Influence of Cannabis Abuse Variables on Psychotic Symptoms

Influence of Cannabis Abuse Variables on Psychotic Symptoms Influence of variables of cannabis abuse on psychotic symptoms and their severity: an Indian experience Abstract: Context: Cannabis is probably the most commonly used illicit drug. While not all cannabis users present mental health problems, heavy cannabis use may increase the risk of cognitive abnormalities, psychotic illness, and mood disorders. Cannabis-induced psychosis is not easily distinguishable from schizophrenic symptomatology, although it is characterized by more bizarre behaviour, violence, panic, more agitation, and less blunting of affect, and incoherent speech. Aims: To evaluate severity of various psychotic symptoms in relation to variables of cannabis abuse. Settings and Design: A cross sectional study of 30 male patients admitted at tertiary psychiatric centre, with diagnosis of cannabis induced psychosis was carried out. Methods and Material: Cannabis abuse variables along with psychotic symptoms severity on BPRS scale was obtained. Statistical analysis used: SPSS-17 was used for analysis, and significance level was at p-value Results: The symptoms that were associated with increased severity in majority of patients were hostility (83%), excitement (77%), and elevated mood, grandiosity, suspiciousness and motor hyperactivity were preset in more than 60% of individuals in range of severe to very severe form. Conclusions: Patients with long duration and early onset of cannabis abuse were presented with more severe form of psychosis. Frequency of cannabis use was not significantly correlated with total BPRS score, although amount spent over cannabis was significantly associated with total BPRS score. Family history of cannabis abuse predicted early onset of cannabis abuse. Introduction Cannabis is probably most commonly used illicit drug. [1,2] It is widely used in India and is an integral part of Indian culture and religious customs.[3,4] The correlation between cannabis and negative mental health outcomes has been unequivocally established [1,5,6,7,12]. While not all cannabis users present mental health problems, [5] epidemiological studies suggest that heavy cannabis use during adolescence may increase the risk of cognitive abnormalities and psychotic disorders.[1,8-10] Use of cannabis at early age and high frequency are associated with a greater risk of problems [5,7,11]. Arendt et al. consider that this cannabis-induced psychosis is an early expression of schizophrenia in vulnerable individuals rather than part of the differential diagnosis [12]. Moore’s review reported a 40% higher risk of psychosis in subjects who occasionally used cannabis and a probability of 50% to 200% higher in regular cannabis users [13]. Swedish Conscripts Study (Andreasson et al.) of inductees into the military reported a risk for schizophrenia 2.4 times higher among those who had used cannabis by 18 years than among non-users [14,24]. This cannabis-induced psychosis is not easily distinguishable from Schizophrenic symptomatology, [15,19] although it has been characterized by more bizarre behavior, violence, panic, more hypomanic symptoms and agitation, and fewer hallucinations and less blunting of affect and incoherent speech.[20,21] Need of the current study Studies have found cannabis associated psychosis a constellation of affective symptoms (euphoria, increased psychomotor activity), [16,17,18] whereas others have found similarity with schizophrenic symptomology of social withdrawal, thought disorder and disorganized behavior [19,22] so there is immense need to define the presenting features of this disorder in Indian population. Additionally phenomenology of the cannabis use disorder need to be explored to clearly define, identify and manage this population. Despite widespread use of cannabis there is lack of research data from most part of the world including India. Aims and objectives: Based on the existing literature we formulated following hypothesis that â€Å"Patients with cannabis associated psychosis have different symptom profile than other common psychiatric disorders, relating to variables of cannabis abuse e.g. dose, frequency, duration†. To test the hypothesis following objectives were formulated To assess variables of cannabis abuse in patients with cannabis associated psychosis. To explore the relationship between variables of cannabis abuse, and individual symptom profile and total BPRS score. Subjects and Methods: Patients in whom there was temporal association of cannabis use with onset of psychotic illness were included in the study. The study included 30 consequentially admitted, Hindi speaking patients of 18-50 years