背景:神经性厌食症(AN)的复发率仍然很高,有必要探索进一步的治疗方法。大麻素激动剂是令人感兴趣的,因为它们在相关疾病的治疗中显示出成功的结果。比如创伤后应激障碍。本范围审查探讨了内源性大麻素系统(ECS),大麻素治疗的益处/危害/无效效果,以及在AN中使用大麻的危害。
方法:PubMed,PsycINFO,科克伦,搜索了WebofScience在2010年至2023年8月之间发表的研究,人类参与者探索了ECS,大麻素治疗,或使用大麻,并在标题和/或摘要中包含大麻和AN的1个或多个关键字。描述继发性厌食症的报道,报告没有英文版本,灰色文学,将来自AN的数据与其他条件相结合的报告,仅报告大麻滥用/依赖流行率的报告被排除在外。数据来自17份报告(n=15项研究)。对于ECS,结果包括遗传学,如与ECS相关的等位基因表达,大麻素受体可用性,和内源性大麻素的循环水平。对于大麻素治疗的益处/危害/无效效果,结果包括体重的变化,进食障碍(ED)症状,身体活动(PA),和荷尔蒙。对于使用大麻的危害,结果包括与大麻使用障碍相关的遗传学以及大麻使用与ED症状之间的关联.
结果:8项研究(n=8报告)发现了AN中ECS的异常,包括相关等位基因的表达,基因型,和单倍型,大麻素受体的可用性,和内源性大麻素的水平。三项研究(n=5报告)发现了大麻素治疗的益处/危害/无效效果。好处包括体重增加,改善ED症状并降低PA,而无效效应不包括体重或ED症状的变化,危害包括PA增加和脂肪激素降低。四项研究(n=4报告)扩大了使用大麻的危害,包括大麻使用障碍的遗传易感性,以及与使用大麻有关的补偿性行为。
结论:有限的证据表明,AN中ECS的异常可能使大麻成为体重恢复和相关症状的潜在治疗方法。未来的研究可能希望研究个性化的给药方法,以最大限度地提高有益效果,同时最大限度地减少危害。二级证据:范围审查。
神经性厌食症(AN)影响来自不同背景的人,导致明显的身体和精神损伤。对于所有患有该疾病的人来说都是成功的恢复过程并不存在。由于AN的高复发率,探索进一步的治疗方法势在必行。大麻在治疗其他精神疾病方面显示出了希望,其中一些也发生在有AN的人身上;因此,现有研究的概述是必要的.本范围综述介绍了有关大麻与AN之间关系的研究结果。结果表明,患有AN的个体在与大麻相互作用的生物系统中有异常,提出大麻对回收的潜在有用性。尽管一些研究报道了大麻对AN的好处,包括体重增加,改善进食障碍(ED)症状,减少体力活动(PA),其他研究表明体重或ED症状没有变化,PA增加,食欲激素水平恶化。最后,一些研究表明,患AN风险较高的个体患大麻使用障碍的风险可能更大,使用大麻可能与ED症状有关。未来的研究应该检查大麻在AN中的个性化剂量,以最大限度地提高收益并最大限度地减少危害。
BACKGROUND: Relapse rates in Anorexia Nervosa (AN) remain high, warranting exploration of further treatments. Cannabinoid agonists are of interest as they have shown successful outcomes in the treatment of associated conditions, such as post-traumatic stress disorder. This scoping
review explores the endocannabinoid system (ECS), benefits/harms/null effects of cannabinoid treatment, and harms of cannabis use in AN.
METHODS: PubMed, PsycINFO, Cochrane, and Web of Science were searched for studies published between 2010 and August 2023, with human participants that explored the ECS, cannabinoid treatment, or cannabis use, and included 1 or more keywords for both cannabis and AN in the title and or abstract. Reports describing secondary anorexia, reports not available in English, grey literature, reports combining data from AN with other conditions, and reports only reporting the prevalence of cannabis abuse/dependence were excluded. Data were extracted from 17 reports (n = 15 studies). For the ECS, outcomes included genetics such as allele expression related to the ECS, cannabinoid receptor availability, and circulating levels of endocannabinoids. For benefits/harms/null effects of cannabinoid treatment, outcomes included changes in weight, eating disorder (ED) symptoms, physical activity (PA), and hormones. For harms of cannabis use, outcomes included genetics related to cannabis use disorder and associations between cannabis use and ED symptoms.
RESULTS: Eight studies (n = 8 reports) found abnormalities in the ECS in AN including expression of related alleles, genotypes, and haplotypes, availability of cannabinoid receptors, and levels of endocannabinoids. Three studies (n = 5 reports) found benefits/harms/null effects of cannabinoid treatment. Benefits included weight gain, improved ED symptoms and reduced PA, while null effects included no changes in weight or ED symptoms, and harms included increased PA and lowered adipose hormones. Four studies (n = 4 reports) expanded upon harms of cannabis use, including genetic predispositions to cannabis use disorder, and compensatory behaviors related to cannabis use.
CONCLUSIONS: Limited evidence suggests that abnormalities in the ECS in AN may render cannabis a potential treatment for weight restoration and associated symptoms. Future research may wish to investigate individualized dosing approaches to maximize beneficial effects while minimizing harms. Level II Evidence: Scoping
Review.
Anorexia Nervosa (AN) affects people from various backgrounds causing notable physical and mental impairments. A recovery process that is successful for everyone who has the condition does not exist. Due to high relapse rates in AN, exploring further treatments is imperative. Cannabis has shown promise in treatments of other psychiatric disorders, some of which also occur in those with AN; thus, an overview of the available research is warranted. This scoping
review presents results from studies about the relationship between cannabis and AN. Results suggest that individuals with AN have abnormalities in a biological system that interacts with cannabis, proposing the potential usefulness of cannabis for recovery. Although some studies reported benefits of cannabis for AN, including weight gain, improved eating disorder (ED) symptoms, and reduced physical activity (PA), other studies suggested no changes in weight or ED symptoms, increased PA, and worsened appetite hormone levels. Lastly, some studies suggested that individuals at higher risk of developing AN may be at greater risk for developing cannabis use disorder, and that cannabis use may be associated with ED symptoms. Future studies should examine individualized dosing of cannabis in AN to maximize benefits and minimize harms.