Cognitive behavioral therapy program for cannabis use cessation in first-episode psychosis patients: study protocol for a randomized controlled trial

Itxaso González-Ortega, Enrique Echeburúa, Adriana García-Alocén, Patricia Vega, Ana González-Pinto, Itxaso González-Ortega, Enrique Echeburúa, Adriana García-Alocén, Patricia Vega, Ana González-Pinto

Abstract

Background: The high rate of cannabis use among patients with first-episode psychosis (FEP), as well as the associated negative impact on illness course and treatment outcomes, underlines the need for effective interventions in these populations. However, to date, there have been few clinical treatment trials (of pharmacological or psychological interventions) that have specifically focused on addressing comorbid cannabis use among these patients. The aim of this paper is to describe the design of a study protocol for a randomized controlled trial in which the objective is to assess the efficacy of a specific cognitive behavioral therapy program for cannabis cessation in patients with FEP compared to standard treatment (psychoeducation).

Methods/design: This is a single-blind randomized study with 1 year of follow-up. Patients are to be randomly assigned to one of two treatments: (1) specific cognitive behavioral therapy for cannabis cessation composed of 1-hour sessions once a week for 16 weeks, in addition to pharmacological treatment scheduled by the psychiatrist, or (2) a control group (psychoeducation + pharmacological treatment) following the same format as the experimental group. Participants in both groups will be evaluated at baseline (pre-treatment), at 16 weeks (post-treatment), and at 3 and 6 months and 1 year of follow-up. The primary outcome will be that patients in the experimental group will have greater cannabis cessation than patients in the control group at post-treatment. The secondary outcome will be that the experimental group will have better clinical and functional outcomes than the control group.

Discussion: This study provides the description of a clinical trial design based on specific cognitive behavioral therapy for cannabis cessation in FEP patients, aiming to improve clinical and functional outcome, as well as tackling the addictive disorder.

Trial registration: NCT02319746 ClinicalTrials.gov Identifier. ClinicalTrials.gov Protocol and Results Registration System (PRS) Receipt Release Date: 15 December 2014.

Keywords: Cannabis; First-episode psychosis; Psychological treatment.

