BACKGROUND Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known. METHODS The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted). RESULTS The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding. CONCLUSIONS There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.

中文翻译：

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药用大麻治疗精神疾病：以临床为重点的系统评价。

背景技术近年来，由于全球监管变化的放松，药用大麻受到越来越多的研究关注。据报道，药用大麻在减轻疼痛、肌肉痉挛、化疗引起的恶心和呕吐以及顽固性儿童癫痫方面具有潜在功效。然而它在精神病学领域的潜在应用却鲜为人知。方法 对大麻在所有主要精神疾病中的新兴医学应用进行了首次以临床为重点的系统评价。讨论了有关全植物配方和植物源大麻素分离物在情绪、焦虑、睡眠、精神障碍和注意力缺陷/多动障碍 (ADHD) 方面的当前证据；同时还详细介绍了临床处方考虑因素（包括药物基因组学）、职业和公共卫生要素以及未来的研究建议。2019 年对文献进行了系统回顾，评估了涉及药用大麻或植物源分离物治疗所有主要精神疾病的所有案例研究和临床试验的数据（忽略了神经系统疾病和疼痛）。结果 精神病学大麻素治疗新兴领域的现有证据尚处于萌芽阶段，因此目前推荐基于大麻素的干预措施还为时过早。然而，孤立的积极研究表明，大麻素（即大麻二酚；CBD）对于减少社交焦虑有初步支持；具有辅助治疗精神分裂症的混合（主要是积极的）证据。案例研究表明，药用大麻可能有益于改善睡眠和创伤后应激障碍，但目前证据薄弱。初步研究结果表明，高 delta-9 四氢大麻酚 (THC) 疗法对抑郁症没有任何益处，对躁狂症也没有益处。一项孤立的研究表明口服大麻素/萜烯组合对多动症具有一定的潜在功效。临床处方考虑包括谨慎使用高 THC 制剂（青少年、焦虑或精神障碍患者避免使用）、逐渐滴定、定期评估以及心血管和呼吸系统疾病、怀孕和哺乳期的谨慎。结论 目前有令人鼓舞的证据表明药用大麻可以治疗一系列精神疾病，尽管还处于萌芽状态。对于一些关键菌株，正在出现支持性的发现，但是，临床医生需要注意一系列规定和职业安全考虑因素，特别是在开始使用更高剂量的 THC 配方时。