Search Results (127)

Cannabis is the most widely consumed illicit substance worldwide, with rising use particularly among adolescents and young adults. Accumulating evidence indicates that chronic cannabis use may negatively impact several domains of cognition, yet findings across studies remain varied and fragmented. This comprehensive review synthesizes current knowledge on the long-term cognitive consequences of cannabis use, focusing on attention, executive functioning, learning, memory, language, motor coordination, and social cognition. Consistent impairments have been observed in domains such as attention, executive function, memory, and learning; however, most evidence derives from studies of acute or residual effects. Evidence of long-lasting deficits after extended abstinence remains more limited and methodologically heterogeneous. Acute motor coordination deficits are well established, but persistent impairments in this domain lack conclusive evidence. Effects on language remain inconclusive, and findings regarding social cognition, though limited, suggest potential deficits in emotion recognition and mental state inference. Early onset and high-frequency use are critical risk factors for more severe and enduring cognitive effects. Some deficits may partially reverse with abstinence, although many persist long after cessation. Overall, cannabis use is associated with widespread and lasting cognitive impairments. These findings underscore the need for targeted prevention strategies, especially among youth, and point to future longitudinal and mechanistic research to better understand the nature, persistence, and potential reversibility of these cognitive effects. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Purpose: Suicide is a leading cause of death among children and adolescents worldwide. This study examined the prevalence and characteristics of suicides among children and adolescents (aged ≤ 19 years) over a 13-year period in the broader area of Athens, Greece. Key aspects analyzed included victim demographics, circumstances surrounding the incidents, and methods employed. Methods: A retrospective analysis was conducted on autopsy cases performed at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, from 1 January 2011, to 31 December 2023. Results: Out of 5819 autopsies conducted between 2011 and 2023, 371 were classified as suicides. Among these, 12 cases (representing 3.2% of suicides) involved children and adolescents aged ≤ 19 years and met the study’s inclusion criteria for detailed forensic analysis. The average age of the victims was 17.7 ± 2.1 years (range: 14–19), with males representing 58.3% of cases. Hanging was the most common method of suicide (9 cases, 75.0%), followed by firearm use, falls from height, and hydrogen sulfide inhalation (one case each). Death occurred in the home in 10 cases (83.3%), with 6 specifically taking place in the bedroom. Scars indicative of prior self-harming behavior were present in two cases (16.7%), while suicide notes were found in three cases (25.0%). Toxicological analysis revealed alcohol and cannabis use in one case, cannabis alone in one case, and alcohol alone in two cases. Four victims (33.3%) had a documented psychiatric diagnosis, with two of them under antidepressant treatment at the time of death. Conclusions: This study highlights the forensic value of autopsy-based investigations in unveiling hidden patterns of adolescent suicidality and informs targeted prevention strategies. Integrating medico-legal findings into public health responses may enhance early identification and intervention in vulnerable youth populations. Full article

Epilepsy affects over 12 million children worldwide, with approximately 30% classified as having drug-resistant epilepsy (DRE), often accompanied by neuropsychiatric comorbidities that severely impact quality of life. The endocannabinoid system (ECS) functions as a multifaceted neuromodulatory network regulating neuronal excitability, synaptic plasticity, and immune homeostasis from early life through adolescence and into aging. In pediatric epilepsies, alterations in ECS components, particularly CB1 receptor expression and endocannabinoid levels, reveal disorder-specific vulnerabilities and therapeutic opportunities. Cannabidiol (CBD), a non-psychoactive compound from Cannabis sativa, has shown strong preclinical and clinical efficacy in treating DRE and is approved for Dravet syndrome, Lennox–Gastaut syndrome, and Tuberous Sclerosis Complex. Other ECS-based strategies, such as the use of CB1 receptor-positive allosteric modulators, can selectively enhance endogenous cannabinoid signaling where and when it is active, potentially reducing seizures in conditions like Dravet and absence epilepsy. Similarly, FAAH and MAGL inhibitors may help restore ECS tone without directly activating CB1 receptors. Precision targeting of ECS components based on regional expression and syndrome-specific pathophysiology may optimize seizure control and associated comorbidities. Nonetheless, long-term pediatric use must be approached with caution, given the critical role of the ECS in brain development. Full article

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child’s talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents’ difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent–teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents. Full article

