Influence of cannabis use on incidence of psychosis in people at clinical high risk

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Abstract

Aims

Evidence for case–control studies suggests that cannabis use is a risk factor for the development of psychosis. However, there have been limited prospective studies and the direction of this association remains controversial. The primary aim of the present study was to examine the association between cannabis use and the incidence of psychotic disorders in people at clinical high risk of psychosis. Secondary aims were to assess associations between cannabis use and the persistence of psychotic symptoms, and with functional outcome.

Methods

Current and previous cannabis use were assessed in individuals at clinical high risk of psychosis ( n = 334) and healthy controls ( n = 67), using a modified version of the Cannabis Experience Questionnaire. Participants were assessed at baseline and followed up for 2 years. Transition to psychosis and persistence of psychotic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States criteria. Level of functioning at follow up was assessed using the Global Assessment of Functioning disability scale.

Results

During follow up, 16.2% of the clinical high-risk sample developed psychosis. Of those who did not become psychotic, 51.4% had persistent symptoms and 48.6% were in remission. There was no significant association between any measure of cannabis use at baseline and either transition to psychosis, the persistence of symptoms, or functional outcome.

Conclusions

These findings contrast with epidemiological data that suggest that cannabis use increases the risk of psychotic disorder.

Related collections

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The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

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Author and article information

Journal

Journal ID (nlm-journal-id): 9513551

Journal ID (nlm-ta): Psychiatry Clin Neurosci

Journal ID (iso-abbrev): Psychiatry Clin Neurosci

Title: Psychiatry and clinical neurosciences

ISSN (Print): 1323-1316

ISSN (Electronic): 1440-1819

Publication date (Print): 01 September 2023

Publication date (Electronic): 13 May 2023

Publication date Nihms-submitted: 19 January 2024

Publication date PMC-release: 29 January 2024

Volume: 77

Issue: 9

Pages: 469-477

Affiliations

[1 ]Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

[2 ]Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

[3 ]Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK

[4 ]Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

[5 ]Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

[6 ]Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

[7 ]Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands

[8 ]Department Early Psychosis, Amsterdam UMC, Amsterdam, The Netherlands

[9 ]Arkin Amsterdam, Amsterdam, The Netherlands

[10 ]Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia

[11 ]Orygen, Parkville, Victoria, Australia

[12 ]Faculty of Medicine, University of Basel, Basel, Switzerland

[13 ]Department of Psychology, Division of Personality and Developmental Psychology, University of Basel, Basel, Switzerland

[14 ]LiNC—Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, Sao Paulo, Brazil

[15 ]Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Fundació, Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain

[16 ]Hôpital Sainte-Anne, C’JAAD, Service Hospitalo-Universitaire, Inserm U894, Institut de Psychiatrie (CNRS 3557), University Paris Descartes, Paris, France

[17 ]Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark

[18 ]Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Kobenhavn, Denmark

[19 ]Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

[20 ]Department of Psychiatry and Psychotherapy, Medical University of Vienna, Wien, Austria