of age at tertiary psychiatric centre in north India from March 2011 to July 2011. Patients with mental retardation, a significant medical condition compromising ability to participate, history of head injury with any documented cognitive sequele, and inability to provide informed consent were excluded from study. Patients having history of psychiatric illness prior to onset of cannabis abuse, predominant abuse/dependence of other psychoactive substance and having any other significant medical illness were also excluded from study. Study design: A cross sectional study of subjects who satisfied the inclusion criteria was carried out. After recording socio demographic data, each participant in the study was subjected to questionnaire regarding his cannabis abuse and brief psychiatric rating scale (BPRS). To measure the quantity of cannabis intake by individual indirect measure in form of average amount (INR) spent daily was inquired. The age of onset, duration of abuse, and cause of onset- accidental, casual, peer group and offer by elder family members were recorded. The history of cannabis abuse as well as psychiatric illness in other family members was inquired. Results: Majority of the participants were young male adults of the rural background. About 47 % (n-14) of them were unmarried and 60 % (n-18) were belonged to joint family. All the study participants were formally educated and at least one family member of about 43% (n-13) of participants had history of cannabis abuse. As it has been shown in table 2 majority of the study participants were abusing cannabis for more than 10 years with mean duration of cannabis abuse 14.2 years. 50 % of the individuals experienced first cannabis intake before age of 13 years with average onset of cannabis use 14.5 years. Majority of the participants (66%) were daily cannabis abusers. More than 2/3 rd of the subjects was spending Rs. 15 per day on average over the cannabis. Onset of cannabis was occurred mostly due to influence of peer group (n-21). The symptoms that were associated with increased severity in majority of patients were hostility 25 (83%), excitement 23 (77%), and elevated mood, grandiosity, suspiciousness, distractibility and motor hyperactivity in more than 60% of individuals. Other symptoms that were present in severe to very severe form in more than half individuals were hallucinations, unusual thought content, uncooperativeness, and self neglect. Suicidability and tension was absent in 28(93%) of p atients, depression and motor retardation was absent in 25(83%) of participants, guilt was absent in 70% of patients and blunted affect, conceptual disorganization and emotional withdrawal were completely absent in >60% of individual patients. Correlation with duration of cannabis abuse Long duration of abuse was negatively correlated with depression and hostility but other symptoms like suspiciousness, hallucinations, unusual thought content were positively correlated. Duration of cannabis abuse was significantly associated with total BPRS score (p-0.002). Patients with long duration of cannabis were presented with more severe form of psychosis than patients with short duration of cannabis abuse. Correlation with Age of onset of cannabis abuse Older age of onset of cannabis use was significantly associated with depression (p Correlation with frequency of cannabis abuse Frequency of cannabis abuse was significantly associated with self neglect (p-0.007) and tension (p Correlation with amount spent over cannabis The amount spent over cannabis was significantly correlated with anxiety (p-0.030), hallucinations (p-0.001), bizarre behavior (p Discussion: This study was aimed at determining clinical symptoms in relation to variables of cannabis abuse. All subjects were male. This could be attributable to low levels of substance use among females in general and cannabis in particular. Age range was wide and may be due to variation in genetic vulnerability to psychosis, dose of cannabis and duration of illness leading to variable age at presentation. Positive symptoms (motor hyperactivity, excitement, hostility, elevated mood, suspiciousness, grandiosity) were found at higher frequency than negative symptoms (blunted effect, emotional withdrawal and motor retardation). Hallucinations were present in only half of the participants. Other symptoms of the psychosis like conceptual disorganization and catatonic symptoms were absent. Our result was in support of Vani Kulhali and colleagues [23] finding that patients with cannabis associated psychosis had high positive scores (>5) on respective BPRS items were hostility 25 (83%), excitement 23 (77%), and motor hyperactivity, elevated mood, grandiosity, suspiciousness, distractibility in more than 60% of individuals. The least common symptoms were suicidability and tension 2 (6), depression and motor retardation 5 (15%), guilt was present in 30% of patients and blunted affect, conceptual disorganization and emotional withdrawal were completely absent in >60% of individuals. Most studies have reported that cannabis produces psychosis with prominent positive symptoms [16,1718]. Our findings are in keeping with these studies. Scores on BPRS reflected both the total intensity and the profile of psychopathology. Thus our findings largely confirm that reports of other authors that cannabis produces a psychosis with predominantly affective features and more of positive symptoms. Family history of drug disorders is regarded as risk factor for substance use including cannabis, whether it also results in increased vulnerability to cannabis psychosis is not clear. Conclusions The implication of this study is that cannabis contributes in causing and modifying psychosis. Several noteworthy findings emerged from this heterogeneous sample of cannabis associated psychosis. First the severity of psychotic episode was significantly associated with younger age of onset of cannabis abuse and increased spending was associated with more severe psychotic episode. Second family history of psychosis was not associated with increased severity of cannabis abuse, although family history of psychosis predicted more severe excitement, elevated mood and grandiosity and early onset of cannabis abuse. Limitations of the study As this was a cross sectional study and cannabis variables were obtained from interview possibility of â€Å"recall bias† can`t be ruled out. It was not possible to measure the amount of cannabis in unit time. Proxy used to represent this variable may not be representative of active ingredient of delta- 9THC. We have to rely on the subjects `self- report` of not using any other substances and were unable to objectively verify this report. Thus, the possibility that some symptoms were related to abstinence from other drugs cannot be completely excluded. Wide age range could be a drawback of study since homogeneity in duration of illness and amount of cannabis abuse could not be ensured.

Biography of St Thomas Becket Essay -- essays research papers

St Thomas Becket (December 21, 1118 – December 29, 1170) was Archbishop of Canterbury from 1162 to 1170. He engaged in a conflict with King Henry II over the rights and privileges of the Church and was assassinated by followers of the king in Canterbury Cathedral. Life before his consecration Thomas Becket (also known as Thomas à   Becket, although many people consider this incorrect)[1] was born in London sometime between 1115 and 1120, though most authorities agree that he was born December 21, 1118, at Cheapside, to Gilbert of Thierceville, Normandy, and Rosea or Matilda of Caen. His parents were of the upper-middle class near Rouen, and Thomas never knew hardship as a child. One of Thomas's father's rich friends, Richer de L'aigle, was attracted to the sisters of Thomas. He often invited Thomas to his estates in Sussex. There, Thomas learned to ride a horse, hunt, behave, and engage in popular sports such as jousting. When he was 10, Becket received an excellent education in "Civil & Canon Law" at Merton Priory in England, and then overseas at Paris, Bologna, and Auxerre. Richer was later a signer at the Constitution of Clarendon against Thomas. Upon returning to the Kingdom of England, he attracted the notice of Theobald, Archbishop of Canterbury, who entrusted him with several important missions to Rome and finally made him archdeacon of Canterbury and provost of Beverley. He so distinguished himself by his zeal and efficiency that Theobald commended him to King Henry II when the important office of Lord Chancellor was vacant. Henry, like all the Norman kings, desired to be absolute ruler of his dominions, both Church and State, and could find precedents in the traditions of the throne when he planned to do away... ...ve inspired the masonic legend of the death of Hiram Abif. This theory included reference to a company of masons in the City of London making a procession to St Thomas's Chapel on his saint's day. He suggests that they may have been an emblematic performance concerning the death of Thomas on that day. They also supported St Thomas's Hospital which was the headquarters of the Knights of St Thomas, a military order, during the crusades which was very close to the Templars. St Thomas of Canterbury remains the patron saint of Roman Catholic secular clergy. In the Roman Catholic calendar of saints, his annual feast day is 29 December. The Becket Fund for Religious