M.Cur. (Psychiatric Nursing) / In local communities, young people use different substances for reasons known to them alone. This research study is about young people who are aged between 18 and 30 years, who smoke cannabis and are mentally ill. Mostly the parents of these young people, as well as other members of the family, the neighbours and the community at large experience many challenges resulting from cannabis smoking. The objectives of this study were to explore and describe the experiences of parents living with mental health care users smoking cannabis and to issue guidelines for the advanced psychiatric nurse practitioner to facilitate the mental health of parents living with mental health care users smoking cannabis in the context under study. A qualitative research design that was exploratory, descriptive and contextual was followed to achieve the aim and objectives of the study. Purposive sampling was used for sample selection based on inclusion criteria. The number of participants selected for this study was guided by data saturation. The total number of participants selected for this study was seven. The data collection methods used were phenomenological interviews, observation and field notes. In the phenomenological interview, the participant was asked: “How is it for you living with a mental health care user smoking cannabis?” The phenomenological interviews were audiotaped and transcribed. The researcher and an independent coder analysed the transcribed phenomenological interviews and field notes. The researcher used Tesch’s method of data analysis (Creswell, 2007:157) in analysing the data. The measures to ensure trustworthiness in this study include credibility, dependability, confirmability, transferability and authenticity. The seven ethical principles of competence of the researcher, right to self-determination, right to privacy, right to autonomy and confidentiality, right to protection from exploitation and obtaining informed consent guided this study ...

Thesis (Ph. D.)--Florida State University, 2006. / Advisor: Alan R. Lang, Florida State University, College of Arts and Sciences, Dept. of Psychology. Title and description from dissertation home page (viewed June 15, 2006). Document formatted into pages; contains xii, 111pages. Includes bibliographical references.

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.

Background Herbal marijuana alternatives (HMA), legal plant products adulterated with synthetic cannabinoid receptor agonists, represent a growing public health concern. Only a few case reports describe HMA and synthetic cannabinoid’s clinical toxicity. We describe an outbreak of HMA abuse primarily in the Midwest, the clinical presentation of HMA toxicity, and clinical and forensic testing. Methods During the course of ongoing surveillance for emerging drugs of abuse between November 2009 and August 2010, we retrospectively and prospectively identified a convenience sample comprising 81 cases of abuse of HMA products. Subject demographics, vital signs, lab results and urine were obtained (when available) and tested via gas chromatography mass spectrometry (GCMS) analysis. Samples of HMAs and synthetic cannabinoids were also analyzed via GCMS. Results HMA users were predominantly young males who inhaled HMAs. Analysis of their urine detected synthetic cannabinoid parent compound in one subject. GCMS analysis of synthetic cannabinoids established a reference library that confirmed the presence of synthetic cannabinoids in sampled HMA products. Conclusion HMA products were available in head shops, gas stations, and via the Internet. We have confirmed the presence of synthetic cannabinoids in these HMA products. The tachycardia, hypertension, agitation, anxiety, vomiting and hallucinations observed in this convenience sample are not readily explained by the presence of synthetic cannabinoids acting on CB1 and CB2 receptors. Further research must be done on HMA products and their abusers.

How adolescents spend their time is a crucial predictor of their engagement in delinquency. Activities with peers away from direct supervision of adults are of concern as more opportunities and motivation to use marijuana exist in such situations. However, adolescents may vary in their propensity to use marijuana when faced the opportunity. Especially adolescents living with a single parent may have a higher propensity compared to those from two-parent households to use marijuana due to reduced parental monitoring and increased peer attachment. This thesis investigates the moderating effects of family structure on the routine leisure activities and adolescent marijuana use relationship, using data from Monitoring the Future Study 2007, 12th Grade Survey. The results provide partial support for the moderating effects.

Made available in DSpace on 2015-07-22T20:50:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-24. Added 1 bitstream(s) on 2015-08-11T03:26:09Z : No. of bitstreams: 1 Publico-12675.pdf: 644045 bytes, checksum: 4760c174c211a52ff1a44e954522d1af (MD5) / A aderência ao tratamento para dependência química é questão preocupante e requer atenção especial dos profissionais que atuam com esta população. OBJETIVO: identificar características dos pacientes usuários de maconha que possam ser consideradas fatores preditivos de abandono do tratamento. METODOLOGIA: foi realizada a análise secundária dos dados de um Ensaio Clínico Randomizado em que foram incluídos 169 dependentes de maconha avaliados no ingresso e reavaliados três vezes nos seguimentos realizados após o tratamento breve ao qual foram submetidos. Os pacientes foram randomizados em três grupos de tratamento: no Grupo 1, os pacientes foram submetidos a quatro sessões de tratamento em um mês, no Grupo 2, as mesmas quatro sessões em três meses e no Grupo 3 ficaram os pacientes em espera, os quais, posteriormente foram randomizados para um dos dois grupos de tratamento. RESULTADOS: Os pacientes alocados no grupo três, ou seja, de espera, apresentaram 3.47 vezes mais chance de abandono do que aqueles inseridos nos outros grupos. Baseado nos dados sócio demográficos, concluiu-se que para cada ano de idade do paciente, as chances de abandono poderiam ser multiplicadas por 0,91, representando riscos mais baixos. Para cada ano de consumo da maconha, as chances também seriam multiplicadas por 0,92 representando menores riscos. CONCLUSÃO: Diante dos dados obtidos, pode-se inferir que quanto mais velho e quanto mais anos de consumo de maconha o sujeito tem, menores são suas chances de desistência do tratamento. Desta forma, pode-se apontar a importância de intervenções específicas para os grupos com riscos mais altos de abandono do tratamento foi discutida bem como a relevância de outros estudos envolvendo usuários de maconha e indicações para os profissionais ajudarem os pacientes a aderirem ao programa proposto. / The present study involved secondary analysis of data from a Randomized Clinical Trial including 169 cannabis-dependents not only dependents assessed at baseline and submitted to brief treatment. Patients were first randomized into three treatment groups. OBJECTIVES: The objective was to identify characteristics which could be considered predictors of treatment dropout. RESULTS: Patients initially allocated into the control group presented a 3.47 greater chance of drop out than those of the treatment groups. Based on the socio-demographic data, it was concluded that for every year of patient age, the chances of drop out would be multiplied by 0.91, representing lower risk. For every year of cannabis use, chances of drop out would be multiplied by 0.92, again representing reduced risk. CONCLUSIONS: The importance of specific interventions for groups with a higher risk of treatment drop out was discussed, along with the relevance of other studies involving cannabis users and possible guidelines for professionals help patient to adhere. / TEDE / BV UNIFESP: Teses e dissertações