Monday, June 26, 2017

වෛද්‍ය කනිෂ්ක කරුණාරත්න ගේ මුල්‍ය වංචා

 


2008 වසරේදී මහරගම පිළිකා රෝහලේ රෝගීන් සඳහා මනෝ උපදේශන  ලබා දීමේ වැඩ සටහනක් ක්‍රියාත්මක කරන ලෙස එවකට සෞඛ්‍ය අමාත්‍යාංශයේ මානසික සෞඛ්‍ය අධ්‍යක්‍ෂිකා හිරන්තී ද සිල්වා මහත්මිය මගෙන් ඉල්ලීමක් කලාය​. ඒ අනුව  මම මහරගම පිලිකා රෝහලේ හිටපු අධ්‍යක්‍ෂ වෛද්‍ය කනිෂ්ක කරුණාරත්න මහතාව දුරකථනයෙන් අමතා අපගේ යෝජනා ක්‍රමය පිලිබඳව දැණුම් දුන්නෙමි. 

මේ ගැන වැඩිදුරටත් සාකච්ඡා කිරීම සඳහා ඉන් පසුව එලැඹෙන සඳුදා දින උදේ 10 ට ඔහු හමු වීම සඳහා ඔහුගේ කාර්‍යාලයට එන ලෙසට කනිෂ්ක කරුණාරත්න මහතා මට දැණුම් දුන්නේය​. ඒ අනුව මම ඔහුව හමුවීම සඳහා මහරගම පිළිකා රෝහලට ගියෙමි. මගේ පුදුමයට මෙන් ඔහු කාර්‍යාලයේ නොසිටියේය​. විශේෂඥ මනෝ වෛද්‍ය නීල් ප්‍රනාන්දු මහතා ගේ සහායද ලබා ගෙන මහරගම පිළිකා රෝහලේ රෝගීන් සඳහා මනෝ උපදේශන වැඩසටහන් ක්‍රියාත්මක කිරීමට අදහස් කරගෙන සිටි අපව වෛද්‍ය කනිෂ්ක කරුණාරත්න විසින් මඟ හැරීම පුදුමයට උපදවන කරුණක් විය​. ඔහු එන තෙක් අප පැය ගනනක් සිටි මුත් වෛද්‍ය කනිෂ්ක කරුණාරත්න නාවේය​. එසේම ඔහුගේ ජංගම දුරකථනයටද ක්‍රියා විරහිත කොට තිබුනේය​. ඉන් පසුව අප ඔහුව  සම්බන්ධ කර ගැනීම සඳහා කිහිප වතාවක්ම උත්සහ කල නමුදු කනිෂ්ක කරුණාරත්න අපව සිතා මතාම මඟ හැරියේය​. 

කායිකව විඳවන පිළිකා  රෝගීන් සඳහා මානසික සහනය සත් භාවයෙන් ලබා දීමට අප විසින් ගත් උත්සහය වෛද්‍ය කනිෂ්ක කරුණාරත්න කඩාකප්පල් කලේ මන්ද කියා අපට ප්‍රහේලිකාවක් විය​. 

පිළිකා රෝගයට ප්‍රතිකාර කරන වෛද්‍යවරයෙකු ලෙසට ජනප්‍රිය මෙන්ම බෝධිසත්ව චරිතයක් ලෙස බාහිරයට පෙන්වාගෙන සිටි වෛද්‍ය කරුණාරත්න මෙම උපදේශන වැඩසටහන  කඩාකප්පල් කලේ මන්ද කියා පසුව හෙළි විය​. මෙම හෙළි කිරීම කරනු ලැබුවේ මහරගම පිළිකා රෝහලේ තවත් වෛද්‍යවරයෙකු විසිනි. 

මහරගම පිළිකා රෝහලේ රෝගීන් සඳහා මනෝ උපදේශන  ලබා දීමට කියා වෛද්‍ය කනිෂ්ක කරුණාරත්න මහතා හැටන් නැෂනල් බැංකුවෙන් මාසිකව රුපියල් පනස් දහසක් ලබා ගත්තේය​. තවද මනෝ උපදේශන සඳහා සුදුසුකම් නොමැති සමදරා නම් තැනැත්තියක් බඳවාගෙන ඇයට මාසිකව රුපියල්  6000 පමණක් ගෙවන ලදි. ඉතිරි මුදල් ගියේ කාගේ සාක්කුවටද කියා අපට තේරුණි.  මහරගම පිළිකා රෝහලේ රෝගීන් සඳහා මනෝ උපදේශනය සෞඛ්‍ය අමාත්‍යාංශයේ කාර්‍ය මණ්ඩලය කලේ නම් ඔවුන් වැටුප් ලබා ගන්නේ සෞඛ්‍ය අමාත්‍යාංශයෙනි. එසේ වී නම් හැටන් නැෂනල් බැංකුව මාසිකව  රුපියල් පනස් දහස බැගින්  කනිෂ්ක කරුණාරත්නට නොදෙන්නේය​. මේ හේතුව නිසා ඔහු අප පිළිකා රෝහල පැත්ත පළාතටවත් ඒම අපේක්‍ෂා නොකලේය​. 

