Cannabis use and symptom severity in individuals at ultra high risk for psychosis: a meta‐analysis

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Abstract

Objective

We aimed to assess whether individuals at ultra high risk ( UHR) for psychosis have higher rates of cannabis use and cannabis use disorders ( CUDs) than non‐ UHR individuals and determine whether UHR cannabis users have more severe psychotic experiences than non‐users.

Method

We conducted a meta‐analysis of studies reporting cannabis use in the UHR group and/or positive or negative symptoms among UHR cannabis users and non‐users. Logit event rates were calculated for cannabis use, in addition to odds ratios to assess the difference between UHR and controls. Severity of clinical symptoms in UHR cannabis users and non‐users was compared using Hedges’ g.

Results

Thirty unique studies were included ( UHR n = 4205, controls n = 667) containing data from cross‐sectional and longitudinal studies, and randomised control trials. UHR individuals have high rates of current (26.7%) and lifetime (52.8%) cannabis use, and CUDs (12.8%). Lifetime use and CUDs were significantly higher than controls (lifetime OR: 2.09; CUD OR: 5.49). UHR cannabis users had higher rates of unusual thought content and suspiciousness than non‐users.

Conclusion

Ultra high risk individuals have high rates of cannabis use and CUDs, and cannabis users had more severe positive symptoms. Targeting substance use during the UHR phase may have significant benefits to an individual's long‐term outcome.

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Most cited references 51

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A comparison of statistical methods for meta-analysis.

S E Brockwell, I R Gordon (2001)

Meta-analysis may be used to estimate an overall effect across a number of similar studies. A number of statistical techniques are currently used to combine individual study results. The simplest of these is based on a fixed effects model, which assumes the true effect is the same for all studies. A random effects model, however, allows the true effect to vary across studies, with the mean true effect the parameter of interest. We consider three methods currently used for estimation within the framework of a random effects model, and illustrate them by applying each method to a collection of six studies on the effect of aspirin after myocardial infarction. These methods are compared using estimated coverage probabilities of confidence intervals for the overall effect. The techniques considered all generally have coverages below the nominal level, and in particular it is shown that the commonly used DerSimonian and Laird method does not adequately reflect the error associated with parameter estimation, especially when the number of studies is small. Copyright 2001 John Wiley & Sons, Ltd.

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Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States.

Alison R Yung, Hok Pan Yuen, Patrick D McGorry … (2015)

Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI = 1.5-103.41, p = 0.0025)). The CAARMS had good to excellent reliability. In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder.

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Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

Juanita A Haagsma, Suzanne Polinder, Miranda Olff … (2012)

Background Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes. Methods We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment. Results Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL. Conclusions Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.

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Author and article information

Contributors

R. Carney:

ORCID: http://orcid.org/0000-0002-2859-6825

rebekah.carney@postgrad.manchester.ac.uk

Journal

Journal ID (nlm-ta): Acta Psychiatr Scand

Journal ID (iso-abbrev): Acta Psychiatr Scand

Journal ID (doi): 10.1111/(ISSN)1600-0447

Journal ID (publisher-id): ACPS

Title: Acta Psychiatrica Scandinavica

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0001-690X

ISSN (Electronic): 1600-0447

Publication date (Electronic): 07 February 2017

Publication date (Print): July 2017

Volume: 136

Issue: 1 ( doiID: 10.1111/acps.2017.136.issue-1 )

Pages: 5-15

Affiliations

[ ¹ ] Division of Psychology and Mental HealthUniversity of Manchester ManchesterUK

[ ² ] Division of Nursing Midwifery and Social WorkUniversity of Manchester ManchesterUK

[ ³ ]Greater Manchester West Mental Health NHS Foundation Trust ManchesterUK

Author notes

[*] [* ] Rebekah Carney, Division of Psychology and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.

E‐mail: rebekah.carney@ 123456postgrad.manchester.ac.uk

Author information

R. Carney http://orcid.org/0000-0002-2859-6825

J. Cotter http://orcid.org/0000-0002-3414-6265

Article

Publisher ID: ACPS12699

DOI: 10.1111/acps.12699

PMC ID: 5484316

PubMed ID: 28168698

SO-VID: c60154d3-0233-494b-b599-95bed8a2ffaf

License:

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 09 January 2017

Page count

Figures: 3, Tables: 2, Pages: 11, Words: 7383

Funding

Funded by: Economic and Social Research Council

Award ID: ES/J500094/1

Custom metadata

source-schema-version-number 2.0

component-id acps12699

cover-date July 2017

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.2 mode:remove_FC converted:26.06.2017

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: cannabis,ultra high risk,clinical high risk,at‐risk mental state,substance use,prodrome

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: cannabis, ultra high risk, clinical high risk, at‐risk mental state, substance use, prodrome

Cannabis use and symptom severity in individuals at ultra high risk for psychosis: a meta‐analysis

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Most cited references 51

A comparison of statistical methods for meta-analysis.

Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States.

Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

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