Publications by authors named "Eva Hoch"

39 Publications

Cannabis Use and Car Crashes: A Review.

Front Psychiatry 2021 28;12:643315. Epub 2021 May 28.

Clinic and Polyclinic for Psychiatry and Psychotherapy, Clinic of the Ludwig-Maximilian-University Munich, Munich, Germany.

In this review, state-of-the-art evidence on the relationship between cannabis use, traffic crash risks, and driving safety were analyzed. Systematic reviews, meta-analyses, and other relevant papers published within the last decade were systematically searched and synthesized. Findings show that meta-analyses and culpability studies consistently indicate a slightly but significantly increased risk of crashes after acute cannabis use. These risks vary across included study type, crash severity, and method of substance application and measurement. Some studies show a significant correlation between high THC blood concentrations and car crash risk. Most studies do not support this relationship at lower THC concentrations. However, no scientifically supported clear cut-off concentration can be derived from these results. Further research is needed to determine dose-response effects on driving skills combined with measures of neuropsychological functioning related to driving skills and crash risk.
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http://dx.doi.org/10.3389/fpsyt.2021.643315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195290PMC
May 2021

Cannabis use and cannabis use disorder.

Nat Rev Dis Primers 2021 02 25;7(1):16. Epub 2021 Feb 25.

National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia.

Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.
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http://dx.doi.org/10.1038/s41572-021-00247-4DOI Listing
February 2021

Psychosocial and pharmacological treatments for cannabis use disorder and mental health comorbidities: a narrative review.

Psychol Med 2021 02 4;51(3):353-364. Epub 2021 Feb 4.

Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK.

Cannabis is the most widely used illicit drug worldwide, and it is estimated that up to 30% of people who use cannabis will develop a cannabis use disorder (CUD). Demand for treatment of CUD is increasing in almost every region of the world and cannabis use is highly comorbid with mental disorders, where sustained use can reduce treatment compliance and increase risk of relapse. In this narrative review, we outline evidence for psychosocial and pharmacological treatment strategies for CUD, both alone and when comorbid with psychosis, anxiety or depression. Psychosocial treatments such as cognitive behavioural therapy, motivational enhancement therapy and contingency management are currently the most effective strategy for treating CUD but are of limited benefit when comorbid with psychosis. Pharmacological treatments targeting the endocannabinoid system have the potential to reduce cannabis withdrawal and cannabis use in CUD. Mental health comorbidities including anxiety, depression and psychosis hinder effective treatment and should be addressed in treatment provision and clinical decision making to reduce the global burden of CUDs. Antipsychotic medication may decrease cannabis use and cannabis craving as well as psychotic symptoms in patients with CUD and psychosis. Targeted treatments for anxiety and depression when comorbid with CUD are feasible.
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http://dx.doi.org/10.1017/S0033291720005449DOI Listing
February 2021

DAILY-A Personalized Circadian Therapy as an Adjunctive Treatment for Alcohol Use Disorder Patients: Study Protocol for a Randomized Controlled Trial.

Front Psychiatry 2020 14;11:569864. Epub 2021 Jan 14.

Circadian Biology Group, Department of Molecular Neurobiology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany.

Hallmarks of alcohol use disorder (AUD) are disturbances of circadian rhythms and everyday structures. While circadian rhythms dictate the timing of daily recurring activities such as sleep, activity, and meals, conversely, these activities represent time cues, so called , that the circadian system uses to synchronize with the environment. Here we present a study protocol for our newly developed therapy approach for AUD patients, in which we take advantage of this mutual influence and stabilize and strengthen their circadian system by creating strict daily schedules for daily activities. Since every person has a circadian system with its own characteristics and is subject to social obligations, the daily plans are personalized for each test person. Our hypothesis is that a regular exposure to stabilizes behavioral and physiological circadian rhythms and thereby reduces the risk of alcohol relapses and depressive symptoms and facilitates physical recovery in AUD patients during the 1st weeks of their addiction therapy. The study is a 6-weeks single site trial with a controlled, randomized, single-blinded, parallel-group design including patients with a diagnosis of AUD. The study runs parallel to the standard addiction therapy of the clinic. Patients are randomly assigned to either an intervention group (DAILY) or a sham control group (placebo treatment). Questionnaires and physiological assessments of both groups are conducted before and immediately after the intervention or control treatment. According to our hypothesis, the primary outcomes of this study are improvements of regularity, alcohol consumption, and relapse rate in AUD patients compared to AUD patients receiving control treatment. Secondary outcomes are reduced depressive symptoms and increased physical recovery. This study is a randomized controlled trial to investigate the efficacy of a personalized circadian therapy as an adjunctive treatment for alcohol use disorder patients. The overall goal of this and more extended future studies is the development of an adjunctive therapy for AUD patients that is uncomplicated in its use and easy to implement in the clinical and everyday routine. This study is registered at the German Clinical Trial Register with the trial number DRKS00019093 on November 28, 2019.
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http://dx.doi.org/10.3389/fpsyt.2020.569864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840704PMC
January 2021

