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Cannabis and cognitive performance in psychosis: a cross-sectional study in patients with non-affective psychotic illness and their unaffected siblings

  • J. H. Meijer (a1), N. Dekker (a1), M. W. Koeter (a2), P. J. Quee (a3), N. J. M. van Beveren (a4), C. J. Meijer (a1) and Genetic Risk and Outcome of Psychosis (GROUP) Investigators...



The relationship between cannabis use and cognitive functioning in patients with psychosis has yielded contradictory findings. In individuals at genetic high risk for psychosis, information is sparse. The aim of this study was to assess the association between recency and frequency of cannabis use and cognitive functioning in patients with psychosis and their unaffected siblings.


We conducted a cross-sectional study in 956 patients with non-affective psychosis, 953 unaffected siblings, and 554 control subjects. Participants completed a cognitive test battery including assessments of verbal learning, set shifting, sustained attention, processing speed, working memory, acquired knowledge, reasoning and problem solving and social cognition. Cannabis use was assessed by urinalysis and by the Composite International Diagnostic Interview. Using random-effect regression models the main effects of cannabis (recency and frequency) and the interaction with status (patient, sibling, control) on cognitive functioning were assessed.


Current cannabis use was associated with poorer performance on immediate verbal learning, processing speed and working memory (Cohen's d −0.20 to −0.33, p<0.005). Lifetime cannabis use was associated with better performance on acquired knowledge, facial affect recognition and face identity recognition (Cohen's d+0.17 to +0.33, p<0.005). There was no significant interaction between cannabis and status on cognitive functioning.


Lifetime cannabis-using individuals might constitute a subgroup with a higher cognitive potential. The residual effects of cannabis may impair short-term memory and processing speed.


Corresponding author

*Address for correspondence: L. de Haan (GROUP Investigator), AMC-Academisch Psychiatrisch Centrum, Postbus 75867, 1070 AW Amsterdam, The Netherlands. (Email:


