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Cannabis use and transition to psychosis in people at ultra-high risk

Published online by Cambridge University Press:  06 February 2014

L. R. Valmaggia*
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
F. L. Day
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
C. Jones
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
S. Bissoli
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
C. Pugh
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
D. Hall
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
S. Bhattacharyya
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
O. Howes
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
J. Stone
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
P. Fusar-Poli
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
M. Byrne
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
P. K. McGuire
Affiliation:
Institute of Psychiatry, King's College London, London, UK Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
*Corresponding
* Address for correspondence: L. R. Valmaggia, Ph.D., Institute of Psychiatry, King's College London, Box P077, De Crespigny Park, London SE5 8AF, UK. (Email: Lucia.Valmaggia@kcl.ac.uk)

Abstract

Background

Cannabis use is associated with an increased risk of developing a psychotic disorder but the temporal relationship between cannabis use and onset of illness is unclear. The objective of this study was to assess prospectively the influence of cannabis use on transition to psychosis in people at ultra-high risk (UHR) for the disorder.

Method

Lifetime and continued cannabis use was assessed in a consecutively ascertained sample of 182 people (104 male, 78 female) at UHR for psychosis. Individuals were then followed clinically for 2 years to determine their clinical outcomes.

Results

Lifetime cannabis use was reported by 134 individuals (73.6%). However, most of these individuals had stopped using cannabis before clinical presentation (n = 98, 73.1%), usually because of adverse effects. Among lifetime users, frequent use, early-onset use and continued use after presentation were all associated with an increase in transition to psychosis. Transition to psychosis was highest among those who started using cannabis before the age of 15 years and went on to use frequently (frequent early-onset use: 25%; infrequent or late-onset use: 5%; χ 2 1 = 10.971, p = 0.001). However, within the whole sample, cannabis users were no more likely to develop psychosis than those who had never used cannabis (cannabis use: 12.7%; no use: 18.8%; χ 2 1 = 1.061, p = 0.303).

Conclusions

In people at UHR for psychosis, lifetime cannabis use was common but not related to outcome. Among cannabis users, frequent use, early-onset use and continued use after clinical presentation were associated with transition to psychosis.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