Cannabis-basierte Arzneimittel bei psychischen Störungen : Psychiatrie -- Autoren: E. Hoch, O. Pogarell, U. W. Preuss.

MMW Fortschr Med 2020 09;162(Suppl 8):26-33

Vitos Herborn gem GmbH, Herborn, Germany.

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http://dx.doi.org/10.1007/s15006-020-4324-9DOI Listing
September 2020

[Psychosocial support during the COVID-19 pandemic: interdisciplinary concept of care at a university hospital].

Nervenarzt 2021 Jul 6;92(7):701-707. Epub 2020 Oct 6.

Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nußbaumstraße 7, 80336, München, Deutschland.

Background: Since the beginning of the outbreak, the COVID-19 pandemic has caused an increased demand for psychosocial support for patients, their family members, and healthcare workers. Concurrently, possibilities to provide this support have been hindered. Quarantine, social isolation, and SARS-CoV‑2 infections represent new and severe stressors that have to be addressed with innovative psychosocial care.

Objective And Method: This article describes the COVID-19 psychosocial first aid concept at the University Hospital Munich (LMU Klinikum) developed by an interdisciplinary team of psychiatric, psychological, spiritual care, psycho-oncological, and palliative care specialists.

Results: A new psychosocial first aid model has been implemented for COVID-19 inpatients, family members, and hospital staff consisting of five elements.

Conclusion: The concept integrates innovative and sustainable ideas, e.g. telemedicine-based approaches and highlights the importance of multidisciplinary collaboration to cope with challenges in the healthcare system.
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http://dx.doi.org/10.1007/s00115-020-01014-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538057PMC
July 2021

Classical blood biomarkers identify patients with higher risk for relapse 6 months after alcohol withdrawal treatment.

Eur Arch Psychiatry Clin Neurosci 2021 Aug 5;271(5):891-902. Epub 2020 Jul 5.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.

This naturalistic study among patients with alcohol dependence examined whether routine blood biomarkers could help to identify patients with high risk for relapse after withdrawal treatment. In a longitudinal study with 6-month follow-up among 133 patients with alcohol dependence who received inpatient alcohol withdrawal treatment, we investigated the usefulness of routine blood biomarkers and clinical and sociodemographic factors for potential outcome prediction and risk stratification. Baseline routine blood biomarkers (gamma-glutamyl transferase [GGT], alanine aminotransferase [ALT/GPT], aspartate aminotransferase [AST/GOT], mean cell volume of erythrocytes [MCV]), and clinical and sociodemographic characteristics were recorded at admission. Standardized 6 months' follow-up assessed outcome variables continuous abstinence, days of continuous abstinence, daily alcohol consumption and current abstinence. The combined threshold criterion of an AST:ALT ratio > 1.00 and MCV > 90.0 fl helped to identify high-risk patients. They had lower abstinence rates (P = 0.001), higher rates of daily alcohol consumption (P < 0.001) and shorter periods of continuous abstinence (P = 0.027) compared with low-risk patients who did not meet the threshold criterion. Regression analysis confirmed our hypothesis that the combination criterion is an individual baseline variable that significantly predicted parts of the respective outcome variances. Routinely assessed indirect alcohol biomarkers help to identify patients with high risk for relapse after alcohol withdrawal treatment. Clinical decision algorithms to identify patients with high risk for relapse after alcohol withdrawal treatment could include classical blood biomarkers in addition to clinical and sociodemographic items.
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http://dx.doi.org/10.1007/s00406-020-01153-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236027PMC
August 2021

Mapping and mitigating the health risks of legalizing recreational cannabis use: a call for synergy between research and policy.

World Psychiatry 2020 Jun;19(2):189-191

School of Behavioural & Health Sciences, Australia Catholic University, Fitzroy, VIC, Australia.

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http://dx.doi.org/10.1002/wps.20738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214955PMC
June 2020

Adolescent cannabis use, cognition, brain health and educational outcomes: A review of the evidence.

