Biobehavioral Interactions between Endocannabinoid and Hypothalamic-pituitary-adrenal Systems in Psychosis: A Systematic Review

Marco Colizzi; Riccardo Bortoletto; Giulia Antolini; Sagnik Bhattacharyya; Matteo Balestrieri; Marco Solmi

doi:10.2174/1570159X21666230801150032

Biobehavioral Interactions between Endocannabinoid and Hypothalamic-pituitary-adrenal Systems in Psychosis: A Systematic Review

Marco Colizzi, Riccardo Bortoletto, Giulia Antolini, Sagnik Bhattacharyya, Matteo Balestrieri, Marco Solmi

Department of Medicine (DAME)
Department of Medical Area, University of Udine, Udine, Italy.
Department of Psychosis Studies
Health Psychology Section, Psychology Department, Institute of Psychology, Psychiatry and Neuroscience, King's College London, United Kingdom.
1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King's College School of Medicine at King's College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King's College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
University Hospital Integrated Trust of Verona
Department of Chemistry & Biomolecular Sciences, University of Ottawa, Ottawa, ON, Canada,University of Ottawa Heart Institute, Ottawa, ON, Canada

Research output: Contribution to journal › Review article › peer-review

3 Citations (Scopus)

Abstract

BACKGROUND: The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other.

OBJECTIVE: This PRISMA 2020-compliant systematic review aimed at reappraising the interplay be- tween the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psy- chosis-spectrum disorder risk and outcome.

METHODS: All pathophysiological and outcome clinical studies, concomitantly evaluating the two sys- tems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed.

RESULTS: 41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). In- dependent contributions of aberrancies in the two systems to the physiopathology and outcome of psy- chosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocanna- binoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not on- ly within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA ax- is), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling).

CONCLUSION: There is a need to concomitantly study the two systems' mechanistic contribution to psychosis in order to establish more refined biological relevance.

Original language	English
Pages (from-to)	495-520
Number of pages	26
Journal	Current Neuropharmacology
Volume	22
Issue number	3
Early online date	1 Aug 2023
DOIs	https://doi.org/10.2174/1570159X21666230801150032
Publication status	Published - 2024

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title = "Biobehavioral Interactions between Endocannabinoid and Hypothalamic-pituitary-adrenal Systems in Psychosis: A Systematic Review",

abstract = "BACKGROUND: The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other.OBJECTIVE: This PRISMA 2020-compliant systematic review aimed at reappraising the interplay be- tween the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psy- chosis-spectrum disorder risk and outcome.METHODS: All pathophysiological and outcome clinical studies, concomitantly evaluating the two sys- tems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed.RESULTS: 41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). In- dependent contributions of aberrancies in the two systems to the physiopathology and outcome of psy- chosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocanna- binoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not on- ly within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA ax- is), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling).CONCLUSION: There is a need to concomitantly study the two systems' mechanistic contribution to psychosis in order to establish more refined biological relevance.",

author = "Marco Colizzi and Riccardo Bortoletto and Giulia Antolini and Sagnik Bhattacharyya and Matteo Balestrieri and Marco Solmi",

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doi = "10.2174/1570159X21666230801150032",

language = "English",

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T1 - Biobehavioral Interactions between Endocannabinoid and Hypothalamic-pituitary-adrenal Systems in Psychosis

T2 - A Systematic Review

AU - Colizzi, Marco

AU - Bortoletto, Riccardo

AU - Antolini, Giulia

AU - Bhattacharyya, Sagnik

AU - Balestrieri, Matteo

AU - Solmi, Marco

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N2 - BACKGROUND: The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other.OBJECTIVE: This PRISMA 2020-compliant systematic review aimed at reappraising the interplay be- tween the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psy- chosis-spectrum disorder risk and outcome.METHODS: All pathophysiological and outcome clinical studies, concomitantly evaluating the two sys- tems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed.RESULTS: 41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). In- dependent contributions of aberrancies in the two systems to the physiopathology and outcome of psy- chosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocanna- binoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not on- ly within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA ax- is), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling).CONCLUSION: There is a need to concomitantly study the two systems' mechanistic contribution to psychosis in order to establish more refined biological relevance.

AB - BACKGROUND: The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other.OBJECTIVE: This PRISMA 2020-compliant systematic review aimed at reappraising the interplay be- tween the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psy- chosis-spectrum disorder risk and outcome.METHODS: All pathophysiological and outcome clinical studies, concomitantly evaluating the two sys- tems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed.RESULTS: 41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). In- dependent contributions of aberrancies in the two systems to the physiopathology and outcome of psy- chosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocanna- binoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not on- ly within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA ax- is), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling).CONCLUSION: There is a need to concomitantly study the two systems' mechanistic contribution to psychosis in order to establish more refined biological relevance.

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Biobehavioral Interactions between Endocannabinoid and Hypothalamic-pituitary-adrenal Systems in Psychosis: A Systematic Review

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