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References

Addington, J, Case, N, Saleem, MM, Auther, AM, Cornblatt, BA, Cadenhead, KS (2013). Substance use in clinical high risk for psychosis: a review of the literature. Early Intervention in Psychiatry. Published online 14 November 2013 . doi: 10.1111/eip.12100.Google ScholarPubMed
Arseneault, L, Cannon, M, Poulton, R, Murray, R, Caspi, A, Moffitt, TE (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 12121213.CrossRefGoogle ScholarPubMed
Auther, AM, McLaughlin, D, Carrion, RE, Nagachandran, P, Correll, CU, Cornblatt, BA (2012). Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychological Medicine 42, 24852497.CrossRefGoogle ScholarPubMed
Barkus, EJ, Stirling, J, Hopkins, RS, Lewis, S (2006). Cannabis-induced psychosis-like experiences are associated with high schizotypy. Psychopathology 39, 175178.CrossRefGoogle ScholarPubMed
Batalla, A, Crippa, JA, Busatto, GF, Guimaraes, FS, Zuardi, AW, Valverde, O, Atakan, Z, McGuire, PK, Bhattacharyya, S, Martin-Santos, R (2013). Neuroimaging studies of acute effects of THC and CBD in humans and animals: a systematic review. Current Pharmaceutical Design. Published online 14 June 2013 . doi: 10.2174/13816128113199990432.Google Scholar
Bhattacharyya, S, Atakan, Z, Martin-Santos, R, Crippa, JA, Kambeitz, J, Prata, D, Williams, S, Brammer, M, Collier, DA, McGuire, PK (2012 a). Preliminary report of biological basis of sensitivity to the effects of cannabis on psychosis: AKT1 and DAT1 genotype modulates the effects of δ−9-tetrahydrocannabinol on midbrain and striatal function. Molecular Psychiatry 17, 11521155.CrossRefGoogle ScholarPubMed
Bhattacharyya, S, Crippa, JA, Allen, P, Martin-Santos, R, Borgwardt, S, Fusar-Poli, P, Rubia, K, Kambeitz, J, O'Carroll, C, Seal, ML, Giampietro, V, Brammer, M, Zuardi, AW, Atakan, Z, McGuire, PK (2012 b). Induction of psychosis by Δ9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Archives of General Psychiatry 69, 2736.CrossRefGoogle ScholarPubMed
Casadio, P, Fernandes, C, Murray, RM, Di Forti, M (2011). Cannabis use in young people: the risk for schizophrenia. Neuroscience and Biobehavioural Reviews 35, 17791787.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Chadwick, B, Miller, ML, Hurd, YL (2013). Cannabis use during adolescent development: susceptibility to psychiatric illness. Frontiers in Psychiatry 4, 129.CrossRefGoogle ScholarPubMed
Corcoran, CM, Kimhy, D, Stanford, A, Khan, S, Walsh, J, Thompson, J, Schobel, S, Harkavy-Friedman, J, Goetz, R, Colibazzi, T, Cressman, V, Malaspina, D (2008). Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis. Schizophrenia Research 106, 286293.CrossRefGoogle ScholarPubMed
Di Forti, M, Iyegbe, C, Sallis, H, Kolliakou, A, Falcone, MA, Paparelli, A, Sirianni, M, La Cascia, C, Stilo, SA, Marques, TR, Handley, R, Mondelli, V, Dazzan, P, Pariante, C, David, AS, Morgan, C, Powell, J, Murray, RM (2012). Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biological Psychiatry 72, 811816.CrossRefGoogle ScholarPubMed
Di Forti, M, Morgan, C, Dazzan, P, Pariante, C, Mondelli, V, Marques, TR, Handley, R, Luzi, S, Russo, M, Paparelli, A, Butt, A, Stilo, SA, Wiffen, B, Powell, J, Murray, RM (2009). High-potency cannabis and the risk of psychosis. British Journal of Psychiatry 195, 488491.CrossRefGoogle ScholarPubMed
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2013). National Report 2012: United Kingdom. EMCDDA: Lisbon.Google Scholar
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, LR, Barale, F, Caverzasi, E, McGuire, PK (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.CrossRefGoogle ScholarPubMed
Gage, SH, Zammit, S, Hickman, M (2013). Stronger evidence is needed before accepting that cannabis plays an important role in the aetiology of schizophrenia in the population. F1000 Medicine Reports 5, 2.CrossRefGoogle ScholarPubMed
Gill, KE, Poe, L, Azimov, N, Ben-David, S, Vadhan, NP, Girgis, R, Moore, H, Cressman, V, Corcoran, CM (2013). Reasons for cannabis use among youths at ultra high risk for psychosis. Early Intervention in Psychiatry. Published online 26 November 2013 . doi: 10.1111/eip.12112.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Grech, A, van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry 20, 349353.CrossRefGoogle Scholar
Hall, W, Degenhardt, L (2000). Cannabis use and psychosis: a review of clinical and epidemiological evidence. Australian and New Zealand Journal of Psychiatry 34, 2634.CrossRefGoogle Scholar
Henquet, C, Krabbendam, L, Spauwen, J, Kaplan, C, Lieb, R, Wittchen, H-U, van Os, J (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ 330, 11.CrossRefGoogle ScholarPubMed
Hermann, D, Schneider, M (2012). Potential protective effects of cannabidiol on neuroanatomical alterations in cannabis users and psychosis: a critical review. Current Pharmaceutical Design 18, 48974905.CrossRefGoogle ScholarPubMed
Jonsson, F, Freeman, J, Hinton, M, Towle, L, O'Donnell, J, Power, P (2004). Cannabis and psychosis: a clinical audit of the prevalence and persistence of cannabis use in first-episode psychosis patients attending the Lambeth Early Onset (LEO) service in London. Schizophrenia Research 70 (Suppl. 1), 72.Google Scholar
Konings, M, Henquet, C, Maharajh, HD, Hutchinson, G, van Os, J (2008). Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica 118, 209213.CrossRefGoogle ScholarPubMed