Background/Objectives: Adolescents and young adults (AYAs) with opioid use disorder (OUD) frequently have co-occurring psychiatric conditions and substance use disorders (SUDs). This study evaluated the association of psychiatric comorbidities and other SUDs with treatment retention and urine drug test (UDT) results in AYAs with OUD. Methods: This retrospective cohort study included AYAs enrolled in the Substance Use Treatment and Recovery clinic from 2009 to 2022. Participants were categorized into four groups: no comorbidities, only mental health disorders, only other SUDs, and both disorders. Treatment outcomes included retention time and UDT results for medication for OUD (MOUD) and illicit substances, including tetrahydrocannabinol (THC). Kruskal–Wallis tests were used to evaluate differences across groups, and regression models identified variables associated with outcomes. Statistical significance was set at p < 0.05. Results: Among 157 patients, the median retention time was 300 days. Depression (p = 0.04), post-traumatic stress disorder (p = 0.002), and alcohol use disorder (p = 0.04) were associated with prolonged retention, whereas cannabis use disorder predicted shorter retention (p = 0.02). The median proportion of positive UDTs was 0.9 for MOUD, 0.1 for illicit substances, and 0.0 for THC. Older age (p = 0.02) and the use of antidepressants and anxiolytics were associated with greater adherence to MOUD. Cannabis use disorder (p = 0.02) and male sex (p = 0.04) predicted positive UDTs for THC, while MOUD use was linked to lower THC positivity (p = 0.02). The main limitations of this study were related to its retrospective study design and single-center setting. Conclusions: Psychiatric and substance use comorbidities significantly influence retention and treatment adherence in AYAs with OUD. Integrated treatment may improve engagement and outcomes. Further research is needed to tailor interventions for AYAs with co-occurring disorders. Full article

Background: Research is limited regarding the relationship between adolescent substance use and polysubstance use (SU/PSU) as well as their outcomes later in adolescence, while accounting for early risk factors. This study explored substance-related and psychosocial outcomes at age 17 associated with SU/PSU developmental trajectories in a population-representative cohort from Quebec, Canada (N = 1593; 48.4% male), while controlling for preadolescent individual, familial, and social risk factors. SU/PSU included concurrent use of alcohol (AL), cannabis (CA), and other illicit drugs (ODs). Methods: Self-reported substance use data were collected at ages 12, 13, 15, and 17. Latent growth modeling identified five trajectories: Non-Users (12.8%) and four SU/PSU classes (5.8–37.5%) with varying severity based on onset, frequency, and substance type. Multinomial regression, using non-users as the reference group, assessed trajectory associations with age-17 outcomes. Individual, familial, and social risk factors assessed at ages 10–12 served as control variables. Results: Adolescents in high-risk SU/PSU classes showed the most negative substance-related and psychosocial outcomes compared to non-users and lower-risk SU/PSU classes. Lower-risk SU/PSU classes showed higher maladjustment than non-users. Conclusions: The findings highlight a dose–response relationship between SU/PSU trajectories and late-adolescent outcomes, independent of preadolescent risk factors. Results emphasize the importance of longitudinal studies that incorporate multiple substances to better capture the complexity of teenagers’ involvement in substance use throughout adolescence. Full article

Cannabis abuse has been linked to acute psychotic symptoms as well as to the development of schizophrenia. Although the association has been well described, causation has not yet been investigated. Therefore, we investigated whether cannabis or cannabinoid use is causal for the development of schizophrenia, conducting a systematic literature review according to the PRISM guidelines. Epidemiological studies and randomized clinical trials investigating the links between cannabis and psychosis-like events (PLE) and schizophrenia were identified (according to PRISM guidelines), and relevant studies were included in a Forest plot analysis. Confounder analysis was performed using a funnel plot, and the Hill causality criteria were used to estimate causation. A total of 18 studies fulfilled the search criteria; 10 studies were included in a forest plot. All studies reported an increased risk for PLE or schizophrenia, and nine of the ten studies, a significant increase; the overall OR was calculated to be 2.88 (CI 2.24 to 3.70), with a twofold-higher risk calculated for cannabis use during adolescence. Confounder effects were indicated by a funnel plot. The Hill criteria indicated a high likelihood for the contribution of cannabis to schizophrenia development. Cannabinoids likely contribute to chronic psychotic events and schizophrenia, especially if taken during adolescence. This effect likely increases with a high cannabis THC concentration and increased frequency of cannabis use, and is stronger in males than in females. This points to the possibility of a selective cannabis toxicity on synaptic plasticity in adolescence, as compared to adult cannabis use. Cannabis use should be regulated and discouraged, and prevention efforts should be strengthened, especially with reference to adolescence. Full article

