WEBVTT NOTE duration: "01:02:41.706" NOTE Confidence: 0.9772152 00:00:00.960 --> 00:00:02.960 Good afternoon, everyone. It's, it's NOTE Confidence: 0.9772152 00:00:02.960 --> 00:00:05.059 my great, pleasure to introduce NOTE Confidence: 0.99573326 00:00:05.759 --> 00:00:07.540 my friend and today's speaker, NOTE Confidence: 0.87798214 00:00:08.400 --> 00:00:09.780 professor Marta DeForti. NOTE Confidence: 0.99592924 00:00:11.200 --> 00:00:12.340 She is a NOTE Confidence: 0.9897357 00:00:12.894 --> 00:00:15.155 clinician scientist whose work has NOTE Confidence: 0.9897357 00:00:15.215 --> 00:00:16.675 has really fundamentally NOTE Confidence: 0.99993026 00:00:17.055 --> 00:00:17.555 shaped NOTE Confidence: 0.99158907 00:00:18.335 --> 00:00:20.755 our, understanding of the link NOTE Confidence: 0.99158907 00:00:20.814 --> 00:00:21.875 between cannabis NOTE Confidence: 0.99915373 00:00:22.414 --> 00:00:23.235 and psychosis. NOTE Confidence: 0.9425906 00:00:23.614 --> 00:00:25.555 Professor DeForti holds the chair NOTE Confidence: 0.9678189 00:00:26.160 --> 00:00:28.000 in drug use, genetics, and NOTE Confidence: 0.9678189 00:00:28.000 --> 00:00:28.500 psychosis NOTE Confidence: 0.96480674 00:00:29.280 --> 00:00:30.740 in the department of social, NOTE Confidence: 0.9367966 00:00:31.440 --> 00:00:34.020 genetics and developmental psychiatry at NOTE Confidence: 0.9367966 00:00:34.320 --> 00:00:35.780 King's College in London NOTE Confidence: 0.96669245 00:00:36.239 --> 00:00:37.780 and serves as an honorary NOTE Confidence: 0.96669245 00:00:38.000 --> 00:00:38.500 consultant, NOTE Confidence: 0.97577894 00:00:39.945 --> 00:00:40.925 adult psychiatrist, NOTE Confidence: 0.99321413 00:00:41.305 --> 00:00:42.664 with the South London and NOTE Confidence: 0.99321413 00:00:42.664 --> 00:00:43.164 Maudsley, NOTE Confidence: 0.9875509 00:00:44.265 --> 00:00:46.125 NHS Foundation Trust. NOTE Confidence: 0.890995 00:00:47.144 --> 00:00:47.964 Her research, NOTE Confidence: 0.9991602 00:00:48.504 --> 00:00:49.644 sits at the crossroads NOTE Confidence: 0.99864995 00:00:50.745 --> 00:00:51.565 of psychiatry, NOTE Confidence: 0.94587874 00:00:52.230 --> 00:00:53.990 genetics, and substance use, NOTE Confidence: 0.98931366 00:00:54.390 --> 00:00:54.890 epidemiology. NOTE Confidence: 0.994581 00:00:56.630 --> 00:00:58.230 Through her clinical work with NOTE Confidence: 0.994581 00:00:58.230 --> 00:01:00.410 young people experiencing first episode NOTE Confidence: 0.994581 00:01:00.470 --> 00:01:00.970 psychosis, NOTE Confidence: 0.8921779 00:01:01.670 --> 00:01:03.770 professor DeForti has observed firsthand NOTE Confidence: 0.9849038 00:01:04.310 --> 00:01:05.830 the impact of cannabis use, NOTE Confidence: 0.9849038 00:01:05.830 --> 00:01:07.209 particularly high potency, NOTE Confidence: 0.802053 00:01:09.244 --> 00:01:10.625 high THC varieties, NOTE Confidence: 0.9967208 00:01:11.645 --> 00:01:12.765 and she's gone on to NOTE Confidence: 0.9967208 00:01:12.765 --> 00:01:14.865 provide some compelling evidence linking NOTE Confidence: 0.9891661 00:01:15.405 --> 00:01:16.204 use of these, NOTE Confidence: 0.9617375 00:01:16.685 --> 00:01:18.365 of these products with the NOTE Confidence: 0.9617375 00:01:18.365 --> 00:01:20.225 increased risk of psychotic disorders. NOTE Confidence: 0.95254356 00:01:20.685 --> 00:01:22.304 Amongst her many contributions, NOTE Confidence: 0.99877286 00:01:23.110 --> 00:01:23.930 as a clinician, NOTE Confidence: 0.9995011 00:01:24.390 --> 00:01:25.130 she has NOTE Confidence: 0.91802984 00:01:25.670 --> 00:01:27.189 founded the the the United NOTE Confidence: 0.91802984 00:01:27.189 --> 00:01:27.689 Kingdom's NOTE Confidence: 0.9991819 00:01:27.990 --> 00:01:30.090 first dedicated cannabis clinic NOTE Confidence: 0.9748662 00:01:30.630 --> 00:01:32.549 for patients with psychosis, creating NOTE Confidence: 0.9748662 00:01:32.549 --> 00:01:33.130 a bridge NOTE Confidence: 0.9985339 00:01:33.670 --> 00:01:35.209 between clinical care, NOTE Confidence: 0.9944731 00:01:35.985 --> 00:01:38.084 mechanistic research, and public health. NOTE Confidence: 0.9102982 00:01:38.545 --> 00:01:39.905 In twenty twenty, she was NOTE Confidence: 0.9102982 00:01:39.905 --> 00:01:41.745 awarded a senior research fellowship NOTE Confidence: 0.9102982 00:01:41.745 --> 00:01:43.825 from the u UK's medical NOTE Confidence: 0.9102982 00:01:43.825 --> 00:01:45.444 research count council NOTE Confidence: 0.9833222 00:01:45.745 --> 00:01:47.125 to continue her work. NOTE Confidence: 0.9697222 00:01:47.425 --> 00:01:48.705 And most recently, and I NOTE Confidence: 0.9697222 00:01:48.705 --> 00:01:49.825 had the pleasure of being NOTE Confidence: 0.9697222 00:01:49.825 --> 00:01:51.600 present for this, she was NOTE Confidence: 0.9697222 00:01:51.920 --> 00:01:53.600 she received the twenty twenty NOTE Confidence: 0.9697222 00:01:53.600 --> 00:01:54.500 five outstanding NOTE Confidence: 0.998822 00:01:54.800 --> 00:01:56.420 translational research award NOTE Confidence: 0.97459143 00:01:56.800 --> 00:01:59.060 from the Schizophrenia International Research NOTE Confidence: 0.97459143 00:01:59.200 --> 00:01:59.700 Society. NOTE Confidence: 0.98164463 00:02:01.200 --> 00:02:02.660 Her vision is to illuminate NOTE Confidence: 0.98164463 00:02:02.880 --> 00:02:05.280 how individual vulnerability genetics and NOTE Confidence: 0.98164463 00:02:05.280 --> 00:02:05.780 epigenetics NOTE Confidence: 0.87484574 00:02:06.795 --> 00:02:08.415 interacts with cannabis exposure NOTE Confidence: 0.98994565 00:02:09.595 --> 00:02:10.255 to influence NOTE Confidence: 0.99526966 00:02:10.875 --> 00:02:12.735 psychosis onset and outcomes. NOTE Confidence: 0.9812726 00:02:13.675 --> 00:02:14.175 She NOTE Confidence: 0.93365 00:02:15.595 --> 00:02:16.255 so please NOTE Confidence: 0.9308139 00:02:16.635 --> 00:02:18.415 join me in welcoming professor NOTE Confidence: 0.9308139 00:02:18.475 --> 00:02:19.375 Marta DiForti. NOTE Confidence: 0.54408264 00:02:20.075 --> 00:02:20.575 And NOTE Confidence: 0.9812298 00:02:22.610 --> 00:02:23.750 in today's presentation, NOTE Confidence: 0.99347717 00:02:24.290 --> 00:02:25.350 feel free to, NOTE Confidence: 0.99780464 00:02:26.050 --> 00:02:27.169 to jump in and ask NOTE Confidence: 0.99780464 00:02:27.169 --> 00:02:29.570 questions during the talk. Don't NOTE Confidence: 0.99780464 00:02:29.570 --> 00:02:30.770 wait till the end. We'd NOTE Confidence: 0.99780464 00:02:30.770 --> 00:02:32.070 like to make this as NOTE Confidence: 0.8740325 00:02:32.450 --> 00:02:34.290 interactive as prop as possible. NOTE Confidence: 0.8740325 00:02:34.290 --> 00:02:34.790 So, NOTE Confidence: 0.9844246 00:02:35.330 --> 00:02:37.185 Marta, the stage is yours. NOTE Confidence: 0.98487663 00:02:37.565 --> 00:02:38.865 Thank you very much, Cyril. NOTE Confidence: 0.98487663 00:02:39.165 --> 00:02:40.205 And I would like to NOTE Confidence: 0.98487663 00:02:40.205 --> 00:02:42.224 say that it's very embarrassing NOTE Confidence: 0.98487663 00:02:42.285 --> 00:02:43.965 when friends introduce you because NOTE Confidence: 0.98487663 00:02:43.965 --> 00:02:45.264 they are far too kind. NOTE Confidence: 0.98487663 00:02:45.485 --> 00:02:47.505 But, actually, I still remember NOTE Confidence: 0.98436683 00:02:48.125 --> 00:02:49.470 the first time I've ever NOTE Confidence: 0.98436683 00:02:49.550 --> 00:02:51.010 met Cyril at a conference NOTE Confidence: 0.98436683 00:02:51.070 --> 00:02:52.430 in Washington, and I was NOTE Confidence: 0.98436683 00:02:52.430 --> 00:02:53.330 blown away NOTE Confidence: 0.9914469 00:02:53.630 --> 00:02:54.910 by his data. So I NOTE Confidence: 0.9914469 00:02:54.910 --> 00:02:56.210 would like to say that NOTE Confidence: 0.9914469 00:02:56.430 --> 00:02:57.550 anything that I might have NOTE Confidence: 0.9914469 00:02:57.550 --> 00:02:58.370 done since NOTE Confidence: 0.9977479 00:02:58.669 --> 00:02:59.970 has been heavily influenced NOTE Confidence: 0.79704535 00:03:00.350 --> 00:03:01.250 by actually NOTE Confidence: 0.8945179 00:03:01.780 --> 00:03:03.250 Cyril pioneering work NOTE Confidence: 0.9971469 00:03:03.615 --> 00:03:05.475 in understanding how cannabinoid NOTE Confidence: 0.98423254 00:03:06.095 --> 00:03:07.475 can sort of exacerbate NOTE Confidence: 0.98208964 00:03:08.255 --> 00:03:09.075 and precipitate, NOTE Confidence: 0.98253417 00:03:09.935 --> 00:03:11.635 psychosis. So thank you, serial, NOTE Confidence: 0.98253417 00:03:11.695 --> 00:03:13.294 for having me in in NOTE Confidence: 0.98253417 00:03:13.294 --> 00:03:14.035 your home. NOTE Confidence: 0.93768865 00:03:14.895 --> 00:03:16.115 So I guess NOTE Confidence: 0.97563654 00:03:16.959 --> 00:03:18.880 I very interested in cannabis NOTE Confidence: 0.97563654 00:03:18.880 --> 00:03:20.319 use and psychosis because this NOTE Confidence: 0.97563654 00:03:20.319 --> 00:03:22.000 is something that where I NOTE Confidence: 0.97563654 00:03:22.000 --> 00:03:23.200 work as a psychiatrist, as NOTE Confidence: 0.97563654 00:03:23.200 --> 00:03:24.560 a clinician in inner city NOTE Confidence: 0.97563654 00:03:24.560 --> 00:03:25.060 London NOTE Confidence: 0.9653097 00:03:25.440 --> 00:03:26.800 is in your face. You NOTE Confidence: 0.9653097 00:03:26.800 --> 00:03:28.400 cannot ignore it, and I NOTE Confidence: 0.9653097 00:03:28.400 --> 00:03:29.280 will tell you a little NOTE Confidence: 0.9653097 00:03:29.280 --> 00:03:29.940 bit more, NOTE Confidence: 0.94841653 00:03:30.995 --> 00:03:32.514 about it. So first of NOTE Confidence: 0.94841653 00:03:32.514 --> 00:03:33.474 all, I just want to NOTE Confidence: 0.94841653 00:03:33.474 --> 00:03:35.635 start by reminding us all NOTE Confidence: 0.94841653 00:03:35.635 --> 00:03:37.334 that there have been, to NOTE Confidence: 0.97244644 00:03:37.635 --> 00:03:39.314 date, free meta analysis, which NOTE Confidence: 0.97244644 00:03:39.314 --> 00:03:40.594 are really the way in NOTE Confidence: 0.97244644 00:03:40.594 --> 00:03:42.515 research we tend to make NOTE Confidence: 0.97244644 00:03:42.515 --> 00:03:44.355 sense of all the studies NOTE Confidence: 0.97244644 00:03:44.355 --> 00:03:45.540 that have been published in NOTE Confidence: 0.97244644 00:03:45.540 --> 00:03:47.300 a specific area. And in NOTE Confidence: 0.97244644 00:03:47.300 --> 00:03:48.980 this case, all the studies NOTE Confidence: 0.97244644 00:03:48.980 --> 00:03:50.120 that have explored NOTE Confidence: 0.9825384 00:03:50.580 --> 00:03:52.819 the association between cannabis use NOTE Confidence: 0.9825384 00:03:52.819 --> 00:03:54.739 and psychotic disorder. And what NOTE Confidence: 0.9825384 00:03:54.739 --> 00:03:56.260 is quite interesting is that NOTE Confidence: 0.9825384 00:03:56.260 --> 00:03:57.540 while the phase two meta NOTE Confidence: 0.9825384 00:03:57.540 --> 00:03:58.680 analysis suggested NOTE Confidence: 0.99365366 00:03:59.355 --> 00:04:00.895 that if you use cannabis, NOTE Confidence: 0.99365366 00:04:00.955 --> 00:04:02.795 you double your risk of, NOTE Confidence: 0.94065344 00:04:03.435 --> 00:04:05.195 psychotic disorder, the third meta NOTE Confidence: 0.94065344 00:04:05.195 --> 00:04:06.955 analysis approached this question in NOTE Confidence: 0.94065344 00:04:06.955 --> 00:04:08.635 a different way. Now if NOTE Confidence: 0.94065344 00:04:08.635 --> 00:04:09.775 we were all together, NOTE Confidence: 0.928354 00:04:10.075 --> 00:04:11.915 perhaps in the beautiful Yale NOTE Confidence: 0.928354 00:04:11.915 --> 00:04:13.615 library where Cyril is, NOTE Confidence: 0.9906333 00:04:13.995 --> 00:04:15.090 I would ask you this NOTE Confidence: 0.9906333 00:04:15.090 --> 00:04:15.590 question. NOTE Confidence: 0.9397963 00:04:15.890 --> 00:04:17.270 Have you ever used alcohol? NOTE Confidence: 0.9397963 00:04:17.330 --> 00:04:18.930 Yes or no? So I NOTE Confidence: 0.9397963 00:04:18.930 --> 00:04:20.370 can't see you, but if NOTE Confidence: 0.9397963 00:04:20.370 --> 00:04:21.250 I ask people to put NOTE Confidence: 0.9397963 00:04:21.250 --> 00:04:22.290 their hand up is the NOTE Confidence: 0.9397963 00:04:22.290 --> 00:04:23.510 answer is yes. NOTE Confidence: 0.95968235 00:04:24.130 --> 00:04:26.070 And I would suspect probably NOTE Confidence: 0.95968235 00:04:26.290 --> 00:04:27.490 most of you would say NOTE Confidence: 0.95968235 00:04:27.490 --> 00:04:28.770 that you have tried alcohol NOTE Confidence: 0.95968235 00:04:28.770 --> 00:04:29.650 at some point in your NOTE Confidence: 0.95968235 00:04:29.650 --> 00:04:30.150 lifetime. NOTE Confidence: 0.90761024 00:04:30.604 --> 00:04:31.725 Now the first two met NOTE Confidence: 0.90761024 00:04:31.725 --> 00:04:32.845 Analia, I can see Wendy. NOTE Confidence: 0.90761024 00:04:32.845 --> 00:04:33.725 Thank you. Put her hand NOTE Confidence: 0.90761024 00:04:33.725 --> 00:04:35.565 up. Well, Wendy, I guess NOTE Confidence: 0.90761024 00:04:35.565 --> 00:04:36.845 this would tell me nothing NOTE Confidence: 0.90761024 00:04:36.845 --> 00:04:37.824 about your risk NOTE Confidence: 0.9865055 00:04:38.205 --> 00:04:40.365 of developing either liver disease NOTE Confidence: 0.9865055 00:04:40.365 --> 00:04:41.664 or or or even neurological NOTE Confidence: 0.9568251 00:04:41.964 --> 00:04:44.044 consequences of alcohol consumption because NOTE Confidence: 0.9568251 00:04:44.044 --> 00:04:45.324 I don't know if you NOTE Confidence: 0.9568251 00:04:45.324 --> 00:04:46.500 mean that you've tried it NOTE Confidence: 0.9568251 00:04:46.500 --> 00:04:47.779 twice or that you drink NOTE Confidence: 0.9568251 00:04:47.779 --> 00:04:48.980 a bottle of whiskey every NOTE Confidence: 0.9568251 00:04:48.980 --> 00:04:50.820 day. So it's interesting that NOTE Confidence: 0.9568251 00:04:50.820 --> 00:04:51.880 these first studies, NOTE Confidence: 0.969978 00:04:52.420 --> 00:04:53.460 even if they had a NOTE Confidence: 0.969978 00:04:53.460 --> 00:04:55.060 very sort of vague approach NOTE Confidence: 0.969978 00:04:55.060 --> 00:04:56.020 to the question, have you NOTE Confidence: 0.969978 00:04:56.020 --> 00:04:57.720 used cannabis? Yes or no? NOTE Confidence: 0.969978 00:04:58.020 --> 00:04:59.320 They were able to identify NOTE Confidence: 0.9948443 00:04:59.700 --> 00:05:01.480 a signal of increased risk. NOTE Confidence: 0.9948443 00:05:01.714 --> 00:05:02.835 And then there was a NOTE Confidence: 0.9948443 00:05:02.835 --> 00:05:04.355 third meta analysis that is NOTE Confidence: 0.9948443 00:05:04.355 --> 00:05:05.255 the most recent NOTE Confidence: 0.9481519 00:05:06.195 --> 00:05:07.635 done as a senior author NOTE Confidence: 0.9481519 00:05:07.635 --> 00:05:08.695 by doctor Vasus NOTE Confidence: 0.9527948 00:05:09.075 --> 00:05:10.275 who works in the same NOTE Confidence: 0.9527948 00:05:10.275 --> 00:05:12.035 department as me. And what NOTE Confidence: 0.9527948 00:05:12.035 --> 00:05:12.535 Vangelis NOTE Confidence: 0.9178812 00:05:12.995 --> 00:05:14.295 did, he identified NOTE Confidence: 0.9797356 00:05:14.755 --> 00:05:16.750 studies that had some sort NOTE Confidence: 0.9797356 00:05:16.750 --> 00:05:18.389 of measure of amount of NOTE Confidence: 0.9797356 00:05:18.389 --> 00:05:18.889 consumption, NOTE Confidence: 0.9514904 00:05:19.509 --> 00:05:21.130 and he created statistically NOTE Confidence: 0.99769545 00:05:21.509 --> 00:05:23.370 a continuous measure of cannabis NOTE Confidence: 0.99769545 00:05:23.430 --> 00:05:24.810 exposure that you can see NOTE Confidence: 0.95459974 00:05:25.270 --> 00:05:26.490 here on the x axis. NOTE Confidence: 0.90257376 00:05:27.029 --> 00:05:28.810 And each line represent NOTE Confidence: 0.95481926 00:05:29.264 --> 00:05:30.544 actually one of the study NOTE Confidence: 0.95481926 00:05:30.544 --> 00:05:31.745 enter on the meta analysis. NOTE Confidence: 0.95481926 00:05:31.745 --> 00:05:32.884 And you can see that NOTE Confidence: 0.98142624 00:05:33.264 --> 00:05:34.645 for each of the study, NOTE Confidence: 0.98142624 00:05:34.705 --> 00:05:36.324 greater is the cannabis exposure, NOTE Confidence: 0.9954206 00:05:36.705 --> 00:05:37.925 higher is the probability, NOTE Confidence: 0.98939013 00:05:39.104 --> 00:05:41.264 of developing a psychotic disorder. NOTE Confidence: 0.98939013 00:05:41.264 --> 00:05:42.790 And in this case, for NOTE Confidence: 0.98939013 00:05:42.790 --> 00:05:44.550 heavy cannabis use, the overall NOTE Confidence: 0.98939013 00:05:44.550 --> 00:05:46.150 effect went up to a NOTE Confidence: 0.98939013 00:05:46.150 --> 00:05:46.650 fourfold NOTE Confidence: 0.9622342 00:05:47.350 --> 00:05:48.470 increase in the risk for NOTE Confidence: 0.9622342 00:05:48.470 --> 00:05:49.370 psychotic disorder, NOTE Confidence: 0.9901003 00:05:49.830 --> 00:05:51.270 indicating that when you get NOTE Confidence: 0.9901003 00:05:51.270 --> 00:05:53.030 close to understand actually how NOTE Confidence: 0.9901003 00:05:53.030 --> 00:05:54.330 much people are using, NOTE Confidence: 0.9190799 00:05:54.685 --> 00:05:56.044 you get a better sense NOTE Confidence: 0.9190799 00:05:56.044 --> 00:05:57.245 of how strong is, NOTE Confidence: 0.96481925 00:05:58.205 --> 00:06:00.245 this association. And Vangelis knows NOTE Confidence: 0.96481925 00:06:00.365 --> 00:06:02.125 I always make the comment NOTE Confidence: 0.96481925 00:06:02.125 --> 00:06:03.245 that you can see him NOTE Confidence: 0.96481925 00:06:03.245 --> 00:06:05.485 lying flat because cannabis is NOTE Confidence: 0.96481925 00:06:05.485 --> 00:06:07.085 not only bad for who NOTE Confidence: 0.96481925 00:06:07.085 --> 00:06:08.525 takes it, sometimes also for NOTE Confidence: 0.96481925 00:06:08.525 --> 00:06:10.200 people that heavily research it NOTE Confidence: 0.96481925 00:06:10.360 --> 00:06:11.560 because it can be quite NOTE Confidence: 0.96481925 00:06:11.560 --> 00:06:13.900 time consuming. So he's resting NOTE Confidence: 0.96481925 00:06:14.040 --> 00:06:15.880 after the publication of of NOTE Confidence: 0.96481925 00:06:15.880 --> 00:06:16.860 the meta analysis. NOTE Confidence: 0.98931295 00:06:17.320 --> 00:06:18.680 But now I'm going to NOTE Confidence: 0.98931295 00:06:18.680 --> 00:06:19.180 let NOTE Confidence: 0.993012 00:06:19.560 --> 00:06:20.680 one of the people with NOTE Confidence: 0.993012 00:06:20.680 --> 00:06:21.420 lived experience NOTE Confidence: 0.99858654 00:06:21.880 --> 00:06:23.740 of cannabis use and psychosis NOTE Confidence: 0.97352296 00:06:24.360 --> 00:06:25.480 to share with you a NOTE Confidence: 0.97352296 00:06:25.480 --> 00:06:27.294 message that is very dear NOTE Confidence: 0.97352296 00:06:27.294 --> 00:06:28.735 to him, but is also NOTE Confidence: 0.97352296 00:06:28.735 --> 00:06:29.775 very important to him. And NOTE Confidence: 0.97352296 00:06:29.775 --> 00:06:30.675 this is Adam NOTE Confidence: 0.98021585 00:06:32.574 --> 00:06:33.455 that works with me at NOTE Confidence: 0.98021585 00:06:33.455 --> 00:06:34.435 the cannabis clinic. NOTE Confidence: 0.99561214 00:06:35.375 --> 00:06:37.214 Oops. Sorry. I pressed the NOTE Confidence: 0.99561214 00:06:37.214 --> 00:06:38.034 wrong bit. NOTE Confidence: 0.9571652 00:06:44.029 --> 00:06:45.229 Two ninety five, I started NOTE Confidence: 0.9571652 00:06:45.229 --> 00:06:47.310 getting high, and that's, like, NOTE Confidence: 0.9571652 00:06:47.310 --> 00:06:48.669 thirty years ago. And I'm NOTE Confidence: 0.9571652 00:06:48.669 --> 00:06:49.949 only just coming back to NOTE Confidence: 0.9571652 00:06:49.949 --> 00:06:51.310 thinking of career, you know, NOTE Confidence: 0.9571652 00:06:51.310 --> 00:06:52.690 serious things in the future. NOTE Confidence: 0.8967861 00:06:53.229 --> 00:06:54.750 So if I can say NOTE Confidence: 0.8967861 00:06:54.750 --> 00:06:56.129 somebody thirty years, NOTE Confidence: 0.93622255 00:06:56.785 --> 00:06:58.305 I'll easily do that because NOTE Confidence: 0.93622255 00:06:58.305 --> 00:06:59.025 I would I would like NOTE Confidence: 0.93622255 00:06:59.025 --> 00:06:59.585 it if they did it NOTE Confidence: 0.93622255 00:06:59.585 --> 00:07:00.245 to me. NOTE Confidence: 0.99953556 00:07:00.865 --> 00:07:01.365 So NOTE Confidence: 0.9919593 00:07:01.985 --> 00:07:02.865 I think this is a NOTE Confidence: 0.9919593 00:07:02.865 --> 00:07:04.645 very powerful message because NOTE Confidence: 0.99627316 00:07:05.665 --> 00:07:07.365 Adam was a very skilled NOTE Confidence: 0.99627316 00:07:07.585 --> 00:07:08.805 psychology student. NOTE Confidence: 0.9998924 00:07:09.120 --> 00:07:10.740 He went to Canada NOTE Confidence: 0.95129406 00:07:11.200 --> 00:07:12.420 for a gap year, NOTE Confidence: 0.9838969 00:07:12.880 --> 00:07:15.040 and he found himself in NOTE Confidence: 0.9838969 00:07:15.040 --> 00:07:16.640 a circle a social circle NOTE Confidence: 0.9838969 00:07:16.640 --> 00:07:18.260 where everybody were using cannabis. NOTE Confidence: 0.9970109 00:07:18.640 --> 00:07:20.580 He developed very severe psychosis. NOTE Confidence: 0.985785 00:07:21.085 --> 00:07:22.125 He didn't really see the NOTE Confidence: 0.985785 00:07:22.125 --> 00:07:23.965 association between the two, and NOTE Confidence: 0.985785 00:07:23.965 --> 00:07:25.664 he started a vicious circle NOTE Confidence: 0.985785 00:07:25.724 --> 00:07:26.224 of NOTE Confidence: 0.9510345 00:07:26.604 --> 00:07:28.125 using, becoming unwell, going to NOTE Confidence: 0.9510345 00:07:28.125 --> 00:07:29.965 hospital, getting better, becoming unwell, NOTE Confidence: 0.9510345 00:07:29.965 --> 00:07:31.405 and so on. And took NOTE Confidence: 0.9510345 00:07:31.405 --> 00:07:33.724 him fifteen years before he NOTE Confidence: 0.9510345 00:07:33.724 --> 00:07:35.664 stopped cannabis, and he's now NOTE Confidence: 0.94448376 00:07:36.030 --> 00:07:37.470 thirty years since he's first NOTE Confidence: 0.94448376 00:07:37.470 --> 00:07:39.630 joined that he's really beginning, NOTE Confidence: 0.94448376 00:07:39.630 --> 00:07:40.450 as he says, NOTE Confidence: 0.9709794 00:07:40.830 --> 00:07:42.110 you know, a new life. NOTE Confidence: 0.9709794 00:07:42.110 --> 00:07:43.790 And so he feels very NOTE Confidence: 0.9709794 00:07:43.790 --> 00:07:46.270 strongly about sharing a message NOTE Confidence: 0.9709794 00:07:46.270 --> 00:07:47.650 and, as he said himself, NOTE Confidence: 0.9358516 00:07:48.110 --> 00:07:50.370 saving people the thirty years NOTE Confidence: 0.9358516 00:07:50.430 --> 00:07:52.025 have been absorbed for in NOTE Confidence: 0.9358516 00:07:52.025 --> 00:07:53.324 his own experience by NOTE Confidence: 0.9870867 00:07:53.625 --> 00:07:55.164 cannabis associated psychosis. NOTE Confidence: 0.9691248 00:07:55.865 --> 00:07:57.064 And if we had more NOTE Confidence: 0.9691248 00:07:57.064 --> 00:07:57.944 time, I would have let NOTE Confidence: 0.9691248 00:07:57.944 --> 00:07:59.544 you listen to Adam until NOTE Confidence: 0.9691248 00:07:59.544 --> 00:08:00.604 the end of the video NOTE Confidence: 0.9691248 00:08:00.745 --> 00:08:02.585 where he also explained what NOTE Confidence: 0.9691248 00:08:02.585 --> 00:08:04.104 actually is psychosis in the NOTE Confidence: 0.9691248 00:08:04.104 --> 00:08:05.625 context of cannabis use was NOTE Confidence: 0.9691248 00:08:05.625 --> 00:08:06.120 about. NOTE Confidence: 0.98219895 00:08:06.520 --> 00:08:07.960 And instead, to to make NOTE Confidence: 0.98219895 00:08:07.960 --> 00:08:08.919 it shorter, I'm going to NOTE Confidence: 0.98219895 00:08:08.919 --> 00:08:09.820 use this cartoon NOTE Confidence: 0.98121125 00:08:10.199 --> 00:08:11.419 that has actually been NOTE Confidence: 0.95861524 00:08:11.880 --> 00:08:13.100 created by people NOTE Confidence: 0.9206052 00:08:13.720 --> 00:08:15.260 under my care where NOTE Confidence: 0.99952614 00:08:15.800 --> 00:08:17.880 they begin to experience the NOTE Confidence: 0.99952614 