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Journal of Psychiatric Practice®: November 2016 - Volume 22 - Issue 6 - p 427–428
doi: 10.1097/PRA.0000000000000194


November, 2016. Remarkable transitions take place in our society, some at glacial speed and some as rapidly as wildfire. Among the former is the gradual but steady containment of cigarette smoking in this country. The romance of the smoke-filled room is, for the most part, a thing of the past, and the health hazards of cigarette smoking are now indisputable. Among the latter, it seems to me, is the crescendo of legalization of marijuana, not just for medical but also for recreational use. I’ve just come from a professional meeting held in Denver, where the legal “retail” sale of marijuana products is a booming business. Although for the most part similar restrictions apply, preventing the smoking of either cigarettes or marijuana in public places, the market demand for marijuana reminds me of the early days when the advertising world trumpeted the health benefits of cigarettes. Are we just trading horses here?

Not long ago at our annual “Advances in Clinical Psychiatry” fall symposium cosponsored by Baylor College of Medicine and the Menninger Clinic, we focused on “Addictive Behavior” as the symposium theme. Christopher Verrico, PhD, a Baylor faculty member and researcher at the Michael E. DeBakey Veterans Affairs Medical Center, presented a review of trends in the groundswell of legalization of marijuana, and he focused particularly on adolescent use. Among the concerns he emphasized were the steady increase in marijuana use among adolescents, accompanied by a clear increase in emergency department visits by adolescents that involve cannabinoids. He reviewed the stages of maturation of the prefrontal cortex, the neural substrate of cognitive control and working memory. Studies, he argued, are persuasive that the adolescent brain is particularly vulnerable to the effects of marijuana, suggesting that marijuana use in adolescence could disrupt these crucial aspects of brain development, resulting in persistent impairments in working memory function.

In this issue of the Journal, in a guest Law and Psychiatry column, LeNoue, Wongngamnit, and Thurstone present an excellent guide entitled “Practical Aspects of Discussing Marijuana in a New Era.” This outstanding summary covers current critical information that is increasingly relevant in today’s world, highlighting common perceptions (and misperceptions) about marijuana use, known harms from marijuana use, and authoritative resources to guide clinicians in this evolving and often controversial landscape. They present a 5-part informed consent proposal that could be most helpful for an organized approach to recommendations to patients and families. Their focus concludes with a brief summary of the data supporting the medical use of marijuana for specific categories of illness.

Also presented in this issue of the Journal are reports of 2 studies reflecting the increasing emphasis on prevention and early intervention, crucial early alert systems for high-risk youth. Friesen analyzes the status of genetic testing for schizophrenia in young adults known to be at high risk to develop psychosis. Ferreira-Maia and colleagues report data suggesting the importance of regular monitoring of children and adolescents with mood disturbances, to facilitate early detection of early-onset bipolar disorder. Finally, Wenze reviews an open trial using a smartphone to improve treatment adherence in bipolar disorder—a technology rapidly emerging with great potential in many aspects of health care today, perhaps particularly as a way to start speaking the language of our younger generations.

As a closing note, it is my distinct pleasure to introduce Dr Eric Plakun as our new Contributing Editor for the Journal’s Psychotherapy Column. Eric is a leading light in the area of psychotherapy; he will bring a wide knowledge base and a strong voice to keep us educated about the crucial importance of psychotherapy in our field. I also extend my heartfelt thanks to Drew Clemens for his many years of outstanding contributions to the Journal as our Psychotherapy Contributing Editor.

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