionnaires about their cannabis use patterns, impulsivity traits and risk-taking. Results show that users with a CUD displayed more risky behaviours in the simulator than users without a CUD, regardless of their impulsivity level and without being under the effects of the substance. Several explanations have been proposed: difficulty adjusting to driving without the influence of the substance for users with a CUD; presence of a confounding variable different from the impulsivity; or residual effects of cannabis, not detected by the stop-signal task. In summary, this thesis emphasizes that cannabis use is a contributing factor to young drivers’ risky behaviours, regardless of their impulsivity. Moreover, cannabis users are not a homogeneous group, which is why it is important to specifically target problematic users in prevention campaigns.
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Thornton, Louise K. "Attitudes and perceptions regarding tobacco, alcohol or cannabis use among people with and without mental disorders." Thesis, 2012. http://hdl.handle.net/1959.13/935325.
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Research Doctorate - Doctor of Philosophy (PhD)Co-occurring substance use and mental disorders are a major health problem. Substance use disorders are very common among people with mental disorders, cost health care systems large amounts of money and have been consistently linked to a number of adverse consequences among this population. It is clear therefore that effective intervention and preventative strategies are needed to address these co-occurring disorders and it is suggested that a clear understanding of people’s attitudes and perceptions regarding substances is needed to develop such strategies. Very little research investigating the substance related attitudes and perceptions among people with mental disorders exists. The broad aim of this thesis was to generate a greater understanding of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with mental disorders. To address this aim the thesis presents five papers. Paper 1 describes a systematic review of current literature investigating attitudes and perceptions towards tobacco, alcohol and cannabis among people with mental disorders. The review aimed to identify the strengths, weaknesses and gaps in this literature. Paper 2 and Paper 3 describe a study of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with psychotic disorders. This study elicited both quantitative and qualitative data and aimed to identify any similarities and differences between participants’ reasons for tobacco, alcohol and cannabis use. It also aimed to generate some initial insights regarding the perceived effectiveness of anti-tobacco public health campaigns among people with mental disorders. Paper 4 describes a study which investigated reasons for tobacco, alcohol and cannabis use among people with depression or a psychotic disorder. It aimed to identify similarities and differences in reasons for substance use between people with different mental disorders. Paper 5 describes a qualitative study of attitudes and perceptions regarding tobacco, alcohol and cannabis among people with a psychotic disorder, current symptoms of depression or without a mental disorder. The study aimed to generate insights regarding a range of substance related attitudes and perceptions by employing a flexible interview schedule that allowed issues important to the participants to be raised. The concluding chapter of this thesis reviews and synthesizes the main findings of these five papers and discusses their implications for future research and the development of effective intervention and prevention strategies. The findings of this thesis suggest that attitudes and perceptions regarding tobacco, alcohol and cannabis differ considerably. While all three substances were found to be used to cope with stress and to relax, this reason was particularly important for tobacco use among people with and without mental disorders. Social factors were found to play an important role in the alcohol use of people with and without mental disorders, while cannabis was often used as a source of pleasure by people with and without mental disorders. The type of harm these substances were perceived to cause was also found to differ considerably. Very few differences between the attitudes and perceptions of people with and without mental disorders, regarding tobacco, alcohol and cannabis, were found. However, among people with mental disorders specifically, mental health and substance use were perceived to interact. Anti-substance use campaigns were perceived to be ineffective by people both with and without mental disorders. Attitudes and perceptions towards tobacco, alcohol and cannabis were also found to differ between people with a psychotic disorder and people experiencing depression. The findings of this research add considerably to our understanding of the attitudes and perceptions regarding tobacco, alcohol and cannabis use held among people with mental disorders. The findings also suggest that it may be important to tailor intervention and prevention strategies regarding tobacco, alcohol and cannabis by substance type and perhaps type of mental disorder.
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Degenhardt, Louisa. "Comorbidity between substance abuse and mental health in Australia : relationships of alcohol, tobacco and cannabis use with other substance use and mental disorders /." 2001. http://www.library.unsw.edu.au/~thesis/adt-NUN/public/adt-NUN20020823.095252/index.html.
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Costa, Ana Sofia Carvalho. "Internship reports and Monograph entitled "Psychotic Disorders and the Use of Cannabis in Adolescents and Young Adults" referring to the Curricular Unit "Internship"." Master's thesis, 2021. http://hdl.handle.net/10316/99092.