මෙම සිදුවීමෙන් පසු කාලයක තවත් පුවතක් වාර්තා විය​. එනම්  කනිෂ්ක කරුණාරත්න විසින් මහරගම පිළිකා රෝහලට පරිත්‍යාගශීලීන්ගෙන් ලැබුණු කෝටි ගණනක මුදලක් "ජනාධිපති අරමුදල" ලෙස හඳුන්වමින් සිය පුද්ගලික ගිණුමකට බැර කරවාගෙන කරන ලද වංචාවයි. මෙම වංචාව නිසා ඔහු මේ වන විට වැඩ තහනමට ලක්වී සිටින අතර  ඔහුට එරෙහිව මුල්‍ය අපරාධ කොට්ටාශය පරීක්‍ෂණ පවත්වමින් සිටී. එහෙත් මෙම චෝදනා තම සබඳතා මගින් සාර්ථක ලෙස යට ගසාගෙන වැඩ තහනමද ඉවත් කිරීමේ මෙහෙයුමක් ද මේ වන විට ඔහු විසින් දියත් කොට තිබේ. 

වෛද්‍ය කනිෂ්ක කරුණාරත්න මහතා විසින් කරන ලද  අයථා ක්‍රියා පිලිබඳ විමසීමට  යාමේදී මෙම බෝසත් වෛද්‍යවරයා අපට සී. අයි.ඩී එකේ සිටින පාසල් මිතුරන් මගින් පාඩමක් උගන්වන බවත් තමුසෙලාගේ ළමයින්ට පිළිකා හැදී හැඳි ගෑවී යා යුතු බව  කියා  සාප කලේය​. මේ දුප්පත් පිළිකා රෝගීන්ට ප්‍රතිකාර සඳහා ලැබුනු ආධාර සහ ඖෂධ යටි මඩි ගසා ගත්  සමාජය ඉදිරියේ සිල් රෙදි පොරවා ගත් හොරෙකුගේ තත්‍ය ස්වභාවයයි. 

වෛද්‍ය රුවන් එම් ජයතුංග 

පහත දැක්වෙන්නේ කනිෂ්ක කරුණාරත්න විසින් කරන ලද මුල්‍ය වංචාව පිලිබඳ ලංකා ඊ නිවුස් විසින් පළ කරන ලද වාර්තාවයි. 

මහරගම පිලිකා රෝහලට ලැබුණු කෝටි ගණනක ආධාර මුදල් සිය පුද්ගලික ගිණුමක තැන්පත් කරගත් රාජපක්ෂ ඥාති නීචයා රටින් පැනීමේ සූදානමක්..! පනින්න පෙර අල්ලා ගනු..!!  (ලංකා ඊ නිව්ස් -2016.මාර්.30, පෙ.ව‍.6.15) මැදමූලන රාජපක්ෂලාට ඥාතීත්වයක් ඇති කනිෂ්ක කරුණාරත්න යනු මහරගම පිලිකා රෝහලේ හිටපු අධ්‍යක්ෂ වරයායි. 2015 ජනාධිපතිවරණ ප්‍රචාරක කටයුතු ජනවාරි 5 වෙනිදා රාත්‍රියෙන් අවසන් කළ පසු ජනවාරි 6 දින ජාතික රුපවාහිනියේ වෛද්‍ය හමුව වැඩසටහනකට සහභාගිවෙමින් කිසිදු හිරිකිතයකින් තොරව මහින්ද රාජපක්ෂට චන්දය දෙන්නැයි ආයාචනා කර සිටියේ ඥාතීත්වය හා බැඳුනු සට්ටැඹි භාවය නිසාම ය.  රාජපක්ෂ ඥාතීත්වයද උපයෝගී කර ගත් කණිෂ්ක කරුණාරත්න මහින්ද රාජපක්ෂ ජනාධිපති කාලයේදී මහරගම පිළිකා රෝහලට පරිත්‍යාග ශීලීන්ගෙන් ලැබුණු කෝටි ගණනක මුදලක් "ජනාධිපති අරමුදල" ලෙස හඳුන්වමින් සිය පුද්ගලික ගිණුමකට බැර කරවා ගත්තේය. පිලිකා රෝගීන්ගේ මුදල් ගසා කෑම තරම් පහත් නීච ක්‍රියාවක් කළ හැක්කේ රාජපක්ෂලාගේ ඥාතියෙකුටම පමණි.   නව රජය පත්වූ පසු ඒ සම්බන්ධයෙන් මොහුට විරුද්දව FCID යට පැමිණිලි කිරිමෙන් පසු මේ වනවිට වැඩ තහනමට ලක්වී සිටින අතර ඔහුට එරෙහිව මුල්‍ය අපරාධ කොට්ටාශය පරීක්ෂණ පවත්වමින් සිටී.  කෙසේ වෙතත් මෙම ආණ්ඩුව තුලටද රිංගාගෙන සිටින මරාවාදී ඇමතිවරුන් කිහිපදෙනෙකු මෙම පරීක්ෂණ යටගසා දැමීම සඳහා දැඩි පරිශ්‍රමයක යෙදෙන අතර පරීක්ෂණ මගහැර රටින් පිටවී සිටින ලෙස ඉහලින් ලැබුණු උපදෙසක් මත කනිෂ්ක කරුණාරත්න මේ වන විට රටෙන් පිටවීමේ සුදානමක් පවතින බව ලංකා ඊ නිවුස් අභ්‍යන්තර තොරතුරු සේවය වෙත වාර්තා වේ.  අස්පයා පැන ගියාට පසු ඉස්තාලය වැසීමෙන් පලක් නොවන අතර පිළිකා රෝගීන්ගේ ආධාර මුදල් පවා හොරකම් කළ මෙවැනි නීචයෙක් රටින් පැනීම වළකා හැකි ඉක්මනින් අපරාධ විමර්ශනය කර කොල්ලා කෑ මහජන මුදල් යලි ලබා ගැනීමට ක්‍රියා කළ යුතුය.(Lanka E News) 