00:08:17.880 --> 00:08:20.255 outside environment as progressively NOTE Confidence: 0.9962373 00:08:20.635 --> 00:08:22.555 more and more intrusive and NOTE Confidence: 0.9962373 00:08:22.555 --> 00:08:23.615 and and hostile. NOTE Confidence: 0.9814508 00:08:24.075 --> 00:08:25.835 They feel under surveillance. They NOTE Confidence: 0.9814508 00:08:25.835 --> 00:08:26.795 feel that people in the NOTE Confidence: 0.9814508 00:08:26.795 --> 00:08:28.075 street are not just looking NOTE Confidence: 0.9814508 00:08:28.075 --> 00:08:29.515 at them randomly, but they're NOTE Confidence: 0.9814508 00:08:29.515 --> 00:08:31.135 actually looking at them intentionally, NOTE Confidence: 0.938308 00:08:31.515 --> 00:08:32.015 meaning, NOTE Confidence: 0.95399475 00:08:32.875 --> 00:08:34.175 in in a threatening meaning. NOTE Confidence: 0.9621824 00:08:34.715 --> 00:08:37.080 And this sense of persecution NOTE Confidence: 0.9995141 00:08:37.460 --> 00:08:38.440 tends to leak NOTE Confidence: 0.98269176 00:08:38.740 --> 00:08:40.179 as well into the place NOTE Confidence: 0.98269176 00:08:40.179 --> 00:08:41.620 where we should all feel NOTE Confidence: 0.98269176 00:08:41.620 --> 00:08:43.400 safe by definition, which is NOTE Confidence: 0.98269176 00:08:43.460 --> 00:08:45.059 their own house. And they NOTE Confidence: 0.98269176 00:08:45.059 --> 00:08:46.500 begin to worry that the NOTE Confidence: 0.98269176 00:08:46.500 --> 00:08:48.365 neighbors are against them. They NOTE Confidence: 0.98269176 00:08:48.365 --> 00:08:49.804 are spying upon them. They NOTE Confidence: 0.98269176 00:08:49.804 --> 00:08:51.165 put a microchip under the NOTE Confidence: 0.98269176 00:08:51.165 --> 00:08:51.665 floorboards. NOTE Confidence: 0.98632693 00:08:52.204 --> 00:08:53.644 They feel the television is NOTE Confidence: 0.98632693 00:08:53.644 --> 00:08:55.024 referring to their own life. NOTE Confidence: 0.98632693 00:08:55.165 --> 00:08:57.264 They describe their brain as NOTE Confidence: 0.99991274 00:08:57.725 --> 00:08:58.225 transparent NOTE Confidence: 0.99640286 00:08:58.605 --> 00:09:00.045 and on fire. And you NOTE Confidence: 0.99640286 00:09:00.045 --> 00:09:01.530 can imagine how this is NOTE Confidence: 0.99640286 00:09:01.530 --> 00:09:02.970 something that has a huge NOTE Confidence: 0.99640286 00:09:02.970 --> 00:09:04.190 disabling impact NOTE Confidence: 0.9598257 00:09:04.490 --> 00:09:05.610 on the ability to go NOTE Confidence: 0.9598257 00:09:05.610 --> 00:09:06.890 out, to get by with NOTE Confidence: 0.9598257 00:09:06.890 --> 00:09:08.890 everyday life, and also in, NOTE Confidence: 0.9681786 00:09:09.370 --> 00:09:11.210 having sort of a healthy NOTE Confidence: 0.9681786 00:09:11.210 --> 00:09:13.130 and trusting relationship with with NOTE Confidence: 0.9681786 00:09:13.130 --> 00:09:13.870 other people. NOTE Confidence: 0.9855568 00:09:14.325 --> 00:09:15.925 And these symptoms are not NOTE Confidence: 0.9855568 00:09:15.925 --> 00:09:17.385 just subjective experience. NOTE Confidence: 0.9620801 00:09:17.765 --> 00:09:19.525 They've also been described in NOTE Confidence: 0.9620801 00:09:19.525 --> 00:09:21.605 research as a characteristic of NOTE Confidence: 0.9620801 00:09:21.605 --> 00:09:23.205 people that develop psychosis in NOTE Confidence: 0.9620801 00:09:23.205 --> 00:09:24.804 the context of cannabis use NOTE Confidence: 0.9620801 00:09:24.804 --> 00:09:26.640 where paranoia, if you like, NOTE Confidence: 0.9620801 00:09:26.960 --> 00:09:28.880 persecutory belief are actually at NOTE Confidence: 0.9620801 00:09:28.880 --> 00:09:31.380 the core of, cannabis associated NOTE Confidence: 0.9620801 00:09:31.679 --> 00:09:33.040 psychosis. And this is something NOTE Confidence: 0.9620801 00:09:33.040 --> 00:09:35.120 that also professor D'Souza has, NOTE Confidence: 0.9620801 00:09:35.440 --> 00:09:36.960 has shown in in in NOTE Confidence: 0.9620801 00:09:36.960 --> 00:09:37.920 many of his, NOTE Confidence: 0.9919941 00:09:38.880 --> 00:09:40.000 of his of his paper NOTE Confidence: 0.9919941 00:09:40.000 --> 00:09:41.460 with his with his team. NOTE Confidence: 0.9873779 00:09:42.045 --> 00:09:42.545 And, NOTE Confidence: 0.95231986 00:09:43.005 --> 00:09:44.845 one thing we have always NOTE Confidence: 0.95231986 00:09:44.845 --> 00:09:46.205 been interested is in the NOTE Confidence: 0.95231986 00:09:46.205 --> 00:09:48.045 question, of course, by all NOTE Confidence: 0.95231986 00:09:48.045 --> 00:09:49.885 means, not all cannabis use NOTE Confidence: 0.95231986 00:09:49.885 --> 00:09:50.945 a developed psychosis. NOTE Confidence: 0.99698794 00:09:51.485 --> 00:09:53.005 And so going back to NOTE Confidence: 0.99698794 00:09:53.005 --> 00:09:54.445 the meta analysis, something that NOTE Confidence: 0.99698794 00:09:54.445 --> 00:09:56.065 I've always wanted to understand NOTE Confidence: 0.9995883 00:09:56.760 --> 00:09:57.260 was NOTE Confidence: 0.9352334 00:09:57.640 --> 00:09:59.160 the nature of this dose NOTE Confidence: 0.9352334 00:09:59.160 --> 00:09:59.660 response, NOTE Confidence: 0.98471636 00:10:00.280 --> 00:10:01.560 which were the sort of NOTE Confidence: 0.98471636 00:10:01.560 --> 00:10:03.000 aspect of the pattern of NOTE Confidence: 0.98471636 00:10:03.000 --> 00:10:04.780 use that perhaps were driving NOTE Confidence: 0.99769044 00:10:05.240 --> 00:10:06.460 the strongest association. NOTE Confidence: 0.9570703 00:10:07.080 --> 00:10:08.120 I mean, you would know NOTE Confidence: 0.9570703 00:10:08.120 --> 00:10:10.174 that if you are trying NOTE Confidence: 0.9570703 00:10:10.174 --> 00:10:11.934 to understand if somebody, maybe NOTE Confidence: 0.9570703 00:10:11.934 --> 00:10:13.295 a dear one, a friend NOTE Confidence: 0.9570703 00:10:13.295 --> 00:10:15.074 is drinking too much alcohol, NOTE Confidence: 0.955629 00:10:15.375 --> 00:10:16.334 you would not just ask NOTE Confidence: 0.955629 00:10:16.334 --> 00:10:17.615 them again, have you drinking NOTE Confidence: 0.955629 00:10:17.615 --> 00:10:19.054 alcohol? Yes or no. You NOTE Confidence: 0.955629 00:10:19.054 --> 00:10:20.415 would want to know perhaps NOTE Confidence: 0.955629 00:10:20.415 --> 00:10:22.195 how many units, how frequently NOTE Confidence: 0.955629 00:10:22.255 --> 00:10:23.214 they are using, what type NOTE Confidence: 0.955629 00:10:23.214 --> 00:10:24.355 of alcohol they are using. NOTE Confidence: 0.99253434 00:10:24.720 --> 00:10:25.600 And so in a very NOTE Confidence: 0.99253434 00:10:25.600 --> 00:10:26.500 similar way, NOTE Confidence: 0.9480178 00:10:26.879 --> 00:10:28.660 we had data on detail, NOTE Confidence: 0.9972837 00:10:29.279 --> 00:10:30.259 cannabis use NOTE Confidence: 0.9757527 00:10:30.559 --> 00:10:32.740 from, a very large collaboration NOTE Confidence: 0.98012763 00:10:33.199 --> 00:10:35.459 study that included eleven sites NOTE Confidence: 0.98012763 00:10:35.759 --> 00:10:36.660 across Europe NOTE Confidence: 0.9617662 00:10:37.120 --> 00:10:38.559 where, first of all, we NOTE Confidence: 0.9617662 00:10:38.559 --> 00:10:39.699 were trying to NOTE Confidence: 0.9585731 00:10:40.095 --> 00:10:41.615 measure the incidence rate of NOTE Confidence: 0.9585731 00:10:41.615 --> 00:10:43.135 psychotic disorders. So how many NOTE Confidence: 0.9585731 00:10:43.135 --> 00:10:44.975 people in each site were NOTE Confidence: 0.9585731 00:10:44.975 --> 00:10:47.554 developing psycho psychosis every year NOTE Confidence: 0.9585731 00:10:47.615 --> 00:10:48.975 per one hundred thousand, which NOTE Confidence: 0.9585731 00:10:48.975 --> 00:10:49.855 is the way you measure NOTE Confidence: 0.9585731 00:10:49.855 --> 00:10:52.014 incidence, and then explore how NOTE Confidence: 0.9585731 00:10:52.014 --> 00:10:53.154 different risk factors NOTE Confidence: 0.97982997 00:10:53.615 --> 00:10:55.235 were contributing to this. NOTE Confidence: 0.9933879 00:10:55.695 --> 00:10:56.550 And, of course, as you NOTE Confidence: 0.9933879 00:10:56.550 --> 00:10:57.750 can imagine, I was interested NOTE Confidence: 0.9933879 00:10:57.750 --> 00:10:59.750 in cannabis use. And so NOTE Confidence: 0.9933879 00:10:59.750 --> 00:11:01.429 in this graph, I'm just NOTE Confidence: 0.9933879 00:11:01.429 --> 00:11:02.870 going to show you the NOTE Confidence: 0.9933879 00:11:02.870 --> 00:11:04.730 data from the three largest NOTE Confidence: 0.9933879 00:11:04.790 --> 00:11:06.710 city of the study, London, NOTE Confidence: 0.9933879 00:11:06.710 --> 00:11:07.210 Amsterdam, NOTE Confidence: 0.99058 00:11:07.590 --> 00:11:08.890 and, and Paris. NOTE Confidence: 0.99770147 00:11:09.270 --> 00:11:10.710 And what we did was NOTE Confidence: 0.99770147 00:11:10.710 --> 00:11:11.450 we combined NOTE Confidence: 0.99609673 00:11:12.845 --> 00:11:14.845 data on how frequently people NOTE Confidence: 0.99609673 00:11:14.845 --> 00:11:15.904 were using cannabis NOTE Confidence: 0.97419965 00:11:16.524 --> 00:11:18.045 with the potency of the NOTE Confidence: 0.97419965 00:11:18.045 --> 00:11:19.325 cannabis we were they were NOTE Confidence: 0.97419965 00:11:19.325 --> 00:11:21.325 using. And the potency was NOTE Confidence: 0.97419965 00:11:21.325 --> 00:11:23.184 described in terms of THC NOTE Confidence: 0.96308744 00:11:23.645 --> 00:11:25.165 concentration of the type of NOTE Confidence: 0.96308744 00:11:25.165 --> 00:11:26.225 cannabis available. NOTE Confidence: 0.9617923 00:11:26.800 --> 00:11:27.940 And we had a cutoff, NOTE Confidence: 0.9617923 00:11:28.080 --> 00:11:29.540 which was mostly informed NOTE Confidence: 0.9971858 00:11:29.920 --> 00:11:31.360 in a conservative way by NOTE Confidence: 0.9971858 00:11:31.360 --> 00:11:32.500 experimental study NOTE Confidence: 0.7383472 00:11:33.040 --> 00:11:34.260 where THC NOTE Confidence: 0.94514835 00:11:34.800 --> 00:11:36.160 equal or greater than ten NOTE Confidence: 0.94514835 00:11:36.160 --> 00:11:37.860 percent was considered hypotency, NOTE Confidence: 0.97215223 00:11:38.400 --> 00:11:39.520 less than ten percent low NOTE Confidence: 0.97215223 00:11:39.520 --> 00:11:40.880 potency. You will probably laugh NOTE Confidence: 0.97215223 00:11:40.880 --> 00:11:41.774 at this because I know NOTE Confidence: 0.97215223 00:11:41.774 --> 00:11:43.535 in the states, ten percent NOTE Confidence: 0.97215223 00:11:43.535 --> 00:11:44.514 is a pretty pathetic, NOTE Confidence: 0.9511542 00:11:45.535 --> 00:11:47.135 amount of THC and actually NOTE Confidence: 0.9511542 00:11:47.135 --> 00:11:48.675 in London now as well. NOTE Confidence: 0.9511542 00:11:48.735 --> 00:11:50.175 But in those days, it NOTE Confidence: 0.9511542 00:11:50.175 --> 00:11:51.855 was a quite conservative way NOTE Confidence: 0.9511542 00:11:51.855 --> 00:11:52.735 to to have a little NOTE Confidence: 0.9511542 00:11:52.894 --> 00:11:53.934 begin to have a sense NOTE Confidence: 0.9511542 00:11:53.934 --> 00:11:54.755 of how potency NOTE Confidence: 0.97503215 00:11:55.350 --> 00:11:57.029 might shape the relationship between NOTE Confidence: 0.97503215 00:11:57.029 --> 00:11:58.250 cannabis use and psychosis. NOTE Confidence: 0.9819813 00:11:58.950 --> 00:12:00.230 And you can see that NOTE Confidence: 0.9819813 00:12:00.230 --> 00:12:01.850 in these three cities, NOTE Confidence: 0.94953996 00:12:02.230 --> 00:12:03.190 when you look at the NOTE Confidence: 0.94953996 00:12:03.190 --> 00:12:05.350 green bar, which represent people NOTE Confidence: 0.94953996 00:12:05.350 --> 00:12:07.190 that were using daily, this NOTE Confidence: 0.94953996 00:12:07.190 --> 00:12:08.950 high potency ten percent and NOTE Confidence: 0.94953996 00:12:08.950 --> 00:12:10.730 more THC type of cannabis. NOTE Confidence: 0.9989155 00:12:11.225 --> 00:12:12.585 In London, they had an NOTE Confidence: 0.9989155 00:12:12.585 --> 00:12:13.085 increase NOTE Confidence: 0.96184826 00:12:13.545 --> 00:12:15.465 in the probability of developing NOTE Confidence: 0.96184826 00:12:15.465 --> 00:12:17.065 a psychotic disorder of five NOTE Confidence: 0.96184826 00:12:17.065 --> 00:12:18.585 times compared to never user, NOTE Confidence: 0.96184826 00:12:18.585 --> 00:12:19.885 which is this group here. NOTE Confidence: 0.96184826 00:12:20.105 --> 00:12:22.025 In Amsterdam, over nine times, NOTE Confidence: 0.96184826 00:12:22.025 --> 00:12:23.465 and in Paris, over four NOTE Confidence: 0.96184826 00:12:23.465 --> 00:12:25.710 time. And Amsterdam is really NOTE Confidence: 0.96184826 00:12:25.710 --> 00:12:27.870 representing a place where in NOTE Confidence: 0.96184826 00:12:27.870 --> 00:12:29.710 those days, ten percent wasn't NOTE Confidence: 0.96184826 00:12:29.710 --> 00:12:31.070 very common. It was thirty NOTE Confidence: 0.96184826 00:12:31.070 --> 00:12:32.590 percent very common. And so NOTE Confidence: 0.96184826 00:12:32.590 --> 00:12:33.630 that that's what is really NOTE Confidence: 0.96184826 00:12:33.630 --> 00:12:35.330 driving the this very high, NOTE Confidence: 0.9906507 00:12:35.790 --> 00:12:37.470 sort of, probability. And this NOTE Confidence: 0.9906507 00:12:37.470 --> 00:12:38.670 was the case even when NOTE Confidence: 0.9906507 00:12:38.670 --> 00:12:39.330 we control NOTE Confidence: 0.9115555 00:12:39.774 --> 00:12:41.774 for non social demographic. They NOTE Confidence: 0.9115555 00:12:41.774 --> 00:12:43.154 are associated with psychosis NOTE Confidence: 0.9750822 00:12:43.455 --> 00:12:44.815 and also other drug of NOTE Confidence: 0.9750822 00:12:44.815 --> 00:12:46.015 abuse that we know are NOTE Confidence: 0.9750822 00:12:46.015 --> 00:12:48.255 associated with risk of psychotic NOTE Confidence: 0.9750822 00:12:48.255 --> 00:12:48.755 disorder. NOTE Confidence: 0.99776804 00:12:49.535 --> 00:12:50.995 And we were also interested NOTE Confidence: 0.99776804 00:12:51.214 --> 00:12:53.214 in calculating something that is NOTE Confidence: 0.99776804 00:12:53.214 --> 00:12:55.475 called the population attributable fraction NOTE Confidence: 0.9993733 00:12:55.830 --> 00:12:57.290 which is really a statistical NOTE Confidence: 0.9993733 00:12:57.430 --> 00:12:58.490 way to estimate NOTE Confidence: 0.8607054 00:12:59.270 --> 00:13:00.490 once you have identified NOTE Confidence: 0.98696333 00:13:01.110 --> 00:13:02.390 a risk factor that you NOTE Confidence: 0.98696333 00:13:02.390 --> 00:13:04.010 know has a causal role NOTE Confidence: 0.98696333 00:13:04.309 --> 00:13:05.430 in the onset of a NOTE Confidence: 0.98696333 00:13:05.430 --> 00:13:05.930 disease NOTE Confidence: 0.94609123 00:13:06.710 --> 00:13:08.230 and you have a specific NOTE Confidence: 0.94609123 00:13:08.470 --> 00:13:09.510 you have data on how NOTE Confidence: 0.94609123 00:13:09.510 --> 00:13:10.470 common it is on a NOTE Confidence: 0.94609123 00:13:10.470 --> 00:13:12.695 specific geographical area, you can NOTE Confidence: 0.94609123 00:13:12.695 --> 00:13:13.595 actually estimate NOTE Confidence: 0.952754 00:13:14.054 --> 00:13:15.654 the proportion of new cases NOTE Confidence: 0.952754 00:13:15.654 --> 00:13:16.775 of the disease that you NOTE Confidence: 0.952754 00:13:16.775 --> 00:13:18.715 can prevent if that disorder NOTE Confidence: 0.952754 00:13:18.934 --> 00:13:19.434 was NOTE Confidence: 0.9996004 00:13:19.815 --> 00:13:20.315 abolished. NOTE Confidence: 0.96354336 00:13:20.775 --> 00:13:22.315 And so in this case, NOTE Confidence: 0.96354336 00:13:22.375 --> 00:13:23.755 we were able to estimate NOTE Confidence: 0.96354336 00:13:23.815 --> 00:13:26.070 that if hypotensive cannabis NOTE Confidence: 0.95756143 00:13:26.530 --> 00:13:28.050 was no longer available in NOTE Confidence: 0.95756143 00:13:28.050 --> 00:13:29.410 southeast London, which is actually NOTE Confidence: 0.95756143 00:13:29.410 --> 00:13:30.929 where I work, we could NOTE Confidence: 0.95756143 00:13:30.929 --> 00:13:32.690 prevent every year up to NOTE Confidence: 0.95756143 00:13:32.690 --> 00:13:34.530 thirty percent of new cases NOTE Confidence: 0.95756143 00:13:34.530 --> 00:13:36.070 of psychosis and in Amsterdam, NOTE Confidence: 0.9833971 00:13:36.625 --> 00:13:38.245 up to fifty percent. Now NOTE Confidence: 0.9833971 00:13:38.384 --> 00:13:39.184 either that you are a NOTE Confidence: 0.9833971 00:13:39.184 --> 00:13:40.464 clinician or you are a NOTE Confidence: 0.9833971 00:13:40.464 --> 00:13:42.065 loved one or somebody with NOTE Confidence: 0.9833971 00:13:42.065 --> 00:13:42.725 with psychosis, NOTE Confidence: 0.93050116 00:13:43.105 --> 00:13:44.144 you will know these are NOTE Confidence: 0.93050116 00:13:44.144 --> 00:13:45.125 huge numbers, NOTE Confidence: 0.871002 00:13:45.904 --> 00:13:46.944 that that have a great NOTE Confidence: 0.871002 00:13:46.944 --> 00:13:48.464 impact to an individual and NOTE Confidence: 0.871002 00:13:48.464 --> 00:13:49.745 also at a sort of NOTE Confidence: 0.871002 00:13:49.745 --> 00:13:50.485 health services, NOTE Confidence: 0.9896743 00:13:51.750 --> 00:13:52.250 level. NOTE Confidence: 0.92701465 00:13:52.949 --> 00:13:54.949 And, of course, when we NOTE Confidence: 0.92701465 00:13:54.949 --> 00:13:56.089 publish this data, NOTE Confidence: 0.9998097 00:13:57.110 --> 00:13:57.610 people NOTE Confidence: 0.96440846 00:13:58.709 --> 00:14:00.230 share their skepticism, which I NOTE Confidence: 0.96440846 00:14:00.230 --> 00:14:01.190 think is is is right NOTE Confidence: 0.96440846 00:14:01.190 --> 00:14:03.350 and understandable and provokes discussion. NOTE Confidence: 0.96440846 00:14:03.350 --> 00:14:04.309 And they said, well, you NOTE Confidence: 0.96440846 00:14:04.309 --> 00:14:06.365 know, maybe this is really NOTE Confidence: 0.96440846 00:14:06.365 --> 00:14:08.785 all confounded by genetic NOTE Confidence: 0.98892796 00:14:09.485 --> 00:14:11.084 vulnerability. So it might just NOTE Confidence: 0.98892796 00:14:11.084 --> 00:14:11.745 be that NOTE Confidence: 0.97375405 00:14:12.365 --> 00:14:13.725 people that use sort of NOTE Confidence: 0.97375405 00:14:13.725 --> 00:14:15.024 cannabis, heavily, NOTE Confidence: 0.93881005 00:14:15.884 --> 00:14:16.925 they are people that got NOTE Confidence: 0.93881005 00:14:16.925 --> 00:14:18.860 lots of genes for schizophrenia, NOTE Confidence: 0.97136134 00:14:19.320 --> 00:14:20.040 and so they would have NOTE Confidence: 0.97136134 00:14:20.040 --> 00:14:22.680 developed psychotic disorder anyway. So NOTE Confidence: 0.97136134 00:14:22.680 --> 00:14:23.640 we wanted to look at NOTE Confidence: 0.97136134 00:14:23.640 --> 00:14:25.420 this question again in this, NOTE Confidence: 0.93093777 00:14:27.000 --> 00:14:28.140 multisite European NOTE Confidence: 0.97888434 00:14:28.520 --> 00:14:30.360 study because we had as NOTE Confidence: 0.97888434 00:14:30.360 --> 00:14:31.880 well as data on cannabis NOTE Confidence: 0.97888434 00:14:31.880 --> 00:14:32.840 use, we we we had NOTE Confidence: 0.97888434 00:14:32.840 --> 00:14:33.340 DNA. NOTE Confidence: 0.9492858 00:14:34.095 --> 00:14:35.375 So this is really the NOTE Confidence: 0.9492858 00:14:35.375 --> 00:14:37.214 work of my postdoc, Isabel NOTE Confidence: 0.9492858 00:14:37.214 --> 00:14:38.654 Austin Zimmermann, and, NOTE Confidence: 0.9105494 00:14:39.774 --> 00:14:41.695 and Eduardo Spinazzola, who is NOTE Confidence: 0.9105494 00:14:41.695 --> 00:14:42.675 a colleague psychiatrist NOTE Confidence: 0.9693838 00:14:43.055 --> 00:14:44.175 and and and current PhD NOTE Confidence: 0.9693838 00:14:44.175 --> 00:14:44.675 student. NOTE Confidence: 0.95680296 00:14:45.295 --> 00:14:46.595 So we had the data NOTE Confidence: 0.95680296 00:14:46.730 --> 00:14:48.170 from from this European study, NOTE Confidence: 0.95680296 00:14:48.170 --> 00:14:49.130 and we also had data NOTE Confidence: 0.95680296 00:14:49.130 --> 00:14:50.670 from the UK bio biobank, NOTE Confidence: 0.95680296 00:14:50.810 --> 00:14:52.030 which is a very large NOTE Confidence: 0.8888235 00:14:52.410 --> 00:14:52.910 population, NOTE Confidence: 0.9902928 00:14:54.010 --> 00:14:55.790 sample from, from UK. NOTE Confidence: 0.9745635 00:14:56.170 --> 00:14:58.090 And the first question we NOTE Confidence: 0.9745635 00:14:58.090 --> 00:14:59.550 wanted to address was, NOTE Confidence: 0.9952752 00:14:59.875 --> 00:15:01.155 if you look at the, NOTE Confidence: 0.9956607 00:15:01.555 --> 00:15:03.555 impact that daily cannabis use NOTE Confidence: 0.9956607 00:15:03.555 --> 00:15:04.935 has on risk of psychotic NOTE Confidence: 0.9956607 00:15:04.995 --> 00:15:05.495 disorder, NOTE Confidence: 0.99675024 00:15:05.875 --> 00:15:07.475 what happens if we estimate NOTE Confidence: 0.99675024 00:15:07.475 --> 00:15:08.215 this risk NOTE Confidence: 0.9718537 00:15:09.075 --> 00:15:10.995 controlling, taking into account the NOTE Confidence: 0.9718537 00:15:10.995 --> 00:15:13.175 potential role of the underlying NOTE Confidence: 0.9718537 00:15:13.235 --> 00:15:14.375 genetic for schizophrenia? NOTE Confidence: 0.9693165 00:15:14.930 --> 00:15:16.290 And what we we show NOTE Confidence: 0.9693165 00:15:16.290 --> 00:15:17.410 was that even when you NOTE Confidence: 0.9693165 00:15:17.410 --> 00:15:18.470 take into account NOTE Confidence: 0.9834914 00:15:18.850 --> 00:15:20.949 individual genetic load for schizophrenia, NOTE Confidence: 0.8950877 00:15:21.329 --> 00:15:23.089 daily cannabis use as an NOTE Confidence: 0.8950877 00:15:23.089 --> 00:15:23.589 independent NOTE Confidence: 0.93732 00:15:24.209 --> 00:15:26.050 effect on increasing the the NOTE Confidence: 0.93732 00:15:26.050 --> 00:15:28.105 risk of psychotic disorder, which NOTE Confidence: 0.93732 00:15:28.105 --> 00:15:29.625 is almost a four time, NOTE Confidence: 0.93732 00:15:29.625 --> 00:15:30.845 three point eight seven, NOTE Confidence: 0.977827 00:15:31.705 --> 00:15:33.705 and vice versa. So the NOTE Confidence: 0.977827 00:15:33.705 --> 00:15:34.765 genes for schizophrenia NOTE Confidence: 0.92878824 00:15:35.145 --> 00:15:36.585 increase the risk of psychotic NOTE Confidence: 0.92878824 00:15:36.585 --> 00:15:38.205 disorder as you would expect NOTE Confidence: 0.92878824 00:15:38.265 --> 00:15:38.765 independently NOTE Confidence: 0.99914104 00:15:39.225 --> 00:15:40.925 of daily cannabis use. NOTE Confidence: 0.9639956 00:15:41.440 --> 00:15:42.560 When I talk to my NOTE Confidence: 0.9639956 00:15:42.560 --> 00:15:43.440 student, and I hope you NOTE Confidence: 0.9639956 00:15:43.440 --> 00:15:44.480 won't mind me using the NOTE Confidence: 0.9639956 00:15:44.480 --> 00:15:46.480 same analogy with you, I NOTE Confidence: 0.9639956 00:15:46.480 --> 00:15:47.680 gave them the example of NOTE Confidence: 0.9639956 00:15:47.680 --> 00:15:49.600 diabetes type two. So if NOTE Confidence: 0.9639956 00:15:49.600 --> 00:15:50.640 you have lots of gene NOTE Confidence: 0.9639956 00:15:50.640 --> 00:15:52.320 for diabetes type two, you NOTE Confidence: 0.9639956 00:15:52.320 --> 00:15:54.080 might develop diabetes type two NOTE Confidence: 0.9639956 00:15:54.080 --> 00:15:56.180 anyway independently of your lifestyle. NOTE Confidence: 0.99950594 00:15:57.035 --> 00:15:58.895 But if you eat NOTE Confidence: 0.8015833 00:15:59.435 --> 00:15:59.935 donuts NOTE Confidence: 0.9351545 00:16:00.235 --> 00:16:00.975 every day NOTE Confidence: 0.9888752 00:16:01.595 --> 00:16:02.875 for a very long period NOTE Confidence: 0.9888752 00:16:02.875 --> 00:16:04.335 of time, you would increase NOTE Confidence: 0.9888752 00:16:04.395 --> 00:16:06.075 your risk of diabetes type NOTE Confidence: 0.9888752 00:16:06.075 --> 00:16:07.435 two even if you have NOTE Confidence: 0.9888752 00:16:07.435 --> 00:16:09.835 little genes for diabetes type NOTE Confidence: 0.9888752 00:16:09.835 --> 00:16:10.875 two. But what if you NOTE Confidence: 0.9888752 00:16:10.875 --> 00:16:11.615 have both? NOTE Confidence: 0.9766295 00:16:12.269 --> 