Introduction- Cannabis use disorders are global emerging problem nowadays, with high prevalence and morbidity. Though cognitive impairments are one of the most replicated findings in individuals with cannabis dependence, but there are very few studies assessed cognitive functioning as a risk factor for cannabis use disorder. In this study, we assessed cognitive functioning as an endophenotype in cannabis use disorders. Methodology- In this study comparison of cognitive functioning was done among three groups- patients with cannabis dependence syndrome, their first degree relative (FDR) and normal healthy controls (HC). Each group included 30 participants. Individuals of all three groups were assessed in domains of complex attention, executive functions, language, learning and memory and perceptual-motor. Results- Performance of patients with cannabis dependence was impaired in attention, verbal memory, executive functions compared to both other groups. Attention, semantic verbal fluency and memory were found to be an endophenotype as both patient and FDR group performed poorly than HC group. Verbal memory was impaired in patients’ group compared to group of first-degree relatives, whose performance in-turn impaired than normal healthy controls. Performances of verbal and visual memory were correlated positively with age of onset and negatively with frequency of cannabis intake. Age of first-degree relatives was inversely correlated with verbal memory. Conclusion- Performance of individuals with cannabis dependence was impaired than normal healthy controls in all domains of cognitive functioning. As per definition, verbal memory could be considered as an endophenotype marker in cannabis use disorders.
Aim: Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment to determine common trajectories of care. Methods: We collected health record data for all individuals treated by early intervention teams in two NHS mental health trusts in England. We collected data on individuals’ primary mental health care provider for 52 weeks after the end of their treatment and calculated common trajectories of care using sequence analysis. Results: We identified 2224 eligible individuals. For those discharged to primary care we identified four common trajectories: Stable Primary Care, Relapse and return to CMHT, Relapse and return to EIP, and Discontinuity of Care. We also identified four trajectories for those transferred to alternative secondary mental health care: Stable Secondary Care, Relapsing Secondary Care, Long-term Inpatient, and Discharged Early. The Long-term Inpatient trajectory (1% of sample) accounted for 29% of all inpatient days in the year follow-up, with Relapsing Secondary Care (2% of sample and 21% of inpatient days), and Relapse and return to CMHT (5% of sample, 15% of inpatient days) the second and third most frequent. Conclusions: Individuals have common care pathways at the end of early intervention in psychosis treatment. Understanding common individual and service features that lead to poor care pathways could improve care and reduce hospital use.
Aims: Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Incorporating Information and Communication Technologies (ICT) has improved the information patients receive and the relationship between health professionals and patients. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. Methods: A cross-sectional quantitative study was carried out by experts in psychosis and technologies. 41 patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. Results: An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. Conclusions: Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.