Kristensen, K, Cadenhead, KS (2007). Cannabis abuse and risk for psychosis in a prodromal sample. Psychiatry Research 151, 151154.CrossRefGoogle Scholar
Lappin, JM, Morgan, KD, Valmaggia, LR, Broome, MR, Woolley, JB, Johns, LC, Tabraham, P, Bramon, E, McGuire, PK (2007). Insight in individuals with an at risk mental state. Schizophrenia Research 90, 238244.CrossRefGoogle ScholarPubMed
Macleod, J, Oakes, R, Copello, A, Crome, I, Egger, M, Hickman, M, Oppenkowski, T, Stokes-Lampard, H, Davey Smith, G (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet 363, 15791588.CrossRefGoogle ScholarPubMed
Miller, P, Lawrie, SM, Hodges, A, Clafferty, R, Cosway, R, Johnstone, EC (2001). Genetic liability, illicit drug use, life stress and psychotic symptoms: preliminary findings from the Edinburgh Study of People at High Risk for Schizophrenia. Social Psychiatry and Psychiatric Epidemiology 36, 338342.CrossRefGoogle ScholarPubMed
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TRE, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.CrossRefGoogle ScholarPubMed
Phillips, LJ, Curry, C, Yung, AR, Yuen, HP, Adlard, S, McGorry, PD (2002). Cannabis use is not associated with the development of psychosis in an ‘ultra’ high-risk group. Australian and New Zealand Journal of Psychiatry 36, 800806.CrossRefGoogle ScholarPubMed
Rapp, C, Bugra, H, Riecher-Rossler, A, Tamagni, C, Borgwardt, S (2012). Effects of cannabis use on human brain structure in psychosis: a systematic review combining in vivo structural neuroimaging and post mortem studies. Current Pharmaceutical Design 18, 50705080.CrossRefGoogle ScholarPubMed
Rebgetz, S, Conus, P, Hides, L, Kavanagh, DJ, Cotton, S, Schimmelmann, BG, McGorry, PD, Lambert, M (2013). Predictors of substance use reduction in an epidemiological first-episode psychosis cohort. Early Intervention in Psychiatry. Published online 24 July 2013 . doi: 10.1111/eip.12067.Google Scholar
Rocchetti, M, Crescini, A, Borgwardt, S, Caverzasi, E, Politi, P, Atakan, Z, Fusar-Poli, P (2013). Is cannabis neurotoxic for the healthy brain? A meta-analytical review of structural brain alterations in non-psychotic users. Psychiatry and Clinical Neurosciences 67, 483492.CrossRefGoogle Scholar
Rubino, T, Parolaro, D (2013). Cannabis abuse in adolescence and the risk of psychosis: a brief review of the preclinical evidence. Progress in Neuropsychopharmacology and Biological Psychiatry. Published online 31 July 2013 . doi: 10.1016/j.pnpbp.2013.07.020.Google ScholarPubMed
Stefanis, NC, Dragovic, M, Power, BD, Jablensky, A, Castle, D, Morgan, VA (2013). Age at initiation of cannabis use predicts age at onset of psychosis: the 7- to 8-year trend. Schizophrenia Bulletin 39, 251254.CrossRefGoogle ScholarPubMed
Stone, JM, Fisher, HL, Major, B, Chisholm, B, Woolley, J, Lawrence, J, Rahaman, N, Joyce, J, Hinton, M, Johnson, S, Young, AH (2014). Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation. Psychological Medicine 44, 499506.CrossRefGoogle ScholarPubMed
Stowkowy, J, Addington, J (2013). Predictors of a clinical high risk status among individuals with a family history of psychosis. Schizophrenia Research 147, 281286.CrossRefGoogle ScholarPubMed
Tosato, S, Lasalvia, A, Bonetto, C, Mazzoncini, R, Cristofalo, D, De Santi, K, Bertani, M, Bissoli, S, Lazzarotto, L, Marrella, G, Lamonaca, D, Riolo, R, Gardellin, F, Urbani, A, Tansella, M, Ruggeri, M; PICOS-VENETO Group (2013). The impact of cannabis use on age of onset and clinical characteristics in first-episode psychotic patients. Data from the Psychosis Incident Cohort Outcome Study (PICOS). Journal of Psychiatric Research 47, 438444.CrossRefGoogle Scholar
United Nations Office on Drugs and Crime (2013). World Drug Report 2013. UNODC: Vienna (http://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf).Google ScholarPubMed
Valmaggia, LR, Stahl, D, Yung, AR, Nelson, B, Fusar-Poli, P, McGorry, PD, McGuire, PK (2013). Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study. Psychological Medicine 43, 23112325.CrossRefGoogle ScholarPubMed
van der Meer, FJ, Velthorst, E, Meijer, CJ, Machielsen, MW, de Haan, L (2012). Cannabis use in patients at clinical high risk of psychosis: impact on prodromal symptoms and transition to psychosis. Current Pharmaceutical Design 18, 50365044.CrossRefGoogle ScholarPubMed
van Nierop, M, Janssens, M; Genetic Risk and Outcome of Psychosis (GROUP) Investigators, Bruggeman, R, Cahn, W, de Haan, L, Kahn, RS, Meijer, CJ, Myin-Germeys, I, van Os, J, Wiersma, D (2013). Evidence that transition from health to psychotic disorder can be traced to semi-ubiquitous environmental effects operating against background genetic risk. PLOS ONE 8, e76690.CrossRefGoogle ScholarPubMed
van Os, J, Bak, M, Hanssen, M, Bijl, RV, de Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319327.CrossRefGoogle ScholarPubMed
van Winkel, R, Esquivel, G, Kenis, G, Wichers, M, Collip, D, Peerbooms, O, Rutten, B, Myin-Germeys, I, van Os, J (2010). Review: genome-wide findings in schizophrenia and the role of gene–environment interplay. CNS Neuroscience and Therapeutics 16, 185192.CrossRefGoogle ScholarPubMed
van Winkel, R; Genetic Risk and OUtcome of Psychosis (GROUP) Investigators (2011). Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis: sibling analysis and proband follow-up. Archives of General Psychiatry 68, 148157.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry Supplement 172, 1420.Google ScholarPubMed
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