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Edition, Text Revision (American Psychiatric Association,
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The movement to legalize marijuana for medical use in the United States has renewed discussion about how this drug affects the brain, and whether it might be useful in treating psychiatric disorders.
Unfortunately, most of the research on marijuana is based on people who smoked the drug for recreational rather than medical purposes. A review by researchers in Canada (where medical marijuana is legal) identified only 31 studies (23 randomized controlled trials and eight observational studies) specifically focused on medical benefits of the drug.
A separate review by the American Medical Association (AMA) also concluded that the research base remains sparse. This was one reason that the AMA urged the federal government to reconsider its classification of marijuana as a Schedule 1 controlled substance (prohibiting both medical and recreational use), so that researchers could more easily conduct clinical trials.
Consensus exists that marijuana may be helpful in treating certain carefully defined medical conditions. In its comprehensive 1999 review, for example, the Institute of Medicine (IOM) concluded that marijuana may be modestly effective for pain relief (particularly nerve pain), appetite stimulation for people with AIDS wasting syndrome, and control of chemotherapy-related nausea and vomiting.
Given the availability of FDA-approved medications for these conditions, however, the IOM advised that marijuana be considered as a treatment only when patients don't get enough relief from currently available drugs. Additional research since then has confirmed the IOM's core findings and recommendations.
Although anecdotal reports abound, few randomized controlled studies support the use of medical marijuana for psychiatric conditions. The meager evidence for benefits must be weighed against the much better documented risks, particularly for young people who use marijuana.
Researchers have long disagreed about whether gastrointestinal
problems may underlie some symptoms of autism spectrum disorders
(ASDs). This has not stopped some researchers and celebrities from
promoting theories and special "autism diets" with no scientific
support. Yet these unfounded recommendations might appeal to
grieving and vulnerable parents who are heartbroken about a child's
sudden developmental regression.
In an effort to provide guidance for clinicians, parents, and
patients, a multidisciplinary panel has published the first
consensus report about gastrointestinal problems in individuals
with ASDs. A companion report provides detailed advice about
diagnosing and treating the most common problems.
Major depression is the most common type of mood disorder in the
United States, affecting about 15 million American adults (almost
7% of the population) in a typical year. For many of those
affected, symptoms are mild or moderate. One nationally
representative survey of Americans with depression, for example,
found that symptoms were mild in 20% of people, moderate in 50%,
and severe in 30%.
A meta-analysis adds to the growing evidence that antidepressants
work best for people with severe symptoms of depression, as we've
reported before. But this latest study provides a reminder that for
patients newly diagnosed with milder forms of depression, it may
make sense to try psychotherapy, exercise, and other nondrug
People who sustain serious and painful physical injuries are at
increased risk of developing post-traumatic stress disorder (PTSD).
A study of U.S. soldiers injured in Iraq — confirming the findings
of two earlier studies — suggests that those who receive morphine
for pain relief have a lower risk of developing PTSD later on.
All of these studies were observational and cannot prove cause and
effect. They also cannot answer crucial questions about the drug's
mechanism of action or whether the results are applicable to other
types of people at risk for PTSD (such as those who suffer an
emotional rather than physical trauma). An editorial accompanying
the most recent study noted, however, that together these studies
suggest that alleviating pain with morphine might help lower risk
A survey of clinicians found that the language used to describe a
person with an addiction problem affected the respondents'
attitude about the person.
Another potential treatment for Alzheimer's disease failed in a
randomized trial to perform better than a placebo.
My daughter has schizophrenia. The psychiatrist at her mental
health center prescribed an antipsychotic. I know some of these
drugs increase risk of diabetes and heart disease. What sort of
clinical monitoring do you advise?
My son always seems to be in trouble at school. His elementary
school teacher told me she thinks he has sensory processing
disorder. What is that?