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Andreasen, NC, Flaum, M, Arndt, S (1992). The Comprehensive Assessment of Symptoms and History (CASH): an instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.
Barnes, TR, Mutsatsa, SH, Hutton, SB, Watt, HC, Joyce, EM (2006). Comorbid substance use and age at onset of schizophrenia. British Journal of Psychiatry 188, 237242.
Benton, AL, Sivan, AB, Hamsher, K, Varney, NR, Spreen, O (1983). Benton's Test of Facial Recognition. Oxford University Press: New York.
Bersani, G, Orlandi, V, Kotzalidis, GD, Pancheri, P (2002). Cannabis and schizophrenia: impact on onset, course, psychopathology and outcomes. European Archives of Psychiatry and Clinical Neuroscience 252, 8692.
Bilder, RM, Turkel, E, Lipschutz-Broch, L, Lieberman, (1992). Antipsychotic medication effects on neuropsychological functions. Psychopharmacological Bulletin 28, 353366.
Brand, N, Jolles, J (1985). Learning and retrieval rate of words presented auditorily and visually. Journal of General Psychology 112, 201210.
Caspi, A, Moffitt, TE, Cannon, M, McClay, J, Murray, R, Harrington, H, Taylor, A, Arseneault, L, Williams, B, Braithwaite, A, Poulton, R, Craig, IW (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biological Psychiatry 57, 11171127.
Castle, D (2008). Drawing conclusions about cannabis and psychosis. Psychological Medicine 38, 459460.
Cohen, M, Solowij, N, Carr, V (2008). Cannabis, cannabinoids and schizophrenia: integration of the evidence. Australian and New Zealand Journal of Psychiatry 42, 357368.
Coulston, CM, Perdices, M, Tennant, CC (2007 a). The neuropsychological correlates of cannabis use in schizophrenia: lifetime abuse/dependence, frequency of use, and recency of use. Schizophrenia Research 96, 169184.
Coulston, CM, Perdices, M, Tennant, CC (2007 b). The neuropsychology of cannabis and other substance use in schizophrenia: review of the literature and critical evaluation of methodological issues. Australian and New Zealand Journal of Psychiatry 41, 869884.
D'Souza, DC, Abi-Saab, WM, Madonick, S, Forselius-Bielen, K, Doersch, A, Braley, G, Gueorguieva, R, Cooper, TB, Krystal, JH (2005). Delta-9-tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry 57, 594608.
de la Serna, E, Baeza, I, Toro, J, Andres, S, Puig, O, Sanchez-Guistau, V, Romero, S, Bernardo, M, Castro-Fornieles, J (2010). Relationship between clinical and neuropsychological characteristics in child and adolescent first degree relatives of subjects with schizophrenia. Schizophrenia Research 116, 159167.
DeRosse, P, Kaplan, A, Burdick, KE, Lencz, T, Malhotra, AK (2010). Cannabis use disorders in schizophrenia: effects on cognition and symptoms. Schizophrenia Research 120, 95–100.
Ehrenreich, H, Rinn, T, Kunert, HJ, Moeller, MR, Poser, W, Schilling, L, Gigerenzer, G, Hoehe, MR (1999). Specific attentional dysfunction in adults following early start of cannabis use. Psychopharmacology (Berlin) 142, 295301.
Fergusson, DM, Boden, JM (2008). Cannabis use and later life outcomes. Addiction 103, 969976.
Fernandez-Serrano, MJ, Perez-Garcia, M, Verdejo-Garcia, A (2011). What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neuroscience and Biobehavioral Reviews 35, 377406.
Fried, PA, Watkinson, B, Gray, R (2005). Neurocognitive consequences of marihuana – a comparison with pre-drug performance. Neurotoxicology and Teratology 27, 231239.
Genetic Risk and Outcome of Psychosis (GROUP) Investigators (2011). Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient–sibling and sibling–control pairs. Archives of General Psychiatry 68, 138147.
González-Pinto, A, Alberich, S, Barbeito, S, Gutierrez, M, Vega, P, Ibáñez, B, Haidar, MK, Vieta, E, Arango, C (2011). Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophrenia Bulletin 37, 631639.
Grant, I, Gonzalez, R, Carey, CL, Natarajan, L, Wolfson, T (2003). Non-acute (residual) neurocognitive effects of cannabis use: a meta-analytic study. Journal of the International Neuropsychological Society 9, 679689.
Green, MF (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321330.
