ABSTRACT
This study was mainly focused on repeating what other studies have done in the past; to understand the relationship between marijuana and schizophrenia. The literature suggested that there was not enough research on the topic in terms of finding out the root cause of patients taking marijuana, even if they had medication. What was discovered in the literature was also the theory that there were other contributing outside factors such as genetics and family history. Patients that were also mentally healthy were having the same effects when taking marijuana. What the literature also spoke about was distinguishing between actual psychotic diseases versus psychotic symptoms. Schizophrenic patients that ingested marijuana showed an increase in their symptoms. On the other hand, marijuana provided a form of supplemental medication to schizophrenia patients. The fact that it can amplify symptoms for schizophrenic patients and have mentally healthy patients experience the same symptoms shows that perhaps overall, schizophrenia is not caused by marijuana. However, there are a few exceptions where that is the case, but that again is a contribution to outside factors aside from the marijuana abuse. Family history was added to this study just to see if that made a difference between those participants that were mentally healthy versus those with schizophrenia. As well as to see if gender made any difference or if it played a role in duration of marijuana effects on the brain both for mentally healthy participants and those with schizophrenia.
INTRODUCTION
Although there are numerous studies on the effect of marijuana on schizophrenia, a clear correlation/relationship between the two is never clear and always left open for further research. According to the literature, there are various factors that can lead someone to use marijuana or even develop schizophrenia. These reasons may not be mutually exclusive. Various research studies have shown that there is more of a relationship between marijuana and schizophrenia rather than a correlation. How we understand mental disease as well as drug addiction can affect our ways of interpreting the results researchers produce.
This study will take into consideration the various research studies in the literature review and combine them into a more effective study that looks at marijuana and schizophrenia. The study not only looks at whether patients are schizophrenic or not, but takes into consideration their history of mental illness as well as drug addiction. The participants’ lifestyles will also be included in the study in order to see if there are any outside stressors that could lead to addiction or unstable mental health.
LITERATURE REVIEW
Drugs vs. Mental Disease
The research on the effects of marijuana on schizophrenia is very scarce even among top researchers. The reason for this being the lack of direct understanding of what comes first, the mental disease or the addiction , or whether people with marijuana addiction are destined to develop schizophrenia. In ancient times, psychotic and substance abuse linked together were a sign of insanity (Schneier and Siris, 1987). What researchers have found is that drug intoxication can lead to a trigger in psychotic episodes (Volkow, 2009). However, one thing to remember is that very few people in the population develop mental illness due to marijuana usage (D’Souza et al., 2009). There are numerous other factors that can link the correlation between schizophrenia and drug use; those will be discussed in a different section. Another conceptualizing factor in comparing drugs to mental disease is remembering that there is a difference between psychotic symptoms and a psychotic disorder (D’Souza et. al., 2009). For example, smoking marijuana can cause euphoria, depersonalization, no time sense, lethargy, drowsiness, confusion, anxiety and impairments of sensory motor (O’Leavy, 2002). These are some symptoms that can occur to mentally healthy people as well, but without knowing that information we may assume the person has a mental disorder. The main difference between psychotic symptoms and psychotic disorders is that psychotic symptoms can occur to even the healthiest person. You can be mentally healthy but still get psychotic symptoms when experimenting with drugs. Psychotic disorders are mainly mutually exclusive with mental illness and require medications.
Effects of Schizophrenia and Marijuana
Schizophrenia has positive, negative, and cognitive deficit symptoms. The positive symptoms include hallucinations, delusions, thought disorder and paranoia. The negative symptoms include amotivation, social withdrawal, and emotional blunting. Lastly, cognitive deficits include impairments in memory, difficulty paying attention, and function (D’Souza et al., 2009). The research has shown that half of the people with schizophrenia have had a history with substance abuse at a much higher rate (Volkow, 2009). The effects of what marijuana does with those that have schizophrenia vary greatly. Repeated exposure to the drug tends to enhance the negative symptoms of schizophrenia (Volkow, 2009). In a study conducted by Dean et. al (2001), there was also evidence that marijuana exacerbated or caused psychoses and increased schizophrenia. In fact, there was evidence in that same study that showed that it perpetuated schizophrenia symptoms up to six times as much (Dean, 2001). However, in D’Souza’s et al (2009) study, marijuana produced a full range of schizophrenic-like symptoms that included negative, positive, and cognitive disorders among mentally healthy people as well.