Liberty, a nonprofit, nonpartisan, interfaith, legal and educational institute dedicated to protecting the free expression of all religious traditions, took its inspiration and namesake from Thomas Becket. Biography of St Thomas Becket Essay -- essays research papers St Thomas Becket (December 21, 1118 – December 29, 1170) was Archbishop of Canterbury from 1162 to 1170. He engaged in a conflict with King Henry II over the rights and privileges of the Church and was assassinated by followers of the king in Canterbury Cathedral. Life before his consecration Thomas Becket (also known as Thomas à   Becket, although many people consider this incorrect)[1] was born in London sometime between 1115 and 1120, though most authorities agree that he was born December 21, 1118, at Cheapside, to Gilbert of Thierceville, Normandy, and Rosea or Matilda of Caen. His parents were of the upper-middle class near Rouen, and Thomas never knew hardship as a child. One of Thomas's father's rich friends, Richer de L'aigle, was attracted to the sisters of Thomas. He often invited Thomas to his estates in Sussex. There, Thomas learned to ride a horse, hunt, behave, and engage in popular sports such as jousting. When he was 10, Becket received an excellent education in "Civil & Canon Law" at Merton Priory in England, and then overseas at Paris, Bologna, and Auxerre. Richer was later a signer at the Constitution of Clarendon against Thomas. Upon returning to the Kingdom of England, he attracted the notice of Theobald, Archbishop of Canterbury, who entrusted him with several important missions to Rome and finally made him archdeacon of Canterbury and provost of Beverley. He so distinguished himself by his zeal and efficiency that Theobald commended him to King Henry II when the important office of Lord Chancellor was vacant. Henry, like all the Norman kings, desired to be absolute ruler of his dominions, both Church and State, and could find precedents in the traditions of the throne when he planned to do away... ...ve inspired the masonic legend of the death of Hiram Abif. This theory included reference to a company of masons in the City of London making a procession to St Thomas's Chapel on his saint's day. He suggests that they may have been an emblematic performance concerning the death of Thomas on that day. They also supported St Thomas's Hospital which was the headquarters of the Knights of St Thomas, a military order, during the crusades which was very close to the Templars. St Thomas of Canterbury remains the patron saint of Roman Catholic secular clergy. In the Roman Catholic calendar of saints, his annual feast day is 29 December. The Becket Fund for Religious Liberty, a nonprofit, nonpartisan, interfaith, legal and educational institute dedicated to protecting the free expression of all religious traditions, took its inspiration and namesake from Thomas Becket.

Dietary Reference Values DRVs Essay

Dietary Reference Values (DRVs) Introduction            A balanced diet is very important for one’s body, and is defined as that diet which provides adequate amounts of nutrients and energy for health and well-being. Dietary reference Values are set of nutrient recommendations that are comprised of estimates of the amount of nutrients and energy needed by the population of healthy people in the United Kingdom. There are several uses of these estimates. However, Dietary Reference Values (DRVs) shows some limitations.            The main purpose of DRVs is to guide people other than offering recommendations. For any nation to have healthy people, it should make sure that they are well versed with what they should include in their diets. With DRVs, different groups of people can know what they need to include in their diets. This is a very important factor in the health sector. It reduces medical bills since it ensures that the whole population in healthy and free from diseases. Chronic diseases such as cancer and blood pressure can be avoided if one eats healthy. This means that if middle-aged people follow DRVs, infections of such diseases will go down.            