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Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial

Published online by Cambridge University Press:  08 October 2012

C. R. Hjorthøj ,
A. Fohlmann ,
A.-M. Larsen ,
C. Gluud ,
M. Arendt  and
M. Nordentoft
C. R. Hjorthøj*
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
A. Fohlmann
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
A.-M. Larsen
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
C. Gluud
Affiliation:
Copenhagen Trial Unit, Department 33.44, Rigshospitalet, Copenhagen Ø, Denmark
M. Arendt
Affiliation:
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Denmark
M. Nordentoft
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Copenhagen NV, Denmark
*
*Address for correspondence: C. R. Hjorthøj, Ph.D., M.Sc., Copenhagen University Hospital, Mental Health Centre Copenhagen, Research Unit, Bispebjerg Bakke 23, Building 13A, DK-2400 Copenhagen NV, Denmark. (Email: [email protected])
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Abstract

Background

Cannabis abuse in psychotic patients is associated with rehospitalizations, reduced adherence and increased symptom severity. Previous psychosocial interventions have been ineffective in cannabis use, possibly because of low sample sizes and short interventions. We investigated whether adding CapOpus to treatment as usual (TAU) reduces cannabis use in patients with cannabis use disorder and psychosis.

Method

A total of 103 patients with psychosis and cannabis use disorder were centrally randomized to 6 months of CapOpus plus TAU (n = 52) or TAU (n = 51). CapOpus consisted mainly of motivational interviewing and cognitive behaviour therapy (CBT). TAU was targeted primarily at the psychotic disorder. The primary outcome was self-reported days with cannabis use in the preceding month.

Results

Pre-randomization cannabis use frequency was 14.9 [95% confidence interval (CI) 12.7–17.1] days/month. Post-treatment, the ratio of days/month with cannabis use in CapOpus versus TAU was 0.76 (95% CI 0.38–1.50) (p = 0.42), and 0.80 (95% CI 0.21–3.10) (p = 0.75) at the 4-month follow-up. From 46.4 (95% CI 36.4–56.3) monthly joints pre-randomization, consumption fell to 27.3 (95% CI 12.6–41.9) joints in CapOpus and 48.2 (95% CI 31.8–64.6) in TAU (p = 0.06). Follow-up amounts were 28.4 (95% CI 13.5–43.2) and 41.6 (95% CI 25.2–58.0) joints (p = 0.23). Several subgroup analyses suggested benefits of CapOpus.

Conclusions

CapOpus did not reduce the frequency, but possibly the amount, of cannabis use. This is similar to the findings of previous trials in this population. Implementation of CapOpus-type interventions is thus not warranted at present but subgroup analyses call for further trials.

Keywords

Cannabisdual diagnosispsychosisrandomized clinical trialschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1499 - 1510
Copyright
Copyright © Cambridge University Press 2012 