Treatment and History
So if mentally healthy people are also showing schizophrenic-like symptoms when using marijuana, does that mean marijuana causes schizophrenia? Not necessarily and it is not a direct correlation. As stated earlier, the effects of marijuana usage varies from person to person whether you are mentally ill or not. Schizophrenic patients are more likely to increase the prevalence of marijuana usage (Schneier and Siris, 1987). Forty-five percent of patients with schizophrenia will more likely develop an addiction to it over their lives than 11% of those without a mental disease (Schneier and Siris, 1987). Both schizophrenia and marijuana addiction are highly heritable and both are associated with stressors (Volkow, 2009). Genes play a big role in how patients react to this as well as the environment they were surrounded by as young adults (Volkow, 2009).
One of the reasons marijuana is used by both mentally healthy and unhealthy people is because it helps cope with stress (Volkow, 2009). How schizophrenia is treated is usually with medication or anti-psychotic drugs (Volkow, 2009). What the anti-psychotic drug does is block neurotransmission of the DA (dopamine), which is more of a side effect than actual problem. (Volkow, 2009). Without the dopamine, patients at times will smoke marijuana in order to stimulate the neural systems (Schneier and Siris, 1987). It is more of a way to compensate and induce anhedonia (Volkow, 2009). Marijuana tends to increase the heart rate, blood pressure, and mood-enhancing effects (O’Leavy, 2002). The problem with this is that at times doctors do not know that patients are taking other substances and the treatment then becomes ineffective.
Why Research?
As seen in past literature, there is a gap between treatment and full understanding of schizophrenia and marijuana use. The reason this research is important and still needs to be researched is because outcomes seem to change depending on the population. In order to contribute to already existing research, the homeless population will be the main focus in order to establish new research the correlation between marijuana and schizophrenia. There are many studies that look at different factors, and they seem to either support past theories of marijuana and schizophrenia or debunk the myths.
METHODS
The past literature emphasized the importance of outside factors besides drug use such as family history. For this research, the focus will be on was just the relationship between marijuana and schizophrenia among the homeless population instead of a controlled study with one group being mentally healthy and the other with schizophrenia. The reason the study was focused on the homeless was because at times due to the cutoff from society, a lot of times they will grow a dependence on drugs and/or develop mental illness. A quantitative method was used to create this study. Data collection was basic information such as gender, age, and family history on drug use and mental illness, and whether or not they had schizophrenia. A fair amount of male and female participants, so that we could see which gender was more active in terms of substance abuse and what it said about them. A few follow ups with the participants was done to measure brain activity using the radiolingand binding and autoradiography instruments to measure the receptors in the brain, which was a tool used in previous studies. The analysis compared how past family history, age, and gender affect the usage of marijuana in the brain and how it is different among people with and without schizophrenia throughout a certain amount of time.
In order to ensure follow up data. My study was conducted in a homeless shelter in a downtown area that specializes in mental health and housing care for the homeless. Many of these shelters are grant funded so they are required to keep track of clients (how many are taken in as well as how many are discharged). However, due to the fact that access was required to their files, an IRB contract was required in order to allow access to client records as well as written consent from participants ensuring that their information would remain confidential and used solely for the purpose of research.