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Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de FarmáciaO estágio curricular, parte do plano de estudos do Mestrado Integrado em Ciências Farmacêuticas, é o culminar de uma aprendizagem feita ao longo de cinco anos. É a altura de colocar o conhecimento teórico na prática e também de realizar novas aprendizagens. Durante o estágio curricular tive a oportunidade de conhecer melhor o funcionamento de uma indústria farmacêutica, assim como, de me aperceber da realidade do dia a dia de uma farmácia comunitária. Os dois relatórios de estágio, acompanhados de uma análise SWOT, descrevem o meu percurso tanto na Bluepharma como na Farmácia Moura Glicínias.A psicose é uma doença psiquiátrica grave e incapacitante, que atinge aproximadamente 1% da população mundial, sendo o seu diagnóstico feito, maioritariamente, entre o fim da adolescência e o início da idade adulta. Existem múltiplos fatores de risco, entre os quais história familiar da doença, problemas ao nascimento, situações traumáticas em indivíduos com predisposição à doença e, também, o consumo de drogas recreativas. Dados recentes mostram que o consumo destas drogas tem vindo a crescer ao longo dos anos, especialmente, entre os adolescentes e jovens adultos.A canábis é considerada a droga mais consumida no mundo e o aumento da adesão a esta substância deve-se ao facto de se registar uma crescente legalização a par da diminuição da consciência dos seus malefícios. Estima-se que a população entre os 16 e 24 anos seja a mais propensa a consumir canábis e a sofrer mais com os perigos a ela associados. A adolescência é, por si só, um período crítico para o desenvolvimento cerebral e o consumo indiscriminado desta substância torna-se uma preocupação cada vez maior. O seu uso contínuo nesta faixa etária potencia efeitos negativos a nível emocional e cognitivo, aumentando o risco de desenvolvimento de psicose ou surtos psicóticos.Nesta monografia vai ser discutido o consumo de canábis na adolescência e início da idade adulta como sendo um sério e importante fator de risco para o desenvolvimento de psicoses e também será analisado o impacto que a pandemia COVID-19 teve nestes hábitos de consumo.
The curricular internship that takes part of the curricular plan of the Integrated Master of Pharmaceutical Sciences is the culmination of a five-year studying. It is the time to put into practice the theorical knowledge and also to make new learnings. During the curricular internship I had the opportunity to get to know better the functioning of a pharmaceutical industry as well as to understand the reality of a community pharmacy’s daily life. The two internship reports, accompanied by a SWOT analysis, describe my path both at Bluepharma and at Farmácia Moura Glícinias.Psychotic disorder is a serious and disabling psychiatric illness that affects 1% of the worldwide population and the typical age of onset is between late adolescence and the beginning of adulthood. There are multiple risk factors such as family history of the disease, birth problems, traumatic events and the use of recreative drugs. Recent data shows an increase of the consumption of these drugs, especially among teenagers and young adults.Cannabis is the most consumed drug in the world and the perception of its harm has been decreasing. People are also starting to use it more recurrently due to its ongoing legalization and decreased awareness of its harm. It is estimated that the population between 16 and 24 years is the most likely to consume cannabis and to suffer more from the consequences associated with it. Adolescence by itself is a critical period for brain development and the indiscriminate consumption of this substance is becoming an increasing concern. The continuous consumption in this age group intensifies the negative effects on both emotional and cognitive levels, leading to an increased risk of developing psychosis and experiencing psychotic outbreaks.In this monography, the consumption of cannabis in adolescence and early adulthood is going to be discussed as a serious and important risk factor for psychosis development. The impact that the COVID-19 pandemic had in the Cannabis’s consumption patterns is also going to be analyzed and discussed.
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Beaudoin, Mélissa. "Étude de la relation entre la consommation de cannabis et la violence chez les individus atteints de troubles mentaux graves." Thèse, 2019. http://hdl.handle.net/1866/23658.