The second use of DRVs is to determine optical amount of nutrients needed in the body. According to a study done by (Ross et. al 2011, pp.55) nutritional requirements vary with age, gender, and physical characteristics of the body. The study points the importance of understanding one’s nutritional requirement. DRVs help people know the optimal amount of nutrients based on their age, gender and body characteristics. For example, DRVs point out that women of child bearing age require more iron than men. If such studies were not available, it would be very hard for one to determine the amount of nutrients required by his/her body. Read more:  Essay About Nutritional Requirements of Individuals            DRVs help people understand particular functions of nutrients in their bodies. This eliminates diseases such as obesity, which is brought about by too much consumption of fats. When people are well informed about the role of nutrients in their bodies, they will always make informed decisions when preparing their meals. Some nutrients are needed in larger quantities while others are needed in small quantities. DRVs state the quantities in grams, milligrams or micrograms. DRVs show that vitamin C is needed in milligram quantities while proteins are needed in gram quantities. This knowledge helps nutritionists to know what a person lacks before administering their prescriptions (Hoey et.al. 2013, pp.105).            DRVs have certain limitations. First, they are complex and can only be interpreted by a health professional. This means that when a lay person is left on his or her own, he/she can take undesirable amounts of nutrients due to misinterpretation of the diet tables, and this is likely to affect that person negatively. It can lead to diseases such as obesity or malnutrition. The other problem associated with DRVs is that some people may view them as recommendations, but in actual sense they are not. DRVs should only be used as guidelines and requires interpretation by professionals. Thus, they function like dietary advice. Population Reference Intake may yield undesirable advice to the population because people are not identical. Thus, having a fixed value for the whole population may mislead some people. People are affected differently by different factors of the environment. When coming up with population reference Intake, individual factors ought to be taken into co nsideration (Manson, 2011, pp.525). References Hoey, L., McNulty, H., Duffy, M. E., Hughes, C. F., & Strain, J. J. (2013), ‘EURRECA—Estimating folate requirements for deriving dietary reference values’, Critical reviews in food science and nutrition, vol.53, no.10, pp.104-105. Manson, J. E., (2011), ‘The 2011 Dietary Reference Intakes for Calcium and Vitamin D: what dietetics practitioners need to know,’ Journal of the American Dietetic Association, vol.111, no.4, pp. 524-527. Ross, A. C., Manson, J. E., Abrams, S. A., Aloia, J. F., Brannon, P. M., Clinton, S. K., †¦ & Shapses, S. A. (2011), ‘The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know’, Journal of Clinical Endocrinology & Metabolism, vol.96. , no.1, pp.53-58. Source document

Essay on Organized Crime Wthin The Unit - 1461 Words

Organized Crime Within the United States Organized crime is a widespread topic of concern among many Americans due to its popularity in the media and entertainment industry. The public is aware of its existence, yet is not fully aware of why and how this complex â€Å"underworld† exists. In order to fully understand this area of criminology, one must take into account the characteristics of organized crime, the variables that allow organized crime to thrive, its large-scale effects on society, and the measures that have been taken to extinguish organized crime. The roots of organized crime can be traced back to periods of vast amounts of immigration within the United States. Many of the immigrants sought wealth and prosperity upon their†¦show more content†¦According to Ianni, there are six types of causal relationships within the networks of organized crime. The first relationship stems from childhood bonds in which the individuals were of the same race and socioeconomic background. The second segue into organized crime comes from the recruitment of talented young boys. There is also a high amount of involvement in organized crime that stems from past prison acquaintances. Although infrequent, the fourth type of causal relationship is with wives and lovers that have been known to take part in organized crime. Next are kinship ties, which are also capable of fostering criminal relationships. The last and most common type of causal relationship is between partners who are in complementary business positions. Ianni contends that the strengths of each of these causal relationships is due to the fact that each is â€Å"marked by a sense of mutual trust in the personal characters of those within the relationship† (Ianni 1998). Although no two groups of organized criminals are exactly alike, many share a common framework and acknowledge one another as suppliers of a demanded â€Å"Mafioso† protection (Nelken 1995). Overall, there are two widely used analogies when analyzing organized crime: the quasi-government analogy and the firm analogy. The quasi-government analogy stems from the fact that â€Å"the core business of criminal