Eur Neuropsychopharmacol 2020 07 5;36:169-180. Epub 2020 Apr 5.

Centre for Youth Substance Abuse Research, The University of Queensland, St Lucia, Queensland, Australia. Electronic address:

We review the findings of systematic reviews and meta-analyses of case-control studies that examine brain functioning and cognitive correlates of adolescent cannabis use using structural and functional neuroimaging tools and standardised neuropsychological tests. We also examine prospective epidemiological studies on the possible effects of adolescent and young adult cannabis use on cognitive performance in adult life and the completion of secondary education. We summarize the findings of studies in each of these areas that have been published since the most recent systematic review. Systematic reviews find that adolescent cannabis use is inconsistently associated with alterations in the structure of prefrontal and temporal brain regions. Meta-analyses reveal functional alterations in the parietal cortex and putamen. Differences in the orbitofrontal cortex predate cannabis use; it is unclear if they are affected by continued cannabis use and prolonged abstinence. Longitudinal and twin studies report larger declines in IQ among cannabis users than their non-using peers but it is unclear whether these findings can be attributed to cannabis use or to genetic, mental health and environmental factors. Several longitudinal studies and a meta-analysis of cross-sectional studies suggest that there is some cognitive recovery after abstinence from cannabis. Longitudinal studies and some twin studies have found that cannabis users are less likely to complete secondary school than their non-using controls. This association might reflect an effect of cannabis use and/or the social environment of cannabis users and their cannabis using peers. Cognitive performance is altered in some domains (e.g. IQ, verbal learning) in young people while they are regularly using cannabis. There are two important messages to adolescents and young adults: First, cannabis has potentially detrimental effects on cognition, brain and educational outcomes that persist beyond acute intoxication. Second, impaired cognitive function in cannabis users appears to improve with sustained abstinence.
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http://dx.doi.org/10.1016/j.euroneuro.2020.03.012DOI Listing
July 2020

[Cannabis, Cannabinoids and Cannabis Use Disorders].

Fortschr Neurol Psychiatr 2019 Dec 17;87(12):714-728. Epub 2019 Dec 17.

Cannabis currently leads to intensive, and sometimes highly emotional discussions like no other drug. What are the health and social risks, if the substance is used recreationally? This article describes the most important cannabinoids, the endogenous cannabinoid system and possible risks of cannabis if used as drug. Psychotherapeutic treatment options of cannabis abuse and dependence are shown.
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http://dx.doi.org/10.1055/a-1008-7427DOI Listing
December 2019

Cannabis use and psychosis: a review of reviews.

Eur Arch Psychiatry Clin Neurosci 2020 Jun 28;270(4):403-412. Epub 2019 Sep 28.

Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nussbaumstrasse 7, 80336, Munich, Germany.

We conducted a systematic review of meta-analyses and systematic reviews to evaluate the impact of cannabis use on the onset and course of psychoses. Following a systematic literature search of five data bases (2005-2016) and consecutive structured evaluation, we were able to include 26 systematic reviews and meta-analyses. The methodological quality of the included publications were in the range of high and poor. The scientific literature indicates that psychotic illness arises more frequently in cannabis users compared to non-users, cannabis use is associated with a dose-dependent risk of developing psychotic illness, and cannabis users have an earlier onset of psychotic illness compared to non-users. Cannabis use was also associated with increased relapse rates, more hospitalizations and pronounced positive symptoms in psychotic patients. We make recommendations about the type of research that is required to better characterize the relationship between cannabis use and the development and outcomes of psychosis.
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http://dx.doi.org/10.1007/s00406-019-01068-zDOI Listing
June 2020

[Medicinal cannabis and cannabis-based medication: an appeal to physicians, journalists, health insurances, and politicians for their responsible handling].

Schmerz 2019 Oct;33(5):466-470

Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen (UMG), Göttingen, Deutschland.

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.
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http://dx.doi.org/10.1007/s00482-019-00409-0DOI Listing
October 2019

Heavy cannabis use, dependence and the brain: a clinical perspective.

Addiction 2020 03 4;115(3):559-572. Epub 2019 Sep 4.

Neuroscience of Addiction Lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.

Aims: To summarize and evaluate our knowledge of the relationship between heavy cannabis use, cannabis use disorder (CUD) and the brain.

Methods: Narrative review of relevant literature identified through existing systematic reviews, meta-analyses and a PubMed search. Epidemiology, clinical representations, potential causal mechanisms, assessments, treatment and prognosis are discussed.

Results: Although causality is unclear, heavy and dependent cannabis use is consistently associated with a high prevalence of comorbid psychiatric disorders and learning and memory impairments that seem to recover after a period of abstinence. Evidence regarding other cognitive domains and neurological consequences, including cerebrovascular events, is limited and inconsistent. Abstinence after treatment is only achieved in a minority of cases; treatment targeted at reduction in use appears have some success. Potential moderators of the impact of CUD on the brain include age of onset, heaviness of use, CUD severity, the ratio of ∆9-tetrahydrocannabinol to cannabidiol and severity of comorbid disorders.

Conclusions: Current evidence of long-term effects of daily cannabis use and cannabis use disorder on brain-related outcomes is suggestive rather than conclusive, but use is associated with psychiatric morbidity and with cognitive impairments that recover after a period of abstinence.
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http://dx.doi.org/10.1111/add.14776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027478PMC
March 2020

[Efficacy and safety of medicinal cannabis: results of the CaPRis study].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019 Jul;62(7):825-829

Vitos Klinik Psychiatrie und Psychotherapie, Herborn, Deutschland.

In the 1990s, the endocannabinoid system was discovered as part of the human physiology. Since then, the effects of cannabis as a medicine have been researched more systematically. To summarize the scientific knowledge, the German Federal Ministry of Health commissioned an expertise.The project "Cannabis: Potential and Risks: a Scientific Analysis" (CaPRis), which started in 2016, aimed at analyzing the potential of medicinal cannabis and the risks of recreational cannabis use. A search of systematic reviews (SRs) and randomized-controlled trials (RCTs) were conducted in five international databases (publication date: 2006-2017). For the medical use of cannabis 16 SRs (of 186 RCTs) were included from a global search and nine further RCTs were comprised from a de novo search. All studies were methodologically assessed.Evidence for the efficacy of cannabis medicine (given as an adjunct to other medication) was found in patients with chronic pain and spasticity due to multiple sclerosis. Benefits were also found for appetite stimulation, improvement of nausea, and weight gain in patients with cancer, HIV/AIDS or in palliative care. Effects were often small. For other physical or mental disorders, only few or no controlled human studies are available. Adverse effects of cannabis medicine are often reported; severe adverse effects were mentioned in single cases only.To provide reliable treatment recommendations for clinicians and patients, more large-sized RCTs with follow-up assessments, consistent outcome measures, and active comparisons are needed.
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http://dx.doi.org/10.1007/s00103-019-02965-3DOI Listing
July 2019

Correction to: How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review.

Eur Arch Psychiatry Clin Neurosci 2019 12;269(8):995

Cannabinoid Research and Treatment Group, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 7, 80336, Munich, Germany.

The article "How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review", written by Eva Hoch, was originally published Online First without open access. After publication in volume 269, issue 1, page 87-105 the author decided to opt for Open Choice and to make the article an Open Access publication. Therefore, the copyright of the article has been changed to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
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http://dx.doi.org/10.1007/s00406-019-00999-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841644PMC
December 2019

Advanced formulation of methacryl- and acetyl-modified biomolecules to achieve independent control of swelling and stiffness in printable hydrogels.

J Mater Sci Mater Med 2019 Mar 6;30(3):35. Epub 2019 Mar 6.

Fraunhofer-Institute for Interfacial Engineering and Biotechnology IGB, Nobelstraße 12, 70569, Stuttgart, Germany.

Biobased hydrogels are considered to mimic native extracellular matrix due to their high water content and are considered as adequate matrices for cell encapsulation. However, the equilibrium degree of swelling (EDS) and stiffness of simple hydrogel formulations are typically confined: Increasing polymer concentration results in increasing stiffness and simultaneously decreasing EDS. The aim of this contribution was to decouple this standard correlation between polymer content, stiffness and EDS as well as the assembly of hydrogels with graded composition of hydrogels by layer-wise printing. We investigated two sets of formulations, which consisted of three different compositions with increasing total biopolymer concentration (10.6%, 11.5%, 13.0%). Within these compositions the amount of gelatin methacryloyl acetyl (GMA) was constant (10%), whereas the proportion of methacrylated hyaluronic acid and chondroitin sulfate increased. In the first set of formulations GMA with one fixed degree of methacryloylation (DM) was used, whereby the storage modulus (G') increased from ~10 to ~25 kPa and the EDS decreased from ~700 to ~600%. In the second set of formulations we gradually lowered the DM of the GMA in parallel to increase of polymer concentration and achieved an increase of both, G' from ~11 to ~18 kPa and EDS from ~690 to ~790%. By dispensing these compositions, we created a glycosaminoglycan-graded hydrogel. We proved the cytocompatibility of the dispensing process, the used photoinitiator lithium phenyl-2,4,6-trimethylbenzoylphosphinate, and layer-wise UVA irradiation. Glycosaminoglycan gradient was proved stable for 28 d,encapsulated chondrocytes were viable and produced new matrix.
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http://dx.doi.org/10.1007/s10856-019-6231-0DOI Listing
March 2019