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References

Baker, A, Bucci, S, Lewin, TJ, Kay-Lambkin, F, Constable, PM, Carr, VJ (2006). Cognitive-behavioural therapy for substance use disorders in people with psychotic disorders: randomised controlled trial. British Journal of Psychiatry 188, 439–448.CrossRefGoogle ScholarPubMed
Barrowclough, C, Haddock, G, Tarrier, N, Lewis, SW, Moring, J, O'Brien, R, Schofield, N, McGovern, J (2001). Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry 158, 1706–1713.CrossRefGoogle ScholarPubMed
Barrowclough, C, Haddock, G, Wykes, T, Beardmore, R, Conrod, P, Craig, T, Davies, L, Dunn, G, Eisner, E, Lewis, S, Moring, J, Steel, C, Tarrier, N (2010). Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. British Medical Journal 341, c6325.CrossRefGoogle ScholarPubMed
Bellack, AS, Bennett, ME, Gearon, JS, Brown, CH, Yang, Y (2006). A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Archives of General Psychiatry 63, 426–432.CrossRefGoogle ScholarPubMed
Bersani, G, Orlandi, V, Gherardelli, S, Pancheri, P (2002). Cannabis and neurological soft signs in schizophrenia: absence of relationship and influence on psychopathology. Psychopathology 35, 289–295.CrossRefGoogle ScholarPubMed
Bonsack, C, Gibellini, MS, Favrod, J, Montagrin, Y, Besson, J, Bovet, P, Conus, P (2011). Motivational intervention to reduce cannabis use in young people with psychosis: a randomized controlled trial. Psychotherapy and Psychosomatics 80, 287–297.CrossRefGoogle ScholarPubMed
Bowie, CR, Harvey, PD (2006). Administration and interpretation of the Trail Making Test. Nature Protocols 1, 2277–2281.CrossRefGoogle ScholarPubMed
Brandt, J (1991). The Hopkins verbal learning test: development of a new memory test with six equivalent forms. Clinical Neuropsychologist 5, 125–142.CrossRefGoogle Scholar
Brooks, R (1996). EuroQol: the current state of play. Health Policy 37, 53–72.CrossRefGoogle ScholarPubMed
Caspari, D (1999). Cannabis and schizophrenia: results of a follow-up study. European Archives of Psychiatry and Clinical Neuroscience 249, 45–49.CrossRefGoogle ScholarPubMed
Cleary, M, Hunt, G, Matheson, S, Siegfried, N, Walter, G (2008). Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database of Systematic Reviews. Issue 1, Art. No. CD001088.CrossRefGoogle ScholarPubMed
Compton, WM, Grant, BF, Colliver, JD, Glantz, MD, Stinson, FS (2004). Prevalence of marijuana use disorders in the United States. Journal of the American Medical Association 291, 2114–2121.CrossRefGoogle ScholarPubMed
Cornblatt, BA, Lenzenweger, MF, Erlenmeyer-Kimling, L (1989). The continuous performance test, identical pairs version: II. Contrasting attentional profiles in schizophrenic and depressed patients. Psychiatry Research 29, 65–85.CrossRefGoogle ScholarPubMed
D'Souza, DC, Abi-Saab, WM, Madonick, S, Forselius-Bielen, K, Doersch, A, Braley, G, Gueorguieva, R, Cooper, TB, Krystal, JH (2005). Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry 57, 594–608.CrossRefGoogle ScholarPubMed
Edwards, J, Elkins, K, Hinton, M, Harrigan, SM, Donovan, K, Athanasopoulos, O, McGorry, PD (2006). Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis. Acta Psychiatrica Scandinavica 114, 109–117.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.CrossRefGoogle Scholar
Grech, A, van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349–353.CrossRefGoogle ScholarPubMed
Green, B, Young, R, Kavanagh, D (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry 187, 306–313.CrossRefGoogle ScholarPubMed
Halling Hastrup, L, Nordentoft, M, Hjorthøj, C, Gyrd-Hansen, D (2011). Does the EQ-5D measure quality of life in schizophrenia? Journal of Mental Health Policy and Economics 14, 187–196.Google ScholarPubMed
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Hides, L, Dawe, S, Kavanagh, DJ, Young, RM (2006). Psychotic symptom and cannabis relapse in recent-onset psychosis. Prospective study. British Journal of Psychiatry 189, 137–143.CrossRefGoogle ScholarPubMed
Hinton, M, Elkins, K, Edwards, J (2002). Cannabis and Psychosis: An Early Psychosis Treatment Manual. EPPIC: Melbourne.Google Scholar
Hjorthøj, C, Fohlmann, A, Larsen, A-M, Madsen, MT, Vesterager, L, Gluud, C, Arendt, MC, Nordentoft, M (2008). Design paper: The CapOpus trial: a randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis. Trials 9, 42.CrossRefGoogle Scholar
Hjorthøj, C, Fohlmann, A, Nordentoft, M (2009). Treatment of cannabis use disorders in people with schizophrenia spectrum disorders – a systematic review. Addictive Behaviors 34, 520–525.CrossRefGoogle ScholarPubMed
Hjorthøj, CR, Fohlmann, A, Larsen, AM, Arendt, M, Nordentoft, M (2012 a). Correlations and agreement between delta-9-tetrahydrocannabinol (THC) in blood plasma and timeline follow-back (TLFB)-assisted self-reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial. Addiction 107, 1123–1131.CrossRefGoogle ScholarPubMed
Hjorthøj, CR, Hjorthøj, AR, Nordentoft, M (2012 b). Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances – systematic review and meta-analysis. Addictive Behaviors 37, 225–233.CrossRefGoogle ScholarPubMed
