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DOI: 10.1055/a-1651-9979
Therapeutischer Einsatz von Cannabis bei Störungen aus dem schizophrenen Formenkreis
Medizin oder Droge – eine kritische Nutzen-Risiko-BewertungTherapeutic use of cannabis for schizophrenic spectrum disordersMedicine or drug – a critical risk-benefit evaluation
ZUSAMMENFASSUNG
Hintergrund Bei Patienten mit Störungen aus dem schizophrenen Formenkreis ist der Konsum von Cannabis und anderen psychoaktiven Substanzen weit verbreitet. Es besteht eine wissenschaftliche Evidenz, dass der hochdosierte und regelmäßige Freizeitkonsum von Cannabis mit nachteiligen Langzeitfolgen assoziiert ist. Und dennoch könnte die physiologische Bedeutung des Endocannabinoidsystems (ECS) den Einsatz von Cannabispräparaten – womöglich mit einem hohen Gehalt an Cannabidiol (CBD) – zur Therapie neuropsychiatrischer Erkrankungen als nützlich erscheinen lassen.
Ziel Darstellung der Grundlagen für die Wirksamkeit von medizinischem Cannabis bei neuropsychiatrischen Erkrankungen – insbesondere Störungen aus dem schizophrenen Formenkreis – und kritische Nutzen-Risiko-Bewertung.
Ergebnisse und Diskussion Die beiden wichtigsten neuroaktiven Bestandteile von Cannabis sind CBD und Tetrahydrocannabinol (THC). THC scheint psychose- und angstfördernd zu wirken und die Kognition zu beeinträchtigen. Basierend auf einer Recherche aktueller Literatur ist anzunehmen, dass CBD im Gegensatz zu THC nicht euphorisierend, sondern antikonvulsiv, analgetisch, angstlösend und antipsychotisch wirken könnte und möglicherweise die kognitive Leistungsfähigkeit verbessern kann. Somit wäre CBD ein natürlicher Antagonist von THC. Während es eine hinreichende Evidenz gibt, dass der Freizeitkonsum von meist THC-lastigem Cannabis die psychische Gesundheit nachteilig beeinflusst und Psychosen fördert, gibt es Studien, die darauf hindeuten, dass CBD protektiv sein könnte. Allerdings mangelt es an hochwertigen kontrollierten klinischen Studien mit größeren Patientenzahlen und guter Methodik, um eine ausreichende Evidenz für den Einsatz von Cannabidiol in der klinischen Praxis zu begründen.
ABSTRACT
Background Use of cannabis and further psychoactive drugs is common among patients with schizophrenic spectrum disorders. Existing scientific evidence associates high dose and regular recreational use of cannabis with unfavorable long-term effects. Nevertheless, the importance of the endocannabinoid-system (ECS) for mental health could make cannabis-preparations with high concentrations of cannabidiol (CBD) useful for treating neuropsychiatric disorders.
Objective To outline the basics of medical cannabis efficacy in neuropsychiatric diseases – especially schizophrenic spectrum disorders – and to critical evaluate benefits and risks.
Results and discussion The two major neuroactive components of cannabis are CBD and tetrahydrocannabinol (THC). THC seems to have psychosis- and anxiety-promoting effects and impairs cognition. According to a review of recent literature, CBD appears in contrast to THC, without euphoriant, but rather with anticonvulsive, analgesic, anxiolytic and antipsychotic effects. Moreover, it possibly enhances cognitive performance. Therefore, CBD might be a natural antagonist of THC. Despite sufficient evidence for an impairment of psychic health and promotion of psychoses through recreational use of mainly cannabis containing THC, some studies indicate a protective effect of CBD. To gain enough evidence to justify the use of cannabidiol in clinical practice, high-quality controlled clinical trials with sufficient patient numbers and flawless methods are still missing.
Publication History
Article published online:
09 February 2022
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