Cannabis use and mental health: risks and benefits.

Eur Arch Psychiatry Clin Neurosci 2019 Feb;269(1):1-3

School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, 2601, Australia.

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http://dx.doi.org/10.1007/s00406-019-00986-2DOI Listing
February 2019

How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review.

Eur Arch Psychiatry Clin Neurosci 2019 Feb 31;269(1):87-105. Epub 2019 Jan 31.

Cannabinoid Research and Treatment Group, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstr. 7, 80336, Munich, Germany.

We conducted a review of systematic reviews (SRs) and randomized-controlled trials (RCTs) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders. Five data bases were systematically searched (2006-August 2018); 4 SRs (of 11 RCTs) and 14 RCTs (1629 participants) were included. Diagnoses were: dementia, cannabis and opioid dependence, psychoses/schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, and Tourette`s disorder. Outcome variables were too heterogeneous to conduct a  meta-analysis. A narrative synthesis method was applied. The study quality was assessed using the risk-of-bias tool and SIGN-checklists. THC- and CBD-based medicines, given as adjunct to pharmaco- and psychotherapy, were associated with improvements of several symptoms of mental disorders, but not with remission. Side effects occurred, but severe adverse effects were mentioned in single cases only. In order to provide reliable treatment recommendations, more and larger RCTs with follow-up assessments, consistent outcome measures and active comparisons are needed.
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http://dx.doi.org/10.1007/s00406-019-00984-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595000PMC
February 2019

A versatile perfusion bioreactor and endothelializable photo cross-linked tubes of gelatin methacryloyl as promising tools in tissue engineering.

Biomed Tech (Berl) 2019 Aug;64(4):397-406

Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany.

Size and function of bioartificial tissue models are still limited due to the lack of blood vessels and dynamic perfusion for nutrient supply. In this study, we evaluated the use of cytocompatible methacryl-modified gelatin for the fabrication of a hydrogel-based tube by dip-coating and subsequent photo-initiated cross-linking. The wall thickness of the tubes and the diameter were tuned by the degree of gelatin methacryl-modification and the number of dipping cycles. The dipping temperature of the gelatin solution was adjusted to achieve low viscous fluids of approximately 0.1 Pa s and was different for gelatin derivatives with different modification degrees. A versatile perfusion bioreactor for the supply of surrounding tissue models was developed, which can be adapted to several geometries and sizes of blood-vessel mimicking tubes. The manufactured bendable gelatin tubes were permeable for water and dissolved substances, like Nile Blue and serum albumin. As a proof of concept, human fibroblasts in a three-dimensional collagen tissue model were successfully supplied with nutrients via the central gelatin tube under dynamic conditions for 2 days. Moreover, the tubes could be used as scaffolds to build-up a functional and viable endothelial layer. Hence, the presented tools can contribute to solving current challenges in tissue engineering.
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http://dx.doi.org/10.1515/bmt-2018-0015DOI Listing
August 2019

Is Cannabis Use Treatment Also Indicated for Patients with Low to Moderate Polysubstance Use.

Eur Addict Res 2018 14;24(2):79-87. Epub 2018 Jun 14.

Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.

Background: Polysubstance use (PSU) is common among patients with cannabis use (CU) and is related to more severe CU problems. However, it is unclear how PSU predicts CU treatment outcomes beyond CU patterns. We examined the frequency, amount, and class of additionally used substances as predictors for primary and secondary outcomes.

Methods: We conducted crude and adjusted regression analyses for PSU variables as predictors of remission, abstinence, -reduction, and secondary outcomes in 166 help-seeking -patients from a randomized clinical trial of CANDIS, a -cognitive behavioral treatment program.