00:16:13.790 Now I suggest you don't NOTE Confidence: 0.9766295 00:16:13.790 --> 00:16:15.230 eat donuts any every day NOTE Confidence: 0.9766295 00:16:15.230 --> 00:16:16.589 anyway. But, of course, if NOTE Confidence: 0.9766295 00:16:16.589 --> 00:16:17.630 you also have a family NOTE Confidence: 0.9766295 00:16:17.630 --> 00:16:19.070 history of diabetes type two, NOTE Confidence: 0.9766295 00:16:19.070 --> 00:16:20.670 the two together will really NOTE Confidence: 0.9766295 00:16:20.670 --> 00:16:21.870 push your risk of the NOTE Confidence: 0.9766295 00:16:21.870 --> 00:16:24.190 disease quite highly. Well, we NOTE Confidence: 0.9766295 00:16:24.190 --> 00:16:25.490 looked at the same question NOTE Confidence: 0.9986884 00:16:25.949 --> 00:16:27.170 in relation to NOTE Confidence: 0.99521923 00:16:27.524 --> 00:16:29.285 different combination of frequency and NOTE Confidence: 0.99521923 00:16:29.285 --> 00:16:31.545 potency of cannabis use and NOTE Confidence: 0.99521923 00:16:31.685 --> 00:16:33.444 genetic load for schizophrenia. So NOTE Confidence: 0.99521923 00:16:33.444 --> 00:16:34.904 the genetic load for schizophrenia NOTE Confidence: 0.9249265 00:16:35.444 --> 00:16:35.764 is, NOTE Confidence: 0.9567384 00:16:36.245 --> 00:16:38.185 expressed in a standardized continuous NOTE Confidence: 0.9567384 00:16:38.245 --> 00:16:39.545 way on the x axis NOTE Confidence: 0.9567384 00:16:39.764 --> 00:16:41.444 where zero really represent what NOTE Confidence: 0.9567384 00:16:41.444 --> 00:16:42.990 you expect to be the NOTE Confidence: 0.9567384 00:16:42.990 --> 00:16:44.590 genetic load for schizophrenia in NOTE Confidence: 0.9567384 00:16:44.590 --> 00:16:45.870 the for the average of NOTE Confidence: 0.9567384 00:16:45.870 --> 00:16:46.590 the pop to be the NOTE Confidence: 0.9567384 00:16:46.590 --> 00:16:47.730 average for the population. NOTE Confidence: 0.99743587 00:16:48.350 --> 00:16:49.630 So you can see that NOTE Confidence: 0.99743587 00:16:49.630 --> 00:16:51.710 for each combination of frequency NOTE Confidence: 0.99743587 00:16:51.710 --> 00:16:52.370 and potency, NOTE Confidence: 0.9861049 00:16:52.910 --> 00:16:54.590 greater is the genetic load NOTE Confidence: 0.9861049 00:16:54.590 --> 00:16:56.190 for schizophrenia, greater is the NOTE Confidence: 0.9861049 00:16:56.190 --> 00:16:57.150 risk. This is not a NOTE Confidence: 0.9861049 00:16:57.150 --> 00:16:57.650 surprise. NOTE Confidence: 0.99701244 00:16:58.085 --> 00:16:59.045 But you can see that NOTE Confidence: 0.99701244 00:16:59.045 --> 00:16:59.685 there is this, NOTE Confidence: 0.9692259 00:17:00.325 --> 00:17:02.565 pink line, which represents the NOTE Confidence: 0.9692259 00:17:02.565 --> 00:17:05.065 daily users of hypotensive cannabis, NOTE Confidence: 0.9692259 00:17:05.365 --> 00:17:07.045 which already starts with a NOTE Confidence: 0.9692259 00:17:07.045 --> 00:17:08.965 reasonable risk. And when they NOTE Confidence: 0.9692259 00:17:08.965 --> 00:17:10.005 get to the average of NOTE Confidence: 0.9692259 00:17:10.005 --> 00:17:11.445 the population for load of NOTE Confidence: 0.9692259 00:17:11.445 --> 00:17:12.425 gene for schizophrenia, NOTE Confidence: 0.99769855 00:17:12.859 --> 00:17:14.460 they are actually already quite NOTE Confidence: 0.99769855 00:17:14.460 --> 00:17:14.960 high NOTE Confidence: 0.9224221 00:17:15.340 --> 00:17:17.420 for the genetic risk, excuse NOTE Confidence: 0.9224221 00:17:17.420 --> 00:17:18.220 me, for the risk of NOTE Confidence: 0.9224221 00:17:18.220 --> 00:17:19.280 cyclotic disorder. NOTE Confidence: 0.98517996 00:17:19.740 --> 00:17:21.340 Meaning that if you do NOTE Confidence: 0.98517996 00:17:21.340 --> 00:17:22.940 use lots of cannabis, you NOTE Confidence: 0.98517996 00:17:22.940 --> 00:17:24.619 don't necessarily need genes for NOTE Confidence: 0.98517996 00:17:24.619 --> 00:17:25.119 schizophrenia. NOTE Confidence: 0.9741945 00:17:25.804 --> 00:17:26.924 But if you have them, NOTE Confidence: 0.9741945 00:17:26.924 --> 00:17:28.205 of course, you get that NOTE Confidence: 0.9741945 00:17:28.205 --> 00:17:30.044 faster and and probably with NOTE Confidence: 0.9741945 00:17:30.044 --> 00:17:31.025 a much higher, NOTE Confidence: 0.91188604 00:17:31.885 --> 00:17:33.905 magnitude of, of of risk, NOTE Confidence: 0.91188604 00:17:34.044 --> 00:17:36.385 which again is not discovering NOTE Confidence: 0.91188604 00:17:36.605 --> 00:17:38.300 sliced bread again, but is NOTE Confidence: 0.91188604 00:17:38.300 --> 00:17:40.080 something that although is intuitive, NOTE Confidence: 0.91895676 00:17:40.380 --> 00:17:41.820 is important to to have NOTE Confidence: 0.91895676 00:17:41.820 --> 00:17:43.500 data that that that supports NOTE Confidence: 0.91895676 00:17:43.500 --> 00:17:44.000 it. NOTE Confidence: 0.9225853 00:17:44.700 --> 00:17:46.140 Is that clear? Yes. I'm NOTE Confidence: 0.9225853 00:17:46.140 --> 00:17:48.059 going to There's a question NOTE Confidence: 0.9225853 00:17:48.059 --> 00:17:49.359 in the in the chat NOTE Confidence: 0.99081933 00:17:49.835 --> 00:17:51.515 from Anahita. Are there any NOTE Confidence: 0.99081933 00:17:51.515 --> 00:17:53.375 sex differences in the association NOTE Confidence: 0.9982877 00:17:54.075 --> 00:17:55.935 between cannabis use and psychosis? NOTE Confidence: 0.9608628 00:17:56.795 --> 00:17:58.155 Well, in the study that NOTE Confidence: 0.9608628 00:17:58.155 --> 00:17:59.755 I've shot just shown you, NOTE Confidence: 0.9608628 00:17:59.755 --> 00:18:01.375 we didn't actually find NOTE Confidence: 0.95168567 00:18:02.050 --> 00:18:03.750 any sex differences except NOTE Confidence: 0.98938227 00:18:04.369 --> 00:18:04.869 psychosis NOTE Confidence: 0.97163916 00:18:05.570 --> 00:18:05.890 is, NOTE Confidence: 0.9417385 00:18:06.530 --> 00:18:07.990 tends to be more prevalent. NOTE Confidence: 0.9417385 00:18:08.050 --> 00:18:09.570 Particularly, psychosis who has an NOTE Confidence: 0.9417385 00:18:09.570 --> 00:18:11.410 onset in late teens, early NOTE Confidence: 0.9417385 00:18:11.410 --> 00:18:12.530 twenties tends to be more NOTE Confidence: 0.9417385 00:18:12.530 --> 00:18:13.810 prevalent in male than in NOTE Confidence: 0.9417385 00:18:13.810 --> 00:18:14.310 female. NOTE Confidence: 0.95629394 00:18:14.764 --> 00:18:16.125 And when we look at NOTE Confidence: 0.95629394 00:18:16.125 --> 00:18:17.325 may we we look at NOTE Confidence: 0.95629394 00:18:17.325 --> 00:18:18.605 lifetime use, it was the NOTE Confidence: 0.95629394 00:18:18.605 --> 00:18:20.544 same, but we found that, NOTE Confidence: 0.9861204 00:18:21.804 --> 00:18:23.184 female who tended NOTE Confidence: 0.99975395 00:18:23.804 --> 00:18:24.465 to have NOTE Confidence: 0.89289695 00:18:25.085 --> 00:18:26.865 an earlier onset of psychosis NOTE Confidence: 0.9877431 00:18:27.490 --> 00:18:29.090 were using more cannabis than NOTE Confidence: 0.9877431 00:18:29.090 --> 00:18:30.690 male. So it seems to NOTE Confidence: 0.9877431 00:18:30.690 --> 00:18:32.049 have an important role in NOTE Confidence: 0.9877431 00:18:32.049 --> 00:18:32.549 female NOTE Confidence: 0.99063075 00:18:33.090 --> 00:18:34.529 in bringing them at the NOTE Confidence: 0.99063075 00:18:34.529 --> 00:18:36.529 same age group as male, NOTE Confidence: 0.99063075 00:18:36.529 --> 00:18:37.490 which we thought it was NOTE Confidence: 0.99063075 00:18:37.490 --> 00:18:37.990 interesting. NOTE Confidence: 0.96289235 00:18:38.450 --> 00:18:40.149 We also found that female NOTE Confidence: 0.99823236 00:18:40.465 --> 00:18:41.285 are more susceptible NOTE Confidence: 0.9956056 00:18:42.145 --> 00:18:44.145 to withdrawal symptoms when they NOTE Confidence: 0.9956056 00:18:44.145 --> 00:18:45.365 try to stop cannabis, NOTE Confidence: 0.9561327 00:18:45.825 --> 00:18:47.585 which is quite interesting. And, NOTE Confidence: 0.9519289 00:18:48.225 --> 00:18:49.105 I would like actually to NOTE Confidence: 0.9519289 00:18:49.105 --> 00:18:50.545 have a discussion with Cyril NOTE Confidence: 0.9519289 00:18:50.545 --> 00:18:51.585 on why he thinks that NOTE Confidence: 0.9519289 00:18:51.585 --> 00:18:52.650 might be the case. NOTE Confidence: 0.9772116 00:18:53.050 --> 00:18:54.830 So there are certainly gender NOTE Confidence: 0.9772116 00:18:55.050 --> 00:18:55.869 gender differences NOTE Confidence: 0.97559106 00:18:56.330 --> 00:18:56.770 in, NOTE Confidence: 0.92250264 00:18:57.210 --> 00:18:58.490 in pattern of use, but NOTE Confidence: 0.92250264 00:18:58.490 --> 00:19:00.170 surprisingly, we found that in NOTE Confidence: 0.92250264 00:19:00.170 --> 00:19:02.410 our courts of patient with NOTE Confidence: 0.92250264 00:19:02.410 --> 00:19:03.550 first episode psychosis, NOTE Confidence: 0.9844949 00:19:04.170 --> 00:19:06.030 the female were using more NOTE Confidence: 0.9844949 00:19:06.090 --> 00:19:06.570 than, NOTE Confidence: 0.9820489 00:19:07.050 --> 00:19:08.270 than than males, NOTE Confidence: 0.93054503 00:19:09.434 --> 00:19:10.875 which made them very different NOTE Confidence: 0.93054503 00:19:10.875 --> 00:19:12.895 from the general population cannabis, NOTE Confidence: 0.98531044 00:19:13.275 --> 00:19:14.875 cannabis users. I don't know, NOTE Confidence: 0.98531044 00:19:14.875 --> 00:19:16.655 Cyril, if you have found NOTE Confidence: 0.98531044 00:19:16.875 --> 00:19:18.315 something different in in in NOTE Confidence: 0.98531044 00:19:18.315 --> 00:19:20.015 the sample you work on. NOTE Confidence: 0.8808632 00:19:24.390 --> 00:19:25.290 You are muted. NOTE Confidence: 0.96314555 00:19:27.990 --> 00:19:29.270 Sorry. I I don't know NOTE Confidence: 0.96314555 00:19:29.270 --> 00:19:30.070 if Mohini is on the NOTE Confidence: 0.96314555 00:19:30.070 --> 00:19:31.990 call, but Mohini did find NOTE Confidence: 0.96314555 00:19:31.990 --> 00:19:33.750 some sex differences in the NOTE Confidence: 0.96314555 00:19:33.750 --> 00:19:35.030 effects of THC in the NOTE Confidence: 0.96314555 00:19:35.030 --> 00:19:36.890 lab. And maybe Anahita NOTE Confidence: 0.9496454 00:19:37.270 --> 00:19:37.635 can, NOTE Confidence: 0.9658697 00:19:38.595 --> 00:19:39.715 can say a little bit NOTE Confidence: 0.9658697 00:19:39.715 --> 00:19:40.455 about that. NOTE Confidence: 0.9960879 00:19:41.715 --> 00:19:42.595 Yes. Hi. NOTE Confidence: 0.98108244 00:19:43.075 --> 00:19:45.155 So Hi. Hi. So we NOTE Confidence: 0.98108244 00:19:45.155 --> 00:19:46.515 do we did look into NOTE Confidence: 0.98108244 00:19:46.515 --> 00:19:48.195 the sex differences in acute NOTE Confidence: 0.98108244 00:19:48.195 --> 00:19:50.195 effects of THC, both IV NOTE Confidence: 0.98108244 00:19:50.195 --> 00:19:51.975 and oral, and we found NOTE Confidence: 0.99787545 00:19:52.440 --> 00:19:54.619 in lower doses, women reported NOTE Confidence: 0.99787545 00:19:54.919 --> 00:19:55.419 higher NOTE Confidence: 0.90352535 00:19:56.119 --> 00:19:58.039 subjective effects, like more intense NOTE Confidence: 0.90352535 00:19:58.039 --> 00:19:59.100 subjective effects. NOTE Confidence: 0.9787328 00:20:00.519 --> 00:20:01.960 Yeah. But not in the NOTE Confidence: 0.9787328 00:20:01.960 --> 00:20:04.059 cognitive effects or physiological NOTE Confidence: 0.99167997 00:20:04.359 --> 00:20:05.720 effects, not other effects of NOTE Confidence: 0.99167997 00:20:05.720 --> 00:20:06.220 THC. NOTE Confidence: 0.98641175 00:20:07.865 --> 00:20:09.545 So that that's that that's NOTE Confidence: 0.98641175 00:20:09.545 --> 00:20:11.244 very that's very interesting. NOTE Confidence: 0.8929879 00:20:12.905 --> 00:20:13.405 I, NOTE Confidence: 0.9637273 00:20:14.425 --> 00:20:15.865 what what what you'll see NOTE Confidence: 0.9637273 00:20:15.865 --> 00:20:17.565 later on I mean, predominantly, NOTE Confidence: 0.9637273 00:20:17.785 --> 00:20:19.225 people that come to my NOTE Confidence: 0.9637273 00:20:19.225 --> 00:20:19.725 clinic NOTE Confidence: 0.942002 00:20:20.440 --> 00:20:21.560 are male. So we we NOTE Confidence: 0.942002 00:20:21.560 --> 00:20:21.960 have, NOTE Confidence: 0.9849508 00:20:22.600 --> 00:20:24.540 a seventy five percent male, NOTE Confidence: 0.9849508 00:20:24.760 --> 00:20:26.600 female ratio. But I think NOTE Confidence: 0.9849508 00:20:26.600 --> 00:20:28.060 that's also to do because, NOTE Confidence: 0.7198627 00:20:29.640 --> 00:20:30.380 their overrepresentation NOTE Confidence: 0.9537481 00:20:30.920 --> 00:20:32.440 in in psychosis at their NOTE Confidence: 0.9537481 00:20:32.440 --> 00:20:33.340 at their age. NOTE Confidence: 0.9615805 00:20:34.055 --> 00:20:35.175 So it would be very NOTE Confidence: 0.9615805 00:20:35.175 --> 00:20:36.695 interesting to see now that NOTE Confidence: 0.9615805 00:20:36.695 --> 00:20:38.135 we are beginning to look, NOTE Confidence: 0.9615805 00:20:38.135 --> 00:20:39.255 at least in my in NOTE Confidence: 0.9615805 00:20:39.255 --> 00:20:41.335 my work, at, a much NOTE Confidence: 0.9615805 00:20:41.335 --> 00:20:42.695 broader age group that go NOTE Confidence: 0.9615805 00:20:42.775 --> 00:20:44.215 that also includes a second NOTE Confidence: 0.9615805 00:20:44.215 --> 00:20:45.734 peak of onset, which is NOTE Confidence: 0.9615805 00:20:45.734 --> 00:20:47.255 the one common in women, NOTE Confidence: 0.9615805 00:20:47.255 --> 00:20:48.055 which is the sort of NOTE Confidence: 0.9615805 00:20:48.055 --> 00:20:50.220 post sort of round menopause, NOTE Confidence: 0.9471265 00:20:51.000 --> 00:20:52.520 what role cannabis might have NOTE Confidence: 0.9471265 00:20:52.520 --> 00:20:53.880 in this group, particularly because NOTE Confidence: 0.9471265 00:20:53.880 --> 00:20:55.960 in UK, cannabis is advertised NOTE Confidence: 0.9471265 00:20:55.960 --> 00:20:57.320 for menopause. So it would NOTE Confidence: 0.9471265 00:20:57.320 --> 00:20:58.540 be is is an interesting NOTE Confidence: 0.9471265 00:20:58.600 --> 00:21:00.920 area I'm I'm looking, I'm NOTE Confidence: 0.9471265 00:21:00.920 --> 00:21:01.740 looking at. NOTE Confidence: 0.78350997 00:21:02.440 --> 00:21:03.740 Interesting. Thank you. NOTE Confidence: 0.95275396 00:21:04.234 --> 00:21:05.595 Pleasure. Thank you very much. NOTE Confidence: 0.95275396 00:21:05.595 --> 00:21:06.815 Thank you very much indeed. NOTE Confidence: 0.95275396 00:21:06.955 --> 00:21:08.234 Ashley and something else I NOTE Confidence: 0.95275396 00:21:08.234 --> 00:21:09.195 wanted to say given that NOTE Confidence: 0.95275396 00:21:09.195 --> 00:21:10.075 we are on the topic NOTE Confidence: 0.95275396 00:21:10.075 --> 00:21:11.375 of of of of DNA NOTE Confidence: 0.95155114 00:21:11.994 --> 00:21:13.675 is that the relationship between NOTE Confidence: 0.95155114 00:21:13.675 --> 00:21:15.135 cannabis use and DNA, NOTE Confidence: 0.99614644 00:21:15.515 --> 00:21:17.215 it's actually much more dynamic NOTE Confidence: 0.99614644 00:21:17.275 --> 00:21:18.555 than we might think. It's NOTE Confidence: 0.99614644 00:21:18.555 --> 00:21:20.020 not just about how the NOTE Confidence: 0.99614644 00:21:20.020 --> 00:21:21.780 structure of our DNA, the NOTE Confidence: 0.99614644 00:21:21.780 --> 00:21:22.840 code of our genes NOTE Confidence: 0.93039525 00:21:23.300 --> 00:21:24.500 might makes us more or NOTE Confidence: 0.93039525 00:21:24.500 --> 00:21:26.200 less susceptible to its effect, NOTE Confidence: 0.93039525 00:21:26.420 --> 00:21:27.859 but it's also the impact NOTE Confidence: 0.93039525 00:21:27.859 --> 00:21:29.800 that cannabis use has actually NOTE Confidence: 0.9869722 00:21:30.340 --> 00:21:31.619 on where, when, and how NOTE Confidence: 0.9869722 00:21:31.619 --> 00:21:33.800 much our DNA is expressed, NOTE Confidence: 0.9869722 00:21:34.095 --> 00:21:35.554 which in simple terms NOTE Confidence: 0.9779581 00:21:35.934 --> 00:21:37.375 in, where, when, and how NOTE Confidence: 0.9779581 00:21:37.375 --> 00:21:38.915 much our DNA is translated NOTE Confidence: 0.9779581 00:21:38.975 --> 00:21:41.075 into biology and then physiology. NOTE Confidence: 0.99078184 00:21:41.855 --> 00:21:42.835 And these processes NOTE Confidence: 0.9956128 00:21:43.135 --> 00:21:44.195 are called broadly, NOTE Confidence: 0.81971645 00:21:44.655 --> 00:21:45.155 epigenetic, NOTE Confidence: 0.9646203 00:21:46.190 --> 00:21:47.790 and they are those processes NOTE Confidence: 0.9646203 00:21:47.790 --> 00:21:49.150 then, for instance, make it NOTE Confidence: 0.9646203 00:21:49.150 --> 00:21:50.130 possible that NOTE Confidence: 0.9850753 00:21:50.430 --> 00:21:52.109 although we have exactly the NOTE Confidence: 0.9850753 00:21:52.109 --> 00:21:52.930 same genes NOTE Confidence: 0.9922864 00:21:53.390 --> 00:21:54.990 in the cell that make NOTE Confidence: 0.9922864 00:21:54.990 --> 00:21:56.190 our skin as well as NOTE Confidence: 0.9922864 00:21:56.190 --> 00:21:57.309 in the neurons in our NOTE Confidence: 0.9922864 00:21:57.309 --> 00:21:57.809 brain, NOTE Confidence: 0.97592896 00:21:59.115 --> 00:22:00.715 we still have two sets NOTE Confidence: 0.97592896 00:22:00.715 --> 00:22:01.915 of cells that have a NOTE Confidence: 0.97592896 00:22:01.915 --> 00:22:02.975 very different function NOTE Confidence: 0.9719696 00:22:03.435 --> 00:22:05.035 just because not all the NOTE Confidence: 0.9719696 00:22:05.035 --> 00:22:06.415 genes in the skin NOTE Confidence: 0.98966587 00:22:06.795 --> 00:22:08.155 are expressed as they are NOTE Confidence: 0.98966587 00:22:08.155 --> 00:22:09.215 in in neurons. NOTE Confidence: 0.96599823 00:22:09.915 --> 00:22:11.930 And I always say that NOTE Confidence: 0.96599823 00:22:11.930 --> 00:22:13.609 we share fifty percent of NOTE Confidence: 0.96599823 00:22:13.609 --> 00:22:14.890 our genes with a banana, NOTE Confidence: 0.96599823 00:22:14.890 --> 00:22:16.010 which is something that always NOTE Confidence: 0.96599823 00:22:16.010 --> 00:22:17.130 surprised me when I say NOTE Confidence: 0.96599823 00:22:17.130 --> 00:22:18.570 it. But, luckily, we do NOTE Confidence: 0.96599823 00:22:18.570 --> 00:22:19.690 function and we look very NOTE Confidence: 0.96599823 00:22:19.690 --> 00:22:20.910 different from a banana. NOTE Confidence: 0.89992714 00:22:21.210 --> 00:22:22.330 This is again to do NOTE Confidence: 0.89992714 00:22:22.330 --> 00:22:23.530 with the the sort of NOTE Confidence: 0.89992714 00:22:23.530 --> 00:22:24.030 epigenetic NOTE Confidence: 0.98579866 00:22:24.330 --> 00:22:26.615 regulation of DNA structure, which NOTE Confidence: 0.98579866 00:22:26.615 --> 00:22:28.395 is otherwise very well conserved NOTE Confidence: 0.98579866 00:22:28.534 --> 00:22:29.595 in in in nature. NOTE Confidence: 0.99951047 00:22:30.054 --> 00:22:31.755 So we wanted to explore NOTE Confidence: 0.9918018 00:22:32.215 --> 00:22:32.534 if, NOTE Confidence: 0.8801669 00:22:33.575 --> 00:22:35.355 cannabis use and particularly hypothesis NOTE Confidence: 0.8801669 00:22:35.575 --> 00:22:37.335 cannabis use did have an NOTE Confidence: 0.8801669 00:22:37.335 --> 00:22:39.515 impact in particularly DNA methylation, NOTE Confidence: 0.96320236 00:22:39.975 --> 00:22:41.115 which is a way, NOTE Confidence: 0.9197859 00:22:41.640 --> 00:22:43.080 by adding a material group, NOTE Confidence: 0.9197859 00:22:43.080 --> 00:22:44.200 you can switch on and NOTE Confidence: 0.9197859 00:22:44.200 --> 00:22:45.740 off genes and therefore NOTE Confidence: 0.9410297 00:22:46.280 --> 00:22:47.880 them being read or not NOTE Confidence: 0.9410297 00:22:47.880 --> 00:22:48.700 into biology. NOTE Confidence: 0.9766912 00:22:49.240 --> 00:22:50.359 And we found and this NOTE Confidence: 0.9766912 00:22:50.359 --> 00:22:51.320 is some work we have NOTE Confidence: 0.9766912 00:22:51.320 --> 00:22:52.680 done in collaboration with Emma NOTE Confidence: 0.9766912 00:22:52.680 --> 00:22:53.175 Dempster NOTE Confidence: 0.9503108 00:22:54.135 --> 00:22:54.375 from, NOTE Confidence: 0.9011794 00:22:55.095 --> 00:22:57.415 from, Exeter University where they NOTE Confidence: 0.9011794 00:22:57.415 --> 00:22:58.455 they they do lots of NOTE Confidence: 0.9011794 00:22:58.455 --> 00:23:00.315 epigenetic work in mental health. NOTE Confidence: 0.7475258 00:23:01.175 --> 00:23:03.195 We found that hypotensive copies NOTE Confidence: 0.9649954 00:23:03.975 --> 00:23:05.035 leads a distinct NOTE Confidence: 0.8995087 00:23:05.575 --> 00:23:06.555 DNA methylation NOTE Confidence: 0.971703 00:23:06.855 --> 00:23:07.755 Yeah. Signature, NOTE Confidence: 0.99912983 00:23:08.340 --> 00:23:09.940 which means that it does NOTE Confidence: 0.99912983 00:23:09.940 --> 00:23:10.440 affect NOTE Confidence: 0.9376498 00:23:10.900 --> 00:23:12.500 where and and and how NOTE Confidence: 0.9376498 00:23:12.500 --> 00:23:14.100 much of the DNA is NOTE Confidence: 0.9376498 00:23:14.100 --> 00:23:15.780 switched on and off. And NOTE Confidence: 0.9376498 00:23:15.780 --> 00:23:16.100 this, NOTE Confidence: 0.96527255 00:23:16.820 --> 00:23:18.660 signature is different when you NOTE Confidence: 0.96527255 00:23:18.660 --> 00:23:20.419 look at people who use NOTE Confidence: 0.96527255 00:23:20.419 --> 00:23:20.919 hypotency NOTE Confidence: 0.99658346 00:23:21.315 --> 00:23:23.154 and have developed psychosis from NOTE Confidence: 0.99658346 00:23:23.154 --> 00:23:23.975 healthy control NOTE Confidence: 0.96326274 00:23:24.355 --> 00:23:25.494 while using hypotency. NOTE Confidence: 0.9530552 00:23:25.955 --> 00:23:27.075 We don't know yet what NOTE Confidence: 0.9530552 00:23:27.075 --> 00:23:28.434 this means, but might be NOTE Confidence: 0.9530552 00:23:28.434 --> 00:23:30.054 a sort of biological hint NOTE Confidence: 0.99551314 00:23:30.434 --> 00:23:32.514 to what makes particular people NOTE Confidence: 0.99551314 00:23:32.514 --> 00:23:33.014 susceptible. NOTE Confidence: 0.9916857 00:23:33.715 --> 00:23:35.575 And the two biological system NOTE Confidence: 0.9609138 00:23:35.890 --> 00:23:37.570 that are affected by this, NOTE Confidence: 0.9365871 00:23:38.450 --> 00:23:40.850 signature of hypotensive cannabis are NOTE Confidence: 0.9365871 00:23:40.850 --> 00:23:41.830 the immune system, NOTE Confidence: 0.9777074 00:23:42.130 --> 00:23:43.669 which we're all familiar with, NOTE Confidence: 0.97463655 00:23:43.970 --> 00:23:46.770 and also the mitochondrial system. NOTE Confidence: 0.97463655 00:23:46.770 --> 00:23:47.510 And mitochondrial NOTE Confidence: 0.98205477 00:23:47.890 --> 00:23:49.650 are the energy factory of NOTE Confidence: 0.98205477 00:23:49.650 --> 00:23:51.155 our cell, so are a NOTE Confidence: 0.98205477 00:23:51.155 --> 00:23:52.534 very important system NOTE Confidence: 0.9515377 00:23:52.835 --> 00:23:53.794 which is really at the NOTE Confidence: 0.9515377 00:23:53.794 --> 00:23:55.075 base of the of the NOTE Confidence: 0.9515377 00:23:55.075 --> 00:23:56.115 life of of, NOTE Confidence: 0.77352 00:23:56.515 --> 00:23:57.335 our functioning. NOTE Confidence: 0.9970264 00:23:58.835 --> 00:23:59.335 And NOTE Confidence: 0.9969895 00:24:00.755 --> 00:24:02.515 one thing I always say NOTE Confidence: 0.9969895 00:24:02.515 --> 00:24:04.215 that when we think about NOTE Confidence: 0.9969895 00:24:04.355 --> 00:24:04.855 susceptibility, NOTE Confidence: 0.9776923 00:24:05.690 --> 00:24:06.730 we tend to think about NOTE Confidence: 0.9776923 00:24:06.730 --> 00:24:08.590 biology, what makes us biologically NOTE Confidence: 0.9716784 00:24:08.890 --> 00:24:09.390 susceptible. NOTE Confidence: 0.9610933 00:24:09.929 --> 00:24:11.450 But, also, there are and, NOTE Confidence: 0.9610933 00:24:11.450 --> 00:24:13.049 actually, the question about gender NOTE Confidence: 0.9610933 00:24:13.049 --> 00:24:14.510 is very important because NOTE Confidence: 0.9984887 00:24:14.970 --> 00:24:16.429 it makes me think that NOTE Confidence: 0.92709875 00:24:16.809 --> 00:24:18.190 there are not only biologically