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La violence est responsable de 2,5 % des décès à travers le monde, en plus d’avoir un impact important sur la santé physique et mentale des victimes. Par conséquent, il s’agit d’un problème de santé publique prioritaire. Des études récentes réalisées auprès d’individus atteints de troubles mentaux graves (TMG) ont démontré qu’il existe une association entre l’usage du cannabis et les comportements violents. Considérant que ces individus sont plus à risque de consommer des drogues et de commettre des crimes que la population générale, cette découverte est particulièrement importante dans le contexte actuel de la légalisation. L’objectif de mon projet de recherche était donc de valider et de préciser la relation entre le cannabis et la violence chez les individus TMG. Pour se faire, trois études ont été réalisées. La première visait à faire état de la littérature au moyen d’une méta-analyse. En regroupant les études ayant calculé une telle association chez les TMG, nous avons mis en lumière l’existence d’une association modérée entre l’usage du cannabis et la violence. Pour ce qui est de la deuxième étude, nous avons identifié les principaux facteurs de risque dynamiques et statiques de la violence et de la criminalité chez les TMG ; dans les deux cas, l’usage du cannabis était un facteur d’une importance majeure. La dernière étude a permis de confirmer la relation unidirectionnelle entre l’usage persistant du cannabis et la violence dans une population atteinte de schizophrénie. Finalement, ces résultats seront particulièrement importants afin de formuler des recommandations cliniques pertinentes. De futures études devront toutefois être réalisées afin d’élucider les mécanismes sous-jacents de cette association.Worldwide, violence is responsible for 2.5% of deaths, besides having an important impact on victims’ physical and mental health. Therefore, it is a priority public health problem. Recent studies of individuals with severe mental illnesses (SMI) have shown that an association exists between cannabis use and violent behaviours. Considering that these individuals are at higher risk of drug consumption and crime than the general population, this discovery is particularly important in the current context of the legalization. My research project therefore aimed to validate and to specify the relationship between cannabis use and violence in SMI individuals. To do so, three studies were conducted. The first one was to report current literature through a meta-analysis. By grouping the studies that calculated such an association among SMI, a moderate association was found between cannabis use and violence. As for the second study, we identified the main dynamic and static risk factors for violence and criminality in SMI; in both cases, cannabis use was one of these factors. The last study confirmed the unidirectional relationship between persistent cannabis use and violence in a population with schizophrenia. Finally, these results will be particularly important in order to formulate relevant clinical recommendations. However, future studies will need to be conducted to elucidate the underlying mechanisms of this association.
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Albrecht, Daniel Strakis. "Assessment of the dopamine system in addiction using positron emission tomography." Thesis, 2014. http://hdl.handle.net/1805/5192.
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Indiana University-Purdue University Indianapolis (IUPUI)Drug addiction is a behavioral disorder characterized by impulsive behavior and continued intake of drug in the face of adverse consequences. Millions of people suffer the financial and social consequences of addiction, and yet many of the current therapies for addiction treatment have limited efficacy. Therefore, there is a critical need to characterize the neurobiological substrates of addiction in order to formulate better treatment options. In the first chapter, the striatal dopamine system is interrogated with [11C]raclopride PET to assess differences between chronic cannabis users and healthy controls. The results of this chapter indicate that chronic cannabis use is not associated with a reduction in striatal D2/D3 receptor availability, unlike many other drugs of abuse. Additionally, recent cannabis consumption in chronic users was negatively correlated with D2/D3 receptor availability. Chapter 2 describes a retrospective analysis in which striatal D2/D3 receptor availability is compared between three groups of alcohol-drinking and tobacco-smoking subjects: nontreatment-seeking alcoholic smokers, social-drinking smokers, and social-drinking non-smokers. Results showed that smokers had reduced D2/D3 receptor availability throughout the striatum, independent of drinking status. The results of the first two chapters suggest that some combustion product of marijuana and tobacco smoke may have an effect on striatal dopamine concentration. Furthermore, they serve to highlight the effectiveness of using baseline PET imaging to characterize dopamine dysfunction in addictions. The final chapter explores the use of [18F]fallypride PET in a proof-of-concept study to determine whether changes in cortical dopamine can be detected during a response inhibition task. We were able to detect several cortical regions of significant dopamine changes in response to the task, and the amount of change in three regions was significantly associated with task performance. Overall, the results of Chapter 3 validate the use of [18F]fallypride PET to detect cortical dopamine changes during a impulse control task. In summary, the results reported in the current document demonstrate the effectiveness of PET imaging as a tool for probing resting and activated dopamine systems in addiction. Future studies will expand on these results, and incorporate additional methods to further elucidate the neurobiology of addiction.
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Dellazizzo, Laura. "La violence chez les personnes ayant des troubles mentaux : éclaircir les liens entre les troubles mentaux graves, les troubles de personnalité et les abus de substances." Thèse, 2017. http://hdl.handle.net/1866/20487.
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