Results: Patients with recent illegal PSU experienced more difficulties in reducing their CU (B = -1.22, p < 0.001). In contrast, remission rates were slightly higher in patients with a wide variety of -last-year-PSU (RD = 0.04, p < 0.001). Amphetamine use -predicted poorer outcomes regarding CU-related problems (B = -4.22, p = 0.019), and the use of opiates, inhalants, and dissociative substances predicted poorer physical health outcomes (B = -0.62, p = 0.009; B = -0.96, p = 0.039; B = -1.18, p = 0.007).

Conclusions: CU treatment is also effective for patients with moderate PSU. However, treatment effects may be enhanced by addressing specific PSU characteristics as part of a modularized program.
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http://dx.doi.org/10.1159/000488345DOI Listing
October 2018

[An effective treatment concept for patients with substance use disorders].

MMW Fortschr Med 2017 10 5;159(Suppl 6):1-5. Epub 2017 Oct 5.

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland.

Background: At the Department of Psychiatry and Psychotherapy of the University of Munich a "day clinic for substance use disorders" was opened in 2014. A multimodal treatment concept for patients with addictions was developed. Employees of the clinic performed a first scientific study to assess the effects of treatment approaches on the course of the disease.

Method: Data were collected over two years to evaluate the treatment concept. I. a., the severity of depressive symptoms, anxiety symptoms, craving and several aspects of the subjective quality of life were documented. In addition, participants were examined about their contentment with the day-clinic treatment.

Results: Symptoms of depression, anxiety and craving were significantly reduced during the day-clinic treatment. The subjective quality of life increased almost in all areas.

Conclusion: In order to stabilize patients with addictions, a multimodal treatment concept can be applied effectively.
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http://dx.doi.org/10.1007/s15006-017-0079-3DOI Listing
October 2017

[Health Care Organization - The New German S3-Guideline on Alcohol-Related Disorders and its Relevance for Health Care].

Rehabilitation (Stuttg) 2018 Oct 22;57(5):314-320. Epub 2018 Jan 22.

Zentralinstitut für Seelische Gesundheit Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg.

Background: Alcohol dependence is one of the most serious diseases of addiction in Germany. The new S3-guideline "Screening, Diagnostics and Treatment of Alcohol-Related Disorders" has been presented in 2015 and summarizes the present state of knowledge pertaining to the diagnosis and treatment of alcohol abuse and alcohol dependence.

Methods: This guideline was developed over four years within the framework of the Association of the Scientific Medical Societies in Germany (AWMF). The German Association for Psychiatry, Psychotherapy and Psychosomatics () and the German Society for Research and Therapy in Addiction (DG-Sucht) took the lead in the organization. More than 50 professional societies and associations and health organizations as well as more than 60 acknowledged experts were involved, including networks of self-help groups and relatives. The working group on "health care organization", whose results are presented here, was one out of thirteen working groups, focusing on the task how to implement the guideline under the basic conditions of the German health care system with its sectors and interfaces.

Results: For the chapter on "health care organization" 27 recommendations have been consented. Many of these have been prepared by the respective working groups. These recommendations cover areas such as screening, diagnostics and short interventions, detoxification and withdrawal as well as pharmacotherapy, physical complications and psychic comorbidity, medical rehabilitation and other forms of post-acute treatment, primary care by general practitioners, as well as specific target groups such as children and adolescents, (pregnant) women and the elderly, and, in addition, self-help approaches.

Conclusion: For needs-based diagnostics and treatment of alcohol-related disorders, guideline-based recommendations for health care organization offer a framework for the cooperation and coordination of all health sectors and occupational groups, especially with respect to their interfaces. This includes the cooperation between the medical and the psychosocial system and stretches from harm reduction to social inclusion of people concerned. Particularly the field of rehabilitation with its explicit aims for participation relies heavily on such a cooperation.
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http://dx.doi.org/10.1055/s-0043-118955DOI Listing
October 2018

Methacrylated gelatin/hyaluronan-based hydrogels for soft tissue engineering.

J Tissue Eng 2017 Jan-Dec;8:2041731417744157. Epub 2017 Dec 21.

Department of Plastic Surgery and Burn Centre, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany.

