Many South African psychiatrists, and particularly those working in psychiatric hospitals with Black and Coloured patients, have the firm clinical impression that in many of these patients acute psychotic illness is associated with the abuse of cannabis. Most of the previous work in this field had been done by clinicians of Eastern countries where the use of cannabis has been endemic for thousands of years. However, those workers were handicapped because they lacked both the sophisticated techniques for standardized psychiatric evaluation and the availability of an assay to confirm cannabis use. It was decided to investigate acute psychoses in Cape Coloured males admitted to Valkenberg Hospital with the following aims: i. To identify a cohort of acutely psychotic patients who had recently been using cannabis and to compare them with a matched control group who were free of any drugs. The recently available EMITR immunochemical analytical technique was used for the detection of urinary cannabinoids. To exclude the contribution of other psychotropic agents to the aetiology of the psychoses, gas chromatography was performed to detect ethanol and thin-layer chromatography to screen for other psychotropic agents. ii. To assess the comprehensive mental state of patients on admission and then again after a 7-10 day period the Present State Examination (PSE), a well validated and standardized diagnostic instrument, was used. iii. To determine serum creatinine phosphokinase (CPK) and serum lactate dehydrogenase (LDH) levels (indicators of muscle damage) in view of the published reports of elevated levels in psychotic patients.

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Bakgrund: Cannabis är den vanligaste drogen i världen. Cannabismissbruket har successivt ökat de senaste åren. De vanligaste negativa effekterna av cannabis är ångest, panikreaktioner och psykotiska symtom. Många patienter med cannabismissbruk har även psykiska diagnoser. Sjuksköterskor upplever frustrationer när patienter med cannabismissbruk inte vill ta del av behandling och anser att patienter med dubbeldiagnoser är svårbehandlade.    Syfte: Att beskriva sjuksköterskors erfarenhet av omvårdnad av patienter med cannabismissbruk inom psykiatrisk vård.   Design: Studien har en kvalitativ, induktiv analysmetod.   Metod: Intervjuer med 18 sjuksköterskor inom öppen och sluten psykiatrisk vård.   Resultat: Sjuksköterskorna uttryckte frustrationer över patientens liberala inställning till cannabis, att patienten såg drogen som ofarlig och inte kopplade missbruket till sina psykiska problem. De möjligheter sjuksköterskorna såg i omvårdnaden var att utgå från där patienten befinner sig, att inte komma med pekpinnar och använda sina erfarenheter av patientgruppen för att motivera patienten till att sluta med missbruket.    Konklusion: Sjuksköterskorna uttryckte att de saknade och var i behov av utbildning om patienter med cannabismissbruk för att kunna ge god omvårdnad till patientgruppen. / Background: Cannabis is the most commonly used drug in the world. Cannabis abuse has gradually increased in recent years. The most common adverse effects of cannabis use include anxiety, panic reaction and psychotic symptoms. Many patients who abuse cannabis has also psychiatric diagnoses. Nurses experience frustration when patients who abuse cannabis do not want to take part in treatment and considering patients with dual diagnoses are difficult to treat.   Aim: To describe nurses’ experience of psychiatric care of patients who abuse cannabis.   Design: This study has an inductive, qualitative approach.   Method: Interviews with 18 nurses in outpatient and inpatient psychiatric care.   Results: The nurses expressed frustrations with the liberal approach the patient had to cannabis, the patient´s approach to the drug as harmless and that the patient did not link abuse to psychological problems. The nurses expressed that they saw opportunities in nursing; to start from the patient´s point of view, not lecturing the patient and to use their experience of this group of patients to motivate the patient to quit his or her abuse.   Conclusion: The nurses expressed lack of and need for adequate training in the care of the patient with cannabis abuse.

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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.