Figures

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Fig. 1
Study procedure

References

    1. Baeza I, Graell M, Moreno D, Castro-Fornieles J, Parellada M, González-Pinto A, Payá B, Soutullo C, de la Serna E, Arango C. Cannabis use in children and adolescents with first episode psychosis: influence on psychopathology and short-term outcome (CAFEPS study) Schizophr Res. 2009;113:129–37. doi: 10.1016/j.schres.2009.04.005.
    1. Schimmelmann BG, Conus P, Cotton S, Kupferschmid S, McGorry PD, Lambert M. Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis. Eur Psychiatry. 2012;27:463–9. doi: 10.1016/j.eurpsy.2011.03.001.
    1. Bagot KS, Milin R, Kaminer Y. Adolescent initiation of cannabis use and early-onset psychosis, substance abuse. 2015. 16:0. [Epub ahead of print].
    1. Donoghue K, Doody GA, Murray RM, Jones PB, Morgan C, Dazzan P, et al. Cannabis use, gender and age of onset of schizophrenia: Data from the ÆSOP study. Psychiatry Res. 2014;215:528–32. doi: 10.1016/j.psychres.2013.12.038.
    1. van der Meer FJ, Velthorst E, Meijer CJ, Machielsen MWJ, de Haan L. Cannabis use in patients at clinical high risk of psychosis: impact on prodromal symptoms and transition to psychosis. Curr Pharm Des. 2012;18:5036–44. doi: 10.2174/138161212802884762.
    1. González-Pinto A, Vega P, Ibañez B, Mosquera F, Barbeito S, Gutierrez M, et al. Impact of cannabis and other drugs on age at onset psychosis. J Clin Psychiatry. 2008;69:1210–16. doi: 10.4088/JCP.v69n0802.
    1. Stone JM, Fisher HL, Major B, Chisholm B, Woolley J, Lawrence J, et al. Cannabis use and first episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation. Psychol Med. 2014;44:499–506. doi: 10.1017/S0033291713000883.
    1. Tosato S, Lasalvia A, Bonetto C, Mazzoncini R, Cristofalo D, De Santi K, PICOS-VENETO GROUP et al. The impact of cannabis use on age of onset and clinical characteristics in first-episode psychotic patients. Data from the Psychosis Incident Cohort Outcome Study (PICOS) J Psychiatric Res. 2013;47:438–44. doi: 10.1016/j.jpsychires.2012.11.009.
    1. Large M, Sharma S, Compton MT, Slade T, Nielssen O. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch Gen Psychiatry. 2011;68:555–61. doi: 10.1001/archgenpsychiatry.2011.5.
    1. Dragt S, Nieman DH, Becker HE, van de Fliert R, Dingemans PM, de Haan L, et al. Age of onset of cannabis use is associated with age of onset of high-risk symptoms for psychosis. Can J Psychiatry. 2010;55:165–71.
    1. Dragt S, Nieman DH, Schultze-Lutter F, van der Meer F, Becker H, de Haan L, EPOS group et al. Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand. 2012;125:45–53. doi: 10.1111/j.1600-0447.2011.01763.x.
    1. Di Forti M, Sallis H, Allegri F, Trotta A, Ferraro L, Stilo SA, et al. Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophr Bull. 2014;40:1509–17. doi: 10.1093/schbul/sbt181.
    1. Leweke FM, Giuffrida A, Koethe D, Schreiber D, Nolden BM, Kranaster L, et al. Anandamide levels in cerebrospinal fluid of first-episode schizophrenic patients: impact of cannabis use. Schizophr Res. 2007;94:29–36. doi: 10.1016/j.schres.2007.04.025.
    1. Bangalore SS, Prasad KM, Montrose DM, Goradia DD, Diwadkar VA, Keshavan MS. Cannabis use and brain structural alterations in first episode schizophrenia—a region of interest, voxel based morphometric study. Schizophr Res. 2008;99:1–6. doi: 10.1016/j.schres.2007.11.029.
    1. Ho BC, Wassink TH, Ziebell S, Andreasen NC. Cannabinoid receptor 1 gene polymorphisms and marijuana misuse interactions on white matter and cognitive deficits in schizophrenia. Schizophr Res. 2011;128:66–75. doi: 10.1016/j.schres.2011.02.021.
    1. Zoppi S, Perez- Nievas BG, Madrigal JL, Manzanares J, Leza JC, García-Bueno B. Regulatory role of cannabinoid receptor 1 in stress-induced excitotoxicity and neuroinflammation. Neuropsychopharmacology. 2011;36:805–18. doi: 10.1038/npp.2010.214.
    1. Eggan SM, Hashimoto T, Lewis DA. Reduced cortical cannabinoid 1 receptor messenger RNA and protein expression in schizophrenia. Arch Gen Psychiatry. 2008;65:772–84. doi: 10.1001/archpsyc.65.7.772.
    1. Ishiguro H, Horiuchi Y, Ishikawa M, Koga M, Imai K, Suzuki Y, et al. Brain cannabinoid CB2 receptor in schizophrenia. Biol Psychiatry. 2010;67:974–82. doi: 10.1016/j.biopsych.2009.09.024.
