Duration of Untreated Disorder and Cannabis Use: An Observational Study on a Cohort of Young Italian Patients Experiencing Psychotic Experiences and Dissociative Symptoms

Abstract

Background: The Duration of Untreated Psychosis (DUP) is the time between the first-episode psychosis (FEP) and the initiation of antipsychotic treatment. It is an important predictor of several disease-related outcomes in psychotic disorders. The aim of this manuscript is investigating the influence of cannabis on the DUP and its clinical correlates. Methods: During years 2014–2019, sixty-two FEP patients with and without cannabis use disorder (CUD) were recruited from several Italian psychiatric hospitals. The subjects were then divided into two groups based on the duration of the DUP and assessed at the beginning of the antipsychotic treatment and after 3 and 6 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale, and the Dissociative Experiences Scale (DES-II). Results: As expected, a longer DUP was associated with worse symptoms and cannabis use did not seem to affect the DUP, but both were related with more dissociative symptoms at onset and over time. Discussion: According to our study, cannabis use can be a predictor of FEP and DUP, and of disease outcome. However, several factors might influence the relationship between cannabis use and DUP. Preventing cannabis use and early diagnosis of psychotic disorders might impact the disease by reducing the persistence of symptoms and limiting dissociative experiences.

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“…In the first-episode psychotic patients (FEP), it was observed that those with cannabis-associated psychosis presented a greater degree of positive symptoms and dissociation and were significantly worse in terms of overall functioning [ 96 ]. According to clinical observation, the authors concluded that cannabis use not only can be a predictor of FEP manifestation but may also influence the disease duration and outcome [ 96 , 97 ]. In cannabis users, in comparison to the non-user group, a process of improvement and recovery after a psychotic episode was found to worsen over time [ 96 ].…”

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“…Cannabis use disorder afflicts about 22% of cannabis users, and 13% develop cannabis dependence ( 25 ). Cannabis use may increase the risk of psychosis and hinder its treatment ( 26 , 27 ).…”

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“…Additionally, as reported by previous studies, patients who start using substances earlier in life are at risk for developing serious secondary psychiatric disorders, such as psychoses. Two studies from 2021, by Ricci et al reported a link between prolonged cannabis use and development of first-episode psychosis associated with higher degrees of dissociative symptoms, observing higher DUP (Duration of Untreated Psychosis) in these patients as well [ 6 , 7 ].…”