01_ICNS_Mar-Apr_2016Dear Colleagues:

Welcome to the March–April 2016 issue of Innovations in Clinical Neuroscience (ICNS). Attitudes regarding marijuana use have changed dramatically over the past 50-plus years in the United States. According to data from the Pew Research Center, support for the legalization of marijuana has gone from 12 percent of the American population in favor of legalization in 1969 to 53 percent in 2015.[1] As of today, nearly half of American states allow the distribution and use of marijuana for medical purposes, 14 states have decriminalized marijuana use, and four states have passed measures to fully legalize marijuana.[1] As social and legal acceptance of marijuana use increases, it may be judicious for healthcare clinicians to become familiar with the latest news, trends, and research on marijuana use and the effects it may have on their patients. With this in mind, we start this issue of ICNS off with two articles that explore the evidence regarding the effects marijuana use, medically and recreationally.

In the first article, MacDonald and Pappas provide a comprehensive review titled, “Why Not Pot? A Review of the Brain-based Risks of Cannabis.” Here, the authors discuss the evidence-based negative effects marijuana use can have on the human brain, particularly among the adolescent, chronic use, and mentally ill populations. In the second article, the “Hot Topics in Neuroscience” column by Kolikanda et al examines the evidence regarding the use of marijuana for treatment-refractory epilepsy. Both articles indicate a need for caution and careful consideration when treating patients who use marijuana for social or medical reasons; the negative effects of marijuana may outweigh the positive, especially in certain populations.

Following these two articles, Bossie et al present the results of their study that examined the inter-rater reliability of ASPECT-R, a tool designed to help researchers understand the pragmatic-explanatory nature of completed or planned trials. The study showed a total score of inter-rater reliability as “excellent,” and the tool achieved “excellent to good” inter-rater reliability for most of the domains examined. Two of the domains, however, received a “fair” to “poor” score for inter-rater reliability, which, according to the authors, may indicate a need for improved domain definition, anchoring, or training materials.

Next, Spiegel et al describe a case of transient amnesia and provide a detailed neurobiological discussion in their article, “A Case of Transient Global Amnesia: A Review and How It May Shed Further Insight into the Neurobiology of Delusions.” Here, the authors present a case of a woman with a history of vascular disease and anxiety who suffered an episode of paranoid delusions that presented suddenly and quickly resolved, followed by amnesia of the event. The authors describe the differential diagnoses of the patient, discuss their ischemia-mediated hypothesis for the pathogenesis of transient global amnesia, and provide insight into the neurobiology of delusion.

And finally, in this month’s “Risk Management” column, McNary provides legal perspective regarding the challenges of managing a suicidal patient in a split-treatment relationship.

We hope you enjoy the issue. As always, we welcome your feedback and submissions.


Amir Kalali, MD
Editor, Innovations in Clinical Neuroscience

1. Motel S. Six facts about marijuana. Pew Research Center. http://www.pewresearch.org/fact-tank/2015/04/14/6-facts-about-marijuana/. Accessed April 1, 2016.