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This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Contextual Processing in Psychosis and Cannabis use Kane, Fergus Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 05. Oct. 2021 This electronic theses or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Title: Contextual Processing in Psychosis and Cannabis use Author: Kane, Fergus The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENSE AGREEMENT This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. http://creativecommons.org/licenses/by-nc-nd/3.0/ You are free to: Share: to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Volume I THESIS AND SERVICE PROJECT Dr Fergus Kane Thesis submitted in partial fulfilment of the degree of Doctorate in Clinical Psychology Institute of Psychiatry, King’s College London May 2012 Acknowledgements Many people have supported me during the process of completing this thesis, service project and case studies. However, before acknowledging all the wonderful people who have supported me, I must first apportion some blame; in particular to my brother, David, who one Christmas, showed me a paper by his PhD supervisor, Steven Dakin. The paper involved a fusion of two fascinating topics, psychosis and illusions. A brief discussion later, and we were wondering how this might fit with the effects of psychoactive drugs such as cannabis. Although I must accept some responsibility for what has happened since, David provided the triggering event. Some responsibility however, also lies with Paul Morrison and his team of cannabis researchers, who kindly let me bring my ideas to their study of the effects of cannabis compounds. Paul, Amir Englund, Judith Nottage, Dom Hague and Dominic ffytche were not only excellent collaborators, but also provided hours of stimulating conversation, some of which was about work. Similarly, I’d like to thank Oliver Suendermann, my good friend and collaborator on the second study of this Thesis. Without his help, this second study could simply not have happened. I’d like to acknowledge my two thesis supervisors, Suzanne Jolley and Dave Hemsley. Suzanne was everything one could wish for in a supervisor: kind, generous with her time, quick to respond, challenging and always helpful. Dave, although retired, kindly agreed to be my second supervisor and like Suzanne, could not have been a better choice. Dave’s knowledge of the literature, both past and present was a great help – he really did provide the context I needed to make sense of my work. More generally, thanks must go to my placement supervisors, Jerome Carson, Kitty Kwan, Sarah Addison, Catherine Jackman, Eric Morris, Nicola Reynolds and Laura Goldstein. To my Clinical Psychology coursemates, you’ve made this journey so much more in so many ways than it would have been without you. It’s been a real privilege to share my training with you. 2 To my family, once again, thank you for all your support and for providing a calm retreat for writing. This is the last thesis, I promise. Finally to Maria. Thank you for everything. I do not know a kinder and more generous person. 3 Contents of Volume I Main Thesis: Contextual Processing in Psychosis and Cannabis 6 use. Service Project. An Audit of Neuropsychological and 137 Psychometric Measures in South London and Maudsley National and Specialist Child Services 4 Main Thesis Contextual Processing in Psychosis and Cannabis use. Dr Fergus Kane Primary Supervisor: Dr Suzanne Jolley Secondary Supervisor: Professor David Hemsley 5 Abstract Introduction Cognitive models of psychosis highlight the role of underlying differences in cognitive function and information processing in the development and maintenance of psychotic symptoms. As a result there is now an interest in developing a greater understanding of these cognitive changes, in order to guide the development of evidence-based therapeutic interventions. An influential cognitive model of psychosis suggests that the core underlying cognitive difference in psychosis may be one of altered contextual processing. Recent work has suggested that this may be reflected in differential perception of visual illusions. However, it is not clear if such differences are present early in the development of psychosis. Such differences have also been reported to be associated with cannabis use. Further, it has been suggested that, in addition to being risk factors for the development of psychosis, psychoactive substances such as cannabis may provide a useful model for understanding psychosis. The current thesis thus investigated, in two separate studies: (1) the consequences of cannabis use on contextual visual processing and (2), whether reported contextual processing differences in psychosis are present at illness onset. Study One Two main hypotheses were tested. A. That THC, a key cannabis compound would reduce contextual visual suppression as measured using the Chubb illusion, and that this effect would be reduced via pre-treatment with another cannabis compound, cannabidiol (CBD). B. That THC would transiently induce symptoms of psychosis and that this increase would be reduced via CBD pre-treatment. No evidence was found to support the primary hypothesis. However, the secondary hypothesis was supported by the data. Study Two The primary hypothesis was that contextual visual suppression, again measured with the Chubb illusion, would be reduced in patients with first episode psychosis relative to a control group. Although not significant, the data supported this hypothesis. Discussion The results of Study One indicate that THC does not reduce visual contextual suppression as measured by the Chubb illusion. This is in contrast to evidence from other illusions, 6 and may reflect different neural mechanisms underlying contextual visual processing. However, the study provided clear evidence that THC can induce psychotic symptoms and that this effect can be reduced by CBD pre-treatment. Study Two replicates previous findings of reduced contextual processing in psychosis and provides evidence that this may be present from the onset of illness. These findings are discussed and interpreted with regards to study limitations, clinical implications and future work. 7 Table of Contents 1 INTRODUCTION 15 2 LITERATURE REVIEW 16 2.1 THE VALIDITY AND UTILITY OF THE TERM ‘SCHIZOPHRENIA’. 16 2.2 DIFFERENCES OF INFORMATION PROCESSING IN SCHIZOPHRENIA. 18 2.2.1 CONTEXT, SALIENCE AND DOPAMINE 19 2.3 COGNITIVE FUNCTION AND PSYCHOSIS: A BAYESIAN FRAMEWORK 22 2.3.1 THE BAYESIAN BRAIN: A VERY BRIEF PRIMER 22 2.3.2 THE BAYESIAN BRAIN: HOW IT MIGHT (NOT) WORK. 23 2.3.3 HALLUCINATIONS VS. PERCEPTUAL DISTORTIONS. A NOTE 25 2.3.4 VISUAL CONTEXT PROCESSING IN PSYCHOSIS. 26 2.3.5 SCHIZOPHRENIA SUBTYPES AND CONTEXT PROCESSING 32 2.4 CANNABIS AS A MODEL FOR UNDERSTANDING PSYCHOSIS 33 2.4.1 PHENOMENOLOGICAL SIMILARITIES BETWEEN DRUG INTOXICATION AND PSYCHOTIC DISORDERS. 34 2.4.2 CANNABIS AND THE CANNABINOID SYSTEM 36 2.4.2.1 Delta-9-tetrahydrocannabinol (Δ9-THC) 36 2.4.2.2 Cannabidiol (CBD) 37 2.4.2.3 A Potent Change 37 2.4.2.4 Subjective Effects of Cannabis 37 2.4.3 A BAYESIAN INTERPRETATION OF THE PSYCHOTOMIMETIC EFFECTS OF CANNABIS 39 2.4.3.1 Hallucinations. 41 2.4.3.2 Experimental Evidence of Cannabis Induced Reductions of Top-Down Processing 41 2.4.4 CANNABIS AND PSYCHOSIS: EVIDENCE OF A CAUSAL LINK. 42 3 AIMS AND HYPOTHESES 45 3.1 STUDY 1: THE EFFECTS OF THC AND CBD ON A TASK ENGAGING TOP-DOWN PROCESSING. 45 3.1.1 HYPOTHESES: 46 3.2 STUDY 2: AN INVESTIGATION OF CONTEXTUAL PROCESSING IN FIRST EPISODE PSYCHOSIS. 47 3.2.1 HYPOTHESES: 47 8 4 STUDY ONE. THE EFFECTS OF CANNABINOIDS ON CONTEXTUAL PROCESSING AND PSYCHOSIS SYMPTOMS 48 4.1 METHODS 48 4.1.1 ETHICAL APPROVAL AND CONSENT.