  

Sunday, June 25, 2017

ප්‍රෝටීන් ඌනතාවය හා උපත් බර අඩු ළමුන්


"මේ පින්බිමේ දවසකට කුකුළ්ලු කී දාහක් මැරෙනවද පින්වතුනි !" කියලා රේඩියෝ එකේ බණක් ඇහෙනවා......
පළවෙනි කරුණ - මේක පින් බිමක් නෙමෙයි.......මේවට "පින් බිම්" කියනව නම් "පින්" සහ "පව්" යනු මොනවාද කියලා ආයෙත් පොත් පෙරළගෙන හරියට හොයල බලන්න ඕන..... ..( උපුටා ගැනීම Damith Kethaka) 
 
සටහන 

ප්‍රෝටීන් ඌනතාවය නිසා ලංකාවේ ළමුන් අඩු උපත් බර ; වර්ධනයේ මන්දනයක් පෙන්වති. මාංශමය අාහාර සඳහා තිබෙන ආගමික විරෝධය නිසා අනාගතයේ   ලෝකයා ඉදිරියේ කායික මානසික වශයෙන් දුර්ලවළ වූ ජාතියක් ලෙස අපට පෙනී සිටිය හැකිය​. අාහාර සහ පෝෂණය ගැන මෙලෝ දෙයක් නොදත්  පූජකයෝ මිනිසුන්ට   අාහාර සම්බන්ධයෙන් ද උපදෙස් දෙති. පුදුමය නම් බුදුන් වහන්සේ අාහාර සම්බන්ධයෙන් කිසිම  තහනමක් ගිහියන්ට නොපැනවූ ප්‍රායෝගිකවාදියෙක් වූවද උන්වහන් සේගේ දේශනා  ද විකෘති කරමින් හිංදු ආගමේ උපාංග (ගව ඝාතන විරෝධය​)  නිර්මාංශ වීම  ඇතැම් භික්‍ෂූන් විසින් සමාජය පුරා වැපිරීමය​

අපි යන්නේ කොයි පාරේ





මල්ලිලා කට්ටියක් අපි යන්නේ කොයි පාරේ ත්‍රීමා වෙනුර ගිය පාරේ කියමින් පාරවල් වල යනවා. ඒ අය එහෙම යන කොට මේ මල්ලිලා මොනෑෂ් , ක්වීන්ස් , මැගිල් පාරවල් වල ගිහිල්ලා ලෝකය දිනලා






Saturday, June 24, 2017

අපගේ ගංජා පත්‍රිකාව


 ගංජා භාවිතය සහ සෞඛ්‍ය පිලිබඳ ආචාර්‍ය මන්ඩේ  ඉග්වේ (නයිජීරියාව) , විශේෂඥ මනෝ වෛද්‍ය උපාලි පීරිස්    සහ මා විසින් ලියන ලද පත්‍රිකාව​. මෙය අප තවමත් වැඩි දියුණු කරමින් සිටින අතර නුදුරු දිනෙක ප්‍රකාශයට පත් කිරීමට නියමිතය​.  


Cannabis use and Mental Health


Dr Monday N. Igwe, Dr. Upali P. K. Peris,   Dr Ruwan M Jayatunge


Cannabis sativa (marijuana) has been used throughout the world medically, recreationally and spiritually for thousands of years (Maule, 2015). It is the most commonly used illicit drug in the world (Wittchen et al., 2009). Despite being illegal in many countries, it is easily obtained and even homegrown (Delisi et al., 2006). According to the results from the 2011 National Survey on Drug Use and Health, the rate of marijuana use has had a steady increase since 2007. Cannabis use continues to constitute social and public health problem.

The cannabis plant (Cannabis sativa) has a long history of use both as a medicinal agent and intoxicant (ElSohly & Slade, 2005). There are over 400 chemicals in marijuana. Active compounds of cannabis, called cannabidiols, have 64 active isomers. Only one metabolite, tetrahydrocannabinol (THC) is reported to be an active metabolite responsive for its effects (Morrison et al., 2009). THC usually refers to the naturally existing isomer of delta-9-THC, but also may include delta-8-THC. The delta-9-tetrahydrocannabinol contains psychoactive properties. Marijuana produces a number of characteristic behaviors in humans and animals, including memory impairment, antinociception, and locomotor and psychoactive effects (Sim-Selley, 2003).

THC leads to increased activation in frontal and paralimbic regions and the cerebellum (Chang   & Chronicle, 2007). Cannabinoids act on a specific receptor that is widely distributed in the brain regions involved in cognition, memory, reward, pain perception, and motor coordination (Adams & Martin, 1996). Cannabis produces euphoria and relaxation, perceptual alterations, time distortion, and the intensification of ordinary sensory experiences (Hall, Solowij & Lemon 1994).

Although most people who smoke cannabis will develop neither severe mental health problems nor dependence, regular use of cannabis may be associated with a range of health, emotional, behavioural, social, and legal problems, particularly in young, pregnant, and severely mentally ill people (Winstock, Ford & Witton, 2010). Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco (Peters, Budne & Carroll 2012).

Epidemiological studies indicate that approximately 10% of lifetime cannabis users meet the criteria for cannabis abuse or dependence (Anthony et al., 1994; Cottler et al., 1995; Hall et al., 1999). The epidemiological literature shows that cannabis use increases the risk of accidents (Hall, 2015) and risk of motor vehicle crashes (Hall & Degenhardt, 2009). Cannabis is currently one of the leading substances reported in arrests (Dennis et al., 2002).

Tolerance and dependence to cannabinoids develop after chronic use, as demonstrated both clinically and in animal models (Sim-Selley, 2003). According to Levin and colleagues (2011) Cannabis dependence is a substantial public health problem. A large body of evidence now demonstrates that cannabis dependence both behavioral and physical, does occur in about 7-10% of regular users, and that early onset of use, and especially of weekly or daily use, is a strong predictor of future dependence (Kalant, 2004).  Cannabis dependence or cannabis use disorder is defined in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition requiring treatment (Gordon   Conley & Gordon, 2013).

Cannabis withdrawal is an important component of cannabis dependence (Lee et al., 2014). As many as 85% of users experience withdrawal (Budney et al., 2004; Winstock et al., 2010). Cannabis withdrawal is characterized by craving, irritability, nervousness, depressed mood, restlessness, sleep difficulty, and anger. With the recent publication of the DSM-5, a cannabis withdrawal syndrome is now officially recognized with defined criteria (APA, 2013).

Consequences of Cannabis Use
Studies show significant negative effects of smoking marijuana on physical and mental health as well as social and occupational functioning (Gazdek, 2014). Smoking marijuana is known to have hemodynamic consequences (Mittleman et al., 2001). Cannabis also has immunosuppressant and endocrine effects although the clinical significance of these is still not clear (Ashton, 2001). Cannabis smoking shows a dose-response relation with pulmonary risk in the same way that tobacco smoking does. Although problems of cannabis use can arise at any level of use, however low, cannabis use disorders and other problems are more likely to arise in long term, heavy daily users than in casual, infrequent users. (Winstock, et al., 2010).

Longitudinal association between cannabis use and mental health has been studied by the researchers. Cannabis use is a known risk factor for a range of mental health problems (van Gastel et al., 2014). Cannabis use has been associated with several adverse life outcomes including unemployment, legal problems, dependence and early school leaving (Serafini et al., 2013). Furthermore, Monshouwer and colleagues (2006) specify that cannabis use is associated with aggression and delinquency. In addition Fergusson and Boden (2008) point out that greater welfare dependence and lower relationship and life satisfaction associated with cannabis abuse.

Majority of studies have suggested a significant cognitive decline in cannabis abusers compared to non-abusers and healthy controls (Shrivastava et al., 2011; Solowij, 1988). According to Kalant (2004) Cannabis use has been linked to a number of both short- and long-term health consequences, including depression, paranoia, learning problems, memory and attention deficits. In addition Cannabis use also causes symptoms of depersonalization, fear of dying and irrational panic ideas (Khan & Akella 2009). Also cannabis use significantly increase the risk for manic symptoms (Henquet, Krabbendam & Graaf, 2006) and mania (Leweke & Koethe, 2008). Evidence indicates that cannabis use is considerably associated with both attempted and completed suicides among healthy youths (Serafini et al., 2013; Price et al., 2009).

Cannabis intoxication can occur shortly after cannabis use. The intoxication by cannabis is associated with subjective symptoms of euphoria, perceptual distortion, continuous giggling, sedation, lethargy, impaired perception of time, difficulties in the performance of complex mental processes, impaired judgment and social withdrawal (Crippa et al. 2012). Some clinicians have noticed panic attacks with cannabis intoxication. Cannabis intoxication symptoms are usually gone after a maximum of one week abstinence (Lishman, 1988).

Heavy cannabis use could lead to an ‘amotivational syndrome which has been described as personality deterioration with loss of energy and drive to work (Tennant & Groesbeck, 1972; Johns, 2001). Cannabis-induced amotivational syndrome negatively impacts on volition, self care and social performance.

Cannabis-induced psychotic disorder (CIPD) refers to psychotic symptoms that arise in the context of cannabis intoxication (Morales-Muñoz et al., 2014). Cannabis use is a risk factor for the development of incident psychotic symptoms (Arendt et al, 2005; Kuepper et al., 2011) and exacerbates psychosis (Hall et al., 2004).  Hall and team (2004) state that cannabis use can precipitate schizophrenia in vulnerable individuals. Deficits in prepulse inhibition (PPI) and cannabis abuse are consistently found in schizophrenia (Morales-Muñoz et al., 2015).

Cannabis use in adolescence leads to a two to three fold increase in relative risk for schizophrenia or schizophreniform disorder in adulthood (Arseneault et al., 2004). The abuse of cannabis by patients with psychiatric disorders such as schizophrenia and mood and anxious disorders has a negative impact both in the acute and advanced stages of these conditions (Diehl, Cordeiro &, Laranjeira, 2010).