Hjorthøj, CR, Vesterager, L, Nordentoft, M (2012 c). Test-retest reliability of the Danish Adult Reading Test in patients with comorbid psychosis and cannabis-use disorder. Nordic Journal of Psychiatry. Published online 24 May 2012. doi:10.3109/08039488.2012.691544.Google ScholarPubMed
Jerrell, JM, Ridgely, MS (1995). Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders. Journal of Nervous and Mental Disease 183, 566–576.CrossRefGoogle ScholarPubMed
Kamali, M, Kelly, BD, Clarke, M, Browne, S, Gervin, M, Kinsella, A, Lane, A, Larkin, C, O'Callaghan, E (2006). A prospective evaluation of adherence to medication in first episode schizophrenia. European Psychiatry 21, 29–33.CrossRefGoogle ScholarPubMed
Kavanagh, DJ, Young, R, White, A, Saunders, JB, Wallis, J, Shockley, N, Jenner, L, Clair, A (2004). A brief motivational intervention for substance misuse in recent-onset psychosis. Drug and Alcohol Review 23, 151–155.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keefe, RSE, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP, Coughenour, L (2004). The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research 68, 283–297.CrossRefGoogle ScholarPubMed
Kemp, R, Harris, A, Vurel, E, Sitharthan, T (2007). Stop Using Stuff: trial of a drug and alcohol intervention for young people with comorbid mental illness and drug and alcohol problems. Australasian Psychiatry 15, 490–493.CrossRefGoogle ScholarPubMed
Larsen, DL, Attkisson, CC, Hargreaves, WA, Nguyen, TD (1979). Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning 2, 197–207.CrossRefGoogle ScholarPubMed
Leeson, VC, Harrison, I, Ron, MA, Barnes, TRE, Joyce, EM (2012). The effect of cannabis use and cognitive reserve on age at onset and psychosis outcomes in first-episode schizophrenia. Schizophrenia Bulletin 38, 873–880.CrossRefGoogle ScholarPubMed
Martino, S, Carroll, KM, Nich, C, Rounsaville, BJ (2006). A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Addiction 101, 1479–1492.CrossRefGoogle ScholarPubMed
Nelson, HE, O'Connell, A (1978). Dementia: the estimation of premorbid intelligence levels using the New Adult Reading Test. Cortex 14, 234–244.CrossRefGoogle ScholarPubMed
Nordentoft, M, Knudsen, HC, Jessen-Petersen, B, Krasnik, A, Sælan, H, Treufeldt, P, Wetcher, B (1996). CCPP – Copenhagen Community Psychiatric Project. Implementation of community mental health centres in Copenhagen: effects of service utilization, social integration, quality of life and positive and negative symptoms. Social Psychiatry and Psychiatric Epidemiology 31, 336–344.CrossRefGoogle ScholarPubMed
Olfson, M, Mechanic, D, Hansell, S, Boyer, CA, Walkup, J, Weiden, PJ (2000). Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatric Services 51, 216–222.CrossRefGoogle ScholarPubMed
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Ohlenschlaeger, J, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.CrossRefGoogle ScholarPubMed
Priebe, S, Huxley, P, Knight, S, Evans, S (1999). Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry 45, 7–12.CrossRefGoogle ScholarPubMed
Prochaska, JO, DiClemente, CC (1992). Stages of change in the modification of problem behaviors. Progress in Behavior Modification 28, 183–218.Google ScholarPubMed
Schofield, D, Tennant, C, Nash, L, Degenhardt, L, Cornish, A, Hobbs, C, Brennan, G (2006). Reasons for cannabis use in psychosis. Australian and New Zealand Journal of Psychiatry 40, 570–574.CrossRefGoogle ScholarPubMed
Schulz, KF, Altman, DG, Moher, D (2010 a). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. British Medical Journal 340, c332.CrossRefGoogle ScholarPubMed
Schulz, KF, Altman, DG, Moher, D, Fergusson, D (2010 b). CONSORT 2010 changes and testing blindness in RCTs. Lancet 375, 1144–1146.CrossRefGoogle ScholarPubMed
Sobell, LC, Sobell, MB (1992). Timeline follow-back: a technique for assessing self-reported alcohol consumption. In Measuring Alcohol Consumption: Psychosocial and Biological Methods (ed. Litten, R. Z. and Allen, J.), pp. 41–72. Humana Press: New Jersey.CrossRefGoogle Scholar
Stern, R, White, T (2003). Neuropsychological Assessment Battery. Psychological Assessment Resources, Inc.: Lutz, FL.Google Scholar
van Os, J, Bak, M, Hanssen, M, Bijl, RV, de Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319–327.CrossRefGoogle ScholarPubMed
Vendsborg, P, Nordentoft, M, Hvenegaard, A, Søgaard, J (1999). Assertive Community Treatment [in Danish]. Institut for Sundhedsvæsen: Copenhagen.Google Scholar
Weinstein, AM, Gorelick, DA (2011). Pharmacological treatment of cannabis dependence. Current Pharmaceutical Design 17, 1351–1358.CrossRefGoogle ScholarPubMed
WHO (2000). World Health Organization Disability Assessment Schedule (WHODAS II). World Health Organization: Geneva.Google Scholar
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589–593.CrossRefGoogle ScholarPubMed
Yücel, M, Bora, E, Lubman, DI, Solowij, N, Brewer, WJ, Cotton, SM, Conus, P, Takagi, MJ, Fornito, A, Wood, SJ, McGorry, PD, Pantelis, C (2012). The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample. Schizophrenia Bulletin 38, 316–330.CrossRefGoogle Scholar