The reason why young people taking concomitantly cannabis (THC) and ethanol (EtOH) are more prone to stroke is underresearched. To investigate whether an underlying mechanism of increased brain damage could be an impaired mitochondrial function, this experiment determined the acute effects of EtOH, both alone and associated with THC, on mitochondrial respiration and oxidative stress (hydrogen peroxide H₂O₂) on young (11 weeks) and middle-aged (45 weeks) brain in rats, using a high-resolution oxygraph (Oxygraph-2K, Oroboros instruments). In young brains, EtOH decreased mitochondrial respiration by −51.76 ± 2.60% (from 32.76 ± 3.82 to 17.41 ± 1.42 pmol/s/mL, p < 0.0001). In 45-week-old brains, the decrease was lesser, but still significant −36.0 ± 2.80% (from 30.73 ± 7.72 to 20.59 ± 5.48 pmol/s/mL, p < 0.0001). Concomitant THC aggravated brain mitochondrial respiration decreases at 11 weeks (−86.86 ± 1.74%, p < 0.0001) and at 45 weeks (−73.95 ± 3.69%, p < 0.0001). Such additional injury was enhanced in young brains (p < 0.01). H₂O₂ production was similar in both age groups (1.0 ± 0.2 versus 1.1 ± 0.08 pmol O₂/s/mL) and was not modified by THC addition. In conclusion, EtOH alone significantly impairs brain mitochondrial respiration and concomitant THC further aggravates such damage, particularly in young brains. These data support the hypothesis that enhanced mitochondrial dysfunction might participate in the increased occurrence of stroke in the young and urge for better prevention against EtOH and THC addictions in adolescents. Full article

Unsatisfactory sleep is a worldwide concern, as evidenced by the high prevalence of insomnia symptoms and diagnosis in the general population, and an issue that has also risen among adolescents. These circumstances are a cause of worry due to, among other factors, the observed bidirectional association of sleep disturbances and the risk of substance use disorder development. In this regard, across the globe, several reports indicate that substance consumption is at an all-time high, with alcohol, nicotine, and cannabis leading the charts. Additionally, the age of onset has dropped, with reports suggesting that first contact is usually during adolescence. Although the nature of the link between poor sleep and substance use disorder development is still not fully understood, it is possible that an overactive orexinergic system could play a role, as it has been observed that treatment with orexinergic antagonists improves insomnia symptoms and that postmortem studies show an increase in orexin immunoreactive neurons in sections obtained from habitual opioid consumers. We further argue that it is during adolescence that this maladaptive loop can be established, priming for the development of substance use disorders. Full article

Adolescence is a phase characterized by reckless and risky behaviors, including the initiation and use of various illicit substances such as cannabis and alcohol. When ingested or administered, these substances affect mental processes by delivering pleasure, inner peace, and satisfaction. The aim of this study was to determine the prevalence and associated factors of psychoactive substance (PAS) use among adolescents. A cross-sectional study was conducted, including 300 participants surveyed using a structured questionnaire. Data were collected using the Mediterranean School Survey Project on Alcohol and Other Drugs (MedSPAD) to assess substance use, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose substance use disorders (SUDs), and the Early Trauma Inventory Self-Report Short Form (ETISR-SF) to identify childhood maltreatment, as well as socio-demographic characteristics. During the study period, 300 secondary school students participated. Their mean age was 17.92 ± 1.40 years, ranging from 15 to 22. There were slightly more males (56.7%) than females. A total of 40.67% of participants admitted to using at least one PAS at least once, while the prevalence of current use was 26%. Tobacco was the most commonly used substance (22.1%), followed by cannabis (7.33%). According to the DSM-5, 40.2% of users met the criteria for severe addiction. Factors associated with PAS use included the father’s level of education; place of use (e.g., home); poor relationships with parents, siblings, and teachers; and childhood maltreatment. Psychoactive substance use was found to be prevalent among adolescents in this study. Full article