Exposure to marijuana during a critical period of neural development may interrupt maturational processes (Jacobus et al., 2009). Adolescents appear more adversely affected by heavy use than adults (Schweinsburg, Brown & Tapert , 2008). Chronic cannabis use may alter brain structure and function in adult and adolescent population (Batalla et al., 2013). Sami and colleagues (2015) suspect cannabis use may be associated with   dopamine signaling alterations. Fontes and team (2011) point out that cannabis use has been associated with prefrontal cortex (PFC) dysfunction.

Arseneault and colleagues (2004) were of the view that cases of psychotic disorder could be prevented by discouraging cannabis use among vulnerable youths. Consequently Moore and team (2007) emphasize that sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

According to El Marroun and team (2009) maternal cannabis use, even for a short period, may be associated with several adverse fetal growth trajectories. Cannabinoids have the ability to cross the placental barrier to the foetus and are detectable in the breast milk of mothers who use cannabis (Liebke, 2001). Current evidence indicates that cannabis use both during pregnancy and lactation, may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation, with impacts on neuropsychiatric, behavioural and executive functioning. (Jaques et al., 2014). Prenatal marijuana exposure is associated with adverse perinatal effects (Astley & Little, 1990).


Medical Uses of Cannabis
The use of cannabis for medical purposes is a controversial but an important topic of public and scientific interest (Ware, Adams &Guy, 2005). According to Grotenhermen and Müller-Vahl  (2012) cannabinoids are useful for the treatment of various medical conditions. Medicinal marijuana has been prescribed in chronic pain management, antiepileptic treatment in partial epilepsy, symptomatic relief in multiple sclerosis and chronic neuropathic pain. However severe risks are associated with the non-medicinal use of cannabis. Hill (2015) emphasizes that physicians should educate patients about medical uses of marijuana to ensure that it is used appropriately and that patients will benefit from its use.

Although cannabis has valid medical applications, it has addictive potential. Heavy cannabis use may contribute to the development of significant psychosocial and health-related problems (Budney,, Vandrey and  Stanger 2010 ). Cannabis use clearly has serious implications for young people who are particularly sensitive to its psychotogenic effects (Kolliakou et al., 2012). Early interventions are essential in treating cannabis related disorders.

Management of Cannabis Use
The prevalence of marijuana abuse and dependence disorders has been increasing among adults and adolescents. They continue to smoke the drug despite social, psychological, and physical impairments, commonly citing consequences such as relationship and family problems, guilt associated with use of the drug, financial difficulties, low energy and self-esteem, dissatisfaction with productivity levels, sleep and memory problems, and low life satisfaction ( Gruber   et al , 2003 ; Budney et al, 2007).

Despite the fact that there are large numbers of people with cannabis dependence, relatively little attention has been paid to the treatment of this condition (Nordstrom & Levin, 2007) and also the   preventative strategies are still limited (Deoganet al., 2015).

Pharmacological and psychological interventions are recommended for the cannabis use disorder. Allsop and team (2014) propose cannabis extract nabiximols (Sativex) as a medication for cannabis withdrawal. Levin and colleagues (2011) suggest Dronabinol for the treatment of cannabis dependence. Haney et al (2013) recommend the FDA-approved synthetic analogue of THC nabilonewhich has higher bioavailability and clearer dose-linearity than dronabinol.

Steinberg and team (2002) suggest psychosocial treatment for cannabis dependence.  Among the psychological interventions Cognitive and behavioral therapies and motivational enhancement therapies have proven to be effective in cannabis withdrawal and dependence (Benyamina et al., 2008).
Motivational enhancement therapy is designed to help resolve ambivalence about quitting and strengthen motivation to change (Elkashef et al., 2008). Cognitive behavioral therapy (CBT) has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies (McHugh, Hearon & Otto, 2010).

CBT for marijuana dependence has typically been delivered in 45 to 60- minute individual or group counseling sessions. The overall focus is the teaching of coping skills relevant to quitting marijuana and coping with other related problems that might interfere with good outcome. Such coping skills include functional analysis of marijuana use and cravings, development of self-management plans to avoid or cope with drug-use triggers, drug refusal skills, problem-solving skills, and lifestyle management (Elkashef et al., 2008). In addition Litt and team (2008) highlight the efficacy of contingency management treatments for marijuana dependence.

Treatment of cannabis use among people with psychotic or depressive disorders is imperative. Available studies indicate that effectively treating the mental health disorder with standard pharmacotherapy may be associated with a reduction in cannabis use and that longer or more intensive psychological intervention rather than brief interventions may be required, particularly among heavier users of cannabis and those with more chronic mental disorders (Baker, Hides & Lubman 2010).

As safer alternative, some propose cannabis substitution which is a method of harm reduction.  Harm reduction refers to policies and programmes that aim to reduce the harms associated with the use of drugs. Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely (Lau et al., 2015). Based on principles of public health, harm reduction offers a pragmatic yet compassionate set of strategies designed to reduce the harmful consequences of addictive behavior for both drug consumers and the communities in which they live (Marlatt, 1996).


Conclusion
Cannabis abuse can have a profound effect on the health of individuals, their families, and their communities. Prevention and intervention programs for marijuana abuse are highly essential. Early intervention initiatives and psycho education strategies are important in preventive actions.