NOTE Confidence: 0.8849604 00:24:18.625 --> 00:24:21.265 biological differences across gender, which NOTE Confidence: 0.8849604 00:24:21.265 --> 00:24:22.164 might makes us NOTE Confidence: 0.98642707 00:24:22.465 --> 00:24:24.005 susceptible in a different way, NOTE Confidence: 0.98642707 00:24:24.225 --> 00:24:25.505 but there might also be NOTE Confidence: 0.98642707 00:24:25.505 --> 00:24:27.125 different environmental exposure, NOTE Confidence: 0.9594994 00:24:27.984 --> 00:24:29.744 that separate sort of, the NOTE Confidence: 0.9594994 00:24:29.744 --> 00:24:31.825 the, male from female that NOTE Confidence: 0.9594994 00:24:31.825 --> 00:24:32.565 could shape NOTE Confidence: 0.9466599 00:24:32.890 --> 00:24:34.429 the vulnerability to cannabis NOTE Confidence: 0.9893154 00:24:34.890 --> 00:24:36.169 use. And one of them, NOTE Confidence: 0.94718 00:24:36.570 --> 00:24:37.609 is the interest of one NOTE Confidence: 0.94718 00:24:37.609 --> 00:24:39.609 of my PhD student who, NOTE Confidence: 0.9929964 00:24:40.250 --> 00:24:42.190 has been exploring the relationship NOTE Confidence: 0.9679753 00:24:42.890 --> 00:24:44.990 between cannabis use and childhood NOTE Confidence: 0.9679753 00:24:45.130 --> 00:24:45.630 adversity. NOTE Confidence: 0.9718735 00:24:46.085 --> 00:24:46.885 And this is the work NOTE Confidence: 0.9718735 00:24:46.885 --> 00:24:48.165 of Julia Trotter that you NOTE Confidence: 0.9718735 00:24:48.165 --> 00:24:49.045 can see with a little NOTE Confidence: 0.9718735 00:24:49.045 --> 00:24:49.545 boy, NOTE Confidence: 0.97050065 00:24:50.165 --> 00:24:51.285 Luca, who I have in NOTE Confidence: 0.97050065 00:24:51.285 --> 00:24:52.645 the picture with her because NOTE Confidence: 0.97050065 00:24:52.645 --> 00:24:54.085 he was in a tummy NOTE Confidence: 0.97050065 00:24:54.085 --> 00:24:55.125 when she was doing this NOTE Confidence: 0.97050065 00:24:55.125 --> 00:24:56.725 work. So he's an honorary NOTE Confidence: 0.97050065 00:24:56.725 --> 00:24:57.845 co author of, NOTE Confidence: 0.9801448 00:24:58.645 --> 00:25:00.265 of, of of the paper. NOTE Confidence: 0.9434255 00:25:00.590 --> 00:25:02.430 And so what Julia has NOTE Confidence: 0.9434255 00:25:02.430 --> 00:25:04.450 really shown in her work NOTE Confidence: 0.9434255 00:25:04.590 --> 00:25:06.850 is that adolescence cannabis use NOTE Confidence: 0.99909264 00:25:07.710 --> 00:25:08.770 seems to mediate NOTE Confidence: 0.9631025 00:25:09.869 --> 00:25:10.609 the association NOTE Confidence: 0.97188884 00:25:10.910 --> 00:25:12.670 between childhood adversity, which has NOTE Confidence: 0.97188884 00:25:12.670 --> 00:25:14.930 been very well, described before, NOTE Confidence: 0.9959967 00:25:15.355 --> 00:25:15.754 and, NOTE Confidence: 0.97758216 00:25:16.315 --> 00:25:18.815 and psychotic and psychotic disorder. NOTE Confidence: 0.89940387 00:25:19.274 --> 00:25:21.434 And also that often people NOTE Confidence: 0.89940387 00:25:21.434 --> 00:25:23.294 who have experienced childhood adversity, NOTE Confidence: 0.9465801 00:25:24.154 --> 00:25:25.054 even in adolescence, NOTE Confidence: 0.9889357 00:25:25.514 --> 00:25:27.274 turn to cannabis use rather NOTE Confidence: 0.9889357 00:25:27.274 --> 00:25:28.394 than just to have fun NOTE Confidence: 0.9889357 00:25:28.394 --> 00:25:29.294 with their friends NOTE Confidence: 0.9692584 00:25:29.820 --> 00:25:31.600 to sort of, self medicate NOTE Confidence: 0.9692584 00:25:31.659 --> 00:25:33.039 the negative affect NOTE Confidence: 0.9923032 00:25:33.419 --> 00:25:35.019 associated with the experience of NOTE Confidence: 0.9923032 00:25:35.019 --> 00:25:35.519 abuse, NOTE Confidence: 0.8574229 00:25:35.899 --> 00:25:36.960 which in turns NOTE Confidence: 0.9558094 00:25:37.340 --> 00:25:38.940 increases their risk of, NOTE Confidence: 0.9638015 00:25:39.980 --> 00:25:41.500 of psychotic disorder. And this NOTE Confidence: 0.9638015 00:25:41.500 --> 00:25:43.195 is, for psychotic disorder, I NOTE Confidence: 0.9638015 00:25:43.195 --> 00:25:44.154 mean, these are people who NOTE Confidence: 0.9638015 00:25:44.154 --> 00:25:45.755 actually have developed the clinical NOTE Confidence: 0.9638015 00:25:45.755 --> 00:25:46.255 condition. NOTE Confidence: 0.98185384 00:25:46.794 --> 00:25:48.075 But Julia has also been NOTE Confidence: 0.98185384 00:25:48.075 --> 00:25:50.014 interested in exploring this relationship NOTE Confidence: 0.98185384 00:25:50.154 --> 00:25:51.934 in a general population sample. NOTE Confidence: 0.9022953 00:25:52.394 --> 00:25:54.090 So to look rather that NOTE Confidence: 0.9022953 00:25:54.250 --> 00:25:56.270 at clinical psychosis and paranoia, NOTE Confidence: 0.9821564 00:25:56.650 --> 00:25:58.010 which I mentioned before is NOTE Confidence: 0.9821564 00:25:58.010 --> 00:25:58.750 an important NOTE Confidence: 0.9194337 00:25:59.130 --> 00:26:01.210 component of the qualitative of NOTE Confidence: 0.9194337 00:26:01.210 --> 00:26:02.250 of this the the the NOTE Confidence: 0.9194337 00:26:02.250 --> 00:26:03.630 psychosis people experience NOTE Confidence: 0.99891245 00:26:04.010 --> 00:26:05.150 when they use cannabis. NOTE Confidence: 0.97505397 00:26:05.529 --> 00:26:06.490 And so this is a NOTE Confidence: 0.97505397 00:26:06.490 --> 00:26:07.450 study that, NOTE Confidence: 0.9966068 00:26:08.565 --> 00:26:09.625 managed to recruit NOTE Confidence: 0.9705051 00:26:10.005 --> 00:26:11.524 three thousand seven hundred and NOTE Confidence: 0.9705051 00:26:11.524 --> 00:26:13.445 thirty seven cannabis user from NOTE Confidence: 0.9705051 00:26:13.445 --> 00:26:14.725 the London area and also NOTE Confidence: 0.9705051 00:26:14.725 --> 00:26:15.845 a sample of people who NOTE Confidence: 0.9705051 00:26:15.845 --> 00:26:16.664 never used. NOTE Confidence: 0.96903455 00:26:17.365 --> 00:26:19.465 And what Julia did was NOTE Confidence: 0.96903455 00:26:19.684 --> 00:26:21.284 she, first of all, reported NOTE Confidence: 0.96903455 00:26:21.284 --> 00:26:22.644 a proportion of people that NOTE Confidence: 0.96903455 00:26:22.644 --> 00:26:24.340 had experienced childhood trauma, which NOTE Confidence: 0.96903455 00:26:24.340 --> 00:26:26.179 is actually quite high, and, NOTE Confidence: 0.99925417 00:26:27.059 --> 00:26:27.559 and NOTE Confidence: 0.92963314 00:26:27.940 --> 00:26:28.679 show that NOTE Confidence: 0.98042756 00:26:29.379 --> 00:26:31.379 childhood trauma by itself was NOTE Confidence: 0.98042756 00:26:31.379 --> 00:26:33.240 a strong predictor of paranoia NOTE Confidence: 0.98042756 00:26:33.299 --> 00:26:35.159 in this general population sample. NOTE Confidence: 0.9910139 00:26:35.539 --> 00:26:36.899 But then she also looked NOTE Confidence: 0.9910139 00:26:36.899 --> 00:26:39.080 at different subtypes of trauma, NOTE Confidence: 0.99420035 00:26:39.765 --> 00:26:41.945 their relationship with cannabis use NOTE Confidence: 0.97073483 00:26:42.565 --> 00:26:44.645 and paranoia, and she looked NOTE Confidence: 0.97073483 00:26:44.645 --> 00:26:46.484 at cannabis use in terms NOTE Confidence: 0.97073483 00:26:46.484 --> 00:26:47.785 of THC units NOTE Confidence: 0.85580903 00:26:48.165 --> 00:26:49.385 that I know, NOTE Confidence: 0.97103405 00:26:50.325 --> 00:26:52.165 Cyril is becoming something that NOTE Confidence: 0.97103405 00:26:52.165 --> 00:26:54.185 NIDA is, sort of advocating NOTE Confidence: 0.97103405 00:26:54.325 --> 00:26:55.369 to to be used more NOTE Confidence: 0.97103405 00:26:55.369 --> 00:26:55.869 widely. NOTE Confidence: 0.98006606 00:26:56.330 --> 00:26:57.769 So Julia used the data NOTE Confidence: 0.98006606 00:26:57.769 --> 00:26:58.570 that we had on the NOTE Confidence: 0.98006606 00:26:58.570 --> 00:26:59.070 potency NOTE Confidence: 0.9965094 00:26:59.529 --> 00:27:00.889 of cannabis that people were NOTE Confidence: 0.9965094 00:27:00.889 --> 00:27:01.389 using NOTE Confidence: 0.9292635 00:27:01.769 --> 00:27:01.929 and, NOTE Confidence: 0.8992879 00:27:02.570 --> 00:27:04.009 the amount they they were NOTE Confidence: 0.8992879 00:27:04.009 --> 00:27:04.909 using weekly NOTE Confidence: 0.9951149 00:27:05.289 --> 00:27:06.029 to develop, NOTE Confidence: 0.9125573 00:27:06.730 --> 00:27:09.149 these weekly THC unit consumption. NOTE Confidence: 0.9961226 00:27:09.934 --> 00:27:11.054 And you can see in NOTE Confidence: 0.9961226 00:27:11.054 --> 00:27:12.655 this graph that when she NOTE Confidence: 0.9961226 00:27:12.655 --> 00:27:13.775 looked at people who had NOTE Confidence: 0.9961226 00:27:13.775 --> 00:27:14.835 reported emotional, NOTE Confidence: 0.9723533 00:27:16.015 --> 00:27:17.395 abusing in childhood, NOTE Confidence: 0.91648185 00:27:18.095 --> 00:27:20.195 greater were the THC unit, NOTE Confidence: 0.96591854 00:27:20.895 --> 00:27:22.595 even in people without trauma, NOTE Confidence: 0.96591854 00:27:22.734 --> 00:27:24.355 greater was the predicted, NOTE Confidence: 0.9645428 00:27:24.760 --> 00:27:26.760 paranoia score. To give you NOTE Confidence: 0.9645428 00:27:26.760 --> 00:27:28.520 a sense, on average, when NOTE Confidence: 0.9645428 00:27:28.520 --> 00:27:29.720 you look at this scale NOTE Confidence: 0.9645428 00:27:29.720 --> 00:27:31.559 for paranoia, average of the NOTE Confidence: 0.9645428 00:27:31.559 --> 00:27:33.559 population would be around thirty NOTE Confidence: 0.9645428 00:27:33.559 --> 00:27:34.460 seven forty. NOTE Confidence: 0.93739486 00:27:34.840 --> 00:27:36.760 So already, fifty one is NOTE Confidence: 0.93739486 00:27:36.760 --> 00:27:38.619 quite, significantly highly NOTE Confidence: 0.989489 00:27:39.065 --> 00:27:40.845 higher than the general population NOTE Confidence: 0.989489 00:27:40.984 --> 00:27:42.445 average on on paranoia. NOTE Confidence: 0.9989526 00:27:42.744 --> 00:27:43.705 But when you look at NOTE Confidence: 0.9989526 00:27:43.705 --> 00:27:44.905 the people who have experienced NOTE Confidence: 0.9989526 00:27:44.905 --> 00:27:46.445 the trauma, the blue line NOTE Confidence: 0.83744055 00:27:46.744 --> 00:27:48.265 with an increase in, NOTE Confidence: 0.98175895 00:27:48.905 --> 00:27:50.345 THC unit, you see there NOTE Confidence: 0.98175895 00:27:50.345 --> 00:27:51.725 is a much sharper NOTE Confidence: 0.95007074 00:27:53.240 --> 00:27:55.100 increase in, in in paranoia, NOTE Confidence: 0.99279207 00:27:55.640 --> 00:27:57.080 which is very similar when NOTE Confidence: 0.99279207 00:27:57.080 --> 00:27:58.700 you look at people with NOTE Confidence: 0.99279207 00:27:58.840 --> 00:27:59.340 household NOTE Confidence: 0.9773209 00:27:59.960 --> 00:28:00.460 discordance, NOTE Confidence: 0.94901097 00:28:00.919 --> 00:28:03.159 which, again, it's another childhood NOTE Confidence: 0.94901097 00:28:03.159 --> 00:28:04.919 trauma that increases the risk NOTE Confidence: 0.94901097 00:28:04.919 --> 00:28:06.520 for psychosis. These two childhood NOTE Confidence: 0.94901097 00:28:06.520 --> 00:28:07.580 trauma by themselves NOTE Confidence: 0.9379168 00:28:08.605 --> 00:28:10.205 mildly increase the risk for NOTE Confidence: 0.9379168 00:28:10.205 --> 00:28:10.705 psychosis NOTE Confidence: 0.9662956 00:28:11.005 --> 00:28:12.445 on their own. But when NOTE Confidence: 0.9662956 00:28:12.445 --> 00:28:13.424 you add cannabis, NOTE Confidence: 0.925901 00:28:13.965 --> 00:28:14.865 this actually, NOTE Confidence: 0.9689894 00:28:15.645 --> 00:28:16.684 is of a of a NOTE Confidence: 0.9689894 00:28:16.684 --> 00:28:18.145 quite striking magnitude. NOTE Confidence: 0.9233907 00:28:18.525 --> 00:28:19.965 And is it quite interesting NOTE Confidence: 0.9233907 00:28:19.965 --> 00:28:21.484 because we got reports that NOTE Confidence: 0.9233907 00:28:21.484 --> 00:28:22.465 these were people NOTE Confidence: 0.99767303 00:28:22.780 --> 00:28:24.300 who were actually trying to NOTE Confidence: 0.99767303 00:28:24.300 --> 00:28:25.040 self medicate NOTE Confidence: 0.7538934 00:28:25.660 --> 00:28:26.700 that discomfort of, NOTE Confidence: 0.96805865 00:28:27.180 --> 00:28:28.780 having been emotionally abused and NOTE Confidence: 0.96805865 00:28:28.780 --> 00:28:30.059 and living in a family NOTE Confidence: 0.96805865 00:28:30.059 --> 00:28:30.559 environment, NOTE Confidence: 0.92008764 00:28:31.020 --> 00:28:32.720 which was, dysfunctional. NOTE Confidence: 0.9451593 00:28:33.100 --> 00:28:34.140 So this is certainly a NOTE Confidence: 0.9451593 00:28:34.140 --> 00:28:35.340 group to to keep an NOTE Confidence: 0.9451593 00:28:35.340 --> 00:28:37.565 eye on for primary prevention NOTE Confidence: 0.9451593 00:28:37.565 --> 00:28:39.165 because this might be young NOTE Confidence: 0.9451593 00:28:39.165 --> 00:28:39.985 people that NOTE Confidence: 0.9540428 00:28:40.285 --> 00:28:42.045 are identifiable, you know, at NOTE Confidence: 0.9540428 00:28:42.045 --> 00:28:43.645 school or in in, in NOTE Confidence: 0.9540428 00:28:43.645 --> 00:28:45.405 youth club or in primary NOTE Confidence: 0.9540428 00:28:45.405 --> 00:28:45.905 care NOTE Confidence: 0.9417979 00:28:46.365 --> 00:28:47.805 settings. So before they get NOTE Confidence: 0.9417979 00:28:47.805 --> 00:28:48.865 actually to the clinical, NOTE Confidence: 0.99764556 00:28:49.885 --> 00:28:51.185 to the clinical psychosis. NOTE Confidence: 0.9230064 00:28:52.500 --> 00:28:54.920 Sil, any any any question? NOTE Confidence: 0.966397 00:28:56.420 --> 00:28:58.020 Yes. There's a question from NOTE Confidence: 0.966397 00:28:58.020 --> 00:28:58.760 your countrymen, NOTE Confidence: 0.5931369 00:29:00.100 --> 00:29:01.080 Nicola Mitali. NOTE Confidence: 0.92528075 00:29:02.100 --> 00:29:02.600 Nicola NOTE Confidence: 0.8536327 00:29:03.220 --> 00:29:04.420 asked the question, when you NOTE Confidence: 0.8536327 00:29:04.420 --> 00:29:05.985 say the cannabis users present NOTE Confidence: 0.8536327 00:29:06.225 --> 00:29:07.605 present many schizophrenia NOTE Confidence: 0.9924275 00:29:07.905 --> 00:29:08.725 risk genes, NOTE Confidence: 0.9471805 00:29:09.105 --> 00:29:10.225 how many genes do you NOTE Confidence: 0.9471805 00:29:10.225 --> 00:29:12.065 mean to show risk poly NOTE Confidence: 0.9471805 00:29:12.385 --> 00:29:12.885 polymorphisms? NOTE Confidence: 0.98835766 00:29:14.465 --> 00:29:16.485 Well, the polygenic risk score, NOTE Confidence: 0.98835766 00:29:16.705 --> 00:29:18.485 which is the way we, NOTE Confidence: 0.84284914 00:29:19.184 --> 00:29:21.025 calculated the genetic load in NOTE Confidence: 0.84284914 00:29:21.025 --> 00:29:21.684 the study, NOTE Confidence: 0.99965966 00:29:22.350 --> 00:29:23.330 really includes NOTE Confidence: 0.98538774 00:29:23.790 --> 00:29:25.150 hundreds and hundreds of, NOTE Confidence: 0.9788389 00:29:25.790 --> 00:29:27.650 common gene of small effect. NOTE Confidence: 0.9837721 00:29:28.030 --> 00:29:29.790 And it doesn't really tell NOTE Confidence: 0.9837721 00:29:29.790 --> 00:29:31.150 you anything about which are NOTE Confidence: 0.9837721 00:29:31.150 --> 00:29:33.410 the genes that perhaps drive NOTE Confidence: 0.9837721 00:29:33.710 --> 00:29:35.170 the most of the association. NOTE Confidence: 0.9836667 00:29:35.815 --> 00:29:37.495 To do that, you probably NOTE Confidence: 0.9836667 00:29:37.495 --> 00:29:38.455 need to do a different NOTE Confidence: 0.9836667 00:29:38.455 --> 00:29:39.415 type of work, which is NOTE Confidence: 0.9836667 00:29:39.415 --> 00:29:41.755 to look at biological pathway. NOTE Confidence: 0.9568393 00:29:42.135 --> 00:29:43.595 So to see if NOTE Confidence: 0.9351713 00:29:43.895 --> 00:29:45.255 when you think about people NOTE Confidence: 0.9351713 00:29:45.255 --> 00:29:46.615 who develop psychosis in the NOTE Confidence: 0.9351713 00:29:46.615 --> 00:29:48.455 context of cannabis use, if NOTE Confidence: 0.9351713 00:29:48.455 --> 00:29:49.675 out of this overall NOTE Confidence: 0.94959277 00:29:50.200 --> 00:29:51.960 genetic load for schizophrenia, there NOTE Confidence: 0.94959277 00:29:51.960 --> 00:29:53.720 are some genes that drive NOTE Confidence: 0.94959277 00:29:53.720 --> 00:29:54.220 particularly NOTE Confidence: 0.9472504 00:29:54.760 --> 00:29:55.500 the susceptibility. NOTE Confidence: 0.94939643 00:29:56.200 --> 00:29:57.400 And this is some work NOTE Confidence: 0.94939643 00:29:57.400 --> 00:29:59.660 that actually professor D'Souza team NOTE Confidence: 0.94939643 00:29:59.720 --> 00:30:00.600 has been doing, and I NOTE Confidence: 0.94939643 00:30:00.600 --> 00:30:02.280 can't give away his, his NOTE Confidence: 0.94939643 00:30:02.280 --> 00:30:03.740 his data on his behalf. NOTE Confidence: 0.9388316 00:30:04.865 --> 00:30:07.044 But also my my postdoc NOTE Confidence: 0.9388316 00:30:07.105 --> 00:30:08.304 has been looking at that, NOTE Confidence: 0.9388316 00:30:08.304 --> 00:30:09.205 and we have, NOTE Confidence: 0.97683436 00:30:09.985 --> 00:30:11.424 the paper in review. And NOTE Confidence: 0.97683436 00:30:11.424 --> 00:30:12.225 just to give you a NOTE Confidence: 0.97683436 00:30:12.225 --> 00:30:14.404 sense, it's quite interesting because NOTE Confidence: 0.97683436 00:30:14.625 --> 00:30:15.745 some of the genes, for NOTE Confidence: 0.97683436 00:30:15.745 --> 00:30:17.184 instance, are genes involving the NOTE Confidence: 0.97683436 00:30:17.184 --> 00:30:18.950 GABA system, which is not NOTE Confidence: 0.97683436 00:30:18.950 --> 00:30:19.910 surprising because, NOTE Confidence: 0.8518483 00:30:21.510 --> 00:30:22.010 THC, NOTE Confidence: 0.95014966 00:30:22.790 --> 00:30:24.310 when it gets into our NOTE Confidence: 0.95014966 00:30:24.310 --> 00:30:25.590 body and it binds the NOTE Confidence: 0.95014966 00:30:25.590 --> 00:30:27.030 targets in in in in NOTE Confidence: 0.95014966 00:30:27.030 --> 00:30:27.850 our brain, NOTE Confidence: 0.90832955 00:30:28.230 --> 00:30:29.670 has a a an effect NOTE Confidence: 0.90832955 00:30:29.670 --> 00:30:31.270 on regulating the the the NOTE Confidence: 0.90832955 00:30:31.270 --> 00:30:32.170 GABA signaling. NOTE Confidence: 0.9912043 00:30:32.655 --> 00:30:33.095 So, NOTE Confidence: 0.9643094 00:30:33.535 --> 00:30:35.135 there there are some pathway NOTE Confidence: 0.9643094 00:30:35.135 --> 00:30:35.635 which NOTE Confidence: 0.8527283 00:30:35.935 --> 00:30:36.675 makes sense, NOTE Confidence: 0.95931923 00:30:37.775 --> 00:30:39.295 biologically, but you can't tell NOTE Confidence: 0.95931923 00:30:39.295 --> 00:30:40.995 this from from the polygenic NOTE Confidence: 0.95931923 00:30:41.055 --> 00:30:42.095 risk score, which is a NOTE Confidence: 0.95931923 00:30:42.095 --> 00:30:43.555 very noisy overall, NOTE Confidence: 0.94420266 00:30:44.255 --> 00:30:45.455 measure. I I don't know NOTE Confidence: 0.94420266 00:30:45.455 --> 00:30:46.275 if that helped. NOTE Confidence: 0.97725695 00:30:48.920 --> 00:30:50.060 Thank you. Absolutely. NOTE Confidence: 0.9151655 00:30:50.680 --> 00:30:52.140 Thank you. Pleasure. NOTE Confidence: 0.9774202 00:30:52.520 --> 00:30:54.840 And, I want to then NOTE Confidence: 0.9774202 00:30:54.840 --> 00:30:56.200 give a positive message in NOTE Confidence: 0.9774202 00:30:56.200 --> 00:30:57.560 all of this risk increasing NOTE Confidence: 0.9774202 00:30:57.560 --> 00:30:59.160 here and there, which is NOTE Confidence: 0.9774202 00:30:59.160 --> 00:31:00.760 actually we were interested to NOTE Confidence: 0.9774202 00:31:00.760 --> 00:31:02.360 explore a question that people NOTE Confidence: 0.9774202 00:31:02.360 --> 00:31:04.165 have looked at in relation, NOTE Confidence: 0.9774202 00:31:04.165 --> 00:31:05.685 for instance, to tobacco smoking NOTE Confidence: 0.9774202 00:31:05.685 --> 00:31:06.505 and lung cancer. NOTE Confidence: 0.9875352 00:31:06.805 --> 00:31:08.725 You know that, obviously, tobacco NOTE Confidence: 0.9875352 00:31:08.725 --> 00:31:10.085 smoking increases the risk of NOTE Confidence: 0.9875352 00:31:10.085 --> 00:31:11.205 lung cancer, but you also NOTE Confidence: 0.9875352 00:31:11.205 --> 00:31:12.665 know that when people stop NOTE Confidence: 0.9748963 00:31:12.965 --> 00:31:14.745 smoking tobacco, smoking cigarettes, NOTE Confidence: 0.9812381 00:31:15.125 --> 00:31:16.265 longer they abstain, NOTE Confidence: 0.96728027 00:31:17.140 --> 00:31:18.760 greater they experience a reduction NOTE Confidence: 0.96728027 00:31:18.900 --> 00:31:20.020 in the risk they had NOTE Confidence: 0.96728027 00:31:20.020 --> 00:31:22.200 acquired when they were smokers. NOTE Confidence: 0.967613 00:31:22.740 --> 00:31:23.780 And so we wanted to NOTE Confidence: 0.967613 00:31:23.780 --> 00:31:24.980 see if that was the NOTE Confidence: 0.967613 00:31:24.980 --> 00:31:27.540 same in relation of, cannabis NOTE Confidence: 0.967613 00:31:27.540 --> 00:31:28.360 use and psychosis. NOTE Confidence: 0.9807579 00:31:28.995 --> 00:31:30.195 And, this is, of course, NOTE Confidence: 0.9807579 00:31:30.195 --> 00:31:31.155 a study that will need NOTE Confidence: 0.9807579 00:31:31.155 --> 00:31:32.375 to be to be replicated, NOTE Confidence: 0.9807579 00:31:32.434 --> 00:31:33.735 but we were quite pleased. NOTE Confidence: 0.9815142 00:31:34.195 --> 00:31:35.155 And this is, again, the NOTE Confidence: 0.9815142 00:31:35.155 --> 00:31:36.835 European study I mentioned to NOTE Confidence: 0.9815142 00:31:36.835 --> 00:31:37.495 you about. NOTE Confidence: 0.9650087 00:31:37.795 --> 00:31:38.835 We were able to show NOTE Confidence: 0.9650087 00:31:38.835 --> 00:31:39.955 that, again, and this is NOTE Confidence: 0.9650087 00:31:39.955 --> 00:31:41.875 my favorite combination of frequency NOTE Confidence: 0.9650087 00:31:41.875 --> 00:31:42.995 and potency you have become NOTE Confidence: 0.9650087 00:31:42.995 --> 00:31:44.295 familiar with by now, NOTE Confidence: 0.95223224 00:31:44.820 --> 00:31:46.519 that when we look at NOTE Confidence: 0.95223224 00:31:46.580 --> 00:31:48.440 weeks since the session, so NOTE Confidence: 0.95223224 00:31:48.580 --> 00:31:50.120 how long people had been NOTE Confidence: 0.95223224 00:31:50.340 --> 00:31:52.760 since, had stopped using cannabis. NOTE Confidence: 0.95529145 00:31:53.299 --> 00:31:54.419 And, of course, when you NOTE Confidence: 0.95529145 00:31:54.419 --> 00:31:55.940 look at zero, zero means NOTE Confidence: 0.95529145 00:31:55.940 --> 00:31:57.140 that people are still using NOTE Confidence: 0.95529145 00:31:57.140 --> 00:31:58.595 and then you would have, NOTE Confidence: 0.90877545 00:31:58.975 --> 00:32:00.895 the the accumulation of weeks NOTE Confidence: 0.90877545 00:32:00.895 --> 00:32:02.035 since they have stopped. NOTE Confidence: 0.9967605 00:32:02.495 --> 00:32:03.455 You can see that, NOTE Confidence: 0.9344875 00:32:04.015 --> 00:32:05.535 each of the line that NOTE Confidence: 0.9344875 00:32:05.535 --> 00:32:07.295 represent a combination of potency NOTE Confidence: 0.9344875 00:32:07.295 --> 00:32:07.955 and frequency, NOTE Confidence: 0.9969976 00:32:08.335 --> 00:32:09.554 longer people abstain, NOTE Confidence: 0.9587437 00:32:10.575 --> 00:32:12.640 lower it becomes, which means NOTE Confidence: 0.9587437 00:32:12.640 --> 00:32:13.540 that indicates NOTE Confidence: 0.9835968 00:32:13.920 --> 00:32:15.300 a decrease in the risk NOTE Confidence: 0.9835968 00:32:15.360 --> 00:32:16.880 for psychotic disorder which is NOTE Confidence: 0.9835968 00:32:16.880 --> 00:32:18.260 represented by the y NOTE Confidence: 0.7663003 00:32:18.880 --> 00:32:19.700 vertical axis. NOTE Confidence: 0.9029231 00:32:20.080 --> 00:32:21.520 But the pink line is NOTE Confidence: 0.9029231 00:32:21.520 --> 00:32:22.720 the is the tricky one NOTE Confidence: 0.9029231 00:32:22.720 --> 00:32:23.920 is again the people that NOTE Confidence: 0.9029231 00:32:23.920 --> 00:32:24.660 use frequency, NOTE Confidence: 0.5886334 00:32:25.200 --> 00:32:25.700 everyday, NOTE Confidence: 0.9686082 