    1. De Marchi N, De Petrocellis L, Orlando P, Daniele F, Fezza F, Di Marzo V. Endocannabinoid signalling in the blood of patients with schizophrenia. Lipids Health Dis. 2003;2:5. doi: 10.1186/1476-511X-2-5.
    1. Giuffrida A, Leweke FM, Gerth CW, Schreiber D, Koethe D, Faulhaber J, et al. Cerebrospinal anandamide levels are elevated in acute schizophrenia and are inversely correlated with psychotic symptoms. Neuropsychopharmacology. 2004;29:2108–14. doi: 10.1038/sj.npp.1300558.
    1. González-Pinto A, Alberich S, Barbeito S, Gutierrez M, Vega P, Ibáñez B, et al. Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophr Bull. 2011;37:631–39. doi: 10.1093/schbul/sbp126.
    1. Clausen L, Hjorthoj CR, Thorup A, Jeppesen P, Petersen L, Bertelsen M, et al. Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial. Psychol Med. 2014;44:117–26. doi: 10.1017/S0033291713000433.
    1. Faridi K, Joober R, Malla A. Medication adherence mediates the impact of sustained cannabis use on symptom levels in first-episode psychosis. Schizoph Res. 2012;141:78–82. doi: 10.1016/j.schres.2012.07.023.
    1. van Dijk D, Koeter MW, Hijman R, Kahn RS, van den Brink W. Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Schizoph Res. 2012;137:50–7. doi: 10.1016/j.schres.2012.01.016.
    1. Bahorik AL, Newhill CE, Eack SM. Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization. Addiction. 2013;108:1259–69. doi: 10.1111/add.12153.
    1. Faber G, Smid HG, Van Gool AR, Wunderink L, van den Bosch RJ, Wiersma D. Continued cannabis use and outcome in first-episode psychosis: data from a randomized, open-label, controlled trial. J Clin Psychiatry. 2012;73:632–38. doi: 10.4088/JCP.11m07069.
    1. González-Blanch C, Gleeson JF, Koval P, Cotton SM, McGorry PD, Alvarez-Jimenez M. Social functioning trajectories of young first-episode psychosis patients with and without cannabis misuse: A 30-month follow-up study. PLoS ONE. 2015;10(4):e0122404. doi: 10.1371/journal.pone.0122404.
    1. Lambert M, Conus P, Lubman DI, Wade D, Yuen H, Moritz S, et al. The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatr Scand. 2005;112:141–48. doi: 10.1111/j.1600-0447.2005.00554.x.
    1. Ruiz de Azúa García S, González-Pinto Arrillaga A, Vega Pérez P, Gutíerrez Fraile M, Asua Batarrita J. Revisión de los tratamientos psicológicos en primeros episodios psicóticos. Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad y Política Social Servicio de Evaluación de Tecnologías Sanitarias del País Vasco 2009. Report of the Basque Office for Health Technology Assessment. (OSTEBA) No. 2007/08.
    1. Lecardeur L. Cognitive behavioral therapy after first episodes psychosis. Encephale. 2013;39:115–20. doi: 10.1016/S0013-7006(13)70106-4.
    1. Bonsack C, Gibellini S, Favrod J, Montagrin Y, Besson J, Bovet P, et al. Motivational intervention to reduce cannabis use in young people with psychosis: a randomized controlled trial. Psychother Psychosom. 2011;80:287–97. doi: 10.1159/000323466.
    1. Edwards J, Elkins K, Hinton M, Harrigan SM, Donovan K, Athanasopoulos O, et al. Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis. Acta Psychiatr Scand. 2006;114:109–17. doi: 10.1111/j.1600-0447.2006.00783.x.
    1. Hjorthøj CR, Fohlmann A, Larsen AM, Arendt M, Nordentoft M. 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. 2012a;107:1123–31.
    1. Madigan K, Brennan D, Lawlor E, Turner N, Kinsella A, O’Connor JJ, et al. A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness. Schizophr Res. 2013;143:138–42. doi: 10.1016/j.schres.2012.10.018.
    1. Barrowclough C, Marshall M, Gregg L, Fitzsimmons M, Tomenson B, Warburton J, et al. A phase-specific psychological therapy for people with problematic cannabis use following a first episode of psychosis: a randomized controlled trial. Psychol Med. 2014;44:2749–61. doi: 10.1017/S0033291714000208.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., (text rev.). Washington, DC: American Psychiatric Association; 2000.
    1. Kokkevi A, Hartgers C. EUROP-ASI: European adaptation of a multidimensional assessment instrument for drug and alcohol dependence. Eur Addict Res. 2015;1:208–10. doi: 10.1159/000259089.