Acknowledgements:

·         Mark D. Litt, Ph.D. Professor of Psychology University of Connecticut
·         Dr. Ilan Nachim, HBSc, MSc, MD, CCFP Toronto Canada
·         Dr. Krishna Balachandra, M.D., FRCPC - Assistant clinical professor at the University of Alberta


About the Authors

Dr. Monday Igwe - Lecturer/Head of Department in Department of Psychological Medicine Faculty of Medicine College of Health Sciences Ebonyi State University, Abakaliki Nigeria.

Dr M.U.P.K.Peris MBBS, MD(Psych), FSLCPsych, MRCPsych Head and Senior Lecturer in Psychiatry - Faculty of Medicine, University of Kelaniya Sri Lanka Consultant Psychiatrist - North Colombo Teaching Hospital, Ragama Sri Lanka



References
Adams, I.B., Martin, B.R.(1996). Cannabis: pharmacology and toxicology in animals and humans. Addiction; 91: 1585–614.

Allsop, D.J.,  Copeland, J. , Lintzeris, N. , Dunlop, A.J.,  Montebello, M. , Sadler, C. , Rivas, G.R ., Holland, R.M.,  Muhleisen, P. , Norberg, M.M. , Booth, J. , McGregor, I.S. (2014).Nabiximols as an agonist replacement therapy during cannabis withdrawal: a randomized clinical trial. JAMA Psychiatry.  71(3):281-91.

APA (2013). Diagnostic and Statistical Manual. 5th edition. Arlington: American Psychiatric Association.

Arendt, M. , Rosenberg, R., Foldager, L., Perto, G., Munk-Jørgensen, P.(2005).Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. Br J Psychiatry.  ;187:510-5.

Arseneault, L., Cannon, M., Witton, J., & Murray, R.M. (2004) Causal Associations between cannabis and psychosis: examination of the evidence. Br J Psychiatry, 184, 110- 117.

Ashton, C.(2001). Pharmacology and effects of cannabis: A brief review. Br J Psychiatry. ;178:101–6.
Astley, S.J., Little, R.E.(1990).Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol.  ;12(2):161-8.

Baker, A.L. , Hides, L., Lubman, D.I.(2010).Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review.J Clin Psychiatry. 2010 Mar;71(3):247-54.

Batalla, A., Bhattacharyya, S., Yücel, M., Fusar-Poli ,P., Crippa, J.A., Nogué, S., Torrens, M., Pujol, J., Farré, M., Martin-Santos, R. (2013).Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings.PLoS One. ;8(2):e55821. 

Benyamina, A. , Lecacheux, M., Blecha, L., Reynaud, M., Lukasiewcz, M. (2008).Pharmacotherapy and psychotherapy in cannabis withdrawal and dependence.Expert Rev Neurother.  ;8(3):479-91.
Budney, A.J., Hughes, J.R., Moore, B.A., Vandrey, R.(2004). Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry;161:1967-77.

Budney, A.J. , Roffman, R., Stephens, R.S., Walker, D. (2007).Marijuana dependence and its treatment. Addict Sci Clin Pract. ;4(1):4-16.

Budney, A.J., Vandrey, R.G., Stanger, C.(2010).[Pharmacological and psychosocial interventions for cannabis use disorders].Rev Bras Psiquiatr. ;32 Suppl 1:S46-55.

Chang, L ., Chronicle, E.P.(2007).Functional imaging studies in cannabis users.Neuroscientist.;13(5):422-32.

Crippa, J.A., Derenusson, G.N., Chagas, M.H, et al.(2012).Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature. Harm Reduct J. 9: 7.

Delisi, L.E, Bertisch, H.C., Szulc, K.U., Majche,r M., Brown, K., Bappal, A., Ardekani, B.A. (2006).A preliminary DTI study showing no brain structural change associated with adolescent cannabis use.Harm Reduct J.  9;3:17.

Dennis, M., Babor, T.F., Roebuck, M.C., Donaldson, J.(2002). Changing the focus: the case for recognizing and treating cannabis use disorders.Addiction.  ;97 Suppl 1:4-15.

Deogan, C. , Zarabi, N., Stenström, N., Högberg, P., Skärstrand, E., Manrique-Garcia, E, Neovius, K., Månsdotter, A. (2015).Cost-Effectiveness of School-Based Prevention of Cannabis Use. Appl Health Econ Health Policy. 
Diehl, A., Cordeiro, D.C., Laranjeira, R.(2010).[Cannabis abuse in patients with psychiatric disorders: an update to old evidence].Rev Bras Psiquiatr.  ;32 Suppl 1:S41-5.

Elkashef ,A., Vocci, F., Huestis, M., Haney, M., Budney, A., Grube,r A., el-Guebaly, N.(2008). Marijuana neurobiology and treatment. Subst Abus.;29(3):17-29. 

El Marroun, H. , Tiemeier. H., Steegers, E.A., Jaddoe, V.W., Hofman, A., Verhulst, F.C., van den Brink, W., Huizink, A.C. (2009).Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study.J Am Acad Child Adolesc Psychiatry.  ;48(12):1173-81.

ElSohly, M.A., Slade, D. (2005) Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci 78:539–548.

Fergusson, D.M ., Boden, J.M.(2008).Cannabis use and later life outcomes. Addiction.  103(6):969-76; discussion 977-8.