Hanley, JA, Negassa, A, Edwardes, MD, Forrester, JE (2003). Statistical analysis of correlated data using generalized estimating equations: an orientation. American Journal of Epidemiology 157, 364375.
Henquet, C, Rosa, A, Krabbendam, L, Papiol, S, Fananás, L, Drukker, M, Ramaekers, JG, van Os, J (2006). An experimental study of catechol-O-methyltransferase Val158Met moderation of Δ-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology 31, 27482757.
Ilan, AB, Smith, ME, Gevins, A (2004). Effects of marijuana on neurophysiological signals of working and episodic memory. Psychopharmacology (Berlin) 176, 214222.
Jockers-Scherubl, MC, Wolf, T, Radzei, N, Schlattmann, P, Rentzsch, J, Gomez-Carrillo, de CA, Kuhl, KP (2007). Cannabis induces different cognitive changes in schizophrenic patients and in healthy controls. Progress in Neuropsychopharmacology and Biological Psychiatry 31, 10541063.
Joyal, CC, Halle, P, Lapierre, D, Hodgins, S (2003). Drug abuse and/or dependence and better neuropsychological performance in patients with schizophrenia. Schizophrenia Research 63, 297299.
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive And Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.
Liraud, F, Verdoux, H (2002). Effect of comorbid substance use on neuropsychological performance in subjects with psychotic or mood disorders. Encephale 28, 160168.
Loberg, EM, Hugdahl, K (2009). Cannabis use and cognition in schizophrenia. Frontiers in Human Neuroscience. Published online: 24 November 2009. doi: 10.3389/neuro.09.053.2009.
Lynskey, M, Hall, W (2000). The effects of adolescent cannabis use on educational attainment: a review. Addiction 95, 16211630.
Macleod, J (2007). Cannabis use and symptom experience amongst people with mental illness: a commentary on Degenhardt et al. Psychological Medicine 37, 913916.
Mata, I, Rodriguez-Sanchez, JM, Pelayo-Teran, JM, Perez-Iglesias, R, Gonzalez-Blanch, C, Ramirez-Bonilla, M, Martinez-Garcia, O, Vazquez-Barquero, JL, Crespo-Facorro, B (2008). Cannabis abuse is associated with decision-making impairment among first-episode patients with schizophrenia-spectrum psychosis. Psychological Medicine 38, 12571266.
Morrison, PD, Zois, V, McKeown, DA, Lee, TD, Holt, DW, Powell, JF, Kapur, S, Murray, RM (2009). The acute effects of synthetic intravenous Δ9-tetrahydrocannabinol on psychosis, mood and cognitive functioning. Psychological Medicine 39, 16071616.
Mueser, KT, Drake, RE, Wallach, MA (1998). Dual diagnosis: a review of etiological theories. Addictive Behaviors 23, 717734.
National Institute of Mental Health (1992). Genetics Initiative: Family Interview for Genetic Studies (FIGS). National Institute of Mental Health: Rockville, MD.
Nolan, KA, Bilder, RM, Lachman, HM, Volavka, J (2004). Catechol O-methyltransferase val158met polymorphism in schizophrenia: differential effects of val and met alleles on cognitive stability and flexibility. American Journal of Psychiatry 161, 359361.
Nuechterlein, KHR, Dawson, ME (1984). Information processing and attentional functioning in the developmental course of schizophrenics disorders. Schizophrenia Bulletin 10, 160203.
Palmer, BW, Dawes, SE, Heaton, RK (2009). What do we know about neuropsychological aspects of schizophrenia? Neuropsychology Review 19, 365384.
Pencer, A, Addington, J (2003). Substance use and cognition in early psychosis. Journal of Psychiatry and Neuroscience 28, 4854.
Perkonigg, A, Goodwin, RD, Fiedler, A (2008). The natural course of cannabis use, abuse and dependence during the first decades of life. Addiction 103, 439449.
Pertwee, RG (2008). The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: Δ9-tetrahydrocannabinol, cannabidiol and Δ9-tetrahydrocannabivarin. British Journal of Pharmacology 153, 199215.
Pope, HG Jr., Gruber, AJ, Hudson, JI, Huestis, MA, Yurgelun-Todd, D (2002). Cognitive measures in long-term cannabis users. Journal of Clinical Pharmacology 42, 41S47S.
Potvin, S, Briand, C, Prouteau, A, Bouchard, RH, Lipp, O, Lalonde, P, Nicole, L, Lesage, A, Stip, E (2005). CANTAB explicit memory is less impaired in addicted schizophrenia patients. Brain and Cognition 59, 3842.
