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Acute Mental Health Symptoms in Adolescent Marijuana Users

Educational Objective To review mental health symptoms observed in Adolescent Marijuana Users.
1 Credit CME

Marijuana use is associated with acute psychotic symptoms,1 but the prevalence of these symptoms in youth is not known, to our knowledge. We surveyed adolescents presenting for routine medical care to assess whether they had experienced acute psychotic symptoms during or right after marijuana use.

We analyzed data from a survey of health and substance use that was administered to a convenience sample of youths aged 14 to 18 years presenting for routine care; 1235 patients were approached and 527 consented for a response rate of 42.7%. Youths were enrolled with a waiver of parental consent under the approval of the Boston Children’s Hospital Institutional Review Board. Measures included 2 questions about acute psychotic symptoms (“In the past 12 months, how often have you felt anxious or paranoid during or after using marijuana?” and, “In the past 12 months, how often have you seen, felt, or heard things that were not really there [ie, hallucinations] during or after using marijuana?”) and standardized questions about symptoms of cannabis use disorder (based on the modified World Mental Health Composite International Diagnostic Interview),2 anxiety (based on the 2-item Generalized Anxiety Disorder scale),3 and depression (based on the Patient Health Questionnaire 2)4 and sociodemographic characteristics. One hundred forty-six respondents who affirmed past-year marijuana use and had complete data for measures of interest were included in the analysis.

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Article Information

Accepted for Publication: September 1, 2018.

Corresponding Author: Sharon Levy, MD, MPH, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (sharon.levy@childrens.harvard.edu).

Published Online: December 17, 2018. doi:10.1001/jamapediatrics.2018.3811

Author Contributions: Both authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Weitzman.

Obtained funding: Both authors.

Administrative, technical, or material support: Levy.

Supervision: Levy.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by grant CNF20140273 from the Conrad N. Hilton Foundation.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Murray  RM, Englund  A, Abi-Dargham  A,  et al.  Cannabis-associated psychosis: neural substrate and clinical impact.  Neuropharmacology. 2017;124:89-104. doi:10.1016/j.neuropharm.2017.06.018PubMedGoogle ScholarCrossref
2.
McNeely  J, Wu  L-T, Subramaniam  G,  et al.  Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for substance use screening in primary care patients.  Ann Intern Med. 2016;165(10):690-699. doi:10.7326/M16-0317. doi:10.7326/M16-0317PubMedGoogle ScholarCrossref
3.
Skapinakis  P.  The 2-item Generalized Anxiety Disorder scale had high sensitivity and specificity for detecting GAD in primary care.  Evid Based Med. 2007;12(5):149. doi:10.1136/ebm.12.5.149PubMedGoogle ScholarCrossref
4.
Kroenke  K, Spitzer  RL, Williams  JBW.  The Patient Health Questionnaire–2: validity of a two-item depression screener.  Med Care. 2003;41(11):1284-1292. doi:10.1097/01.MLR.0000093487.78664.3CPubMedGoogle ScholarCrossref
5.
Johnston  L, O’Malley  P, Miech  R, Bachman  J, Schulenberg  J. Overview, key findings on adolescent drug use. 2017. http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2016.pdf. Published January 2017. Accessed July 27, 2017.
6.
Moore  THM, Zammit  S, Lingford-Hughes  A,  et al.  Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.  Lancet. 2007;370(9584):319-328. doi:10.1016/S0140-6736(07)61162-3PubMedGoogle ScholarCrossref
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