Background/Objectives: Cannabinoid Hyperemesis Syndrome (CHS), associated with long-term cannabinoid use, has been increasingly observed in emergency room visits as more states in the U.S. have legislatively permitted medical and recreational marijuana use. The acute management of CHS primarily focuses on antiemetic treatment and supportive care. However, both the condition itself and the antiemetic drugs, such as haloperidol, may cause QTc prolongation. Methods: We reported two adolescent cases admitted to the emergency department for acute antiemesis management of CHS who received haloperidol treatment. A literature review was performed through October 2024 for previously published cases of QTc prolongation and/or Torsades de Pointes (TdP) in adolescents and young adults. Results: A 15-year-old female presented with hypokalemia and hypomagnesemia upon admission. She complained of chest pain and tachycardia, and the electrocardiogram (EKG) showed prolonged QTc (528 msec). The haloperidol infusion was discontinued. She recovered well post-discharge without complaints. A 17-year-old female had a borderline prolonged QT interval (476 msec). Her nausea and vomiting improved with a three-dose course of intravenous fosaprepitant before discharge. Our literature search identified five severe cases with life-threatening episodes of QTc prolongation and/or TdP in adolescents and young adults. Conclusions: Patients with CHS are at higher risk of QTc prolongation due to cannabis use, electrolyte imbalance, and antiemetic medications. We recommend vigilant EKG monitoring, particularly before initiating and throughout haloperidol treatment. If the patient presents with an increased risk of QTc prolongation, consider using topical capsaicin, lorazepam, aprepitant/fosaprepitant, and olanzapine as alternatives. Full article

The endocannabinoid signalling system (ECS) plays a critical role from the very beginning of embryogenesis. Accordingly, the ECS is engaged early on in nervous system development, starting from neurulation, supported by the identification of ECS components—both receptors and enzymes controlling endocannabinoid metabolism—at these early stages. In particular, regarding the brain, the ECS is involved in the tightly regulated sequence of events that comprise brain development, from neurogenesis to neuronal migration, morphological guidance for neuronal connectivity, and synaptic circuitry refinement. The importance of this broad role of the ECS across various brain development processes is further underscored by the growing understanding of the consequences of cannabis exposure at different developmental stages. Despite the considerable knowledge we have on the role of the ECS in brain development, significant gaps in our understanding remain, particularly regarding the long-term impact and underlying mechanisms of cannabis exposure at different developmental stages. This review provides an overview of the current state of knowledge on the role of the ECS throughout brain development, from embryogenesis to adulthood, and discusses the impact of cannabis exposure, especially during adolescence—a critical period of circuitry maturation and refinement coinciding with an increased risk of cannabis use. Full article

Adolescent alcohol and cannabis use pose significant developmental risks. This study examined internalizing and externalizing problems as risk factors and prospective self as a protective factor in relation to alcohol and cannabis use. Self-report data were collected from a diverse sample (N = 2017) of 15–17-year-olds using the Youth Self Report (YSR) for behavior issues and prospective self, a factor-derived variable reflecting future orientation, resistance to peer influence, and academic aspirations. Participants reported on 15 health risk behaviors, including alcohol and cannabis use. Weighted linear regressions evaluated associations between risk and protective factors and substance use. Results indicated a higher externalizing behavior was linked to increased alcohol and cannabis use, while a higher prospective self and internalizing behavior were linked to reduced alcohol use. Higher prospective self was associated with less cannabis use. Interaction terms were largely non-significant, except for the interaction between prospective self and internalizing behavior, where higher internalizing problems and high prospective self were linked to increased cannabis use. The findings highlight the importance of prospective self, especially at clinically elevated levels of behavior problems, and recommend further exploration of the unexpected positive associations between internalizing behavior and prospective self with cannabis use. Full article

Substance-induced psychosis (SIP) is an increasingly prevalent and complex condition that presents significant diagnostic and therapeutic challenges. With the rising use of novel psychoactive substances (NPSs) and potent traditional compounds like cannabis and cocaine, particularly among adolescents and young adults, understanding the mechanisms and clinical manifestations of SIP has become more critical. This review examines the psychopathological characteristics of SIP, focusing on the differentiation between substance-induced and primary psychotic disorders. Two key concepts are explored: Gaëtan de Clérambault’s “mental automatism”, which describes involuntary thoughts and sensations experienced as alien to the self, and the “twilight state” of consciousness, characterized by an altered perception of space, time, and social interaction. These phenomena are essential in understanding how substance use triggers psychotic processes and how SIP differs from endogenous psychosis. This review also highlights the clinical and phenomenological distinctions between acute and chronic psychotic episodes, emphasizing the potential transition from SIP to persistent psychosis, especially in cases of frequent and potent substance use. It discusses the diagnostic and therapeutic importance of recognizing specific psychopathological markers such as alterations in temporality, spatiality, and intersubjectivity. Understanding these features enhances the clinician’s ability to accurately differentiate SIP from primary psychotic disorders, which is often complicated by the widespread use of substances that may not be easily detectable in standard tests. This review concludes by advocating for a clinical–phenomenological approach to empathically engage with patients and provide a solid diagnostic framework for improved treatment strategies, particularly for those at risk of transitioning to chronic psychosis. Full article