00:32:26.240 --> 00:32:27.975 hypotensive cannabis. And you can NOTE Confidence: 0.9686082 00:32:27.975 --> 00:32:29.255 see that for them, there NOTE Confidence: 0.9686082 00:32:29.255 --> 00:32:30.455 is a decline in the NOTE Confidence: 0.9686082 00:32:30.455 --> 00:32:32.295 risk. But at five hundred NOTE Confidence: 0.9686082 00:32:32.295 --> 00:32:33.415 weeks, which is a very NOTE Confidence: 0.9686082 00:32:33.415 --> 00:32:35.335 long time, they still have NOTE Confidence: 0.9686082 00:32:35.335 --> 00:32:36.695 above a twenty five percent NOTE Confidence: 0.9686082 00:32:36.695 --> 00:32:38.215 increased risk. So this is NOTE Confidence: 0.9686082 00:32:38.215 --> 00:32:40.215 a group that takes longer NOTE Confidence: 0.9686082 00:32:40.215 --> 00:32:41.675 to wash out the accumulated NOTE Confidence: 0.9686082 00:32:41.815 --> 00:32:42.695 risk. And I would like NOTE Confidence: 0.9686082 00:32:42.695 --> 00:32:43.860 to say that when you NOTE Confidence: 0.9686082 00:32:43.860 --> 00:32:45.700 get to the majority of NOTE Confidence: 0.9686082 00:32:45.700 --> 00:32:47.380 these people had started using NOTE Confidence: 0.9686082 00:32:47.380 --> 00:32:49.060 the early teens. And for NOTE Confidence: 0.9686082 00:32:49.060 --> 00:32:50.520 those who had stopped NOTE Confidence: 0.99390966 00:32:50.900 --> 00:32:52.660 shortly after, you know, five NOTE Confidence: 0.99390966 00:32:52.660 --> 00:32:54.020 hundred weeks is pretty much NOTE Confidence: 0.99390966 00:32:54.020 --> 00:32:55.140 close to when you are NOTE Confidence: 0.99390966 00:32:55.140 --> 00:32:56.180 at risk of developing a NOTE Confidence: 0.99390966 00:32:56.180 --> 00:32:57.825 psychotic disorder. So this is NOTE Confidence: 0.99390966 00:32:57.825 --> 00:32:59.424 really a group which is NOTE Confidence: 0.99390966 00:32:59.424 --> 00:33:00.725 a significant risk NOTE Confidence: 0.9810607 00:33:01.025 --> 00:33:02.945 and should be supported in NOTE Confidence: 0.9810607 00:33:02.945 --> 00:33:04.725 in in in understanding it. NOTE Confidence: 0.9915164 00:33:05.905 --> 00:33:06.784 Well and this is my NOTE Confidence: 0.9915164 00:33:06.784 --> 00:33:08.544 overall message. Anyway but now NOTE Confidence: 0.9915164 00:33:08.544 --> 00:33:09.605 I'm going to NOTE Confidence: 0.9991701 00:33:10.200 --> 00:33:11.480 come towards the the end NOTE Confidence: 0.9991701 00:33:11.480 --> 00:33:13.240 of the talk by sharing NOTE Confidence: 0.9991701 00:33:13.240 --> 00:33:14.279 with you something that is NOTE Confidence: 0.9991701 00:33:14.279 --> 00:33:15.640 very dear to me as NOTE Confidence: 0.9991701 00:33:15.640 --> 00:33:16.299 a clinician. NOTE Confidence: 0.93079156 00:33:16.919 --> 00:33:19.240 So often, I share this NOTE Confidence: 0.93079156 00:33:19.240 --> 00:33:21.000 data with the family of NOTE Confidence: 0.93079156 00:33:21.000 --> 00:33:22.520 people under my care that NOTE Confidence: 0.93079156 00:33:22.520 --> 00:33:25.179 as, professor D'Souza mentioned are NOTE Confidence: 0.9730002 00:33:26.015 --> 00:33:28.015 young people experiencing psychosis for NOTE Confidence: 0.9730002 00:33:28.015 --> 00:33:29.055 the first time, most of NOTE Confidence: 0.9730002 00:33:29.055 --> 00:33:30.095 the time, in the context NOTE Confidence: 0.9730002 00:33:30.095 --> 00:33:31.535 of cannabis use. And they NOTE Confidence: 0.9730002 00:33:31.535 --> 00:33:32.495 say to me, well, thank NOTE Confidence: 0.9730002 00:33:32.495 --> 00:33:33.375 you very much for all NOTE Confidence: 0.9730002 00:33:33.375 --> 00:33:34.495 this data, but what are NOTE Confidence: 0.9730002 00:33:34.495 --> 00:33:35.775 you actually doing for our NOTE Confidence: 0.9730002 00:33:35.775 --> 00:33:36.515 loved ones? NOTE Confidence: 0.891078 00:33:36.815 --> 00:33:37.955 Particularly because NOTE Confidence: 0.99034894 00:33:38.335 --> 00:33:40.200 they struggle to stop and, NOTE Confidence: 0.9970045 00:33:40.720 --> 00:33:42.240 and the continuing of the NOTE Confidence: 0.9970045 00:33:42.240 --> 00:33:43.220 cannabis use NOTE Confidence: 0.987589 00:33:43.760 --> 00:33:45.520 perpetuates the the the sort NOTE Confidence: 0.987589 00:33:45.520 --> 00:33:47.140 of severity of the illness. NOTE Confidence: 0.9467006 00:33:47.919 --> 00:33:48.419 And NOTE Confidence: 0.9316748 00:33:49.280 --> 00:33:51.520 important work had actually shown NOTE Confidence: 0.9316748 00:33:51.520 --> 00:33:53.600 beyond what family will tell NOTE Confidence: 0.9316748 00:33:53.600 --> 00:33:54.400 me and I will see NOTE Confidence: 0.9316748 00:33:54.400 --> 00:33:55.815 in my clinic that that NOTE Confidence: 0.9316748 00:33:55.815 --> 00:33:57.255 indeed if you develop a NOTE Confidence: 0.9316748 00:33:57.255 --> 00:33:58.855 psychotic disorder and you continue NOTE Confidence: 0.9316748 00:33:58.855 --> 00:34:00.375 to use cannabis after the NOTE Confidence: 0.9316748 00:34:00.375 --> 00:34:01.735 onset of the illness and NOTE Confidence: 0.9316748 00:34:01.735 --> 00:34:03.335 particularly, and this time it's NOTE Confidence: 0.9316748 00:34:03.335 --> 00:34:04.215 not in pink, it's in NOTE Confidence: 0.9316748 00:34:04.215 --> 00:34:04.715 green, NOTE Confidence: 0.90447533 00:34:05.255 --> 00:34:07.095 you do that by using NOTE Confidence: 0.90447533 00:34:07.095 --> 00:34:08.714 everyday hypo and c cannabis, NOTE Confidence: 0.9832746 00:34:09.030 --> 00:34:10.390 you are much more likely NOTE Confidence: 0.9832746 00:34:10.390 --> 00:34:11.590 to relapse and you are NOTE Confidence: 0.9832746 00:34:11.590 --> 00:34:13.450 faster to relapse than people NOTE Confidence: 0.9832746 00:34:13.670 --> 00:34:14.950 who are using much less NOTE Confidence: 0.9832746 00:34:14.950 --> 00:34:16.150 or people that have actually NOTE Confidence: 0.9832746 00:34:16.150 --> 00:34:18.070 stopped. And you're more likely NOTE Confidence: 0.9832746 00:34:18.070 --> 00:34:18.870 to be admitted in a NOTE Confidence: 0.9832746 00:34:18.870 --> 00:34:20.710 psychiatric intensive care unit because NOTE Confidence: 0.9832746 00:34:20.710 --> 00:34:21.750 of the severity of your NOTE Confidence: 0.9832746 00:34:21.750 --> 00:34:23.695 symptoms to have longer hospital NOTE Confidence: 0.9832746 00:34:23.695 --> 00:34:25.375 admission and shorter period of NOTE Confidence: 0.9832746 00:34:25.375 --> 00:34:25.875 remission NOTE Confidence: 0.9632601 00:34:26.175 --> 00:34:28.114 between the relapses. So really NOTE Confidence: 0.9632601 00:34:28.175 --> 00:34:30.015 a huge negative impact on NOTE Confidence: 0.9632601 00:34:30.015 --> 00:34:31.635 the outcome of the illness. NOTE Confidence: 0.9473527 00:34:32.415 --> 00:34:33.535 So in two thousand and NOTE Confidence: 0.9473527 00:34:33.535 --> 00:34:34.035 nineteen, NOTE Confidence: 0.9996883 00:34:34.335 --> 00:34:35.535 we were able to get NOTE Confidence: 0.9996883 00:34:35.535 --> 00:34:37.455 some funding from a local NOTE Confidence: 0.9996883 00:34:37.455 --> 00:34:37.955 charity NOTE Confidence: 0.9456773 00:34:39.359 --> 00:34:41.359 And, we developed a service NOTE Confidence: 0.9456773 00:34:41.359 --> 00:34:42.960 which professor D'Souza mentioned, which NOTE Confidence: 0.9456773 00:34:42.960 --> 00:34:44.079 is called the cannabis clinic NOTE Confidence: 0.9456773 00:34:44.079 --> 00:34:45.280 for patient with psychosis. And, NOTE Confidence: 0.9456773 00:34:45.280 --> 00:34:47.200 actually, this logo is very NOTE Confidence: 0.9456773 00:34:47.200 --> 00:34:48.400 dear to my heart because NOTE Confidence: 0.9456773 00:34:48.400 --> 00:34:49.839 it was designed with the NOTE Confidence: 0.9456773 00:34:49.839 --> 00:34:51.359 first group of patients who NOTE Confidence: 0.9456773 00:34:51.359 --> 00:34:52.799 were part of developing the NOTE Confidence: 0.9456773 00:34:52.799 --> 00:34:53.299 clinic, NOTE Confidence: 0.9773379 00:34:53.694 --> 00:34:54.994 and it really represents NOTE Confidence: 0.93508816 00:34:55.295 --> 00:34:56.575 where they want to be NOTE Confidence: 0.93508816 00:34:56.575 --> 00:34:57.555 with their journey. NOTE Confidence: 0.98913413 00:34:57.855 --> 00:34:58.815 Some of them don't even NOTE Confidence: 0.98913413 00:34:58.815 --> 00:35:00.255 think about psychosis. They just NOTE Confidence: 0.98913413 00:35:00.255 --> 00:35:01.535 think about having a brain NOTE Confidence: 0.98913413 00:35:01.535 --> 00:35:02.895 which is entirely filled with NOTE Confidence: 0.98913413 00:35:02.895 --> 00:35:03.395 cannabis NOTE Confidence: 0.9724442 00:35:03.775 --> 00:35:04.895 and wanted to go back NOTE Confidence: 0.9724442 00:35:04.895 --> 00:35:05.855 to do more in their NOTE Confidence: 0.9724442 00:35:05.855 --> 00:35:08.060 life, such as starting again NOTE Confidence: 0.9724442 00:35:08.060 --> 00:35:09.580 with some hobbies, doing more NOTE Confidence: 0.9724442 00:35:09.580 --> 00:35:10.800 exercise, music, NOTE Confidence: 0.7433939 00:35:11.340 --> 00:35:11.840 studying. NOTE Confidence: 0.9290275 00:35:12.300 --> 00:35:13.820 And CAO knows I always NOTE Confidence: 0.9290275 00:35:13.820 --> 00:35:14.620 say this, and one of NOTE Confidence: 0.9290275 00:35:14.620 --> 00:35:16.460 them said to me, doctor NOTE Confidence: 0.9290275 00:35:16.460 --> 00:35:17.739 Mars, can I get a NOTE Confidence: 0.9290275 00:35:17.739 --> 00:35:19.100 girlfriend if I stop using NOTE Confidence: 0.9290275 00:35:19.100 --> 00:35:20.219 cannabis? I I can't make NOTE Confidence: 0.9290275 00:35:20.219 --> 00:35:20.960 these promises, NOTE Confidence: 0.9717062 00:35:21.335 --> 00:35:22.775 but I always say that NOTE Confidence: 0.9717062 00:35:22.775 --> 00:35:24.154 his social network NOTE Confidence: 0.7191887 00:35:24.454 --> 00:35:25.434 certainly flourished, NOTE Confidence: 0.99419975 00:35:26.134 --> 00:35:27.174 when he was able to NOTE Confidence: 0.99419975 00:35:27.174 --> 00:35:28.614 to stop his his cannabis NOTE Confidence: 0.99419975 00:35:28.614 --> 00:35:29.114 use. NOTE Confidence: 0.99957293 00:35:29.575 --> 00:35:31.035 And we were able to NOTE Confidence: 0.9425172 00:35:31.494 --> 00:35:33.015 do this because we put NOTE Confidence: 0.9425172 00:35:33.015 --> 00:35:34.855 together all the expertise I NOTE Confidence: 0.9425172 00:35:34.855 --> 00:35:36.060 could go get get hold NOTE Confidence: 0.9425172 00:35:36.060 --> 00:35:37.600 of across our clinical NOTE Confidence: 0.87060624 00:35:37.900 --> 00:35:39.200 and academic site, NOTE Confidence: 0.9766353 00:35:39.580 --> 00:35:40.780 and we had people with NOTE Confidence: 0.9766353 00:35:40.780 --> 00:35:42.460 great experience in addiction as NOTE Confidence: 0.9766353 00:35:42.460 --> 00:35:43.360 well as psychosis, NOTE Confidence: 0.9660914 00:35:43.820 --> 00:35:45.500 the nursing staff who are NOTE Confidence: 0.9660914 00:35:45.500 --> 00:35:47.420 usually the driving force of NOTE Confidence: 0.9660914 00:35:47.420 --> 00:35:48.940 any care we we we NOTE Confidence: 0.9660914 00:35:48.940 --> 00:35:50.000 deliver in medicine, NOTE Confidence: 0.9719372 00:35:50.364 --> 00:35:52.125 and also our head of, NOTE Confidence: 0.99078625 00:35:52.525 --> 00:35:53.505 of of pharmacy. NOTE Confidence: 0.9736084 00:35:54.045 --> 00:35:55.325 And, we were able to NOTE Confidence: 0.9736084 00:35:55.325 --> 00:35:56.525 put together a team, which NOTE Confidence: 0.9736084 00:35:56.525 --> 00:35:57.825 is still a baby team, NOTE Confidence: 0.9736084 00:35:58.045 --> 00:35:59.085 but I'm very proud of NOTE Confidence: 0.9736084 00:35:59.085 --> 00:36:00.225 this team because, NOTE Confidence: 0.96742475 00:36:01.005 --> 00:36:02.125 we are very keen in NOTE Confidence: 0.96742475 00:36:02.125 --> 00:36:03.265 UK on diversity. NOTE Confidence: 0.98209906 00:36:03.800 --> 00:36:04.680 And this is certainly a NOTE Confidence: 0.98209906 00:36:04.680 --> 00:36:06.119 team that scores very highly NOTE Confidence: 0.98209906 00:36:06.119 --> 00:36:07.320 because it's very good in NOTE Confidence: 0.98209906 00:36:07.320 --> 00:36:09.580 terms of gender, ethnicity, NOTE Confidence: 0.96694463 00:36:09.960 --> 00:36:11.800 age, and species because you NOTE Confidence: 0.96694463 00:36:11.800 --> 00:36:13.160 can see there are some NOTE Confidence: 0.96694463 00:36:13.160 --> 00:36:14.680 of our pets that feature NOTE Confidence: 0.96694463 00:36:14.680 --> 00:36:15.340 as well NOTE Confidence: 0.9890243 00:36:15.800 --> 00:36:16.540 in the, NOTE Confidence: 0.97864693 00:36:18.040 --> 00:36:18.859 in the team. NOTE Confidence: 0.9919485 00:36:19.565 --> 00:36:21.184 And we have two wonderful, NOTE Confidence: 0.9292508 00:36:22.285 --> 00:36:23.644 members of the team who NOTE Confidence: 0.9292508 00:36:23.644 --> 00:36:25.085 are our peer mentor with NOTE Confidence: 0.9292508 00:36:25.085 --> 00:36:27.325 lead experience, Stacey and Adam, NOTE Confidence: 0.9292508 00:36:27.325 --> 00:36:28.204 that you saw in the NOTE Confidence: 0.9292508 00:36:28.204 --> 00:36:29.585 video at the very beginning, NOTE Confidence: 0.9292508 00:36:29.805 --> 00:36:30.704 and a wonderful NOTE Confidence: 0.90752405 00:36:31.005 --> 00:36:32.525 and new every year, new NOTE Confidence: 0.90752405 00:36:32.525 --> 00:36:34.590 cohort of clinical placement students NOTE Confidence: 0.90752405 00:36:34.890 --> 00:36:36.410 that as students always do NOTE Confidence: 0.90752405 00:36:36.410 --> 00:36:37.690 bring really a breath of NOTE Confidence: 0.90752405 00:36:37.690 --> 00:36:38.730 fresh air and lots of NOTE Confidence: 0.90752405 00:36:38.730 --> 00:36:40.090 new ideas. And also they NOTE Confidence: 0.90752405 00:36:40.090 --> 00:36:41.210 are much closer to my NOTE Confidence: 0.90752405 00:36:41.210 --> 00:36:42.969 patients than I am. So, NOTE Confidence: 0.90752405 00:36:43.290 --> 00:36:44.810 they they they connect with NOTE Confidence: 0.90752405 00:36:44.810 --> 00:36:46.605 them very, very, very well. NOTE Confidence: 0.9538837 00:36:47.244 --> 00:36:48.605 And one of the jewel NOTE Confidence: 0.9538837 00:36:48.925 --> 00:36:49.885 if you ask me, the NOTE Confidence: 0.9538837 00:36:49.885 --> 00:36:50.925 jewel of the crown, and NOTE Confidence: 0.9538837 00:36:50.925 --> 00:36:52.205 and Cyril has been one NOTE Confidence: 0.9538837 00:36:52.205 --> 00:36:53.025 of our speakers, NOTE Confidence: 0.9986768 00:36:53.885 --> 00:36:55.085 is the peer group. So NOTE Confidence: 0.9986768 00:36:55.085 --> 00:36:56.225 we have a peer group NOTE Confidence: 0.9994351 00:36:56.765 --> 00:36:57.984 that runs online NOTE Confidence: 0.9089179 00:36:58.285 --> 00:37:00.180 every Tuesday. We happen today NOTE Confidence: 0.9089179 00:37:00.180 --> 00:37:01.859 four to five where we, NOTE Confidence: 0.9996137 00:37:02.260 --> 00:37:02.760 invite NOTE Confidence: 0.9736256 00:37:03.300 --> 00:37:05.219 world leading experts like Cyril NOTE Confidence: 0.9736256 00:37:05.219 --> 00:37:06.280 to come and NOTE Confidence: 0.9365685 00:37:06.900 --> 00:37:08.099 open the peer group with NOTE Confidence: 0.9365685 00:37:08.099 --> 00:37:09.219 a song or music of NOTE Confidence: 0.9365685 00:37:09.219 --> 00:37:10.760 their choice, and actually Cyril NOTE Confidence: 0.9365685 00:37:10.820 --> 00:37:12.020 delighted us with his own NOTE Confidence: 0.9365685 00:37:12.020 --> 00:37:12.520 band. NOTE Confidence: 0.92236656 00:37:12.900 --> 00:37:14.420 And then we go into NOTE Confidence: 0.92236656 00:37:14.420 --> 00:37:15.195 science. And, NOTE Confidence: 0.97248816 00:37:16.075 --> 00:37:17.594 the the patients that join NOTE Confidence: 0.97248816 00:37:17.594 --> 00:37:18.875 the peer group, some of NOTE Confidence: 0.97248816 00:37:18.875 --> 00:37:19.995 them are on the inpatient NOTE Confidence: 0.97248816 00:37:19.995 --> 00:37:21.215 unit quite unwell. NOTE Confidence: 0.96713173 00:37:21.594 --> 00:37:22.815 Some are in the community. NOTE Confidence: 0.96510476 00:37:23.275 --> 00:37:24.475 And they are given the NOTE Confidence: 0.96510476 00:37:24.475 --> 00:37:26.075 science as you are getting NOTE Confidence: 0.96510476 00:37:26.075 --> 00:37:27.195 it or we might get NOTE Confidence: 0.96510476 00:37:27.195 --> 00:37:27.915 it when we go to NOTE Confidence: 0.96510476 00:37:27.915 --> 00:37:29.375 conference. It's not filtered. NOTE Confidence: 0.95930725 00:37:29.840 --> 00:37:31.280 And they will ask questions. NOTE Confidence: 0.95930725 00:37:31.280 --> 00:37:32.480 They will share their experience. NOTE Confidence: 0.95930725 00:37:32.480 --> 00:37:33.460 They might disagree. NOTE Confidence: 0.9243398 00:37:34.080 --> 00:37:35.760 But I have learned more NOTE Confidence: 0.9243398 00:37:35.760 --> 00:37:36.960 from them and from this NOTE Confidence: 0.9243398 00:37:36.960 --> 00:37:38.640 experience that probably have learned NOTE Confidence: 0.9243398 00:37:38.640 --> 00:37:40.320 from from me because to NOTE Confidence: 0.9243398 00:37:40.320 --> 00:37:41.920 see their interaction, their interest, NOTE Confidence: 0.9243398 00:37:41.920 --> 00:37:42.580 and also NOTE Confidence: 0.8447059 00:37:42.960 --> 00:37:44.719 enrich the science with their NOTE Confidence: 0.8447059 00:37:44.719 --> 00:37:45.460 lead experience NOTE Confidence: 0.96666217 00:37:46.035 --> 00:37:47.635 is actually very powerful for NOTE Confidence: 0.96666217 00:37:47.635 --> 00:37:49.155 them, but also from us. NOTE Confidence: 0.96666217 00:37:49.155 --> 00:37:50.355 And I'm actually going to NOTE Confidence: 0.96666217 00:37:50.355 --> 00:37:52.835 let Stacy tell you why NOTE Confidence: 0.96666217 00:37:52.835 --> 00:37:54.114 she thinks in a role NOTE Confidence: 0.96666217 00:37:54.114 --> 00:37:55.234 of a peer mentor that NOTE Confidence: 0.96666217 00:37:55.234 --> 00:37:56.275 the peer group has a NOTE Confidence: 0.96666217 00:37:56.275 --> 00:37:57.954 value. I see a lot NOTE Confidence: 0.96666217 00:37:57.954 --> 00:37:59.555 of change through people using NOTE Confidence: 0.96666217 00:37:59.555 --> 00:38:01.150 the cannabis clinic. I mean, NOTE Confidence: 0.96666217 00:38:01.150 --> 00:38:02.270 there was one guy that NOTE Confidence: 0.96666217 00:38:02.270 --> 00:38:03.390 started, I cannot say his NOTE Confidence: 0.96666217 00:38:03.390 --> 00:38:04.210 name, Confidentiality, NOTE Confidence: 0.9856232 00:38:04.910 --> 00:38:06.930 but he was smoking, like, NOTE Confidence: 0.9924147 00:38:07.310 --> 00:38:08.450 twenty a day. NOTE Confidence: 0.9916125 00:38:08.910 --> 00:38:10.510 And through the group, he NOTE Confidence: 0.9916125 00:38:10.510 --> 00:38:11.010 started NOTE Confidence: 0.9814704 00:38:11.710 --> 00:38:13.070 five a day to two NOTE Confidence: 0.9814704 00:38:13.070 --> 00:38:15.170 a day to actually stop. NOTE Confidence: 0.9814704 00:38:15.390 --> 00:38:16.875 And without the group, that NOTE Confidence: 0.9814704 00:38:16.875 --> 00:38:17.935 would not have happened. NOTE Confidence: 0.9525198 00:38:18.475 --> 00:38:19.355 Because a lot of the NOTE Confidence: 0.9525198 00:38:19.355 --> 00:38:20.235 time, when you go in NOTE Confidence: 0.9525198 00:38:20.235 --> 00:38:21.295 front of the clinician, NOTE Confidence: 0.96458095 00:38:21.755 --> 00:38:23.114 you're thinking this person can't NOTE Confidence: 0.96458095 00:38:23.114 --> 00:38:24.155 relate to what I'm going NOTE Confidence: 0.96458095 00:38:24.155 --> 00:38:25.275 through. They don't have a NOTE Confidence: 0.96458095 00:38:25.275 --> 00:38:25.775 clue. NOTE Confidence: 0.9045528 00:38:26.715 --> 00:38:27.275 Do you know what I NOTE Confidence: 0.9045528 00:38:27.275 --> 00:38:28.395 mean? This person's got it NOTE Confidence: 0.9045528 00:38:28.395 --> 00:38:29.435 all together. Look at me. NOTE Confidence: 0.9045528 00:38:29.435 --> 00:38:30.555 My life's falling apart. How NOTE Confidence: 0.9045528 00:38:30.555 --> 00:38:31.355 can you guys got it NOTE Confidence: 0.9045528 00:38:31.355 --> 00:38:32.280 all together understand NOTE Confidence: 0.9282668 00:38:32.760 --> 00:38:34.300 understand where I'm coming from? NOTE Confidence: 0.9612559 00:38:35.320 --> 00:38:36.520 So with people like me NOTE Confidence: 0.9612559 00:38:36.520 --> 00:38:38.040 and Adam, it gives them NOTE Confidence: 0.9612559 00:38:38.040 --> 00:38:39.239 that safe space that they NOTE Confidence: 0.9612559 00:38:39.239 --> 00:38:40.200 can say, yeah. They were NOTE Confidence: 0.9612559 00:38:40.200 --> 00:38:41.719 once like me. I can NOTE Confidence: 0.9612559 00:38:41.719 --> 00:38:43.080 be like them too. So NOTE Confidence: 0.9612559 00:38:43.080 --> 00:38:43.960 in a way, it kinda NOTE Confidence: 0.9612559 00:38:43.960 --> 00:38:46.060 motivates them and inspires them NOTE Confidence: 0.9612559 00:38:46.215 --> 00:38:47.175 to say I wanna be NOTE Confidence: 0.9612559 00:38:47.175 --> 00:38:48.455 like Adam. I wanna be NOTE Confidence: 0.9612559 00:38:48.455 --> 00:38:49.195 like Stacy. NOTE Confidence: 0.9527344 00:38:50.055 --> 00:38:51.094 And, actually, I I don't NOTE Confidence: 0.9527344 00:38:51.094 --> 00:38:52.215 think I could ever say NOTE Confidence: 0.9527344 00:38:52.215 --> 00:38:53.575 it as as eloquently as NOTE Confidence: 0.9527344 00:38:53.575 --> 00:38:55.255 Stacy. Stacy has actually started NOTE Confidence: 0.9527344 00:38:55.255 --> 00:38:56.635 university this year, NOTE Confidence: 0.94890517 00:38:57.335 --> 00:38:59.015 which for her is is NOTE Confidence: 0.94890517 00:38:59.015 --> 00:38:59.915 is a wonderful, NOTE Confidence: 0.9419937 00:39:01.185 --> 00:39:01.685 milestone. NOTE Confidence: 0.97016054 00:39:02.989 --> 00:39:04.030 So just to give you NOTE Confidence: 0.97016054 00:39:04.030 --> 00:39:04.910 a sense of what we NOTE Confidence: 0.97016054 00:39:04.910 --> 00:39:05.630 do, so we have the NOTE Confidence: 0.97016054 00:39:05.630 --> 00:39:07.489 peer group. And then weekly, NOTE Confidence: 0.97016054 00:39:07.550 --> 00:39:08.829 we also offer one to NOTE Confidence: 0.97016054 00:39:08.829 --> 00:39:09.310 one, NOTE Confidence: 0.9697319 00:39:09.710 --> 00:39:10.210 session. NOTE Confidence: 0.99879223 00:39:10.510 --> 00:39:11.710 And I always say, NOTE Confidence: 0.9911357 00:39:12.190 --> 00:39:13.950 we haven't actually invented anything NOTE Confidence: 0.9911357 00:39:13.950 --> 00:39:15.225 new. For those of you NOTE Confidence: 0.9911357 00:39:15.225 --> 00:39:16.965 who are familiar with addiction, NOTE Confidence: 0.984716 00:39:17.344 --> 00:39:18.785 we just use tools that NOTE Confidence: 0.984716 00:39:18.785 --> 00:39:19.844 are very well established NOTE Confidence: 0.943976 00:39:20.385 --> 00:39:21.585 and to to work in NOTE Confidence: 0.943976 00:39:21.585 --> 00:39:23.425 addiction across substances. They're not NOTE Confidence: 0.943976 00:39:23.425 --> 00:39:24.485 specific to cannabis. NOTE Confidence: 0.97094524 00:39:24.945 --> 00:39:26.165 But what we do, NOTE Confidence: 0.9853889 00:39:26.625 --> 00:39:28.050 excuse me, we make them NOTE Confidence: 0.9853889 00:39:28.290 --> 00:39:29.890 flexible and adjusted to the NOTE Confidence: 0.9853889 00:39:29.890 --> 00:39:31.410 need of somebody who would NOTE Confidence: 0.9853889 00:39:31.410 --> 00:39:32.610 come to the clinic while NOTE Confidence: 0.9853889 00:39:32.610 --> 00:39:34.469 they are actually experiencing psychosis. NOTE Confidence: 0.92406934 00:39:34.850 --> 00:39:35.810 These are no people in NOTE Confidence: 0.92406934 00:39:35.810 --> 00:39:36.310 remission. NOTE Confidence: 0.9663788 00:39:36.850 --> 00:39:38.930 And we have flexibility not NOTE Confidence: 0.9663788 00:39:38.930 --> 00:39:39.730 only in, NOTE Confidence: 0.9397998 00:39:40.305 --> 00:39:41.665 which of this model we NOTE Confidence: 0.9397998 00:39:41.665 --> 00:39:43.204 use, but actually the combination NOTE Confidence: 0.99968034 00:39:43.585 --> 00:39:44.484 and the timing. NOTE Confidence: 0.9294022 00:39:44.785 --> 00:39:46.385 So sometimes