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Objective: The United States is in the midst of rapidly changing laws regarding cannabis. The increasing availability of cannabis for recreational and medical use requires that mental health clinicians be knowledgeable about evidence to be considered when counseling both patients and colleagues. In this review, the authors outline the evidence from randomized double-blind placebo-controlled trials for therapeutic use of cannabinoids for specific medical conditions and the potential side effects associated with acute and chronic cannabis use.Methods: Searches of PubMed and PsycInfo were conducted for articles published through July 2021 reporting on "cannabis" or "cannabinoids" or "medicinal cannabis." Additional articles were identified from the reference lists of published reviews. Articles that did not contain the terms "clinical trial" or "therapy" in the title or abstract were not reviewed. A total of 4,431 articles were screened, and 841 articles that met criteria for inclusion were reviewed by two or more authors.Results: There are currently no psychiatric indications approved by the U.S. Food and Drug Administration (FDA) for cannabinoids, and there is limited evidence supporting the therapeutic use of cannabinoids for treatment of psychiatric disorders. To date, evidence supporting cannabinoid prescription beyond the FDA indications is strongest for the management of pain and spasticity.Conclusions: As cannabinoids become more available, the need for an evidence base adequately evaluating their safety and efficacy is increasingly important. There is considerable evidence that cannabinoids have a potential for harm in vulnerable populations such as adolescents and those with psychotic disorders. The current evidence base is insufficient to support the prescription of cannabinoids for the treatment of psychiatric disorders. [ABSTRACT FROM AUTHOR]

In recent history, the world has witnessed a trend towards liberalization of abortion laws driven by an increasing understanding of the negative personal and public health consequences of criminalizing abortion. By contrast, several countries have recently implemented restrictive reproductive laws, joining the 112 countries where access to abortion care is banned completely or with narrow exceptions. On June 24, 2022, the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization overturned its landmark decisions in Roe v Wade that established abortion until the point of viability of the fetus as a constitutional right. After Roe v Wade having been overturned, it is projected that many women in the USA will be prevented from accessing safe abortion care. Importantly, abortion bans not only impose constraints on patient autonomy, they also restrict physicians' ability to practice evidence-based medicine, which will negatively impact psychiatric care. It is therefore crucial for the practicing psychiatrist to be familiar with this new legal landscape. In this Personal View, we aim to provide a topical overview to help clinicians gain a clear understanding of legal, clinical, and ethical responsibilities, focusing on the USA. We also discuss the reality that psychiatrists might be called upon to determine medical necessity for an abortion on psychiatric grounds, which is new for most US psychiatrists. We predict that psychiatrists will be confronted with very difficult situations in which lawful and ethical conduct might be incongruent, and that abortion bans will result in greater numbers of patients needing psychiatric care from a system that is ill-prepared for additional demands., Competing Interests: Declaration of interests ASW acknowledges financial support from the Minnesota Medical Discovery Team on Addictions and the MnDRIVE Brain Conditions Initiative. LLC reports clinical trials contracts with Brown University, Janssen, Neuronetics, and Neurolief; consulting income from Janssen, Neuronetics, Neurolief, Sage Therapeutics, Otsuka, and Magnus Medical; and a research equipment loan from Nexstim. JEA receives income from Cambridge University Press, Belvoir Media Group, and Massachusetts General Hospital Psychiatry Academy. JHK reports individual consultant agreements worth less than US$5000 per year with Aptinyx, Biogen, Idec, the state of Massachusetts, Bionomics (Australia), Boehringer Ingelheim International, Epiodyne, EpiVario, Janssen Research & Development, Jazz Pharmaceuticals, Otsuka America Pharmaceutical, Spring Care, and Sunovion Pharmaceuticals; is cofounder of Freedom Biosciences; serves on scientific advisory boards for Biohaven Pharmaceuticals, BioXcel Therapeutics (Clinical Advisory Board), Cerevel Therapeutics, Delix Therapeutics, Eisai, EpiVario, Jazz Pharmaceuticals, Neumora Therapeutics, Neurocrine Biosciences, Novartis Pharmaceuticals Corporation, PsychoGenics, Takeda Pharmaceuticals, Tempero Bio, and Terran Biosciences; owns stock in Biohaven Pharmaceuticals, Freedom Biosciences, and Spring Health; has stock options in Biohaven Pharmaceuticals Medical Sciences, Cartego Therapeutics, Damona Pharmaceuticals, Delix Therapeutics, EpiVario, Neumora Therapeutics, Rest Therapeutics, Tempero Bio, Terran Biosciences, and Tetricus; receives income as the editor of Biological Psychiatry; and holds the following patents and interventions: dopamine and noradrenergic reuptake inhibitors in treatment of schizophrenia (US patent 5447948), glutamate modulating agents in the treatment of mental disorders (US patent 8778979B2, US patent application 15/695164), intranasal administration of ketamine to treat depression (US patent 9592207, licensed to Janssen Research & Development), methods for treating suicidal ideation (US patent application 15/379013), composition and methods to treat addiction (US provisional use patent application 61/973/961), treatment selection for major depressive disorder (US Patent and Trademark Office docket number Y0087.70116US00), compounds, compositions and methods for treating or preventing depression and other diseases (US provisional patent application 62/444552), combination therapy for treating or preventing depression or other mood diseases (US provisional patent application 62/719,935), and mavoglurant in treating gambling and gaming disorders (US provisional patent application 63/125,181); and has the following non-federal research support: AstraZeneca Pharmaceuticals provides Saracatinib