Week 6: Mental Health Final Treatment Plan/Analysis Part 2 Essay

Week 6: Mental Health Final Treatment Plan/Analysis Part 2 Essay

Week 6: Mental Health Final Treatment Plan/Analysis Part 2 Essay

Assignment 6.1 – Mood Disorders Case Part 2

Appraise, Apply, and Educate

Question 1: Does the study address a clearly focused research question?

            The research paper was based on the background knowledge on the increasing use of cannabis products in the management of anxiety and mood disorders, with limited on how effective the product is in the management of such disorders (Botsford et al., 2020). As such, the researchers conducted a study aimed at evaluating the effects of cannabis products on the onset and course of bipolar disorder, depression, post-traumatic stress disorder (PTSD), and anxiety disorders in addition to exploring the therapeutic potential of cannabinoids and cannabis in the management of these disorders. A systematic literature review methodology was utilized in conducting the study, to be able to draw an answer to the research question. The intervention and outcome measures have been clearly outlined, with an appropriate population size of 47 studies.

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Question 2: Did the authors look at the right type of papers?

            The researchersconducted a systematic literature review, looking at longitudinal cohost studies among other randomized controlled trials focusing on the use of cannabis products in the management of mental disorders such as bipolar, PTSD, and anxiety among others (Botsford et al., 2020). A total of 47 studies were utilized for this research, with 32 studies reporting on the onset of the illness, 9 studies focusing on the course of the illness, and 6 studies focusing on cannabinoids therapeutics. The studies were drawn from the PubMed® database, published between the year 1990 to May 2019. All the studies aimed at evaluating cannabis, or cannabinoids as the main intervention.

Question 3: Do you think all the important, relevant studies were included?

            To ensure that only important and relevant studies are included in the research, the PRISMA guidelines for systematic review were used to search for literature on the PubMed® database. Only articles published in English, within a long period, between 1990 and 2018 were considered (Botsford et al., 2020). Appropriate search terms such as cannabis, cannabidiol, tetrahydrocannabinol, cannabinoid, social anxiety, bipolar, post-traumatic stress disorder, and generalized anxiety disorder were used. Looking at the reference list, all the studies were peer-reviewed journal articles which make the information being put across valid and reliable. Consequently, most of the authors of these studies were medical professionals with adequate knowledge in the field. Non-English papers were not considered, in addition to unpublished studies, as a result of a language barrier and lack of reliability and confidence in such literature.

Question 4: Did the review’s authors do enough to assess the quality of the studies?

            Based on the approach outlined in addition to the reference list of the utilized studies, it is clear that the review authors thoroughly assessed the quality of the papers used in this research (Botsford et al., 2020). The authors made sure that all the articles were high quality in terms of the depth and richness of the collected data, appropriate enough in answering the present research question. Other factors considered by the researchers to ensure that only high-quality studies were selected include the scope of the studies, prior knowledge on the study phenomenon, quality of the data, use of an appropriate number of participants, publication year, use of shadowed data, and methodologies utilized. For instance, the research designs used in most of the selected studies include randomized double-blinded trials; case series, open-label, single-dose, retrospective chart review; and randomized control studies.

Question 5: If the results of the review were combined, was it reasonable to do so?

            Out of all the 47 articles utilized in this review, 32 reported finding on the onset of the disorder, whereas only 9 reported finding on the cause of the disease and 6 on the cannabinoid therapeutics (Botsford et al., 2020). Most studies on the course of the illness revealed that cannabis has a negative effect on several disease measures when it comes to bipolar disorder, such as an increase in severity, persistence, and the frequency of psychotic features and manic episodes. Regarding the onset of the disease, most studies reported that continuous use of cannabis among patients who had been exposed to trauma increases the chances of developing PTSD. Results on the therapeutic potentials of cannabinoids were however limited in the management of mood and anxiety disorders. Generally, most studies displayed similar results concerning different outcome measures. Limited variations were however noted among some studies as a result of the difference in the duration of the study period.

Question 6: What are the overall results of the study?