Fontes, M.A., Bolla, K.I., Cunha, P.J., Almeida, .PP., Jungerman, F., Laranjeira, R.R., Bressan, R.A., Lacerda, A.L. (2011). Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users.J Clin Exp Neuropsychol. ;33(5):523-31.

Gazdek, D.(2014).[Marijuana for medical purposes--public health perspective]. Lijec Vjesn. 2014 Jul-Aug;136(7-8):192-9.

Gordon, A.J., Conley, J.W., Gordon, J.M.(2013).Medical consequences of marijuana use: a review of current literature. Curr Psychiatry Rep. ;15(12):419.

Grotenhermen, F. , Müller-Vahl, K.(2012). The therapeutic potential of cannabis and cannabinoids. Dtsch Arztebl Int.  ;109(29-30):495-501.

Gruber, A.J. , Pope, H.G., Hudson ,J.I., Yurgelun-Todd, D.(2003).Attributes of long-term heavy cannabis users: a case-control study. Psychol Med.  ;33(8):1415-22.

Hall, W., Solowij, N., Lemon, J.(1994). The health and psychological consequences of cannabis use. National Drug Strategy Monograph Series no 25. Canberra: Australian Government Publishing Service.

Hall, W., Degenhardt, L., Teesson, M.(2004).Cannabis use and psychotic disorders: an update.Drug Alcohol Rev. ;23(4):433-43.

Hall, W. , Degenhardt, L. (2009).Adverse health effects of non-medical cannabis use. Lancet.  17;374(9698):1383-91.

Hall, W. (2015).What has research over the past two decades revealed about the adverse health effects of recreational cannabis use? Addiction. ;110(1):19-35.

Haney, M., Cooper, Z.D., Bedi ,G., Vosburg, S.K., Comer, S.D., Foltin, R.W. (2013).Nabilone decreases marijuana withdrawal and a laboratory measure of marijuana relapse. Neuropsychopharmacology. ;38(8):1557-65.

Henquet, C., Krabbendam, L., de Graaf, R., et al.(2006).Cannabis use and expression of mania in the general population. J Affect Disord.  ;95(1-3):103–110.

Hill, K.P. (2015).Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review. JAMA.  23-30;313(24):2474-83.

Jacobus, J., Bava, S., Cohen-Zion, M., Mahmood, O., Tapert, S.F.(2009).Functional consequences of marijuana use in adolescents. Pharmacol Biochem Behav. ;92(4):559-65.

Jaques, S.C. , Kingsbury, A. , Henshcke, P. , Chomchai, C. , Clews ,S. , Falconer, J. , Abdel-Latif ,M.E. , Feller ,J.M. , Oei ,.JL . (2014).Cannabis, the pregnant woman and her child: weeding out the myths.J Perinatol. ;34(6):417-24.

Johns , A. (2001). Psychiatric effects of cannabis. The British Journal of Psychiatry.178 (2) 116-122;
Kalant, H. (2004). Adverse effects of cannabis on health: an update of the literature since 1996. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 28(5), 849-863.

Khan, M.A., Akella ,S.(2009).Cannabis-induced bipolar disorder with psychotic features: a case report. Psychiatry (Edgmont).  ;6(12):44-8.

Kolliakou, A., Fusar-Poli, P, Atakan, Z.(2012).Cannabis abuse and vulnerability to psychosis: targeting preventive services. Curr Pharm Des.;18(4):542-9.

Kuepper, R., van Os ,J., Lieb, R., Wittchen, H.U., Höfler, M., Henquet, C.(2011).Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2 1;342:d738.

Lau, N. , Sales, P., Averill, S., Murphy, F., Sato, S.O., Murphy, S. (2015).A safer alternative: Cannabis substitution as harm reduction.Drug Alcohol Rev.  28.

Lee, D., Schroede, J.R., Karschner, E.L., Goodwin, R.S., Hirvonen, J., Gorelick, D.A., Huestis, M.A. (2014).Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment. Am J Addict. 23 (3):234-42.

Levin, F.R. , Mariani, J.J., Brooks, D.J., Pavlicova, M., Cheng, W., Nunes ,E.V. (2011).Dronabinol for the treatment of cannabis dependence: a randomized, double-blind, placebo-controlled trial.Drug Alcohol Depend. 1;116(1-3):142-50.

Leweke, F., Koethe, D. (2008).Cannabis and psychiatric disorders: it is not only addiction. Addict Biol.;13(2):264–275. Review.

Liebke, S. (2001).A Cannabis User’s Harm Reduction Handbook. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?rep=rep1&type=pdf&doi=10.1.1.202.4159.

Lishman, W.A. (1988)Organic Psychiatry: The Psychological Consequences of Cerebral Disorder. 3. Oxford: Blackwell; 1998.

Litt, M.D ., Kadden, R.M., Kabela-Cormier, E., Petry, N.M.(2008). Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change. Addiction.103(4):638-48.

Marlatt, G.A. (1996).Harm reduction: come as you are. Addict Behav. ;21(6):779-88.
Maule, W.J.(2015).Medical uses of marijuana (Cannabis sativa): fact or fallacy? Br J Biomed Sci. ;72(2):85-91.

McHugh ,R.K ., Hearon, B.A., Otto, M.W. (2010).Cognitive behavioral therapy for substance use disorders. Psychiatr Clin North Am. 2010 Sep;33(3):511-25.