In vitro-generated soft tissue could provide alternate therapies for soft tissue defects. The aim of this study was to evaluate methacrylated gelatin/hyaluronan as scaffolds for soft tissue engineering and their interaction with human adipose-derived stem cells (hASCs). ASCs were incorporated into methacrylated gelatin/hyaluronan hydrogels. The gels were photocrosslinked with a lithium phenyl-2,4,6-trimethylbenzoylphosphinate photoinitiator and analyzed for cell viability and adipogenic differentiation of ASCs over a period of 30 days. Additionally, an angiogenesis assay was performed to assess their angiogenic potential. After 24 h, ASCs showed increased viability on composite hydrogels. These results were consistent over 21 days of culture. By induction of adipogenic differentiation, the mature adipocytes were observed after 7 days of culture, their number significantly increased until day 28 as well as expression of fatty acid binding protein 4 and adiponectin. Our scaffolds are promising as building blocks for adipose tissue engineering and allowed long viability, proliferation, and differentiation of ASCs.
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http://dx.doi.org/10.1177/2041731417744157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753891PMC
December 2017

A Brief Outline of the Use of New Technologies for Treating Substance Use Disorders in the European Union.

Eur Addict Res 2017 12;23(4):177-181. Epub 2017 Aug 12.

Scientific Foresight Unit (Science and Technology Options Assessment [STOA]), Directorate-General for Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium.

Background: Clinicians in the field of drug addiction have started to exploit the growth of Technology-Based Interventions (TBIs). However, there is little information on how health personnel evaluate them.

Methods: Semi-structured interviews were conducted among 20 European experts.

Results: All of the interviewees recognised TBIs as a valuable tool to improve the management of substance-use disorders (SUDs). Most interviewees indicated that combining both traditional face-to-face therapist-patient clinic appointment with TBIs is probably the most effective method. Most interviewees agree that TBIs are valuable tools to overcome both physical and social barriers, and hence significantly facilitate the access to treatment. Poor infrastructure and lack of digital literacy are recognised as major barriers to the diffusion of these tools.

Conclusions: The application of various forms of technology in SUD treatment is an interesting development for the European Union. Technical and non-technical barriers exist and impede their full exploitation.
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http://dx.doi.org/10.1159/000478904DOI Listing
June 2018

German Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders.

Eur Addict Res 2017 9;23(1):45-60. Epub 2017 Feb 9.

Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.

Evidence-based strategies for screening, diagnosing and treating alcohol use disorders (AUD) are instrumental in the early and better management of individuals at risk for or suffering from AUD. However, existing guidelines vary and may be biased by conflicts of interests. Unbiased recommendations can be achieved only if sufficient detail is provided on the composition and representativeness of author groups, methodological rigor, handling of potential conflicts of interest and financing. This paper presents the first evidence-based guidelines for AUD from German-speaking countries. These guidelines are based on the work of delegates from a representative sample of 46 scientific societies (mostly medical) from Austria, Germany and Switzerland dealing with AUD. It also included patients and relatives. Recommendations were derived from a standardised hierarchical process involving quality controls drawn from existing guidelines, de novo literature searches and/or expert experience. Potential conflicts of interest were assessed yearly and led to exclusion from voting in specific areas. An overall cost of more than 400,000€ (for alcohol and tobacco guidelines) were exclusively covered by the participating societies and academic institutions. More than 100 recommendations on screening, diagnostics and treatment of AUD are outlined in this paper, and their scientific background is given in the online supplementary material. Tables of aggregated study synopses (in English) and the full version of guidelines (in German) are available (see "Links").
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http://dx.doi.org/10.1159/000455841DOI Listing
June 2017

[Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline].

Z Kinder Jugendpsychiatr Psychother 2016 ;44(4):295-303; quiz 304-5

2 Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit (ZI), Mannheim.

Objective: Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations.

Method: For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued “must,” “should,” and “can” recommendations or a “clinical consensus point (CCP).“

Results: For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a “must” recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP).

Conclusions: Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.
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http://dx.doi.org/10.1024/1422-4917/a000435DOI Listing
September 2016

Gelatin methacrylamide as coating material in cell culture.

Biointerphases 2016 06 13;11(2):021007. Epub 2016 Jun 13.

Institute of Interfacial Process Engineering and Plasma Technology IGVP, University of Stuttgart, Nobelstr. 12, 70569 Stuttgart, Germany.