Data Collection
The shelter assisted in the research by categorizing which homeless clients were diagnosed with schizophrenia and which ones were considered a little more mentally stable. Data was collected only once from health records kept by the shelter such as gender, age, and history of mental illness. After categorization, there were a total of 35 participants, 12 Females and 23 Males. Participants ranged between 28 and 37 years of age; 10 of those participants had history of mentally illness in their family and 25 did not. Lastly, 13 of those participants had diagnosed schizophrenia. This information was then put in an excel spread sheet with a special client ID created for the purpose of my analysis. Brain activity was collected at the shelter once a month from each client for 5 months at the shelter. In order to ensure participant turn around, a gift card was given to the participants each time they came in once a month to measure their brain activity. These numbers were placed in the excel spread sheet alongside the demographics. After five months, results over the last five months were analyzed using the SPSS software and controlled for age, gender, and family history.
Results
Almost half year of work granted the research with interesting results. More detailed information is shown in the Appendix Data Table that is attached to this work. As it was suspected, schizophrenia has no direct connection to use of marijuana. Since our group was not too large and fell into the age gap where men and women generally already have schizophrenia it is hard to determine when the first symptoms of the disease arised. Focus-group participants were diagnosed by professional psychiatrists, who, based on the answers and overall look at the participants then noted down their conclusions. In the beginning of the research, participants were more hostile, but gradually by the end of experiment, their answers became more honest and many of them even turned for help voluntarily.
Some of the participants had history of mental illnesses in the family. If we look at the Data Table of the participants, we will see that there is no direct link between these events. However, worth noting that 90% of participants had an extremely stressful event at some point in their lives. Mostly, after these events the majority went homeless. Generally, marijuana was present in their lives before they went homeless and after finding themselves on the street, some people stopped using marihuana for various periods of time with no noticeable change in the attitude.
Pure numbers:
Out of 35 participants 13 with signs of schizophrenia.
7 women
6 men
5 – with previous history of mental illness in the family
5 people show severe signs, such as depersonalization, voices and hallucination, others – show less obvious signs, such as social problems, depression, apathy, attention disorders.
Discussion:
Overall, the experiment was meant to show the correlation between use of marijuana and schizophrenia, but the results were found controversial due to the following reasons. Participants of the experiment were homeless people, which at first seemed like a good deal, since there was no need to go through numerous circles of authorities for permissions. However, we think the results of the research can only be used in a slightly different field of psychology than was originally intended. And this is why:
Homeless people live on the street or in shelters. Their level of living is very poor and leads to constant depression state. Almost all of these people went through some horrible events in life, which in one or another way affected their mental health. What they eat and drink on daily basis are leftovers and spoiled foods – which often give nausea and in rare cases hallucinations. Amount of marijuana they smoke varies from day to day. However, when asked great majority of participants, even those with signs of schizophrenia, state that it tends to relax them and bring sense of peace.
What we concluded from this research is that it is more likely to be a stressful event that leads to schizophrenia than smoking of marijuana.
References
Dean, B., Sundram, S., Bradbury, R., Scarr, E., & Copolov, D. (2001). Studies on [3 H] CP-55940 binding in the human central nervous system: regional specific changes in density of cannabinoid-1 receptors associated with schizophrenia and cannabis use. Neuroscience, 103(1), 9-15.
D’Souza, D. C., Sewell, R. A., & Ranganathan, M. (2009). Cannabis and psychosis/schizophrenia: human studies. European archives of psychiatry and clinical neuroscience, 259(7), 413-431.
O'Leary, D. S., Block, R. I., Koeppel, J. A., Flaum, M., Schultz, S. K., Andreasen, N. C., & Hichwa, R. D. (2002). Effects of smoking marijuana on brain perfusion and cognition.
Schneier, F. R., & Siris, S. G. (1987). A review of psychoactive substance use and abuse in schizophrenia: Patterns of drug choice. The Journal of nervous and mental disease, 175(11), 641-652.
Volkow, N. D. (2009). Substance use disorders in schizophrenia—clinical implications of comorbidity. Schizophrenia Bulletin, 35(3), 469-472.