Mittleman, M.A ., Lewis, R.A., Maclure, M., Sherwood, J.B., Muller ,J.E. (2001).Triggering myocardial infarction by marijuana. Circulation. 12;103(23):2805-9.

Monshouwer, K. , VAN Dorsselaer, S., Verdurmen, J., Bogt, T.T., D.E., Graaf, R., Vollebergh, W. (2006). Cannabis use and mental health in secondary school children. Findings from a Dutch survey.Br J Psychiatry. ;188:148-53.           

Moore, T.H. , Zammit, S., Lingford-Hughes, A., Barnes, T.R., Jones, P.B., Burke ,M., Lewis, G. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.Lancet. 28;370(9584):319-28. 

Morales-Muñoz, I ., Jurado-Barba, R., Ponce, G. , Martínez-Gras, I. , Jiménez-Arriero, M.Á.  Moratti, S.,  Rubio, G.(2014). Characterizing cannabis-induced psychosis: a study with prepulse inhibition of the startle reflex.Psychiatry Res. 15;220(1-2):535-40.     

Morales-Muñoz, I. , Jurado-Barba, R., Caballero, M., Rodríguez-Jiménez, R., Jiménez-Arriero, M.Á., Fernández-Guinea, S., Rubio ,G. (2015). Cannabis abuse effects on prepulse inhibition in patients with first episode psychosis in schizophrenia. J Neuropsychiatry Clin Neurosci.  ;27(1):48-53.

Morrison, P.D., Zois, V., McKeown, D.A., Lee ,T.D., Holt, D.W., Powell, J.F, et al. (2009).The acute effects of synthetic intravenous Delts9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychol Med. ;31:1607–16.

Nordstrom, B.R., Levin, F.R.(2007).Treatment of cannabis use disorders: a review of the literature. Am J Addict. 16(5):331-42.

Peters ,E.N., Budney, A.J., Carroll, K.M.(2012).Clinical correlates of co-occurring cannabis and tobacco use: a systematic review.Addiction. 2012 Aug;107(8):1404-17.

Price, C, Hemmingsson, T., Lewis, G., Zammit, S., Allebeck, P. (2009).Cannabis and suicide: longitudinal study. Br J Psychiatry.195:492–710.

SAMHSA (2012) Results from the 2011 National Survey on Drug Use and Health: National Findings(Subst Abuse Ment Health Serv Admin, Rockville, MD), NSDUH Series H-30, DHHS Publication No. SMA 06-4194.

Sami, M.B. , Rabiner, E.A. , Bhattacharyya, S . (2015). Does cannabis affect dopaminergic signaling in the human brain? A systematic review of evidence to date.Eur Neuropsychopharmacol. 2015 Mar 30. pii: S0924-977X(15)00088-7.

Schweinsburg, A.D. , Brown, S.A., Tapert, S.F.(2008).The influence of marijuana use on neurocognitive functioning in adolescents. Curr Drug Abuse Rev. ;1(1):99-111.

Serafini, G., Pompili, M., Innamorati, M., Temple, E.C., Borgwardt, S., & Girardi, P. (2013). The association between cannabis use, mental illness and suicidal behaviour: What is the role of hopelessness? Frontiers in Psychiatry, 4, 125.

Shrivastava ,A., Johnston, M., Tsuang, M.(2011). Cannabis use and cognitive dysfunction..Indian J Psychiatry. ;53(3):187-91.
Sim-Selley, L.J.(2003).Regulation of cannabinoid CB1 receptors in the central nervous system by chronic cannabinoids.Crit Rev Neurobiol.  15(2):91-119.

Solowij, N. (1988). Cannabis and cognitive functioning. Cambridge: Cambridge University Press.
Steinberg, K.L., Roffman, R.A., Carroll, K.M., Kabela, E., Kadden, R., Miller, M., Duresky, D. (2002).Tailoring cannabis dependence treatment for a diverse population.Addiction. ;97 Suppl 1:135-42.

Tennant, F. S.,Groesbeck, C. J. (1972) Psychiatric effects of hashish. Archives of General Psychiatry, 27, 133 -136.

van Gastel, W.A. , MacCabe ,J.H., Schubart, C.D., van Otterdijk, E., Kahn, R.S., Boks, M.P.(2014).Cannabis use is a better indicator of poor mental health in women than in men: a cross-sectional study in young adults from the general population. Community Ment Health J. ;50(7):823-30. 

Ware, M.A., Adams, H., Guy, G.W.(2005). The medicinal use of cannabis in the UK: results of a nationwide survey. Int J Clin Pract.  ;59(3):291-5.

Winstock, A.R., Ford, C., Witton, J. (2010).Assessment and management of cannabis use disorders in primary care. BMJ.1;340:c1571.

Wittchen, H.U., Behrendt, S., Hofler, M., Perkonigg, A., Rehm, J., Lieb, R., et al. (2009).A typology of cannabis-related problems among individuals with repeated illegal drug use in the first three decades of life: evidence for heterogeneity and different treatment needs. Drug Alcohol Depend2009;102:151-7.




Friday, June 23, 2017

දරුවෙකු සුරතල් කරන විජේවීර



පටබැඳිගේ දොන් නන්දසිරි විජේවීර , නන්දන මාරසිංහගේ දරුවෙකු සුරතල් කරන අවස්ථාව  

Find Us On Facebook