Unmodified gelatin (uG) is widely used as a coating material in cell culture for improving surface properties. In this study, the authors investigated if gelatin methacrylamide (GM) with a medium degree of methacrylamide modification (GM1.5) and a high degree of methacrylamide modification (GM4) are equally suitable for this purpose. Therefore, gold surfaces were coated with uG, GM1.5, and GM4 by adsorption of the polymers on the surfaces. Coating success was confirmed by spectroscopic ellipsometry, contact angle measurements, surface plasmon resonance spectroscopy (SPRS), and atomic force microscopy (AFM). The authors found that upon adsorption of uG, GM1.5, a nd GM4 on gold, thin films with thicknesses of 2.95 nm, 2.50 nm, and 2.26 nm were formed. The coated surfaces showed advancing contact angles of 46° (uG and GM1.5) and 52° (GM4) without alteration of the surface roughness determined by AFM. Protein adsorption taking place on the coated surfaces was measured during contact of the surfaces with fetal calf serum by SPRS. Protein adsorption on the coated surfaces was reduced by the factor of 6.4 (uG), 5.4 (GM1.5), and 4.6 (GM4) compared to gold surfaces. Human fibroblasts cultured on the surfaces showed excellent viability shown by water soluble tetrazolium salt assay as well as live/dead staining with propidium iodide and fluorescein diacetate. No cytotoxic effects of the GM coated surfaces were observed, giving rise to the conclusion that GMs are suitable materials as coatings in cell culture.
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http://dx.doi.org/10.1116/1.4949545DOI Listing
June 2016

Digital Interventions for Problematic Cannabis Users in Non-Clinical Settings: Findings from a Systematic Review and Meta-Analysis.

Eur Addict Res 2016 4;22(5):233-42. Epub 2016 May 4.

Department for Psychiatry, Ludwig Maximilian University, Munich, Germany.

Background: Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use.

Methods: We systematically searched the Cochrane Central Register of Controlled Trials (2015), PubMed (2009-2015), Medline (2009-2015), Google Scholar (2015) and article reference lists for potentially eligible studies. Randomized controlled trials examining the effects of internet- or computer-based interventions were assessed. Study effects were estimated by calculating effect sizes (ESs) using Cohen's d and Hedges' g bias-corrected ES. The primary outcome assessed was self-reported cannabis use, measured by a questionnaire.

Results: Fifty-two studies were identified. Four studies (including 1,928 participants) met inclusion criteria. They combined brief motivational interventions and cognitive behavioral therapy delivered online. All studies were of good quality. The pooled mean difference (x0394; = 4.07) and overall ES (0.11) give evidence of small effects at 3-month follow-up in favor of digital interventions.

Conclusions: Digital interventions can help to successfully reduce problematic cannabis use outside clinical settings. They have some potential to overcome treatment barriers and increase accessibility for at-risk cannabis users.
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http://dx.doi.org/10.1159/000445716DOI Listing
April 2017

In Reply.

Authors:
Eva Hoch
January 2016

Risks associated with the non-medicinal use of cannabis.

Dtsch Arztebl Int 2015 04;112(16):271-8

Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Teaching Hospital of the University of Duisburg/Essen, German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Göttingen and DFG Research Center and Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB) of the University Medical Center Göttingen, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Kreiskrankenhaus Prignitz, Perleberg; Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Martin-Luther- University Halle-Wittenberg, Halle (Saale).

Background: Cannabis is the most commonly consumed illicit drug around the world; in Germany, about 4.5% of all adults use it each year. Intense cannabis use is associated with health risks. Evidence-based treatments are available for health problems caused by cannabis use.

Methods: Selective literature review based on a search of the PubMed database, with special emphasis on systematic reviews, meta-analyses, cohort studies, randomized controlled trials (RCTs), case-control studies, and treatment guidelines.

Results: The delta-9-tetrahydrocannabinol content of cannabis products is rising around the world as a result of plant breeding, while cannabidiol, in contrast, is often no longer detectable. Various medical conditions can arise acutely after cannabis use, depending on the user's age, dose, frequency, mode and situation of use, and individual disposition; these include panic attacks, psychotic symptoms, deficient attention, impaired concentration, motor incoordination, and nausea. In particular, intense use of high doses of cannabis over many years, and the initiation of cannabis use in adolescence, can be associated with substance dependence (DSM-5; ICD-10), specific withdrawal symptoms, cognitive impairment, affective disorders, psychosis, anxiety disorders, and physical disease outside the brain (mainly respiratory and cardiovascular conditions). At present, the most effective way to treat cannabis dependence involves a combination of motivational encouragement, cognitive behavioral therapy, and contingency management (level 1a evidence). For adolescents, family therapy is also recommended (level 1a evidence). No pharmacological treatments can be recommended to date, as evidence for their efficacy is lacking.

Conclusion: Further research is needed to elucidate the causal relationships between intense cannabis use and potential damage to physical and mental health. Health problems due to cannabis use can be effectively treated.
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http://dx.doi.org/10.3238/arztebl.2015.0271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442549PMC
April 2015