药用大麻对心理健康的不同影响：一项系统综述

IF 13.7 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review Pub Date : 2025-03-29 DOI:10.1016/j.cpr.2025.102581

Nora de Bode , Emese Kroon , Sharon R. Sznitman , Janna Cousijn

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引用次数: 0

摘要

在全球范围内，无论是在临床环境中还是通过自我药疗，越来越多地使用医用大麻来改善精神健康。这涉及到含有∆9-四氢大麻酚（THC）、大麻二酚（CBD）、THC + CBD组合或衍生物的各种产品。本综述提供了药用大麻对精神健康诊断和精神疾病诊断与统计手册第5版相关症状的积极和消极影响的最新概述。在PubMed， PsycInfo， Embase和Cochrane Library（2023年10月和2024年7月）中检索了18,341项研究，其中包括来自15个不同国家的49项对照研究。所有的研究都集中在寻求治疗的参与者使用药用大麻来诊断他们的心理健康（症状）。诊断包括焦虑症、抽动障碍、自闭症谱系障碍、注意力缺陷多动障碍、强迫症、神经性厌食症、精神分裂症、精神病、物质使用障碍、失眠和双相情感障碍。不同的产品成分表现出不同的效果。最一致的是，在高剂量CBD之后，焦虑得到了一些急性缓解，而CBD + THC组合缓解了大麻使用障碍的戒断症状，并改善了睡眠。在临床试验中，四氢大麻酚与剂量依赖性不良事件最相关，在某些情况下，与主要研究结果的恶化有关，例如精神病。在自然主义研究中，使用四氢大麻酚的参与者报告使用后症状有所改善。研究的偏倚风险普遍存在，没有研究发现持久的药物效果或改善。总的来说，药用大麻可以短期缓解某些症状，但不能治愈或没有精神健康风险。

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The differential effects of medicinal cannabis on mental health: A systematic review

The use of medicinal cannabis to improve mental health is increasing globally, both in clinical settings and through self-medication. This involves a variety of products containing ∆9-tetrahydrocannabinol (THC), cannabidiol (CBD), THC + CBD combinations, or derivatives. This review provides an up-to-date overview of the positive and negative effects of medicinal cannabis on mental health diagnoses and related symptoms of the Diagnostic and Statistical Manual of Mental Disorders 5th Edition. Searches in PubMed, PsycInfo, Embase, and the Cochrane Library (October 2023 and July 2024) identified 18,341 studies, of which 49 controlled studies from 15 different countries were included. All studies focused on treatment-seeking participants using medicinal cannabis for (symptoms of) their mental health diagnosis. Included diagnoses were anxiety disorders, tic disorders, autism spectrum disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorders, anorexia nervosa, schizophrenia, psychosis, substance use disorders, insomnia, and bipolar disorders. Varying product compositions showed different effects. Most consistently, high doses of CBD were followed by some acute relief in anxiety, while CBD + THC combinations alleviated withdrawal in cannabis use disorder and improved sleep. In clinical trials, THC was associated most with dose-dependent adverse events and, in some cases, deterioration of primary study outcomes, e.g., in psychosis. In naturalistic studies, participants who used THC reported symptom improvement following usage. Risks of bias across studies were prevalent, and no study found long-lasting medicinal effects or improvement. Overall, medicinal cannabis may provide short-term relief for certain symptoms but is not a cure or without mental health risks.

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来源期刊

Clinical Psychology Review PSYCHOLOGY, CLINICAL-

CiteScore

23.10

自引率

1.60%

发文量

期刊介绍： Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology. While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.