people ask me, NOTE Confidence: 0.9294022 00:39:46.385 --> 00:39:47.744 oh, what is your protocol? NOTE Confidence: 0.9294022 00:39:47.744 --> 00:39:49.025 Well, our protocol is that NOTE Confidence: 0.9294022 00:39:49.025 --> 00:39:50.005 there is no protocol, NOTE Confidence: 0.97753876 00:39:50.385 --> 00:39:51.344 that we have all these NOTE Confidence: 0.97753876 00:39:51.344 --> 00:39:52.484 tools. They are available NOTE Confidence: 0.9800301 00:39:52.944 --> 00:39:53.765 to the therapist NOTE Confidence: 0.9785078 00:39:54.510 --> 00:39:56.270 and, to the patient, and NOTE Confidence: 0.9785078 00:39:56.270 --> 00:39:57.710 the therapist and the patient NOTE Confidence: 0.9785078 00:39:57.710 --> 00:39:58.610 decide together NOTE Confidence: 0.9847364 00:39:59.070 --> 00:40:00.750 where to start from, what NOTE Confidence: 0.9847364 00:40:00.750 --> 00:40:01.730 to start with. NOTE Confidence: 0.8554083 00:40:02.110 --> 00:40:03.010 And sometimes, NOTE Confidence: 0.9174586 00:40:03.390 --> 00:40:04.670 they might use one main NOTE Confidence: 0.9174586 00:40:04.670 --> 00:40:05.969 tool for the role duration NOTE Confidence: 0.9174586 00:40:06.030 --> 00:40:07.390 of the twenty session that NOTE Confidence: 0.9174586 00:40:07.390 --> 00:40:09.538 on average that they, NOTE Confidence: 0.9787071 00:40:10.424 --> 00:40:10.924 they, NOTE Confidence: 0.97869194 00:40:11.811 --> 00:40:13.545 receive. And one thing that NOTE Confidence: 0.97869194 00:40:13.545 --> 00:40:14.825 we do, we link also NOTE Confidence: 0.97869194 00:40:14.825 --> 00:40:16.184 with the local resources. So NOTE Confidence: 0.97869194 00:40:16.184 --> 00:40:16.984 this is not a work NOTE Confidence: 0.97869194 00:40:16.984 --> 00:40:18.684 that is done in isolation. NOTE Confidence: 0.9786046 00:40:19.385 --> 00:40:21.224 And, also, we collect outcome NOTE Confidence: 0.9786046 00:40:21.224 --> 00:40:21.724 measure NOTE Confidence: 0.9782958 00:40:22.130 --> 00:40:23.250 at the beginning and at NOTE Confidence: 0.9782958 00:40:23.250 --> 00:40:24.290 the end. And it's because NOTE Confidence: 0.9782958 00:40:24.290 --> 00:40:25.489 of this outcome measure that NOTE Confidence: 0.9782958 00:40:25.489 --> 00:40:26.370 I'll be able to show NOTE Confidence: 0.9782958 00:40:26.370 --> 00:40:26.870 you NOTE Confidence: 0.99949455 00:40:27.330 --> 00:40:28.870 what we recently NOTE Confidence: 0.9883088 00:40:29.250 --> 00:40:30.850 published in a sort of NOTE Confidence: 0.9883088 00:40:30.850 --> 00:40:32.230 proof of concept paper. NOTE Confidence: 0.999505 00:40:32.850 --> 00:40:34.210 So we were able to NOTE Confidence: 0.999505 00:40:34.210 --> 00:40:35.570 publish the data from the NOTE Confidence: 0.999505 00:40:35.570 --> 00:40:36.790 first forty six NOTE Confidence: 0.9972247 00:40:37.105 --> 00:40:39.285 patients that completed the intervention. NOTE Confidence: 0.99761224 00:40:40.545 --> 00:40:41.045 And NOTE Confidence: 0.9761568 00:40:41.425 --> 00:40:42.245 this first, NOTE Confidence: 0.9987668 00:40:42.785 --> 00:40:44.965 graph shows you where NOTE Confidence: 0.9925143 00:40:45.505 --> 00:40:46.725 people in red NOTE Confidence: 0.9313012 00:40:47.025 --> 00:40:48.705 were at the start of, NOTE Confidence: 0.9313012 00:40:49.025 --> 00:40:49.844 the intervention, NOTE Confidence: 0.98324585 00:40:50.385 --> 00:40:51.445 and the horizontal NOTE Confidence: 0.973806 00:40:51.825 --> 00:40:53.769 darker line represent the threshold NOTE Confidence: 0.973806 00:40:53.769 --> 00:40:55.150 for cannabis dependence. NOTE Confidence: 0.98425883 00:40:55.690 --> 00:40:56.489 You can see that they're NOTE Confidence: 0.98425883 00:40:56.489 --> 00:40:57.930 all well above this this NOTE Confidence: 0.98425883 00:40:57.930 --> 00:40:58.430 threshold. NOTE Confidence: 0.99811614 00:40:58.890 --> 00:40:59.930 And you can see that NOTE Confidence: 0.99811614 00:40:59.930 --> 00:41:00.650 at the end of the NOTE Confidence: 0.99811614 00:41:00.650 --> 00:41:01.150 intervention, NOTE Confidence: 0.994887 00:41:01.690 --> 00:41:03.049 they are pretty close to NOTE Confidence: 0.994887 00:41:03.049 --> 00:41:04.010 zero. The reason they are NOTE Confidence: 0.994887 00:41:04.010 --> 00:41:05.130 not zero is because some NOTE Confidence: 0.994887 00:41:05.130 --> 00:41:06.795 of them decided to just NOTE Confidence: 0.994887 00:41:06.795 --> 00:41:08.575 reduce their frequency of use NOTE Confidence: 0.994887 00:41:08.635 --> 00:41:10.075 from daily to once a NOTE Confidence: 0.994887 00:41:10.075 --> 00:41:11.275 week or even less than NOTE Confidence: 0.994887 00:41:11.275 --> 00:41:12.094 once a week. NOTE Confidence: 0.9993593 00:41:12.555 --> 00:41:13.055 But NOTE Confidence: 0.99912494 00:41:13.515 --> 00:41:14.635 do we care about this? NOTE Confidence: 0.99912494 00:41:14.635 --> 00:41:15.135 Well, NOTE Confidence: 0.99496835 00:41:15.435 --> 00:41:16.875 when we look at, for NOTE Confidence: 0.99496835 00:41:16.875 --> 00:41:17.375 instance, NOTE Confidence: 0.9985605 00:41:17.915 --> 00:41:19.755 the red and the green NOTE Confidence: 0.9985605 00:41:19.755 --> 00:41:21.775 boxes, they represent changes NOTE Confidence: 0.9840502 00:41:22.230 --> 00:41:23.670 between before and after the NOTE Confidence: 0.9840502 00:41:23.670 --> 00:41:24.170 intervention NOTE Confidence: 0.9701247 00:41:24.790 --> 00:41:26.730 in delusion or persecution NOTE Confidence: 0.9623396 00:41:27.190 --> 00:41:28.869 in terms of frequency intensity NOTE Confidence: 0.9623396 00:41:28.869 --> 00:41:30.310 and distress. And you can NOTE Confidence: 0.9623396 00:41:30.310 --> 00:41:31.190 see that there is a NOTE Confidence: 0.9623396 00:41:31.190 --> 00:41:32.969 sort of quite striking reduction, NOTE Confidence: 0.99203813 00:41:33.270 --> 00:41:35.050 which is actually clinically relevant. NOTE Confidence: 0.9822679 00:41:35.594 --> 00:41:36.555 Then you look at the NOTE Confidence: 0.9822679 00:41:36.555 --> 00:41:37.755 blue and the red, which NOTE Confidence: 0.9822679 00:41:37.755 --> 00:41:38.575 is paranoia, NOTE Confidence: 0.99149626 00:41:39.195 --> 00:41:40.715 and that's actually one of NOTE Confidence: 0.99149626 00:41:40.715 --> 00:41:42.234 the greatest differences you you NOTE Confidence: 0.99149626 00:41:42.234 --> 00:41:44.335 will see, going along between, NOTE Confidence: 0.99941814 00:41:44.715 --> 00:41:46.075 the beginning and the end NOTE Confidence: 0.99941814 00:41:46.075 --> 00:41:46.975 of the intervention. NOTE Confidence: 0.98164576 00:41:48.200 --> 00:41:49.240 And then we also look NOTE Confidence: 0.98164576 00:41:49.240 --> 00:41:50.840 at anxiety and and and NOTE Confidence: 0.98164576 00:41:50.840 --> 00:41:52.040 depression. And the reason is NOTE Confidence: 0.98164576 00:41:52.040 --> 00:41:53.480 because often my patients say NOTE Confidence: 0.98164576 00:41:53.480 --> 00:41:54.920 to me, well, I appreciate NOTE Confidence: 0.98164576 00:41:54.920 --> 00:41:55.640 it might be bad for NOTE Confidence: 0.98164576 00:41:55.640 --> 00:41:57.080 my psychosis, but it helps NOTE Confidence: 0.98164576 00:41:57.080 --> 00:41:57.960 me very much with my NOTE Confidence: 0.98164576 00:41:57.960 --> 00:41:59.240 anxiety and with my mood. NOTE Confidence: 0.98164576 00:41:59.240 --> 00:42:00.280 And I always show them NOTE Confidence: 0.98164576 00:42:00.280 --> 00:42:01.400 this graph because these are NOTE Confidence: 0.98164576 00:42:01.400 --> 00:42:02.795 no data I created. These NOTE Confidence: 0.98164576 00:42:02.795 --> 00:42:03.835 are things they told me, NOTE Confidence: 0.98164576 00:42:03.835 --> 00:42:05.035 how things have changed for NOTE Confidence: 0.98164576 00:42:05.035 --> 00:42:06.955 them. And, actually, this shows NOTE Confidence: 0.98164576 00:42:06.955 --> 00:42:08.715 in purple and orange that NOTE Confidence: 0.98164576 00:42:08.715 --> 00:42:09.615 the the anxiety, NOTE Confidence: 0.9959823 00:42:10.395 --> 00:42:10.895 does NOTE Confidence: 0.88710016 00:42:11.435 --> 00:42:12.655 change does reduce NOTE Confidence: 0.98385 00:42:12.955 --> 00:42:14.495 when they stop or significantly, NOTE Confidence: 0.8918482 00:42:15.355 --> 00:42:17.369 reduce their cannabis use. And NOTE Confidence: 0.8918482 00:42:17.369 --> 00:42:18.109 their mood, NOTE Confidence: 0.90771836 00:42:18.410 --> 00:42:21.210 yellow and, and green also NOTE Confidence: 0.90771836 00:42:21.210 --> 00:42:21.710 improves NOTE Confidence: 0.99283177 00:42:22.250 --> 00:42:23.869 when they stop or significantly NOTE Confidence: 0.99283177 00:42:24.010 --> 00:42:25.769 reduce their cannabis use. But NOTE Confidence: 0.99283177 00:42:25.769 --> 00:42:26.670 very strikingly, NOTE Confidence: 0.9933905 00:42:27.130 --> 00:42:28.730 we don't always have a NOTE Confidence: 0.9933905 00:42:28.730 --> 00:42:30.410 perfect mood state. We all NOTE Confidence: 0.9933905 00:42:30.410 --> 00:42:31.450 can be a bit anxious NOTE Confidence: 0.9933905 00:42:31.450 --> 00:42:32.109 or paranoid. NOTE Confidence: 0.9791326 00:42:32.535 --> 00:42:34.055 But what often is very NOTE Confidence: 0.9791326 00:42:34.055 --> 00:42:35.815 difficult for this population is NOTE Confidence: 0.9791326 00:42:35.815 --> 00:42:37.015 to regain a good level NOTE Confidence: 0.9791326 00:42:37.015 --> 00:42:37.594 of functioning NOTE Confidence: 0.9927221 00:42:37.895 --> 00:42:38.934 after the onset of the NOTE Confidence: 0.9927221 00:42:38.934 --> 00:42:39.434 psychosis. NOTE Confidence: 0.99358714 00:42:40.055 --> 00:42:41.094 And you can see here NOTE Confidence: 0.99358714 00:42:41.094 --> 00:42:42.295 where there is a sharp NOTE Confidence: 0.99358714 00:42:42.295 --> 00:42:42.795 improvement NOTE Confidence: 0.9818005 00:42:43.255 --> 00:42:44.555 in the level of functioning, NOTE Confidence: 0.9818005 00:42:44.775 --> 00:42:46.234 which is not just about NOTE Confidence: 0.9818005 00:42:46.375 --> 00:42:47.594 a clinical measure. NOTE Confidence: 0.97176075 00:42:48.069 --> 00:42:49.989 Does actually translate in ninety NOTE Confidence: 0.97176075 00:42:49.989 --> 00:42:51.289 one percent of them NOTE Confidence: 0.8858803 00:42:51.589 --> 00:42:53.690 having become again socially active, NOTE Confidence: 0.98739445 00:42:54.069 --> 00:42:55.750 engaging in work paid work, NOTE Confidence: 0.98739445 00:42:55.750 --> 00:42:57.270 I should say, and going NOTE Confidence: 0.98739445 00:42:57.270 --> 00:42:58.950 back to education. So having NOTE Confidence: 0.98739445 00:42:58.950 --> 00:43:00.010 a sort of meaningful NOTE Confidence: 0.96078986 00:43:00.585 --> 00:43:02.505 quality of life. I see, NOTE Confidence: 0.96078986 00:43:02.505 --> 00:43:03.705 Cyril, there are lots of, NOTE Confidence: 0.96078986 00:43:03.945 --> 00:43:04.984 things in the chat. Do NOTE Confidence: 0.96078986 00:43:04.984 --> 00:43:06.045 you do you want me NOTE Confidence: 0.9986814 00:43:06.665 --> 00:43:07.244 to stop? NOTE Confidence: 0.9985137 00:43:08.825 --> 00:43:09.305 Sure. NOTE Confidence: 0.98717827 00:43:09.864 --> 00:43:10.984 Can you read the questions, NOTE Confidence: 0.98717827 00:43:10.984 --> 00:43:11.785 or would you like me NOTE Confidence: 0.98717827 00:43:11.785 --> 00:43:12.844 to read them out? NOTE Confidence: 0.97632617 00:43:14.090 --> 00:43:15.230 I I can NOTE Confidence: 0.8388217 00:43:15.850 --> 00:43:17.950 I can, read them? Okay. NOTE Confidence: 0.8272538 00:43:19.530 --> 00:43:20.910 So what do I think NOTE Confidence: 0.8272538 00:43:21.050 --> 00:43:22.730 is the synergistic effect of NOTE Confidence: 0.8272538 00:43:22.730 --> 00:43:24.250 childhood trauma and cannabis use NOTE Confidence: 0.8272538 00:43:24.250 --> 00:43:25.450 increase in risk of psychosis? NOTE Confidence: 0.8272538 00:43:25.450 --> 00:43:26.170 We're going to play a NOTE Confidence: 0.8272538 00:43:26.170 --> 00:43:27.070 pilot study, NOTE Confidence: 0.89058757 00:43:27.530 --> 00:43:29.435 which showed lower c b NOTE Confidence: 0.89058757 00:43:29.435 --> 00:43:31.114 o one availability in adults NOTE Confidence: 0.89058757 00:43:31.114 --> 00:43:32.075 with a history of childhood NOTE Confidence: 0.89058757 00:43:32.075 --> 00:43:32.575 trauma. NOTE Confidence: 0.88410467 00:43:32.955 --> 00:43:34.415 Could this reduce ecbitone, NOTE Confidence: 0.93157834 00:43:35.355 --> 00:43:36.635 increase the risk of both NOTE Confidence: 0.93157834 00:43:36.635 --> 00:43:37.855 cannabis use and psychosis? NOTE Confidence: 0.9283284 00:43:38.555 --> 00:43:39.675 I don't see why not. NOTE Confidence: 0.9283284 00:43:39.675 --> 00:43:41.275 We haven't actually Julia is NOTE Confidence: 0.9283284 00:43:41.275 --> 00:43:42.415 looking at the biology, NOTE Confidence: 0.96437293 00:43:43.430 --> 00:43:44.550 right now as part of NOTE Confidence: 0.96437293 00:43:44.550 --> 00:43:45.810 the of the, NOTE Confidence: 0.94907683 00:43:46.230 --> 00:43:47.910 at, PhD. I mean, the NOTE Confidence: 0.94907683 00:43:47.910 --> 00:43:48.410 endocannabinoid NOTE Confidence: 0.99964714 00:43:48.790 --> 00:43:49.290 system NOTE Confidence: 0.9896593 00:43:49.910 --> 00:43:51.110 really sits also NOTE Confidence: 0.9987629 00:43:51.750 --> 00:43:53.050 I mean, sits in between NOTE Confidence: 0.97370815 00:43:53.510 --> 00:43:55.275 so many of the effects NOTE Confidence: 0.97370815 00:43:55.355 --> 00:43:57.194 of, of cannabis, but also NOTE Confidence: 0.97370815 00:43:57.194 --> 00:43:59.055 of potentially stress reactivity. NOTE Confidence: 0.99806815 00:43:59.835 --> 00:44:01.594 So it is certainly possible NOTE Confidence: 0.99806815 00:44:01.594 --> 00:44:02.094 that NOTE Confidence: 0.99103546 00:44:02.395 --> 00:44:04.234 exposure to to cannabis in NOTE Confidence: 0.99103546 00:44:04.234 --> 00:44:05.454 people who have been NOTE Confidence: 0.86783934 00:44:05.914 --> 00:44:07.214 subject to to trauma NOTE Confidence: 0.9456768 00:44:07.770 --> 00:44:09.230 change their stress response NOTE Confidence: 0.9513802 00:44:09.690 --> 00:44:11.370 and increases, for instance, their NOTE Confidence: 0.9513802 00:44:11.370 --> 00:44:12.910 social anxiety and intense, NOTE Confidence: 0.90070355 00:44:13.690 --> 00:44:15.170 the the risk of of NOTE Confidence: 0.90070355 00:44:15.170 --> 00:44:16.590 a paranoid interpretation NOTE Confidence: 0.9256399 00:44:16.969 --> 00:44:18.750 of reality. And their biology NOTE Confidence: 0.98896104 00:44:19.130 --> 00:44:20.650 could be mediated directly by NOTE Confidence: 0.98896104 00:44:20.650 --> 00:44:22.350 the dopamine system and downstream NOTE Confidence: 0.98896104 00:44:22.570 --> 00:44:25.555 by by dopamine. Also, serotonin NOTE Confidence: 0.9948316 00:44:25.934 --> 00:44:26.895 might have a role. We NOTE Confidence: 0.9948316 00:44:26.895 --> 00:44:27.555 know that NOTE Confidence: 0.9875418 00:44:28.015 --> 00:44:28.494 the, NOTE Confidence: 0.974202 00:44:29.455 --> 00:44:31.395 the endocannabinoid system also, NOTE Confidence: 0.9298702 00:44:32.094 --> 00:44:33.234 impacts on serotoninergic, NOTE Confidence: 0.86721 00:44:33.775 --> 00:44:34.755 not just glutamate NOTE Confidence: 0.99377376 00:44:35.055 --> 00:44:36.255 and GABA. So I think NOTE Confidence: 0.99377376 00:44:36.255 --> 00:44:37.454 it's going to be probably NOTE Confidence: 0.99377376 00:44:37.454 --> 00:44:39.279 quite complex and involve a NOTE Confidence: 0.99377376 00:44:39.279 --> 00:44:40.160 variety of, NOTE Confidence: 0.97897464 00:44:40.880 --> 00:44:42.180 of biological pathway, NOTE Confidence: 0.9324164 00:44:43.119 --> 00:44:45.200 which I would suspect have NOTE Confidence: 0.9324164 00:44:45.200 --> 00:44:47.359 also the HPA axis, you NOTE Confidence: 0.9324164 00:44:47.359 --> 00:44:48.799 know, the hypothalamus pitcher, NOTE Confidence: 0.9943358 00:44:49.920 --> 00:44:51.859 adrenal gland axis that regulates NOTE Confidence: 0.9761927 00:44:52.559 --> 00:44:54.259 stress, stress response. NOTE Confidence: 0.8347532 00:44:55.975 --> 00:44:57.415 There's a question about there NOTE Confidence: 0.8347532 00:44:57.415 --> 00:44:58.155 any data? NOTE Confidence: 0.94819266 00:44:58.614 --> 00:44:59.114 Sorry. NOTE Confidence: 0.9246001 00:44:59.655 --> 00:45:00.635 Sorry, Cyril. NOTE Confidence: 0.9275499 00:45:01.094 --> 00:45:01.994 No. You go. NOTE Confidence: 0.98464864 00:45:02.375 --> 00:45:03.734 There's a question about, NOTE Confidence: 0.97352153 00:45:04.455 --> 00:45:06.875 the chemotype of, of cannabis, NOTE Confidence: 0.8510444 00:45:08.040 --> 00:45:09.960 whether one to one CBD NOTE Confidence: 0.8510444 00:45:09.960 --> 00:45:11.260 to THC ratio. NOTE Confidence: 0.999074 00:45:12.360 --> 00:45:14.140 What's the risk of psychosis NOTE Confidence: 0.999074 00:45:14.360 --> 00:45:15.020 with that? NOTE Confidence: 0.86129373 00:45:16.680 --> 00:45:17.980 Well, this is a Shiaquest. NOTE Confidence: 0.86129373 00:45:18.040 --> 00:45:19.080 You have the world experts NOTE Confidence: 0.86129373 00:45:19.080 --> 00:45:20.520 on this with professor D'Souza. NOTE Confidence: 0.86129373 00:45:20.520 --> 00:45:21.260 No. Me. NOTE Confidence: 0.9736447 00:45:21.795 --> 00:45:23.474 I haven't done any, actually, NOTE Confidence: 0.9736447 00:45:23.474 --> 00:45:25.474 experimental work where we have NOTE Confidence: 0.9736447 00:45:25.474 --> 00:45:26.694 played with the ratio. NOTE Confidence: 0.9628318 00:45:27.234 --> 00:45:28.375 What I can tell you NOTE Confidence: 0.9628318 00:45:28.594 --> 00:45:29.175 is that NOTE Confidence: 0.90873194 00:45:29.875 --> 00:45:31.895 our data when, epidemiological NOTE Confidence: 0.92834914 00:45:32.434 --> 00:45:34.214 data, when people in Landau NOTE Confidence: 0.92834914 00:45:34.450 --> 00:45:36.130 were using a a type NOTE Confidence: 0.92834914 00:45:36.130 --> 00:45:38.310 of cannabis, which was, Ashish NOTE Confidence: 0.8719824 00:45:38.690 --> 00:45:39.730 that had a one to NOTE Confidence: 0.8719824 00:45:39.730 --> 00:45:41.090 one ratio of THC and NOTE Confidence: 0.8719824 00:45:41.090 --> 00:45:41.590 CBD, NOTE Confidence: 0.97458667 00:45:41.890 --> 00:45:43.170 when we compared them with NOTE Confidence: 0.97458667 00:45:43.170 --> 00:45:44.610 people who were using a NOTE Confidence: 0.97458667 00:45:44.610 --> 00:45:46.230 type of cannabis with high NOTE Confidence: 0.97458667 00:45:46.370 --> 00:45:47.750 THC and no CBD NOTE Confidence: 0.93485737 00:45:48.265 --> 00:45:49.465 and compared them with people NOTE Confidence: 0.93485737 00:45:49.465 --> 00:45:50.685 who did not use cannabis, NOTE Confidence: 0.98127717 00:45:51.065 --> 00:45:52.185 the one with the ratio NOTE Confidence: 0.98127717 00:45:52.185 --> 00:45:53.545 one to one of low NOTE Confidence: 0.98127717 00:45:53.545 --> 00:45:55.484 THC and equal CBD NOTE Confidence: 0.97881985 00:45:55.864 --> 00:45:57.065 had no increased risk of NOTE Confidence: 0.97881985 00:45:57.065 --> 00:45:58.425 psychosis compared to the one NOTE Confidence: 0.97881985 00:45:58.425 --> 00:45:59.945 that never used. But this NOTE Confidence: 0.97881985 00:45:59.945 --> 00:46:00.825 is what we found in NOTE Confidence: 0.97881985 00:46:00.825 --> 00:46:02.045 those days in cannabis. NOTE Confidence: 0.9631383 00:46:02.460 --> 00:46:04.160 I know data have been NOTE Confidence: 0.9631383 00:46:04.300 --> 00:46:04.980 sort of, NOTE Confidence: 0.960527 00:46:05.420 --> 00:46:07.280 have have been less consistent NOTE Confidence: 0.960527 00:46:07.420 --> 00:46:08.940 in other studies. But I NOTE Confidence: 0.960527 00:46:08.940 --> 00:46:09.980 don't know, Cyril, if you NOTE Confidence: 0.960527 00:46:09.980 --> 00:46:10.940 want to comment on your NOTE Confidence: 0.960527 00:46:10.940 --> 00:46:12.080 experimental work. NOTE Confidence: 0.9825859 00:46:13.260 --> 00:46:15.099 Yeah. Actually, I'm hoping Mohini NOTE Confidence: 0.9825859 00:46:15.099 --> 00:46:16.140 is on the call where NOTE Confidence: 0.9825859 00:46:16.140 --> 00:46:17.425 she can speak about NOTE Confidence: 0.9332496 00:46:17.725 --> 00:46:19.165 the the impact of CBD NOTE Confidence: 0.9332496 00:46:19.165 --> 00:46:20.545 on THC effects. NOTE Confidence: 0.9964047 00:46:20.844 --> 00:46:22.285 Mohini, do you wanna respond NOTE Confidence: 0.9964047 00:46:22.285 --> 00:46:22.945 to this? NOTE Confidence: 0.99985445 00:46:23.565 --> 00:46:24.065 Sure. NOTE Confidence: 0.9888103 00:46:24.605 --> 00:46:26.045 Hi there. This is and NOTE Confidence: 0.9888103 00:46:26.045 --> 00:46:27.325 such a pleasure to hear NOTE Confidence: 0.9888103 00:46:27.325 --> 00:46:27.825 this, NOTE Confidence: 0.9888499 00:46:28.285 --> 00:46:29.984 talk always. Hi, Mohini. NOTE Confidence: 0.998698 00:46:30.285 --> 00:46:31.265 Hi. How are you? NOTE Confidence: 0.96395403 00:46:32.820 --> 00:46:34.660 So with in our lab, NOTE Confidence: 0.96395403 00:46:34.660 --> 00:46:36.600 we do studies with acute NOTE Confidence: 0.96395403 00:46:36.660 --> 00:46:38.739 THC and acute CBD, and NOTE Confidence: 0.96395403 00:46:38.739 --> 00:46:40.340 we have tested a few NOTE Confidence: 0.96395403 00:46:40.340 --> 00:46:40.840 combinations NOTE Confidence: 0.9491946 00:46:41.220 --> 00:46:41.720 of, NOTE Confidence: 0.99674433 00:46:42.420 --> 00:46:43.239 of the drugs. NOTE Confidence: 0.9991395 00:46:43.700 --> 00:46:45.320 And what we found NOTE Confidence: 0.8748447 00:46:45.755 --> 00:46:46.415 is actually, NOTE Confidence: 0.96747196 00:46:47.114 --> 00:46:49.435 so when we administer THC NOTE Confidence: 0.96747196 00:46:49.435 --> 00:46:50.795 and CBD in as close NOTE Confidence: 0.96747196 00:46:50.795 --> 00:46:51.435 to a one is to NOTE Confidence: 0.96747196 00:46:51.435 --> 00:46:52.815 one ratio as possible, NOTE Confidence: 0.9986156 00:46:53.355 --> 00:46:53.855 CBD NOTE Confidence: 0.99968004 00:46:54.155 --> 00:46:54.655 was NOTE Confidence: 0.9754539 00:46:55.675 --> 00:46:57.275 able to attenuate some of NOTE Confidence: 0.9754539 00:46:57.275 --> 00:46:59.195 those psychosis like effects of NOTE Confidence: 0.9754539 00:46:59.195 --> 00:46:59.640 THC. NOTE Confidence: 0.99509597 00:47:00.200 --> 00:47:01.980 We did not see that NOTE Confidence: 0.99509597 00:47:02.200 --> 00:47:03.799 with higher or lower doses NOTE Confidence: 0.99509597 00:47:03.799 --> 00:47:04.940 of, CBD. NOTE Confidence: 0.9847351 00:47:05.480 --> 00:47:07.239 Now these are small studies NOTE Confidence: 0.9847351 00:47:07.239 --> 00:47:08.599 because challenge studies, as you NOTE Confidence: 0.9847351 00:47:08.599 --> 00:47:10.359 know, tend to be much NOTE Confidence: 0.9847351 00:47:10.359 --> 00:47:11.579 smaller in size, NOTE Confidence: 0.96573204 00:47:11.885 --> 00:47:13.405 but it's consistent with some NOTE Confidence: 0.96573204 00:47:13.405 --> 00:47:14.844 of the other literature suggesting NOTE Confidence: 0.96573204 00:47:14.844 --> 00:47:15.645 that this one is to NOTE Confidence: 0.96573204 00:47:15.645 --> 00:47:17.405 one ratio in some way NOTE Confidence: 0.96573204 00:47:17.405 --> 00:47:19.344 is is, kind of more, NOTE Confidence: 0.98540884 00:47:21.964 --> 00:47:23.964 ameliorates those negative effects of NOTE Confidence: 0.98540884 00:47:23.964 --> 00:47:24.464 THC. NOTE Confidence: 0.9932928 00:47:25.130 --> 00:47:25.530 And, NOTE Confidence: 0.98747534 00:47:25.930 --> 00:47:27.050 I think, you know, now NOTE Confidence: 0.98747534 00:47:27.050 --> 00:47:28.489 for many other studies as NOTE Confidence: 0.98747534 00:47:28.489 --> 00:47:30.030 well that people are examining NOTE Confidence: 0.98747534 00:47:30.170 --> 00:47:30.810 a one is to one NOTE Confidence: 0.98747534 00:47:30.810 --> 00:47:32.430 ratio of THC to CBD. NOTE Confidence: 0.9442568 00:47:33.450 --> 00:47:34.810 K. Thank you. Thank you, NOTE Confidence: 0.9442568 00:47:34.810 --> 00:47:35.950 Mohini. And, actually, NOTE Confidence: 0.9966261 00:47:36.410 --> 00:47:37.310 in in London, NOTE Confidence: 0.8941576 