Recovery is a widely discussed concept in the field of research, treatment, and public policy regarding serious mental illness, and mainly schizophrenia. Aim of our study was to assess the relationship between personal recovery and prediction variables, as psychopathology, neurocognition, clinical and cognitive insight, and social functioning in inpatients affected by schizophrenia, with a special interest on cognitive insight. We assessed 76 inpatients affected by schizophrenia at their hospital discharge. Instruments included the Beck Cognitive Insight Scale, the Insight Scale and the Recovery Assessment Scale to assess the cognitive and clinical insight, and personal recovery. The neurocognitive assessment was represented by a single factor score produced by a principal components analysis of a neurocognitive test battery. Social functioning was measured also. Low self-reflectiveness of cognitive insight represented the best predictors of personal recovery. The relationship between cognitive insight and recovery found in this study may contribute to develop tailored interventions, taking into account the personal sense of recovery, despite the psychopathological evaluation.

Objectives The aim of this study is to review the most recent literature data regarding association between use of cannabis and psychotic disorders, especially highlighting epidemiological, neurobiological and clinical data.Methods A MEDLINE search of the international literature data was performed. The following keywords were used: "cannabis use", "onset psychosis", "high risk of psychosis", "at risk mental state", "epidemiology", "neurobiology" and "clinical features". All studies from the years 2000 to 2011, except for epidemiological studies, were selected. Finally, the most relevant literature was chosen.Results Cannabis use is associated with a 2- to 3- fold increase in the relative risk for psychosis in individuals with familial and genetic vulnerability. The results of several prospective studies also show a dose-response relationship between exposure to cannabis and the risk of psychosis after exposure. Many neurobiological studies reported that the Delta(9)-tetrahydrocannabinol (Delta(9)-THC) is the component of cannabis with the most psychotropic effects that can mediate psychotic onset through alteration of the endocannabinoid signal. A key role in genetic vulnerability to these effects is supported by polymorphisms of the gene for catechol-Omethyl-transferase (i.e., the presence of the gene variant Val/Val compared to Met/Met). More recent studies have shown how the use of cannabis preparations with higher concentrations of Delta(9)-THC (e.g., skunk vs. resin vs. leaves) is more associated with onset of psychosis.Conclusions According to literature data, we predict an increase in the rates of psychosis over the next 10 years. However, the possibility to eliminate the cannabis use is fairly remote, and clinicians should concentrate their attention on individuals with genetic vulnerability for psychosis and adolescents. In this latter population, increased use and reduction in the age of first consumption has been observed. Therefore, prevention campaigns in schools to reduce the use of cannabis and the risk of psychopathological consequences linked to it are needed. In subjects at risk for psychosis, defined according to the genetic risk (family) for psychosis or the presence of an at-risk mental state, proper psychoeducation on cannabis use is necessary to prevent the onset of overt symptoms and improve long-term outcomes.

Scopo. Lo scopo dello studio è valutare l’influenza dell’uso di cannabis sul quadro psicopatologico, sulla sua gravità e sul funzionamento globale di soggetti all’esordio di un disturbo psicotico, schizofrenico o affettivo, o con uno stato mentale a rischio. Materiali e metodi. Sono stati reclutati 67 soggetti afferenti consecutivamente al Servizio di Monitoraggio e Intervento precoce per la Lotta agli Esordi della sofferenza mentale e psicologica nei giovani (SMILE) di L’Aquila con diagnosi (DSM-IV) di esordio dello spettro bipolare (N=49), esordio dello spettro schizofrenico (N=5) e di stato mentale a rischio (N=13) secondo i criteri della Comprehensive Assessment of At-Risk Mental States (CAARMS). Il campione totale è stato suddiviso in due gruppi: Gruppo 1, formato da 30 soggetti con uso di cannabinoidi, e Gruppo 2, di 37 soggetti che non avevano mai fatto uso della sostanza. Sono stati utilizzati i seguenti strumenti di valutazione: Self Report Symptom Inventory-90 (SCL-90); la scala per la Valutazione Globale dei Funzionamento (VGF); la Clinical Global Impressions-Severity (CGI-S). È stato, inoltre, indagato l’uso di cannabis nell’ultimo mese. Risultati. I soggetti del Gruppo 1 presentavano punteggi medi significativamente più elevati alle dimensioni della SCL-90 aggressività e psicoticismo e alla CGI-S. La dimensione psicoticismo della SCL-90 e un punteggio maggiore alla CGI-S sembrano discriminare il Gruppo 1. Conclusioni. La valutazione dell’uso di cannabis in soggetti con esordio psicotico, schizofrenico o bipolare, e con SMR sembra aggiungere informazioni cliniche alla descrizione psicopatologica e diagnostica, distinguendo un sottogruppo di soggetti all’esordio. Tale informazione dovrebbe essere “incorporata” nei modelli di scelta del trattamento e di valutazione delle prognosi.

AIM:The aim of the study is to assess the correlations between cannabis use and psychopathological features, disorder severity and global functioning in subjects with onset psychosis (schizophrenic and bipolar psychosis) and at risk mental state.MATERIALS AND METHODS:Sixty-seven consecutive subjects with diagnosis of bipolar spectrum disorder (N=49), schizophrenic spectrum disorder (N=5) and at risk mental state (N=13) were recruited from the SMILE (Service for Monitoring and early Intervention Looking at the fight against the onset of mental Even psychological youths' suffering). All subjects were assessed with the Self Report Symptom Inventory-90 (SCL-90), the Global Assessment of Functioning scale (GAF) and Clinical Global Impressions-Severity (CGI-S). Moreover, they were assessed for the cannabis use in the last month.RESULTS:The total sample was splitted in two groups: Group 1 of cannabis use subjects (N=30) and Group 2 of no cannabis use subjects (N=37). Group 1 subjects showed significant higher scores at psychoticism SCL-90 dimension and at CGI-S than Group 2 subjects. The higher scores at anger/hostility and psychoticism SCL-90 dimensions and at CGI-S seem to be discriminant features of Group 1 cannabis use subjects.CONCLUSIONS:The data reported suggest that cannabis use assessment in onset psychosis (bipolar and schizophrenic onset) and at risk mental state could add clinical information to the psychopathological and diagnostic description. Such information should be ''incorporated'' in the treatment choice model and outcome prediction assessment.