    1. Bobes J, González MP, Sáiz PA, Bousoño M. Índice europeo de la severidad de la adicción: EuropASI. Versión española, Actas de la IV Reunión Interregional de Psiquiatría. 1996. pp. 201–18.
    1. Bashford J, Ross F, Copeland Jan. The Cannabis Use Problems Identification Test (CUPIT): development, reliability, concurrent and predictive validity among adolescents and adults. Addiction. 2010;105:615-25.
    1. Gerevich J, Bacskai E, Rozsa S. Hungarian adaptation of the European Addiction Severity Index. J Subst Use. 2004;9:185–91. doi: 10.1080/14659890410001697442.
    1. Jozsef R, Csilla P, Nauszika MA. The reliability and validity testing of the Hungarian version of the EuropASI. Magyar Psichologiai Szemle. 2002;57:587–603. doi: 10.1556/MPSzle.57.2002.4.4.
    1. Lauritzen G, Ravndal E. Introduction of the EuropASI in Norway: clinical and research experiences from a cost-effectiveness study. J Subst Use. 2004;9:141–6. doi: 10.1080/14659890410001697415.
    1. Weiler D, Vogt M, Kufner H. Anwendung des European Addiction Severity Index (EuropASI) im Rahmen einer ambulanten Behandlung von Drogenabhängigen. Zeistchrift fur Wissenschaft und Praxis. 2000;46:197–208. doi: 10.1024/suc.2000.46.3.197.
    1. Scheurich A, Muller MJ, Wetzel H, Anghelescu I, Klawe C, Ruppe A, et al. Reliability and validity of the German version of the European Addiction Severity Index (EuropASI) J Stud Alcohol. 2000;61:916–9. doi: 10.15288/jsa.2000.61.916.
    1. First MB, Spitzer R, Gibbon M. Structured Clinical Interview for DSM-IV. Axis I Disorders. Washington DC: American Psychiatric Press Inc; 1997.
    1. Guy W. ECDEU assessment manual for psychopharmacology revised. Rockville: Department of Health, Education and Welfare; 1976.
    1. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993;150:873–79. doi: 10.1176/ajp.150.6.873.
    1. Ruiz A, Pousa E, Duñó R, Crosas J, Cuppa S, García C. Spanish adaptation of the Scale to Assess Unawareness of Mental Disorder (SUMD) Actas Esp Psiquiatr. 2008;36:1191–98.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74. doi: 10.1097/00005650-198601000-00007.
    1. Val A, Amorós G, Martínez P, Fernández ML, León M. Descriptive study of patient compliance in pharmacologic antihypertensive treatment and validation of the Morisky and Green test [in Spanish] Aten Primaria. 1992;10:767–70.
    1. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizoph Bull. 1987;13:261–76. doi: 10.1093/schbul/13.2.261.
    1. Peralta-Martin V, Cuesta-Zorita MJ. Validation of Positive and Negative Symptom Scale (PANSS) in a sample of Spanish schizophrenic patients. Actas Luso-Esp Neurol, Psiquiatr Cienc Afines. 1994;22:171–77.
    1. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–96. doi: 10.1111/j.2044-8260.1967.tb00530.x.
    1. Ramos-Brieva JCA. Validación de la versión castellana de la escala de Hamilton para la depresión. Actas Luso-Esp Neurol, Psiquiatr Cienc Afines. 1986;14:324–34.
    1. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatr. 1978;1:429–35. doi: 10.1192/bjp.133.5.429.
    1. Colom F, Vieta E, Martínez-Arán A, García-García M, Reinares M, Torrent C, Goikolea JM, Banús S, Salamero S. Versión española de una escala de evaluación de la manía: validez y fiabilidad de la Escala de Young. Med Clin (Barc) 2002;119:366–71. doi: 10.1016/S0025-7753(02)73419-2.
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5. doi: 10.1111/j.2044-8341.1959.tb00467.x.
    1. Lobo A, Chamorro L. Validación de las versiones en español de la Montgomery-Asberg Depression Rating Scale y la Hamilton Anxiety Rating Scale para la evaluación de la depresión y de la ansiedad. Med Clin (Barc) 2002;118:493–9. doi: 10.1016/S0025-7753(02)72429-9.
    1. Rosa AR, Sánchez-Moreno J, Martıínez-Aran A, Salamero M, Torrent C, Reinares M, Comes M, Colom F, Van Riel W, Ayuso-Mateos JL, Kapczinski F, Vieta E. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3:5. doi: 10.1186/1745-0179-3-5.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: Erlbaum; 1988.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2. New York: Guilford Press; 2002.
    1. Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, Heather N, editors. Addictive behaviors: processes of change. New York: Plenum Press; 1986. pp. 3–28.

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