00:47:38.010 --> 00:47:38.969 one of my colleague at NOTE Confidence: 0.8941576 00:47:38.969 --> 00:47:39.469 Chesney, NOTE Confidence: 0.8746287 00:47:40.330 --> 00:47:42.625 with professor Philip Maguire team, NOTE Confidence: 0.8746287 00:47:42.625 --> 00:47:43.664 I've also looked into these. NOTE Confidence: 0.8746287 00:47:43.664 --> 00:47:45.105 And, actually, they found what NOTE Confidence: 0.8746287 00:47:45.105 --> 00:47:46.464 you say, and they found NOTE Confidence: 0.8746287 00:47:46.464 --> 00:47:46.964 that NOTE Confidence: 0.94230473 00:47:47.265 --> 00:47:48.724 when the ratio was NOTE Confidence: 0.9763898 00:47:49.424 --> 00:47:51.184 with in favor of CBD, NOTE Confidence: 0.9763898 00:47:51.184 --> 00:47:52.625 so high doses of CBD NOTE Confidence: 0.9763898 00:47:52.625 --> 00:47:53.680 and little THC. NOTE Confidence: 0.97596323 00:47:53.980 --> 00:47:55.260 Actually, this didn't make things NOTE Confidence: 0.97596323 00:47:55.260 --> 00:47:56.540 better. Sometimes it made them NOTE Confidence: 0.97596323 00:47:56.540 --> 00:47:57.900 worse. So I think the NOTE Confidence: 0.97596323 00:47:57.900 --> 00:47:59.900 story is is is quite NOTE Confidence: 0.97596323 00:47:59.900 --> 00:48:01.739 complicated, but I think I'm NOTE Confidence: 0.97596323 00:48:01.739 --> 00:48:02.860 with you that the one NOTE Confidence: 0.97596323 00:48:02.860 --> 00:48:04.140 to one ratio seems to NOTE Confidence: 0.97596323 00:48:04.140 --> 00:48:05.340 be perhaps the one that NOTE Confidence: 0.97596323 00:48:05.340 --> 00:48:05.840 consistently NOTE Confidence: 0.92271703 00:48:06.645 --> 00:48:08.165 gives the same result across NOTE Confidence: 0.92271703 00:48:08.165 --> 00:48:10.265 study even if small study NOTE Confidence: 0.92271703 00:48:10.485 --> 00:48:11.525 and at least in our NOTE Confidence: 0.92271703 00:48:11.525 --> 00:48:12.025 epidemiological NOTE Confidence: 0.9858259 00:48:12.485 --> 00:48:14.325 data as well. I just NOTE Confidence: 0.9858259 00:48:14.325 --> 00:48:15.705 wanted to show you this NOTE Confidence: 0.9843512 00:48:16.085 --> 00:48:17.705 this slide for the skeptics. NOTE Confidence: 0.9843512 00:48:17.844 --> 00:48:19.045 People sometimes say to me, NOTE Confidence: 0.9843512 00:48:19.045 --> 00:48:20.005 well, you know, you see NOTE Confidence: 0.9843512 00:48:20.005 --> 00:48:20.665 an improvement NOTE Confidence: 0.97595495 00:48:21.205 --> 00:48:23.099 in the cannabis use, in NOTE Confidence: 0.97595495 00:48:23.099 --> 00:48:24.799 in this pop clinical population, NOTE Confidence: 0.97595495 00:48:25.019 --> 00:48:26.059 and then you also see NOTE Confidence: 0.97595495 00:48:26.059 --> 00:48:27.099 all these changes in the NOTE Confidence: 0.97595495 00:48:27.099 --> 00:48:28.380 symptoms. But they could be NOTE Confidence: 0.97595495 00:48:28.380 --> 00:48:28.960 a coincidence. NOTE Confidence: 0.9710258 00:48:29.339 --> 00:48:30.940 Well, we did actually look NOTE Confidence: 0.9710258 00:48:30.940 --> 00:48:31.759 at that statistically, NOTE Confidence: 0.9799248 00:48:32.219 --> 00:48:33.259 and this is something I NOTE Confidence: 0.9799248 00:48:33.259 --> 00:48:35.180 do show to my patients NOTE Confidence: 0.9799248 00:48:35.180 --> 00:48:35.680 because NOTE Confidence: 0.92879564 00:48:36.085 --> 00:48:37.205 we were able to show, NOTE Confidence: 0.92879564 00:48:37.205 --> 00:48:38.105 Ashley, that NOTE Confidence: 0.99556744 00:48:38.725 --> 00:48:40.585 the changes in cannabis use NOTE Confidence: 0.95916843 00:48:40.885 --> 00:48:42.565 explain twenty seven percent of NOTE Confidence: 0.95916843 00:48:42.565 --> 00:48:43.945 the variance in the delusion, NOTE Confidence: 0.99684626 00:48:44.485 --> 00:48:45.925 twenty six percent in the NOTE Confidence: 0.99684626 00:48:45.925 --> 00:48:47.765 anxiety, thirty two in the NOTE Confidence: 0.99684626 00:48:47.765 --> 00:48:49.445 depression, forty seven in the NOTE Confidence: 0.99684626 00:48:49.445 --> 00:48:51.065 paranoia, and sixty one NOTE Confidence: 0.97807956 00:48:51.410 --> 00:48:52.770 in the gulf. And what NOTE Confidence: 0.97807956 00:48:52.770 --> 00:48:53.890 I say to them, this NOTE Confidence: 0.97807956 00:48:53.890 --> 00:48:54.630 means that NOTE Confidence: 0.98422265 00:48:54.930 --> 00:48:56.130 this is something you have NOTE Confidence: 0.98422265 00:48:56.130 --> 00:48:58.050 control over, that you can NOTE Confidence: 0.98422265 00:48:58.050 --> 00:48:59.830 modify by making a choice NOTE Confidence: 0.9656481 00:49:00.210 --> 00:49:02.050 and and receiving support by NOTE Confidence: 0.9656481 00:49:02.050 --> 00:49:03.170 all means in in in NOTE Confidence: 0.9656481 00:49:03.170 --> 00:49:04.469 in acting on this choice. NOTE Confidence: 0.9823593 00:49:05.045 --> 00:49:06.005 And I think this is NOTE Confidence: 0.9823593 00:49:06.005 --> 00:49:07.364 very important to them because NOTE Confidence: 0.9823593 00:49:07.364 --> 00:49:08.585 it gives them a role NOTE Confidence: 0.9823593 00:49:08.645 --> 00:49:10.105 in their in their recovery NOTE Confidence: 0.9636602 00:49:10.725 --> 00:49:12.565 rather than feeling passive in NOTE Confidence: 0.9636602 00:49:12.565 --> 00:49:13.765 in in the context of NOTE Confidence: 0.9636602 00:49:13.765 --> 00:49:15.364 of other type of inter NOTE Confidence: 0.9636602 00:49:15.525 --> 00:49:17.125 intervention. And what we often NOTE Confidence: 0.9636602 00:49:17.125 --> 00:49:19.130 find is that when we NOTE Confidence: 0.956666 00:49:19.430 --> 00:49:20.869 do, they do succeed in NOTE Confidence: 0.956666 00:49:20.869 --> 00:49:22.390 reducing their cannabis use or NOTE Confidence: 0.956666 00:49:22.390 --> 00:49:23.130 even stopping, NOTE Confidence: 0.89832157 00:49:23.510 --> 00:49:24.869 they can also negotiate with NOTE Confidence: 0.89832157 00:49:24.869 --> 00:49:26.469 a psychiatrist a little reduction NOTE Confidence: 0.89832157 00:49:26.469 --> 00:49:27.210 in the medication, NOTE Confidence: 0.96369284 00:49:27.750 --> 00:49:29.349 which by by all means NOTE Confidence: 0.96369284 00:49:29.349 --> 00:49:30.869 are taken into account in NOTE Confidence: 0.96369284 00:49:30.869 --> 00:49:31.190 this, NOTE Confidence: 0.9923138 00:49:31.750 --> 00:49:32.890 in in this analysis. NOTE Confidence: 0.90994984 00:49:33.474 --> 00:49:34.994 We've also developed I don't NOTE Confidence: 0.90994984 00:49:34.994 --> 00:49:35.954 know if there are any NOTE Confidence: 0.90994984 00:49:35.954 --> 00:49:37.655 carers at this talk talk, NOTE Confidence: 0.9778499 00:49:38.114 --> 00:49:39.315 but we have also developed NOTE Confidence: 0.9778499 00:49:39.315 --> 00:49:40.694 a monthly, meeting NOTE Confidence: 0.9830983 00:49:40.994 --> 00:49:42.594 for the carer to support NOTE Confidence: 0.9830983 00:49:42.594 --> 00:49:43.575 them with, NOTE Confidence: 0.93732846 00:49:44.594 --> 00:49:46.515 communicating better and understanding the NOTE Confidence: 0.93732846 00:49:46.515 --> 00:49:47.890 journey that the loved one NOTE Confidence: 0.93732846 00:49:47.890 --> 00:49:49.330 are have embarked on and NOTE Confidence: 0.93732846 00:49:49.330 --> 00:49:49.910 the complexity NOTE Confidence: 0.80720264 00:49:50.530 --> 00:49:51.510 of that journey. NOTE Confidence: 0.98545676 00:49:52.050 --> 00:49:52.930 We also have, NOTE Confidence: 0.899975 00:49:53.810 --> 00:49:54.930 a branch club. It's got NOTE Confidence: 0.899975 00:49:55.010 --> 00:49:56.210 it was started as breakfast, NOTE Confidence: 0.899975 00:49:56.210 --> 00:49:57.250 but because it's at twelve NOTE Confidence: 0.899975 00:49:57.250 --> 00:49:58.530 o'clock, I I said I NOTE Confidence: 0.899975 00:49:58.530 --> 00:49:59.030 forbid NOTE Confidence: 0.9698575 00:49:59.330 --> 00:50:00.530 my students to call it NOTE Confidence: 0.9698575 00:50:00.530 --> 00:50:01.810 breakfast at twelve. I said NOTE Confidence: 0.9698575 00:50:01.810 --> 00:50:02.450 you have to call it NOTE Confidence: 0.9698575 00:50:02.450 --> 00:50:02.950 brunch. NOTE Confidence: 0.9761367 00:50:03.255 --> 00:50:04.875 And our wonderful students NOTE Confidence: 0.9923725 00:50:05.335 --> 00:50:06.694 meet with our patients who NOTE Confidence: 0.9923725 00:50:06.694 --> 00:50:08.055 can tolerate to meet in NOTE Confidence: 0.9923725 00:50:08.055 --> 00:50:08.555 person, NOTE Confidence: 0.997912 00:50:08.934 --> 00:50:10.375 and they don't find that NOTE Confidence: 0.997912 00:50:10.375 --> 00:50:11.114 too intrusive. NOTE Confidence: 0.9867022 00:50:11.575 --> 00:50:12.535 And they do lots of NOTE Confidence: 0.9867022 00:50:12.535 --> 00:50:13.734 activities, and one of my NOTE Confidence: 0.9867022 00:50:13.734 --> 00:50:15.494 students created this idea of NOTE Confidence: 0.9867022 00:50:15.494 --> 00:50:16.440 the craving box. NOTE Confidence: 0.97472227 00:50:16.920 --> 00:50:19.000 Each patient can build their NOTE Confidence: 0.97472227 00:50:19.000 --> 00:50:20.599 own craving box where they NOTE Confidence: 0.97472227 00:50:20.599 --> 00:50:22.920 include tools, ideas, thoughts, and NOTE Confidence: 0.97472227 00:50:22.920 --> 00:50:24.040 take it with them so NOTE Confidence: 0.97472227 00:50:24.040 --> 00:50:25.800 that when they crave, rather NOTE Confidence: 0.97472227 00:50:25.800 --> 00:50:26.920 than panicky about it, they NOTE Confidence: 0.97472227 00:50:26.920 --> 00:50:28.040 can open the box and NOTE Confidence: 0.97472227 00:50:28.040 --> 00:50:28.859 remind themselves NOTE Confidence: 0.9201316 00:50:29.160 --> 00:50:30.599 the tools that stay they NOTE Confidence: 0.9201316 00:50:30.599 --> 00:50:32.125 have agreed might help to NOTE Confidence: 0.9201316 00:50:32.125 --> 00:50:32.625 overcome NOTE Confidence: 0.98556876 00:50:33.245 --> 00:50:33.725 the, NOTE Confidence: 0.8948642 00:50:34.364 --> 00:50:35.905 the the the the craving. NOTE Confidence: 0.9807425 00:50:36.205 --> 00:50:37.725 And work in progress, we NOTE Confidence: 0.9807425 00:50:37.725 --> 00:50:38.844 are very interested in the NOTE Confidence: 0.9807425 00:50:38.844 --> 00:50:40.925 cannabis withdrawal. I I mentioned NOTE Confidence: 0.9807425 00:50:40.925 --> 00:50:41.725 this to you. I don't NOTE Confidence: 0.9807425 00:50:41.725 --> 00:50:42.685 think we have we have NOTE Confidence: 0.9807425 00:50:42.685 --> 00:50:43.805 time to to watch the NOTE Confidence: 0.9807425 00:50:43.805 --> 00:50:44.785 video, but, NOTE Confidence: 0.92097884 00:50:45.839 --> 00:50:47.440 Ed Chesney have been leading NOTE Confidence: 0.92097884 00:50:47.440 --> 00:50:47.759 on, NOTE Confidence: 0.9424382 00:50:48.239 --> 00:50:48.900 the developments NOTE Confidence: 0.987947 00:50:49.200 --> 00:50:49.519 of, NOTE Confidence: 0.9184422 00:50:50.000 --> 00:50:51.599 the the time scale of NOTE Confidence: 0.9184422 00:50:51.599 --> 00:50:52.960 of the of when you NOTE Confidence: 0.9184422 00:50:52.960 --> 00:50:54.559 expect withdrawal symptoms who have NOTE Confidence: 0.9184422 00:50:54.559 --> 00:50:56.239 an onset, which is pretty NOTE Confidence: 0.9184422 00:50:56.239 --> 00:50:57.839 delayed compared, for instance, to NOTE Confidence: 0.9184422 00:50:57.839 --> 00:50:59.059 tobacco and alcohol. NOTE Confidence: 0.9992531 00:50:59.535 --> 00:51:01.075 And not only on NOTE Confidence: 0.8617226 00:51:01.535 --> 00:51:03.375 these more general sort of, NOTE Confidence: 0.6563197 00:51:04.255 --> 00:51:04.755 symptoms NOTE Confidence: 0.8221071 00:51:05.694 --> 00:51:06.355 that can, NOTE Confidence: 0.9723121 00:51:06.815 --> 00:51:08.994 can can develop during withdrawal, NOTE Confidence: 0.9373556 00:51:09.295 --> 00:51:10.035 but also NOTE Confidence: 0.94842803 00:51:10.335 --> 00:51:11.295 a a series of case NOTE Confidence: 0.94842803 00:51:11.295 --> 00:51:12.494 reports that he has now NOTE Confidence: 0.94842803 00:51:12.494 --> 00:51:14.210 published of people that stop NOTE Confidence: 0.94842803 00:51:14.210 --> 00:51:16.130 using cannabis and develop psychosis NOTE Confidence: 0.94842803 00:51:16.130 --> 00:51:17.109 after they stopped. NOTE Confidence: 0.9934721 00:51:17.650 --> 00:51:18.150 And, NOTE Confidence: 0.95779943 00:51:18.930 --> 00:51:20.230 and so he's been interested NOTE Confidence: 0.95779943 00:51:20.290 --> 00:51:20.869 in how NOTE Confidence: 0.9613445 00:51:21.250 --> 00:51:22.309 abrupt cannabis, NOTE Confidence: 0.8754177 00:51:23.089 --> 00:51:24.390 secession can precipitate NOTE Confidence: 0.9991382 00:51:24.930 --> 00:51:26.230 some psychotic symptoms NOTE Confidence: 0.9742209 00:51:26.705 --> 00:51:28.225 and how important it is NOTE Confidence: 0.9742209 00:51:28.225 --> 00:51:29.745 to be aware of, of NOTE Confidence: 0.9742209 00:51:29.745 --> 00:51:31.265 it as well when people NOTE Confidence: 0.9742209 00:51:31.265 --> 00:51:32.785 are supported in a journey NOTE Confidence: 0.9742209 00:51:32.785 --> 00:51:34.465 of reducing or changing their NOTE Confidence: 0.9742209 00:51:34.465 --> 00:51:36.065 cannabis use. And we have NOTE Confidence: 0.9742209 00:51:36.065 --> 00:51:37.985 an online portal where our NOTE Confidence: 0.9742209 00:51:37.985 --> 00:51:39.690 patient can access all these NOTE Confidence: 0.9742209 00:51:39.690 --> 00:51:41.130 resources, lots of the video. NOTE Confidence: 0.9742209 00:51:41.130 --> 00:51:42.270 There are lots of TikTok NOTE Confidence: 0.9742209 00:51:42.330 --> 00:51:43.070 type video NOTE Confidence: 0.9526762 00:51:43.450 --> 00:51:44.969 for short attention span. One NOTE Confidence: 0.9526762 00:51:44.969 --> 00:51:46.830 of them is, professor D'Souza, NOTE Confidence: 0.9426907 00:51:47.770 --> 00:51:49.130 a shorter version of his NOTE Confidence: 0.9426907 00:51:49.130 --> 00:51:51.130 original talk and many more. NOTE Confidence: 0.9426907 00:51:51.130 --> 00:51:52.330 And this has been great NOTE Confidence: 0.9426907 00:51:52.330 --> 00:51:54.030 because people can watch this NOTE Confidence: 0.9426907 00:51:54.185 --> 00:51:55.885 on their own mobile phone NOTE Confidence: 0.9426907 00:51:56.025 --> 00:51:57.225 anytime of the day and NOTE Confidence: 0.9426907 00:51:57.225 --> 00:51:58.825 night when clinical service are NOTE Confidence: 0.9426907 00:51:58.825 --> 00:51:59.484 not available. NOTE Confidence: 0.9738553 00:51:59.864 --> 00:52:01.225 They can self assess. They NOTE Confidence: 0.9738553 00:52:01.225 --> 00:52:02.425 can build their own cannabis NOTE Confidence: 0.9738553 00:52:02.425 --> 00:52:03.785 diary. And as I said, NOTE Confidence: 0.9738553 00:52:03.785 --> 00:52:05.145 they can watch what other NOTE Confidence: 0.9738553 00:52:05.145 --> 00:52:06.605 people have have experienced. NOTE Confidence: 0.9984085 00:52:07.145 --> 00:52:07.645 And NOTE Confidence: 0.96060055 00:52:08.670 --> 00:52:10.109 about to start, you don't NOTE Confidence: 0.96060055 00:52:10.109 --> 00:52:10.849 get any credibility, NOTE Confidence: 0.95348555 00:52:11.150 --> 00:52:12.109 and she should be if NOTE Confidence: 0.95348555 00:52:12.109 --> 00:52:13.069 you don't do a randomized NOTE Confidence: 0.95348555 00:52:13.069 --> 00:52:14.670 controlled trial. So we're just NOTE Confidence: 0.95348555 00:52:14.670 --> 00:52:15.950 about to start a randomized NOTE Confidence: 0.95348555 00:52:15.950 --> 00:52:17.489 controlled trial of the intervention NOTE Confidence: 0.9898693 00:52:18.109 --> 00:52:19.630 of, of of the cannabis NOTE Confidence: 0.9898693 00:52:19.630 --> 00:52:20.130 clinic. NOTE Confidence: 0.9930808 00:52:20.430 --> 00:52:21.410 And to conclude, NOTE Confidence: 0.9980786 00:52:21.790 --> 00:52:23.089 none of what I said NOTE Confidence: 0.9980786 00:52:23.335 --> 00:52:23.835 could NOTE Confidence: 0.9786288 00:52:24.295 --> 00:52:26.135 happen if it wasn't for NOTE Confidence: 0.9786288 00:52:26.135 --> 00:52:27.655 the inspiration I get for NOTE Confidence: 0.9786288 00:52:27.655 --> 00:52:28.855 the people in my clinic, NOTE Confidence: 0.9786288 00:52:28.855 --> 00:52:30.955 under my care, their family, NOTE Confidence: 0.9746896 00:52:31.255 --> 00:52:33.015 my clinical colleagues, and, of NOTE Confidence: 0.9746896 00:52:33.015 --> 00:52:34.555 course, my research team, NOTE Confidence: 0.9501174 00:52:35.255 --> 00:52:37.310 our mentor with lived experience NOTE Confidence: 0.9501174 00:52:37.310 --> 00:52:38.750 who you have met in NOTE Confidence: 0.9501174 00:52:38.750 --> 00:52:39.489 in the video, NOTE Confidence: 0.9756444 00:52:39.790 --> 00:52:41.310 people like professor D'Souza who NOTE Confidence: 0.9756444 00:52:41.310 --> 00:52:42.670 have guided and inspired my NOTE Confidence: 0.9756444 00:52:42.670 --> 00:52:44.510 work, and my pets who NOTE Confidence: 0.9756444 00:52:44.510 --> 00:52:45.010 feature NOTE Confidence: 0.9752086 00:52:45.390 --> 00:52:46.350 in the slides. And you NOTE Confidence: 0.9752086 00:52:46.350 --> 00:52:47.469 can't see them, but they're NOTE Confidence: 0.9752086 00:52:47.469 --> 00:52:49.310 also behind me right now. NOTE Confidence: 0.9752086 00:52:49.310 --> 00:52:50.370 Thank you very much. NOTE Confidence: 0.8943928 00:52:52.395 --> 00:52:53.675 That was I'm happy to NOTE Confidence: 0.8943928 00:52:53.675 --> 00:52:54.175 answer. NOTE Confidence: 0.9828031 00:52:55.275 --> 00:52:56.555 That was really great. There NOTE Confidence: 0.9828031 00:52:56.555 --> 00:52:57.915 are some questions in the NOTE Confidence: 0.9828031 00:52:57.915 --> 00:52:59.915 in the chat. Tom McMahon, NOTE Confidence: 0.9828031 00:52:59.915 --> 00:53:00.635 do you wanna, NOTE Confidence: 0.96548027 00:53:01.515 --> 00:53:02.555 do you wanna ask your NOTE Confidence: 0.96548027 00:53:02.555 --> 00:53:03.055 question? NOTE Confidence: 0.97375077 00:53:05.280 --> 00:53:06.900 Sure. Thank you very much. NOTE Confidence: 0.9933779 00:53:07.840 --> 00:53:08.980 This is very interesting NOTE Confidence: 0.8000477 00:53:09.280 --> 00:53:09.860 to me, NOTE Confidence: 0.9570334 00:53:10.480 --> 00:53:12.000 particularly that I work with NOTE Confidence: 0.9570334 00:53:12.000 --> 00:53:13.280 this age group and we NOTE Confidence: 0.9570334 00:53:13.280 --> 00:53:13.780 see NOTE Confidence: 0.99977034 00:53:14.320 --> 00:53:15.060 this combination NOTE Confidence: 0.99907374 00:53:16.080 --> 00:53:16.580 of NOTE Confidence: 0.9989591 00:53:16.960 --> 00:53:18.500 difficulty pretty frequently. NOTE Confidence: 0.9878233 00:53:18.844 --> 00:53:20.045 My question is, can you NOTE Confidence: 0.9878233 00:53:20.045 --> 00:53:20.924 talk a little bit about NOTE Confidence: 0.9878233 00:53:20.924 --> 00:53:21.984 the role of antipsychotic NOTE Confidence: 0.99916494 00:53:22.364 --> 00:53:22.864 medication NOTE Confidence: 0.9991742 00:53:23.565 --> 00:53:24.464 at the CCP NOTE Confidence: 0.9912046 00:53:24.765 --> 00:53:26.364 and the role how you NOTE Confidence: 0.9912046 00:53:26.364 --> 00:53:28.464 deal with with issues around NOTE Confidence: 0.9989989 00:53:29.085 --> 00:53:30.464 continuation of antipsychotic NOTE Confidence: 0.99483395 00:53:30.765 --> 00:53:32.065 medication that's usually NOTE Confidence: 0.9949745 00:53:32.525 --> 00:53:33.744 begun in the hospital? NOTE Confidence: 0.94901717 00:53:36.280 --> 00:53:37.480 So this is a very NOTE Confidence: 0.94901717 00:53:37.480 --> 00:53:39.660 important question. So I don't, NOTE Confidence: 0.9801912 00:53:40.680 --> 00:53:41.559 so in my role as NOTE Confidence: 0.9801912 00:53:41.559 --> 00:53:43.000 a consultant of the cannabis NOTE Confidence: 0.9801912 00:53:43.000 --> 00:53:44.520 clinic, I don't have any NOTE Confidence: 0.9801912 00:53:44.520 --> 00:53:45.800 control on what people are NOTE Confidence: 0.9801912 00:53:45.800 --> 00:53:46.920 prescribed in terms of the NOTE Confidence: 0.9801912 00:53:46.920 --> 00:53:47.420 antipsychotic NOTE Confidence: 0.943848 00:53:47.719 --> 00:53:49.275 because if you think about NOTE Confidence: 0.943848 00:53:49.275 --> 00:53:50.234 the way we work, we NOTE Confidence: 0.943848 00:53:50.234 --> 00:53:51.594 are a tertiary service. What NOTE Confidence: 0.943848 00:53:51.594 --> 00:53:53.275 it means that these people NOTE Confidence: 0.943848 00:53:53.275 --> 00:53:54.094 are under NOTE Confidence: 0.99321395 00:53:54.474 --> 00:53:56.315 a main community mental health NOTE Confidence: 0.99321395 00:53:56.315 --> 00:53:57.375 team for psychosis. NOTE Confidence: 0.9614974 00:53:57.755 --> 00:53:58.795 So they are under a NOTE Confidence: 0.9614974 00:53:58.795 --> 00:54:00.474 general psychosis team, and then NOTE Confidence: 0.9614974 00:54:00.474 --> 00:54:02.015 they get referred to us NOTE Confidence: 0.9614974 00:54:02.230 --> 00:54:03.350 to support them with the NOTE Confidence: 0.9614974 00:54:03.350 --> 00:54:05.270 cannabis use. So I don't NOTE Confidence: 0.9614974 00:54:05.270 --> 00:54:05.770 directly NOTE Confidence: 0.9885154 00:54:06.230 --> 00:54:07.770 interfere on their antipsychotic. NOTE Confidence: 0.999485 00:54:08.150 --> 00:54:08.650 Nevertheless, NOTE Confidence: 0.9948081 00:54:09.910 --> 00:54:11.370 they're beginning to be NOTE Confidence: 0.93687654 00:54:11.670 --> 00:54:13.370 more and more evidence suggesting NOTE Confidence: 0.93687654 00:54:13.510 --> 00:54:15.065 that in this population, NOTE Confidence: 0.9858373 00:54:15.525 --> 00:54:16.645 if you give them a NOTE Confidence: 0.9858373 00:54:16.645 --> 00:54:18.825 powerful d two blockade antipsychotic NOTE Confidence: 0.842933 00:54:19.285 --> 00:54:20.265 d two antagonist, NOTE Confidence: 0.97218007 00:54:21.205 --> 00:54:22.585 you're more likely to precipitate NOTE Confidence: 0.97218007 00:54:22.724 --> 00:54:24.565 craving and make them less NOTE Confidence: 0.97218007 00:54:24.565 --> 00:54:25.945 likely to take their antipsychotic NOTE Confidence: 0.96569264 00:54:26.780 --> 00:54:27.900 and also to get them NOTE Confidence: 0.96569264 00:54:27.900 --> 00:54:29.339 to ramp up their cannabis NOTE Confidence: 0.96569264 00:54:29.339 --> 00:54:30.460 use to maintain the same NOTE Confidence: 0.96569264 00:54:30.460 --> 00:54:31.440 level of pleasure. NOTE Confidence: 0.949939 00:54:31.739 --> 00:54:33.339 So some there've been studies NOTE Confidence: 0.949939 00:54:33.339 --> 00:54:34.940 now that suggested that perhaps NOTE Confidence: 0.949939 00:54:34.940 --> 00:54:36.239 using partial agonist, NOTE Confidence: 0.83031857 00:54:37.180 --> 00:54:38.880 say, areoprazole or cariprazine, NOTE Confidence: 0.9073409 00:54:39.820 --> 00:54:41.485 are a better tailor intervention NOTE Confidence: 0.9337778 00:54:42.344 --> 00:54:44.925 and particularly to consider initially NOTE Confidence: 0.9337778 00:54:44.985 --> 00:54:45.885 a long acting NOTE Confidence: 0.9949189 00:54:46.185 --> 00:54:47.565 to guarantee compliance. NOTE Confidence: 0.9997508 00:54:47.945 --> 00:54:48.445 Now NOTE Confidence: 0.9872591 00:54:48.745 --> 00:54:50.265 what we do find is NOTE Confidence: 0.9872591 00:54:50.265 --> 00:54:50.765 that, NOTE Confidence: 0.9279231 00:54:52.265 --> 00:54:54.105 in general, when people start NOTE Confidence: 0.9279231 00:54:54.105 --> 00:54:56.030 reducing their cannabis use, they NOTE Confidence: 0.9279231 00:54:56.030 --> 00:54:57.710 can also negotiate either that NOTE Confidence: 0.9279231 00:54:57.710 --> 00:54:58.510 they are on a partial NOTE Confidence: 0.9279231 00:54:58.510 --> 00:54:59.710 agonist or a d two NOTE Confidence: 0.9279231 00:54:59.710 --> 00:55:00.210 blockade, NOTE Confidence: 0.94579536 00:55:00.589 --> 00:55:02.030 a little reduction of the NOTE Confidence: 0.94579536 00:55:02.030 --> 00:55:04.109 dose with that psychiatrist, particularly NOTE Confidence: 0.94579536 00:55:04.109 --> 00:55:04.849 if the symptomatology NOTE Confidence: 0.9794347 00:55:05.230 --> 00:55:05.730 improves. NOTE Confidence: 0.69263035 00:55:06.109 --> 00:55:07.330 And this in turn NOTE Confidence: 0.8795764 00:55:07.994 --> 00:55:10.394 improves the