for research related to a National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant to the Center for Translational Neuroscience of Alcoholism, Novartis provides mavoglurant for research related to a NIAAA grant to the Center for Translational Neuroscience of Alcoholism, Cerevel provides the drug PF-06412562 for A Translational and Neurocomputational Evaluation of a D1R Partial Agonist for Schizophrenia (project number 1U01MH121766-01). CBN reports consulting income from AbbVie, ANeuroTech (division of Anima BV), Signant Health, Magstim, Intra-Cellular Therapies, EMA Wellness, Sage, Silo Pharma, Engrail Therapeutics, Pasithea Therapeutic, GoodCap Pharmaceuticals, Senseye, Clexio, Ninnion Therapeutics, EmbarkNeuro, SynapseBio, BioXcel Therapeutics, and Relmada Therapeutics; holds stocks in Seattle Genetics, Antares, Corcept Therapeutics Pharmaceuticals, EMA Wellness, Naki Health, and Relmada Therapeutics; serves on the scientific advisory boards of ANeuroTech (division of Anima BV), the Brain and Behavior Research Foundation, the Anxiety and Depression Association of America, Skyland Trail, Signant Health, Laureate Institute for Brain Research, Heading Health, Pasithea Therapeutic, and Sage; is on the board of directors for Gratitude America, the Anxiety and Depression Association of America, and Lucy Scientific Discovery; and holds patents for method and devices for transdermal delivery of lithium (US patent 6375990B1) and method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US patent 7148027B2). All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Objective: Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress., Design: The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here., Conclusion: The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Sarah Bick receives funding from the Neurosurgery Research and Career Development Program (K12 NS080223) and consulting honoraria from Varian Medical Systems. Rafael Carbunaru owns stock options and is an employee of Boston Scientific, a manufacturer of DBS devices. Jennifer Chandler receives funding from CIHR (Canadian Institutes of Health Research) through the ERANET-Neuron program. Binith Cheeran owns stock options and is an employee of Abbott, a manufacturer of DBS devices. Rachel Davis receives consulting honoraria from Medtronic and speaker fees from Baylor for an OCD conference. Darin Dougherty's research has been funded by the International OCD Foundation, Brain and Behavior Research Foundation, National Institute of Mental Health, Tiny Blue Dot Foundation and Medtronic; he has received honoraria and consultation fees from Medtronic, Sage, and Celanese and has equity in Neurable, Innercosmos, and Intrinsic Powers. Ashley Feinsinger receives funding from the NIH (RF1MH121373 and UH3NS103442), received honoraria for her work on the NIH Neuroethics Workgroup, she is on an advisory board of Vivani Medical Products (Orion Early Feasibility Study), and she is on the data safety monitoring board of R01 MH122431. Kelly Foote reported grants from the National Institutes of Health during the conduct of the study; nonfinancial support from Medtronic (donation of closed-loop DBS devices) outside the submitted work; and grants from Medtronic, Boston Scientific, and Functional Neuromodulation outside the submitted work. Wayne Goodman receives funding from NIH (UH3NS100459), the McNair Foundation, and Biohaven. WG receives royalties from Nview, LLC and OCDscales, LLC as well as consulting honoraria from Biohaven. Aysegul Gunduz receives investigational device donations from Medtronic under the NIH BRAIN Public-Private Partnership agreements, and her research is funded by NIH grants UH3NS095553, R01NS096008, UH3NS119844. Casey Halpern has patents related to sensing and brain stimulation for the treatment of neuropsychiatric disorders, and he works as a consultant for Boston Scientific Neuromodulation and Insightec. Brian Kopell has received consulting honoraria from Abbott and Medtronic. Cynthia Kubu receives grant funding from the NIH (5RO1MH114853, 5RC1NS068086, 3RF1MH123407-01S1) and participates on the data safety monitoring boards for studies investigating the use of DBS for pain (UHS3 BRIAN/UH3 HEAL, 3UH3NS113661). She is the president of the Society for Clinical Neuropsychology. Sarah Lisanby receives funding from the NIMH (1ZIAMH002955) and has a role on the Scientific Advisory Boards of the Aalto University School of Science and the German Center for Brain Stimulation. Cameron McIntyre is a paid consultant for Boston Scientific Neuromodulation, receives royalties from Hologram Consultants, Neuros Medical, Qr8 Health, and is a shareholder in the following companies: Hologram Consultants, Surgical Information Sciences, BrainDynamics, CereGate, Autonomic Technologies, Cardionomic, Enspire DBS. Michael Okun serves as Medical Advisor for the Parkinson's Foundation, and has received research grants from NIH, Parkinson's Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Michael Okun's research is supported by: NIHR01 NR014852, R01NS096008, UH3NS119844, U01NS119562. Michael Okun is PI of the NIH R25NS108939 Training Grant. Michael Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford and Cambridge (movement disorders books). Nader Pouratian receives research funding from NIH (R24 MH114796, UH3 NS103442, UH3 NS103549, R01 NS097782, UH3 NS113661, R01 GM135420, RF1 MH121373), consulting/presentation honoraria from Abbott, Sensoria Therapeutics, Boston Scientific, and BrainLab. Nader Pouratian is on an advisory board at Abbott Laboratories and has leadership positions in the Congress of Neurological Surgeons and American Society of Stereotactic and Functional Neurosurgery. Robert Raike owns stock options and is an employee of Medtronic, a manufacturer of DBS devices. Patricio Riva-Posse has received honoraria for consulting for Janssen Pharmaceuticals, Abbott Neuromodulation, and LivaNova. Sameer Sheth received funding from the McNair Foundation for this work. SS receives consulting honoraria from Boston Scientific, Neuropace, Zimmer Biomet, and Koh Young. Nora Vanegas-Arroyave receives research funding from NIH and the Michael J. Fox foundation. Alik Widge has received honoraria for consulting for Abbott, he has received device donations from Medtronic, and he has unlicensed patents in the area of deep brain stimulation., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)