At the end of the literature review, the researchers reported that most literature suggests that the use of cannabis is associated with the onset and poorer cause of disease in PTSD and Bipolar disorders (Botsford et al., 2020). However, the findings were not clear with anxiety disorder and depression. Generally, the findings suggest that it is not clear whether cannabis can be considered an independent risk factor for the onset of anxiety and mood disorders. However, in the case of PTSD, prolonged use of cannabis is associated with increased risks of developing the disease. Consequently, the authors report that cannabis is associated with worsened maniac symptoms among patients with bipolar disorder, with worsened depressive symptoms in PTSD. Despite the available evidence associated with the therapeutic benefits of cannabis in the management of the mental disorder, the authors still feel that more research need to be focused on the same before the intervention can be incorporated into clinical guidelines.

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Question 7: Were all important outcomes considered?

            The data collection process focused on three main measurable outcomes such as the onset of the illness, the therapeutic potential of the drug, and the course of the illness (Botsford et al., 2020). These factors were considered with the use of cannabis among patients with different mental conditions such as depression, PTSD, bipolar, anxiety, depression, and multiple diagnoses. Suicide was the primary outcome, given that it is the most reported limitation associated with the use of cannabis. However, it would have been better if the researcher would have also focused on the exact period of using cannabis to be able to display the above outcomes among patients with mood and anxiety disorders. Consequently, the adverse events displayed by different patients were generalized rather than considering what other factors would have contributed to such outcomes, such as the use of multiple psychotropic agents. This limits the findings of this study, making the result unreliable. More focused research on the use of cannabis must be conducted to display reliable results, which can be used as a point of reference before deciding on whether to adopt the intervention.

Question 8: Can the results be applied to your patient?

From the reference list, it can be noted that all the studies focused on the use of cannabis among participants 17 years of age and above (Botsford et al., 2020). My patient is an adult female with bipolar disorder, just like the participants in most of the reviewed literature. The study findings on the association between the use of cannabis and the onset of bipolar disorder are not consistent, hence irrelevant for my patient. However, regarding the course of the illness, most studies reported that prolonged use of cannabis is associated with increased persistence, frequency, and severity of manic episodes in addition to psychotic features among patients with bipolar disorder. Consequently, the therapeutic potential of cannabis among patients with bipolar disorder has not been clearly defined as a result of limited studies. Hence I cannot consider using this intervention for my patient. Substantial evidence is required to clearly outline the quantity and duration of use, for a patient to be able to realize the above-mentioned negative outcome among patients diagnosed with bipolar disorder.

Question 9: Do the benefits of the experimental intervention (cannabis) outweigh the potential harm it might cause to the patient?

            Other than complementary medicine, my patient has tried the use of calming techniques such as yoga, aquapuncture, massage therapy, and meditation to help reduce anxiety and stress associated with bipolar disorder. These approaches have proven to be beneficial in addition to the use of psychotropic agents such as mood stabilizers. They have limited side effects as compared to the use of pharmacological agents. The use of cannabis has always been an option given that most studies suggest that the drug can help improve symptoms of bipolar disorder such as memory and attention. However, the potential harm associated with the use of cannabis outweighs the benefits. Studies show that the use of cannabis is associated with the development of bipolar disorder at an earlier age, increased frequency and severity of manic episodes, increased incidences of suicidal attempts, and rapid shifts from maniac to depression episodes (Botsford et al., 2020). These side effects are even worse among patients who use cannabis at a young age. For instance, studies show that the use of cannabis before the age of 20 years is associated with a higher probability of attempting suicide as compared to those who use the drug at the age of 30 and above.

Question 10: What is your conclusion about the systematic review? Would you use this systematic review to recommend changes in the patient’s care plan?

            The systemic review by Botsford et al. (2020) has displayed great significance in the development of comprehensive knowledge linking cannabis use and its impact on mental health. It is clear from the review that substance use disorder and/or comorbid substance use in addition to psychosocial factors mediate the relationship between mental health and the use of cannabis. In most studies, the initial significance on the use of cannabis among patients with mental disorders was lost the moment confounding variables were adjusted appropriately. Such variables are patient-related factors such as the use of cannabis below the age of 20 years, and prior use of the drug before the medical diagnosis. Consequently, medication-related factors such as the type of mental disorder the patient is suffering from, in addition to the quantity, frequency, and duration of cannabis use have a great impact on the effect of the drug on the patient. However, the review encountered several limitations such as few studies focusing on the use of cannabis among patients with mood and anxiety disorders in addition to a lack of substantial evidence supporting the benefits of the therapeutic approach. As the review can only be utilized to create background knowledge and promote future research on the association between cannabis use and mental health but does not provide substantial evidence that can be used to modify the patient’s care plan.