therapeutic relationship and NOTE Confidence: 0.8795764 00:55:10.394 --> 00:55:12.255 starts a negotiation or perhaps NOTE Confidence: 0.8795764 00:55:12.474 --> 00:55:13.535 what it might be NOTE Confidence: 0.9529676 00:55:13.835 --> 00:55:15.434 a better antipsychotic that suits NOTE Confidence: 0.9529676 00:55:15.434 --> 00:55:16.555 their need or if they NOTE Confidence: 0.9529676 00:55:16.555 --> 00:55:17.755 can even I mean, we NOTE Confidence: 0.9529676 00:55:17.755 --> 00:55:19.515 had twenty percent of the NOTE Confidence: 0.9529676 00:55:19.515 --> 00:55:20.634 people in the sample I NOTE Confidence: 0.9529676 00:55:20.634 --> 00:55:21.750 show you the data from NOTE Confidence: 0.9529676 00:55:21.910 --> 00:55:22.870 actually were able to stop NOTE Confidence: 0.9529676 00:55:22.870 --> 00:55:24.330 their antipsychotic altogether, NOTE Confidence: 0.91781425 00:55:25.590 --> 00:55:26.710 or even been on a NOTE Confidence: 0.91781425 00:55:26.710 --> 00:55:28.070 dose such as two point NOTE Confidence: 0.91781425 00:55:28.070 --> 00:55:29.050 five of aripiprazole. NOTE Confidence: 0.9839755 00:55:30.630 --> 00:55:31.510 But I think we would NOTE Confidence: 0.9839755 00:55:31.510 --> 00:55:32.870 need a longer follow-up to NOTE Confidence: 0.9839755 00:55:32.870 --> 00:55:34.710 see which proportion is able NOTE Confidence: 0.9839755 00:55:34.710 --> 00:55:36.410 to come off completely antipsychotic. NOTE Confidence: 0.99463725 00:55:38.135 --> 00:55:39.255 So one of the things NOTE Confidence: 0.99463725 00:55:39.255 --> 00:55:40.055 I would like to do NOTE Confidence: 0.99463725 00:55:40.055 --> 00:55:41.594 is to develop a protocol, NOTE Confidence: 0.9746299 00:55:42.295 --> 00:55:43.655 to to to work around NOTE Confidence: 0.9746299 00:55:43.655 --> 00:55:45.335 it with my clinical colleagues NOTE Confidence: 0.9746299 00:55:45.335 --> 00:55:46.635 who prescribe the antipsychotic. NOTE Confidence: 0.99031466 00:55:47.575 --> 00:55:48.614 At the moment, I just NOTE Confidence: 0.99031466 00:55:48.614 --> 00:55:50.455 gently interfere when I feel NOTE Confidence: 0.99031466 00:55:50.455 --> 00:55:51.390 I have to, but NOTE Confidence: 0.99971294 00:55:51.950 --> 00:55:52.849 not too much. NOTE Confidence: 0.9723063 00:55:54.190 --> 00:55:55.309 There there was also a NOTE Confidence: 0.9723063 00:55:55.309 --> 00:55:57.309 question from, Eden Evans from NOTE Confidence: 0.9723063 00:55:57.309 --> 00:55:57.809 MGH. NOTE Confidence: 0.9185624 00:55:58.190 --> 00:55:59.089 Eden, do you wanna NOTE Confidence: 0.99187416 00:55:59.710 --> 00:56:00.670 do you want to ask NOTE Confidence: 0.99187416 00:56:00.670 --> 00:56:01.809 your question now? NOTE Confidence: 0.90360516 00:56:03.710 --> 00:56:04.589 No. No. If you're still NOTE Confidence: 0.90360516 00:56:04.589 --> 00:56:05.410 on the call. NOTE Confidence: 0.9446459 00:56:06.174 --> 00:56:06.894 No. We are. I was NOTE Confidence: 0.9446459 00:56:06.894 --> 00:56:08.015 just trying to here with NOTE Confidence: 0.9446459 00:56:08.015 --> 00:56:09.535 Jody and Gladys Patas from NOTE Confidence: 0.9446459 00:56:09.535 --> 00:56:10.894 our group. And and I NOTE Confidence: 0.9446459 00:56:10.894 --> 00:56:12.174 asked it before you went NOTE Confidence: 0.9446459 00:56:12.174 --> 00:56:12.674 through, NOTE Confidence: 0.9904465 00:56:13.375 --> 00:56:15.295 your your more description of NOTE Confidence: 0.9904465 00:56:15.295 --> 00:56:16.734 your your cannabis clinic for NOTE Confidence: 0.9904465 00:56:16.734 --> 00:56:18.094 patients with psychosis. But my NOTE Confidence: 0.9904465 00:56:18.094 --> 00:56:19.700 question was, what is your NOTE Confidence: 0.9904465 00:56:19.760 --> 00:56:21.280 intervention? What is the treatment? NOTE Confidence: 0.9904465 00:56:21.280 --> 00:56:22.580 And it looks like it's NOTE Confidence: 0.97220767 00:56:22.960 --> 00:56:23.540 primarily behavioral, NOTE Confidence: 0.9805593 00:56:24.239 --> 00:56:25.359 and that you don't have NOTE Confidence: 0.9805593 00:56:25.359 --> 00:56:26.180 a protocol. NOTE Confidence: 0.9172185 00:56:26.800 --> 00:56:27.520 Is that is that right? NOTE Confidence: 0.9172185 00:56:27.520 --> 00:56:28.160 So I was I was NOTE Confidence: 0.9172185 00:56:28.320 --> 00:56:30.239 Exactly. Describe it. Yeah. But NOTE Confidence: 0.9172185 00:56:30.239 --> 00:56:31.119 thank you so much for NOTE Confidence: 0.9172185 00:56:31.119 --> 00:56:31.880 all your work. So thank NOTE Confidence: 0.9172185 00:56:31.880 --> 00:56:33.280 you. All your papers. We NOTE Confidence: 0.9172185 00:56:33.280 --> 00:56:34.400 are very inspired by your NOTE Confidence: 0.9172185 00:56:34.400 --> 00:56:35.655 work. So I'll I'll add NOTE Confidence: 0.9172185 00:56:35.655 --> 00:56:36.375 that too. But, NOTE Confidence: 0.968746 00:56:36.775 --> 00:56:37.815 you know, if we were NOTE Confidence: 0.968746 00:56:37.815 --> 00:56:39.255 to to start a a NOTE Confidence: 0.968746 00:56:39.255 --> 00:56:40.455 a cannabis clinic here, I'm NOTE Confidence: 0.968746 00:56:40.455 --> 00:56:41.655 not clear what we would NOTE Confidence: 0.968746 00:56:41.655 --> 00:56:42.155 do, NOTE Confidence: 0.996192 00:56:42.695 --> 00:56:42.935 to NOTE Confidence: 0.9494593 00:56:43.895 --> 00:56:45.015 Well, what you would do, NOTE Confidence: 0.9494593 00:56:45.015 --> 00:56:46.455 you would get some wonderful NOTE Confidence: 0.9494593 00:56:46.455 --> 00:56:47.815 people with lived experience to NOTE Confidence: 0.9494593 00:56:47.815 --> 00:56:49.450 support you. You will get NOTE Confidence: 0.9494593 00:56:49.450 --> 00:56:50.890 people in a room once NOTE Confidence: 0.9494593 00:56:50.890 --> 00:56:52.350 a week for sixty minutes, NOTE Confidence: 0.97092474 00:56:52.730 --> 00:56:53.690 get them to talk about NOTE Confidence: 0.97092474 00:56:53.690 --> 00:56:55.050 their cannabis use, and let NOTE Confidence: 0.97092474 00:56:55.050 --> 00:56:56.110 them lead the way. NOTE Confidence: 0.99217474 00:56:56.489 --> 00:56:57.770 So what what is really NOTE Confidence: 0.99217474 00:56:57.770 --> 00:56:58.810 the feedback? We've done a NOTE Confidence: 0.99217474 00:56:58.810 --> 00:56:59.310 qualitative NOTE Confidence: 0.9507091 00:56:59.690 --> 00:57:01.870 study, which is also included NOTE Confidence: 0.9507091 00:57:02.090 --> 00:57:03.690 in the paper, where we NOTE Confidence: 0.9507091 00:57:03.690 --> 00:57:05.195 ask them what has really NOTE Confidence: 0.9507091 00:57:05.195 --> 00:57:06.635 been helpful of what you NOTE Confidence: 0.9507091 00:57:06.635 --> 00:57:07.995 have done with us. And NOTE Confidence: 0.9507091 00:57:07.995 --> 00:57:09.455 the answer has been consistency, NOTE Confidence: 0.80186194 00:57:10.075 --> 00:57:10.575 flexibility, NOTE Confidence: 0.9982413 00:57:11.355 --> 00:57:12.475 not to be told what NOTE Confidence: 0.9982413 00:57:12.475 --> 00:57:13.135 to do, NOTE Confidence: 0.995446 00:57:13.675 --> 00:57:15.195 not to be led, but NOTE Confidence: 0.995446 00:57:15.195 --> 00:57:17.375 to be supported in finding NOTE Confidence: 0.9759732 00:57:17.995 --> 00:57:19.035 the way to make the NOTE Confidence: 0.9759732 00:57:19.035 --> 00:57:20.640 change. So I give you NOTE Confidence: 0.9759732 00:57:20.640 --> 00:57:21.760 I give you an example. NOTE Confidence: 0.9759732 00:57:21.760 --> 00:57:22.720 Some of the people that NOTE Confidence: 0.9759732 00:57:22.720 --> 00:57:23.920 come to the first session, NOTE Confidence: 0.9759732 00:57:23.920 --> 00:57:24.800 they come to the first NOTE Confidence: 0.9759732 00:57:24.800 --> 00:57:26.800 session, say, I love my NOTE Confidence: 0.9759732 00:57:26.800 --> 00:57:28.640 cannabis use, but I'm spending NOTE Confidence: 0.9759732 00:57:28.640 --> 00:57:30.099 too much money on it. NOTE Confidence: 0.9822732 00:57:30.480 --> 00:57:31.695 And you work with that. NOTE Confidence: 0.9822732 00:57:31.775 --> 00:57:32.975 You don't start by saying, NOTE Confidence: 0.9822732 00:57:32.975 --> 00:57:34.095 oh, cannabis is bad for NOTE Confidence: 0.9822732 00:57:34.095 --> 00:57:36.175 your psychosis and multi complicated NOTE Confidence: 0.9822732 00:57:36.175 --> 00:57:37.375 motivation. You just work on NOTE Confidence: 0.9822732 00:57:37.375 --> 00:57:38.175 the fact they want to NOTE Confidence: 0.9822732 00:57:38.175 --> 00:57:39.695 save money. And then when NOTE Confidence: 0.9822732 00:57:39.695 --> 00:57:40.435 they start NOTE Confidence: 0.93194944 00:57:40.735 --> 00:57:42.495 reducing their cannabis with some NOTE Confidence: 0.93194944 00:57:42.495 --> 00:57:43.315 very practical NOTE Confidence: 0.96690786 00:57:43.775 --> 00:57:46.010 craving tools and harm reduction, NOTE Confidence: 0.96661186 00:57:46.390 --> 00:57:47.510 you begin to get them NOTE Confidence: 0.96661186 00:57:47.510 --> 00:57:48.870 to reflect on, hold on NOTE Confidence: 0.96661186 00:57:48.870 --> 00:57:49.990 a second, you are getting NOTE Confidence: 0.96661186 00:57:49.990 --> 00:57:50.710 a bit more money in NOTE Confidence: 0.96661186 00:57:50.710 --> 00:57:51.910 your pocket. Have you actually NOTE Confidence: 0.96661186 00:57:51.910 --> 00:57:53.370 noticed anything else changing? NOTE Confidence: 0.99827653 00:57:53.910 --> 00:57:55.270 And then you bring their NOTE Confidence: 0.99827653 00:57:55.270 --> 00:57:56.330 attention into NOTE Confidence: 0.8728672 00:57:56.710 --> 00:57:58.650 perhaps how their cognitive function NOTE Confidence: 0.94219047 00:57:58.974 --> 00:58:00.895 has changed, how the fact NOTE Confidence: 0.94219047 00:58:00.895 --> 00:58:02.675 that they've introduced more activity NOTE Confidence: 0.94219047 00:58:02.734 --> 00:58:04.175 and how play much pleasure NOTE Confidence: 0.94219047 00:58:04.175 --> 00:58:05.375 they are getting from it. NOTE Confidence: 0.94219047 00:58:05.375 --> 00:58:06.175 So I don't know if NOTE Confidence: 0.94219047 00:58:06.175 --> 00:58:07.075 that makes sense. NOTE Confidence: 0.9432237 00:58:07.375 --> 00:58:08.655 And then then there might NOTE Confidence: 0.9432237 00:58:08.655 --> 00:58:09.535 be people that come to NOTE Confidence: 0.9432237 00:58:09.535 --> 00:58:10.335 you and say, I want NOTE Confidence: 0.9432237 00:58:10.335 --> 00:58:11.295 to go to university in NOTE Confidence: 0.9432237 00:58:11.295 --> 00:58:12.575 September, but right now, I NOTE Confidence: 0.9432237 00:58:12.575 --> 00:58:13.775 spend all my days smoking NOTE Confidence: 0.9432237 00:58:13.775 --> 00:58:14.275 cannabis. NOTE Confidence: 0.9724883 00:58:14.600 --> 00:58:15.640 Can you help me? So NOTE Confidence: 0.9724883 00:58:15.640 --> 00:58:17.160 we work with what people NOTE Confidence: 0.9724883 00:58:17.160 --> 00:58:18.380 bring into the session. NOTE Confidence: 0.9970471 00:58:18.760 --> 00:58:20.060 And depending what NOTE Confidence: 0.98036546 00:58:20.360 --> 00:58:22.140 is their goal, their motivation, NOTE Confidence: 0.96333325 00:58:22.840 --> 00:58:24.200 we use the tools that NOTE Confidence: 0.96333325 00:58:24.200 --> 00:58:26.040 fits them rather than the NOTE Confidence: 0.96333325 00:58:26.040 --> 00:58:27.855 other way around. So the NOTE Confidence: 0.96333325 00:58:27.855 --> 00:58:29.215 protocol is that we use NOTE Confidence: 0.96333325 00:58:29.215 --> 00:58:30.575 anything that addiction has shown NOTE Confidence: 0.96333325 00:58:30.575 --> 00:58:31.475 it does work, NOTE Confidence: 0.99900275 00:58:31.775 --> 00:58:33.375 and we tailor it to NOTE Confidence: 0.99900275 00:58:33.375 --> 00:58:34.035 the individual. NOTE Confidence: 0.9996028 00:58:34.495 --> 00:58:36.495 That's the key. Fantastic. Thank NOTE Confidence: 0.9996028 00:58:36.495 --> 00:58:36.995 you. NOTE Confidence: 0.98353136 00:58:37.455 --> 00:58:38.735 We have one last question NOTE Confidence: 0.98353136 00:58:38.735 --> 00:58:40.975 from, from Godfrey. Godfrey, do NOTE Confidence: 0.98353136 00:58:40.975 --> 00:58:41.955 you wanna ask NOTE Confidence: 0.9983395 00:58:42.710 --> 00:58:43.450 your question? NOTE Confidence: 0.95578426 00:58:45.349 --> 00:58:46.630 Sure. Yeah. Marta, thank you NOTE Confidence: 0.95578426 00:58:46.630 --> 00:58:47.670 so much. It's lovely to NOTE Confidence: 0.95578426 00:58:47.670 --> 00:58:48.650 see these data. NOTE Confidence: 0.93798244 00:58:49.430 --> 00:58:50.869 Thank you. In in the NOTE Confidence: 0.93798244 00:58:50.869 --> 00:58:52.009 b SNP sample NOTE Confidence: 0.99133235 00:58:52.549 --> 00:58:54.650 of psychosis from multiple sites, NOTE Confidence: 0.9997883 00:58:55.244 --> 00:58:56.384 we see something NOTE Confidence: 0.9999395 00:58:56.765 --> 00:58:57.984 similar to you NOTE Confidence: 0.9092722 00:58:58.285 --> 00:59:00.684 in that individuals with early NOTE Confidence: 0.9092722 00:59:00.684 --> 00:59:01.744 childhood trauma NOTE Confidence: 0.97515196 00:59:02.045 --> 00:59:03.164 who use lots of high NOTE Confidence: 0.97515196 00:59:03.164 --> 00:59:04.144 potency cannabis NOTE Confidence: 0.98575413 00:59:04.924 --> 00:59:06.924 are at increased risk, and NOTE Confidence: 0.98575413 00:59:06.924 --> 00:59:08.549 they look a little biologically NOTE Confidence: 0.97814405 00:59:08.849 --> 00:59:09.349 different. NOTE Confidence: 0.9895128 00:59:09.890 --> 00:59:11.809 But our effect is seen NOTE Confidence: 0.9895128 00:59:11.809 --> 00:59:13.650 almost exclusively in people who NOTE Confidence: 0.9895128 00:59:13.650 --> 00:59:14.789 are early adopters, NOTE Confidence: 0.9992049 00:59:15.250 --> 00:59:16.309 people who use NOTE Confidence: 0.90807855 00:59:16.930 --> 00:59:18.930 high potency cannabis early in NOTE Confidence: 0.90807855 00:59:18.930 --> 00:59:19.750 early adolescence. NOTE Confidence: 0.993258 00:59:21.555 --> 00:59:22.755 And I I wondered if NOTE Confidence: 0.993258 00:59:22.755 --> 00:59:24.515 you see similar effects that NOTE Confidence: 0.993258 00:59:24.515 --> 00:59:26.135 those individuals are more vulnerable NOTE Confidence: 0.993258 00:59:26.194 --> 00:59:27.954 in some way or more NOTE Confidence: 0.993258 00:59:27.954 --> 00:59:29.655 liable to develop psychosis NOTE Confidence: 0.95268375 00:59:30.194 --> 00:59:31.335 with earlier use. NOTE Confidence: 0.98040575 00:59:32.994 --> 00:59:34.115 So in thank you very NOTE Confidence: 0.98040575 00:59:34.115 --> 00:59:35.259 much. Thank you very much NOTE Confidence: 0.98040575 00:59:35.259 --> 00:59:36.539 for for the question. So NOTE Confidence: 0.98040575 00:59:36.539 --> 00:59:37.740 in the work that Julia NOTE Confidence: 0.98040575 00:59:37.740 --> 00:59:40.140 has done, it's difficult to NOTE Confidence: 0.98040575 00:59:40.140 --> 00:59:41.920 to see this particularly because NOTE Confidence: 0.540723 00:59:42.700 --> 00:59:43.200 practically NOTE Confidence: 0.9440937 00:59:43.660 --> 00:59:45.740 everybody starts at around age NOTE Confidence: 0.9440937 00:59:45.740 --> 00:59:47.579 sixteen. So we don't really NOTE Confidence: 0.9440937 00:59:47.579 --> 00:59:49.599 have enough in the sample, NOTE Confidence: 0.9440937 00:59:49.660 --> 00:59:50.885 say, to, NOTE Confidence: 0.9997271 00:59:51.325 --> 00:59:51.825 separate NOTE Confidence: 0.9612417 00:59:52.285 --> 00:59:53.825 out people that might start NOTE Confidence: 0.9612417 00:59:53.885 --> 00:59:55.805 at age thirteen, fourteen, or NOTE Confidence: 0.9612417 00:59:55.805 --> 00:59:57.965 people that start later. It's NOTE Confidence: 0.9612417 00:59:57.965 --> 00:59:59.005 really a sort of qua NOTE Confidence: 0.9612417 00:59:59.005 --> 01:00:00.925 homogeneous and represents a little NOTE Confidence: 0.9612417 01:00:00.925 --> 01:00:01.165 bit, NOTE Confidence: 0.9705885 01:00:02.220 --> 01:00:03.720 you know, what happens in, NOTE Confidence: 0.9705885 01:00:04.020 --> 01:00:05.500 in, in Europe and and NOTE Confidence: 0.9705885 01:00:05.500 --> 01:00:06.240 in UK. NOTE Confidence: 0.99877286 01:00:06.780 --> 01:00:08.060 What I I can tell NOTE Confidence: 0.99877286 01:00:08.060 --> 01:00:09.119 you is that NOTE Confidence: 0.8388012 01:00:09.500 --> 01:00:11.520 in the general population sample, NOTE Confidence: 0.8388012 01:00:11.580 --> 01:00:13.599 the, cannabis and mis study, NOTE Confidence: 0.998529 01:00:13.900 --> 01:00:15.660 what I've been quite struck NOTE Confidence: 0.998529 01:00:15.660 --> 01:00:17.099 about is that there are NOTE Confidence: 0.998529 01:00:17.099 --> 01:00:17.840 some people NOTE Confidence: 0.9863007 01:00:18.675 --> 01:00:19.895 who actually start NOTE Confidence: 0.90302753 01:00:20.675 --> 01:00:21.575 using cannabis, NOTE Confidence: 0.99019325 01:00:22.035 --> 01:00:24.615 having experienced trauma in childhood. NOTE Confidence: 0.9982587 01:00:24.995 --> 01:00:26.375 They start using cannabis NOTE Confidence: 0.98753387 01:00:26.835 --> 01:00:28.935 later in life, particularly women NOTE Confidence: 0.8539659 01:00:29.315 --> 01:00:31.735 in, their sort of, thirties, NOTE Confidence: 0.98672795 01:00:32.515 --> 01:00:33.415 mid thirties, NOTE Confidence: 0.99977535 01:00:33.849 --> 01:00:34.670 which are NOTE Confidence: 0.7960146 01:00:35.770 --> 01:00:36.670 they they experienced NOTE Confidence: 0.89304394 01:00:36.970 --> 01:00:38.810 a very striking increase in NOTE Confidence: 0.89304394 01:00:38.810 --> 01:00:39.470 the paranoia, NOTE Confidence: 0.94304526 01:00:39.849 --> 01:00:41.690 which I was not expecting. NOTE Confidence: 0.94304526 01:00:41.690 --> 01:00:42.569 Now I don't know if NOTE Confidence: 0.94304526 01:00:42.569 --> 01:00:43.790 it's just a gender NOTE Confidence: 0.9846363 01:00:44.250 --> 01:00:45.369 thing. I don't think we NOTE Confidence: 0.9846363 01:00:45.369 --> 01:00:46.910 have enough to say, but NOTE Confidence: 0.9846363 01:00:47.195 --> 01:00:48.635 I've been going around saying NOTE Confidence: 0.9846363 01:00:48.635 --> 01:00:49.435 that it's all to do NOTE Confidence: 0.9846363 01:00:49.435 --> 01:00:51.115 with early cannabis use. I NOTE Confidence: 0.9846363 01:00:51.115 --> 01:00:51.615 mean, NOTE Confidence: 0.90174884 01:00:53.355 --> 01:00:54.635 adolescent being a critical window NOTE Confidence: 0.90174884 01:00:54.635 --> 01:00:56.315 of exposure, the brain is NOTE Confidence: 0.90174884 01:00:56.315 --> 01:00:57.515 developed and so on. But NOTE Confidence: 0.90174884 01:00:57.515 --> 01:00:58.635 in the cannabis and me NOTE Confidence: 0.90174884 01:00:58.635 --> 01:00:59.935 sample, we have quite NOTE Confidence: 0.9347531 01:01:00.339 --> 01:01:01.700 a good group of of NOTE Confidence: 0.9347531 01:01:01.700 --> 01:01:03.540 later users. Also, people that NOTE Confidence: 0.9347531 01:01:03.540 --> 01:01:04.760 have been prescribed cannabis NOTE Confidence: 0.99975014 01:01:05.140 --> 01:01:05.960 for pain NOTE Confidence: 0.9549511 01:01:06.260 --> 01:01:07.619 or for medicinal reason in NOTE Confidence: 0.9549511 01:01:07.619 --> 01:01:08.819 UK where it is now NOTE Confidence: 0.9549511 01:01:08.819 --> 01:01:09.319 legal, NOTE Confidence: 0.97501546 01:01:09.619 --> 01:01:11.220 who are actually running on NOTE Confidence: 0.97501546 01:01:11.220 --> 01:01:12.885 very high paranoia as well. NOTE Confidence: 0.97501546 01:01:13.205 --> 01:01:14.405 So I don't know. I NOTE Confidence: 0.97501546 01:01:14.405 --> 01:01:15.525 wonder if we ever look NOTE Confidence: 0.97501546 01:01:15.525 --> 01:01:16.905 at this group enough, NOTE Confidence: 0.989837 01:01:18.245 --> 01:01:19.605 and what we will find NOTE Confidence: 0.989837 01:01:19.605 --> 01:01:20.885 if we explore people of NOTE Confidence: 0.989837 01:01:20.885 --> 01:01:21.465 my age, NOTE Confidence: 0.98640597 01:01:22.085 --> 01:01:23.385 using lots of cannabis. NOTE Confidence: 0.94547904 01:01:23.765 --> 01:01:25.525 We might be surprised. But NOTE Confidence: 0.94547904 01:01:25.525 --> 01:01:27.190 Julia when Julia in in NOTE Confidence: 0.94547904 01:01:27.190 --> 01:01:29.050 Julia data with childhood adversity, NOTE Confidence: 0.9398418 01:01:29.350 --> 01:01:30.710 it is earlier than I NOTE Confidence: 0.9398418 01:01:30.710 --> 01:01:31.750 mean, I don't know how NOTE Confidence: 0.9398418 01:01:31.750 --> 01:01:33.110 you define early, but it's NOTE Confidence: 0.9398418 01:01:33.110 --> 01:01:33.610 around NOTE Confidence: 0.9736767 01:01:34.150 --> 01:01:35.770 fifteen, sixteen year of age. NOTE Confidence: 0.9987946 01:01:36.310 --> 01:01:37.370 Alright. Thank you. NOTE Confidence: 0.9319459 01:01:38.310 --> 01:01:39.510 Well, Marta Thank you very NOTE Confidence: 0.9319459 01:01:39.510 --> 01:01:41.135 much. This was an amazing NOTE Confidence: 0.9319459 01:01:41.135 --> 01:01:43.395 talk, I mean, from ready NOTE Confidence: 0.85370195 01:01:43.775 --> 01:01:44.275 epidemiological NOTE Confidence: 0.9128145 01:01:44.734 --> 01:01:47.055 data to actual clinical implic NOTE Confidence: 0.84425026 01:01:47.935 --> 01:01:48.435 implementation NOTE Confidence: 0.54541326 01:01:48.895 --> 01:01:49.215 of, NOTE Confidence: 0.98685956 01:01:50.015 --> 01:01:51.455 so I'm sure people are NOTE Confidence: 0.98685956 01:01:51.455 --> 01:01:52.575 gonna reach out to you NOTE Confidence: 0.98685956 01:01:52.575 --> 01:01:54.000 to about how to start NOTE Confidence: 0.98685956 01:01:54.000 --> 01:01:54.960 a clinic and to get NOTE Confidence: 0.98685956 01:01:54.960 --> 01:01:55.700 your guidance. NOTE Confidence: 0.9478477 01:01:56.080 --> 01:01:57.040 Would you mind if people NOTE Confidence: 0.9478477 01:01:57.040 --> 01:01:58.480 emailed you questions that we NOTE Confidence: 0.9478477 01:01:58.480 --> 01:01:59.620 won't be able to answer? NOTE Confidence: 0.9478477 01:01:59.760 --> 01:02:00.800 No. No. Not not at NOTE Confidence: 0.9478477 01:02:00.800 --> 01:02:02.960 all. And my greatest advice, NOTE Confidence: 0.9478477 01:02:02.960 --> 01:02:04.640 I don't have sophisticated advice. NOTE Confidence: 0.9478477 01:02:04.640 --> 01:02:05.440 You want to do it. NOTE Confidence: 0.9478477 01:02:05.440 --> 01:02:06.960 Start it. Don't wait and NOTE Confidence: 0.9478477 01:02:06.960 --> 01:02:08.000 think, oh, how do we NOTE Confidence: 0.9478477 01:02:08.000 --> 01:02:09.115 do it? There's no such NOTE Confidence: 0.9478477 01:02:09.115 --> 01:02:10.175 a thing as perfection. NOTE Confidence: 0.9852149 01:02:10.635 --> 01:02:11.755 Start, see how it goes, NOTE Confidence: 0.9852149 01:02:11.755 --> 01:02:12.475 and shape it all the NOTE Confidence: 0.9852149 01:02:12.475 --> 01:02:13.755 way. And and the patient NOTE Confidence: 0.9852149 01:02:13.755 --> 01:02:14.635 will tell you if you're NOTE Confidence: 0.9852149 01:02:14.635 --> 01:02:15.855 doing it right or not. NOTE Confidence: 0.9852149 01:02:15.995 --> 01:02:17.115 They they they've been the NOTE Confidence: 0.9852149 01:02:17.115 --> 01:02:19.435 main advisory group of this NOTE Confidence: 0.9852149 01:02:19.435 --> 01:02:20.715 project, I would like to NOTE Confidence: 0.9852149 01:02:20.715 --> 01:02:21.215 say. NOTE Confidence: 0.9566431 01:02:22.220 --> 01:02:23.420 Well, thank you again. We NOTE Confidence: 0.9566431 01:02:23.420 --> 01:02:24.859 really enjoyed this and this, NOTE Confidence: 0.99625254 01:02:25.339 --> 01:02:26.380 and I'll be in touch NOTE Confidence: 0.99625254 01:02:26.380 --> 01:02:27.039 with you. NOTE Confidence: 0.8794343 01:02:27.579 --> 01:02:28.539 Lovely to see you all. NOTE Confidence: 0.8794343 01:02:28.539 --> 01:02:29.339 And thank you very much. NOTE Confidence: 0.8794343 01:02:29.339 --> 01:02:30.619 You have wonderful question. Bye, NOTE Confidence: 0.8794343 01:02:30.619 --> 01:02:31.819 Cyril. See you soon. Bye. NOTE Confidence: 0.8794343 01:02:31.819 --> 01:02:32.960 See you. Thank you, everyone. NOTE Confidence: 0.9846336 01:02:33.339 --> 01:02:34.079 Bye, Wendy. NOTE Confidence: 0.90474254 01:02:34.460 --> 01:02:35.440 Bye bye, Mohini. NOTE Confidence: 0.97844857 01:02:36.140 --> 01:02:36.880 Bye, everybody.