PBG GLOBAL

Schizophrenia

Schizophrenia is a chronic mental health disorder characterized by an array of symptoms. These symptoms can be classified as positive (delusions, hallucinations), negative (disorganized speech, emotional flattening), or symptoms of cognitive impairment (affecting attention, working memory, executive function) [1]. There is no consensus on what causes schizophrenia, or even how it should be diagnosed [2],[3]. The disorder seems to occur due to mainly (>80%) genetic factors and gene-environment interactions, with urbanicity, male gender, and a history of migration being defined as risk factors [4].

The treatment goals for schizophrenia are to target symptoms, prevent relapse, and increase adaptive functioning to integrate the patient back into the community. This is primarily achieved through pharmacotherapy, but psychotherapy can also be crucial [5]. The current approved medications for schizophrenia are effective in treating positive symptoms, but unfortunately fail to treat negative and cognitive symptoms, often accompanied by extrapyramidal side effects, making the overall management of the disorder challenging [6],[7].

CBD and Schizophrenia

Evidence suggests that the ECS contributes to the pathophysiology of schizophrenia [8],[9], so a substance that modulates the ECS could be helpful in treatment. Randomized doubleblind clinical trials involving patients with schizophrenia suggest that CBD may have antipsychotic properties [11],[12],[13]. One study showed that CBD is just as effective as the well-known antipsychotic drug Amisulpride, but without adverse side effects. Another study was performed with individuals belonging to the so-called Clinical High-Risk state for Psychosis (CHR-P) group. In this study, CBD normalized brain function in regions known to be modified in schizophrenia, while those who didn’t receive CBD continued to show abnormal activation in the same brain regions [14]. These findings hint that CBD could be used for the prevention and/or early-stage treatment for high-risk individuals. Unlike most antipsychotic drugs, CBD does not act on dopamine receptors. This opens the possibility for CBD to pave the way to a new treatment group.

Dosing recommendations for schizophrenia

Is CBD safe?

Yes. CBD is considered safe for schizophrenia.

What is the recommended daily dose?

Start with 1 mg/kg/day and titrate to effect - as high as 7.5 mg/kg/day. For higher doses, consult with your doctor. Read General recommendations!

Should I take it before or after a meal?

CBD should be taken during, or after a meal.

How many times a day should I take CBD?

Take your dose twice a day. Half of it in the morning and the other half in the evening.

Are there any known drug interactions?

Some. Read Side effects for more information.

Bibliography

1. Patel KR, Cherian J, Gohil K and Atkinson D: Schizophrenia: overview and treatment options. P T 39: 638-645, 2014.

2. Beck AT, Rector NA, Stolar N and P. G: Biological Contributions. In: Schizophrenia: Cognitive Theory, Research, and Therapy. New York: Guilford Press; 30–61: 2009.

3. H. L: History of Schizophrenia as a Psychiatric Disorder. In: Mueser KT, Jeste DV. Clinical Handbook of Schizophrenia. New York: Guilford Press; 312, 2008.

4. Tandon R, Keshavan MS and Nasrallah HA: Schizophrenia, "just the facts" what we know in 2008. 2. Epidemiology and etiology. Schizophrenia research 102: 1-18, 2008.

5. Dickerson FB and Lehman AF: Evidence-based psychotherapy for schizophrenia: 2011 update. The Journal of nervous and mental disease 199: 520-526, 2011.

6. Citrome L: Unmet needs in the treatment of schizophrenia: new targets to help different symptom domains. The Journal of clinical psychiatry 75 Suppl 1: 21-26, 2014.

7. Gray JA and Roth BL: The pipeline and future of drug development in schizophrenia. Molecular psychiatry 12: 904-922, 2007.

8. Leweke FM, Mueller JK, Lange B, et al: Role of the Endocannabinoid System in the Pathophysiology of Schizophrenia: Implications for Pharmacological Intervention. CNS drugs 32: 605-619, 2018.

9. Fernandez-Espejo E, Viveros MP, Núñez L, Ellenbroek BA and Rodriguez de Fonseca F: Role of cannabis and endocannabinoids in the genesis of schizophrenia. Psychopharmacology 206: 531-549, 2009.

10. Leweke FM, Hellmich M and Pahlisch F ea: Modulation of the endocannabinoid system as a potential new target in the treatment of schizophrenia. Schizophrenia research 153: 2014.

11. Leweke FM, Piomelli D, Pahlisch F, et al: Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry 2: e94-e94, 2012.

12. McGuire P, Robson P, Cubala WJ, et al: Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. The American journal of psychiatry 175: 225-231, 2018.

13. Bhattacharyya S, Wilson R, Appiah-Kusi E, et al: Effect of Cannabidiol on Medial Temporal, Midbrain, and Striatal Dysfunction in People at Clinical High Risk of Psychosis: A Randomized Clinical Trial. JAMA psychiatry 75: 1107-1117, 2018.