Potvin, S, Joyal, CC, Pelletier, J, Stip, E (2008). Contradictory cognitive capacities among substance-abusing patients with schizophrenia: a meta-analysis. Schizophrenia Research 100, 242251.
Ramaekers, JG, Kauert, G, Theunissen, EL, Toennes, SW, Moeller, MR (2009). Neurocognitive performance during acute THC intoxication in heavy and occasional cannabis users. Journal of Psychopharmacology 23, 266277.
Ringen, PA, Vaskinn, A, Sundet, K, Engh, JA, Jonsdottir, H, Simonsen, C, Friis, S, Opjordsmoen, S, Melle, I, Andreassen, OA (2010). Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia. Psychological Medicine 40, 13371347.
Rodriguez-Sanchez, JM, Ayesa-Arriola, R, Mata, I, Moreno-Calle, T, Perez-Iglesias, R, Gonzalez-Blanch, C, Perianez, JA, Vazquez-Barquero, JL, Crespo-Facorro, B (2010). Cannabis use and cognitive functioning in first-episode schizophrenia patients. Schizophrenia Research 124, 142151.
Ruiz-Veguilla, M, Gurpegui, M, Barrigon, ML, Ferrin, M, Marin, E, Rubio, JL, Gutierrez, B, Pintor, A, Cervilla, J (2009). Fewer neurological soft signs among first episode psychosis patients with heavy cannabis use. Schizophrenia Research 107, 158164.
Schnell, T, Koethe, D, Daumann, J, Gouzoulis-Mayfrank, E (2009). The role of cannabis in cognitive functioning of patients with schizophrenia. Psychopharmacology (Berlin) 205, 4552.
Scholes, KE, Martin-Iverson, MT (2010). Cannabis use and neuropsychological performance in healthy individuals and patients with schizophrenia. Psychological Medicine 40, 16351646.
Sevy, S, Burdick, KE, Visweswaraiah, H, Abdelmessih, S, Lukin, M, Yechiam, E, Bechara, A (2007). Iowa gambling task in schizophrenia: a review and new data in patients with schizophrenia and co-occurring cannabis use disorders. Schizophrenia Research 92, 7484.
Smith, MJ, Barch, DM, Wolf, TJ, Mamah, D, Csernansky, JG (2008). Elevated rates of substance use disorders in non-psychotic siblings of individuals with schizophrenia. Schizophrenia Research 106, 294299.
Snitz, BE, Macdonald, AW III, Carter, CS (2006). Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophrenia Bulletin 32, 179194.
Solowij, N, Michie, PT (2007). Cannabis and cognitive dysfunction: parallels with endophenotypes of schizophrenia? Journal of Psychiatry and Neuroscience 32, 3052.
Stirling, J, Lewis, S, Hopkins, R, White, C (2005). Cannabis use prior to first onset psychosis predicts spared neurocognition at 10-year follow-up. Schizophrenia Research 75, 135137.
Tellegen, PJ (2003). De betrouwbaarheid en validiteit van de WAIS-III NL [The reliability and validity of WAIS-III NL]. De Psycholoog 38, 128132.
Van Holst, RJ, Schilt, T (2011). Drug-related decrease in neuropsychological functions of abstinent drug users. Current Drug Abuse Reviews 4, 4256.
Van 't Wout, M, Aleman, A, Kessels, RPC, Larøi, F, Kahn, RS (2004). Emotional processing in a non-clinical psychosis-prone sample. Schizophrenia Research 68, 271281.
van Winkel, R, Genetic Risk and Outcome of Psychosis (GROUP) Investigators (2011). Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis. Archives of General Psychiatry 68, 148157.
Verrico, CD, Jentsch, JD, Roth, RH (2003). Persistent and anatomically selective reduction in prefrontal cortical dopamine metabolism after repeated, intermittent cannabinoid administration to rats. Synapse 49, 6166.
Versmissen, D, Janssen, I, Myin-Germeys, I, Mengelers, R, Campo, JA, van Os, J, Krabbendam, L (2008). Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophrenia Research 99, 103110.
WHO (1990). Composite International Diagnostic Interview. World Health Organization: Geneva.
Wechsler, D (1997). WAIS-III: Wechsler Adult Intelligence Scale, 3rd edn.Administration and Scoring Manual. Psychological Corporation: San Antonio, TX.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.
Yücel, M, Bora, E, Lubman, DI, Solowij, N, Brewer, WJ, Cotton, SM, Conus, P, Takagi, MJ, Fornito, A, Wood, SJ, McGorry, PD, Pantelis, C (2010). The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample. Schizophrenia Bulletin. Published online 25 July 2010. doi: 10.1093/schbul/sbq079.
Zubin, J, Spring, B (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103126.



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