Question 11: If you decide to recommend medical cannabis, recommend a cannabinoid, formulation, and dosing strategy. Include a rationale for your choice of therapy and cite resources supporting your decision.

            According to previous studies, the most recommended formulation of cannabis for adult patients with bipolar disorder is CBD oil. The patient is expected to start with small doses such as one drop of about 0.05 milliliters (mL) once a day containing 5 mg of CBD. The dose will be titrated depending on the treatment outcome, among other factors such as the patient’s weight to a stable dose of about 20 mg in the management of manic episodes (Botsford et al., 2020). However, the product is not regulated by the FDA, hence it is upon the patient to be able to ensure that they can acquire high-quality products to experience the therapeutic benefits. A study conducted by the Center for Disease Control and Prevention (CDC) in 2018 reported that some synthetic products containing CBD are associated with adverse drug reactions, hence the patient needs to ensure that they only acquire products with information about the manufacturer and the ingredients contained (Ferber et al., 2020). Other than the disadvantages, CBD is associated with improved sleep and reduced depression and anxiety, hence beneficial to patients with bipolar disorder.

Question 12: Use patient-friendly terms to educate the patient about what is known about cannabis for the treatment of this disease state. Provide a short (5 – 10 sentence) summary about the evidence. 

            Limited evidence is available supporting the use of cannabis in the management of bipolar. However, studies show that cannabis has anxiety-relieving effect, hence considered beneficial among patients with bipolar disorder, to help improve their mood. Several studieshave reported no harmful and beneficial effects of cannabis such as better mood and low mental impairment, positive outlook, improved sleep, stress reduction, and improved memory (Stanciu et al., 2021). However, other studies have reported negative findings regarding the use of cannabis among patients with bipolar disorder. Such negative findingsinclude worsening of symptoms, initiating maniac episodes, and increased incidences of suicidal attempts (Scherma et al., 2020). Generally, there is still no substantial evidence clearly defining whether the use of marijuana in the management of bipolar disorder is good or bad.

References

Botsford, S. L., Yang, S., & George, T. P. (2020). Cannabis and cannabinoids in mood and anxiety disorders: impact on illness onset and course, and assessment of therapeutic potential. The American journal on addictions, 29(1), 9-26.https://doi.org/10.1111/ajad.12963

Ferber, S. G., Namdar, D., Hen-Shoval, D., Eger, G., Koltai, H., Shoval, G., … & Weller, A. (2020). The “entourage effect”: terpenes coupled with cannabinoids for the treatment of mood disorders and anxiety disorders. Current Neuropharmacology, 18(2), 87-96.https://doi.org/10.2174/1570159X17666190903103923

Scherma, M., Muntoni, A. L., Riedel, G., Fratta, W., & Fadda, P. (2020). Cannabinoids and their therapeutic applications in mental disorders. Dialogues in Clinical Neuroscience, 22(3), 271. https://doi.org/10.31887/DCNS.2020.22.3/pfadda

Stanciu, C. N., Brunette, M. F., Teja, N., & Budney, A. J. (2021). Evidence for use of cannabinoids in mood disorders, anxiety disorders, and PTSD: a systematic review. Psychiatric Services, 72(4), 429-436. https://doi.org/10.1176/appi.ps.202000189

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 You will appraise a systematic review, Cannabis and Cannabinoids in Mood and Anxiety Disorder – Onset Course and Assessment of Potential.pdf , using the CASP Systematic Review Checklist.
This review focuses on the effects of cannabis and cannabinoids on the onset, course, and treatment of depression, bipolar disorder, anxiety disorders, and PTSD.
When evaluating the systematic review focus on outcomes related to the treatment options for patients with bipolar disorder because this is what is affecting Barbara. You should already be well versed on cannabinoids for the treatment of anxiety from Module 3 on Anxiety.
Click Assignment 6.1 – Mood Disorders Case Part 2 – Appraise Apply and Educate (1).docx to download the worksheet
Submit your assignment by clicking on Assignment 6.1 – Mood Disorders Part 2 – Appraise, Apply, and Educate and attach your file