Skip to main content Accessibility help
×
Home

Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation

  • J. M. Stone (a1) (a2), H. L. Fisher (a3), B. Major (a4), B. Chisholm (a5), J. Woolley (a5), J. Lawrence (a6), N. Rahaman (a7) (a8), J. Joyce (a9), M. Hinton (a10) (a11), S. Johnson (a10) (a11) and A. H. Young (a1) (a2)...

Abstract

Background

Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.

Method

Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.

Results

Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.

Conclusions

Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

Copyright

Corresponding author

* Address for correspondence: J. M. Stone, Ph.D., E517, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. (Email: james.m.stone@imperial.ac.uk)

References

Hide All
Abel, KM, Drake, R, Goldstein, JM (2010). Sex differences in schizophrenia. International Review of Psychiatry 22, 417428.
Andreasen, NC (1982). Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry 39, 784788.
Barrowclough, C, Emsley, R, Eisner, E, Beardmore, R, Wykes, T (2013). Does change in cannabis use in established psychosis affect clinical outcome? Schizophrenia Bulletin 39, 339348.
Drake, RE, Mueser, KT, McHugo, GJ (1996). Clinician rating scales: alcohol use scale (AUS), drug use scale (DUS), and substance abuse treatment scale (SATS). In Outcomes Assessment in Clinical Practice (ed. Sederer, L. I. and Dickey, B.), pp. 113116. Williams & Wilkins: Baltimore.
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976). The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766771.
Faber, G, Smid, HG, Van Gool, AR, Wunderink, L, van den Bosch, RJ, Wiersma, D (2012). Continued cannabis use and outcome in first-episode psychosis: data from a randomized, open-label, controlled trial. Journal of Clinical Psychiatry 73, 632638.
Faridi, K, Joober, R, Malla, A (2012). Medication adherence mediates the impact of sustained cannabis use on symptom levels in first-episode psychosis. Schizophrenia Research 141, 7882.
Fisher, H, Theodore, K, Power, P, Chisholm, B, Fuller, J, Marlowe, K, Aitchison, KJ, Tanna, R, Joyce, J, Sacks, M, Craig, T, Johnson, S (2008). Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Social Psychiatry and Psychiatric Epidemiology 43, 960967.
Foti, DJ, Kotov, R, Guey, LT, Bromet, EJ (2010). Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. American Journal of Psychiatry 167, 987993.
Ghali, S, Fisher, HL, Joyce, J, Major, B, Hobbs, L, Soni, S, Chisholm, B, Rahaman, N, Papada, P, Lawrence, J, Bloy, S, Marlowe, K, Aitchison, KJ, Power, P, Johnson, S (2012). Ethnic variations in pathways into early intervention services for psychosis. British Journal of Psychiatry. Published online 6 09 2012 . doi:bjp.bp.111.097865.
Gonzalez-Pinto, A, Alberich, S, Barbeito, S, Gutierrez, M, Vega, P, Ibanez, 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.
Grech, A, Van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349353.
Henquet, C, Krabbendam, L, de Graaf, R, ten Have, M, van Os, J (2006). Cannabis use and expression of mania in the general population. Journal of Affective Disorders 95, 103110.
Ihaka, R, Gentleman, R (1996). R: a language for data analysis and graphics. Journal of Computational and Graphical Statistics 5, 299314.
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Krishnadas, R, Jauhar, S, Telfer, S, Shivashankar, S, McCreadie, RG (2012). Nicotine dependence and illness severity in schizophrenia. British Journal of Psychiatry 201, 306312.
Kuepper, R, van Os, J, Lieb, R, Wittchen, HU, Höfler, M, Henquet, C (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. British Medical Journal 342, d738.
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555561.
Manrique-Garcia, E, Zammit, S, Dalman, C, Hemmingsson, T, Andreasson, S, Allebeck, P (2012). Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort. Psychological Medicine 42, 13211328.
Mullin, K, Gupta, P, Compton, MT, Nielssen, O, Harris, A, Large, M (2012). Does giving up substance use work for patients with psychosis? A systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 46, 826839.
Murray, RM, Morrison, PD, Henquet, C, Di Forti, M (2007). Cannabis, the mind and society: the hash realities. Nature Reviews Neuroscience 8, 885895.
Strakowski, SM, DelBello, MP, Fleck, DE, Adler, CM, Anthenelli, RM, Keck, PE Jr, Arnold, LM, Amicone, J (2007). Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Archives of General Psychiatry 64, 5764.
van Dijk, D, Koeter, MW, Hijman, R, Kahn, RS, van den Brink, W (2012). Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Schizophrenia Research 137, 5057.
van Rossum, I, Boomsma, M, Tenback, D, Reed, C, van Os, J; EMBLEM Advisory Board (2009). Does cannabis use affect treatment outcome in bipolar disorder? A longitudinal analysis. Journal of Nervous and Mental Disease 197, 3540.
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.
Zammit, S, Moore, TH, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2008). Effects of cannabis use on outcomes of psychotic disorders: systematic review. British Journal of Psychiatry 193, 357363.
Zhang, XY, Chen, DC, Xiu, MH, Haile, CN, He, SC, Luo, X, Zuo, L, Rosenheck, R, Kosten, TA, Kosten, TR (2012). Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case–control study. Psychological Medicine. Published online 13 11 2012 . doi:10.1017/S0033291712002590.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed