Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder

Ringen, Petter Andreas; Nesvåg, Ragnar; Helle, Siri; Lagerberg, Trine Vik; Lange, Elisabeth; Løberg, Else‐Marie; Agartz, Ingrid; Andreassen, Ole A.; Melle, Ingrid

doi:10.1017/s0033291716001999

Cited by 41 publications

(38 citation statements)

References 59 publications

(64 reference statements)

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“…We extend previous research on cannabis and psychotic symptoms to a multinational sample confirming the association between cannabis use and positive symptoms of FEP (8, 9). Our results are in line with Schoeler et al (2016), who carefully scrutinised the literature on the effect of continuation of cannabis use after FEP, concluding that this would be associated with a more severe positive symptomatology (43).…”

Section: Discussionsupporting

confidence: 82%

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Cannabis-associated symptom profiles in patients with first episode psychosis and population controls

Quattrone

Ferraro²,

Tripoli³

et al. 2019

Preprint

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ObjectiveThe evidence is mixed on whether cannabis use is associated with a particular symptomatology in first episode psychosis (FEP) patients.The authors set out to investigate a) patterns of association between cannabis use and transdiagnostic symptom dimensions; b) whether the extent of use of cannabis contributes to the variation in clinical and subclinical symptom profiles.MethodThe authors analysed data from 901 patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. Item response modelling was used to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use was evaluated using linear mixed effects models analyses.ResultsIn patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high potency cannabis having the highest score (B=0.35; 95%CI 0.14 to 0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B=-0.27; 95%CI −0.42 to −0.12).In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use.Neither patients nor controls presented differences in the depressive dimension related to cannabis use.ConclusionsThe extent of use of cannabis explains part of the heterogeneous distribution of positive and negative symptoms of FEP patients.

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Section: Discussionsupporting

confidence: 82%

“…Some reports suggest fewer negative symptoms in psychotic patients that use of cannabis (16, 17), which is consistent with having enough social skills to obtain the substance. However, this association has not been confirmed in other studies (7, 8) and others even reported a positive association (9).…”

Section: Introductionmentioning

confidence: 62%

Cannabis-associated symptom profiles in patients with first episode psychosis and population controls

Quattrone

Ferraro²,

Tripoli³

et al. 2019

Preprint

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“…According to our results, we can affirm that, as we expected, the CUP subgroup had a worse real-world functioning in the area of socially useful activities, such as work or study, especially in those patients with >7 years of evolution. Similar to our results, Ringen et al [29] found a worse overall functioning, using the Global Assessment of Functioning scale, in those patients with weekly or daily use of cannabis before schizophrenia. Although this finding is relevant, its usefulness in daily clinical practice would be greater if they could specify the domains of life affected to personalize the interventions.…”

Section: Discussionsupporting

confidence: 92%

History of Lifetime Cannabis Use Is Associated with Better Cognition and Worse Real-World Functioning in Schizophrenia Spectrum Disorders

et al. 2019

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Background: Data on associations between cannabis use and psychopathology, cognition and functional impairment in schizophrenia spectrum disorders (SSD) is controversial. Objectives: To examine the effect of cannabis on psychopathology, cognition and real-world functioning in SSD patients. Method: Naturalistic cross-sectional study, 123 clinically stable SSD outpatients. Assessment: demographic and clinical data, psychometric evaluation: Positive and Negative Syndrome, Hamilton Depression Rating, Clinical Global Impression (CGI), Personal and Social Performance and Screen for Cognitive Impairment in Psychiatry (SCIP) scales. Patients were classified as cannabis user patients (CUP) and non cannabis user patients (NCUP) according to self-report, both lifetime and last year. Statistical analysis: chi-square, Student t test, ANOVA (Duncan post hoc), and general linear model analysis for adjusting for antipsychotic doses. Results: Mean age 40.75, 66.7% male, single (66.7%), prior hospital admissions 2.75, mean length of illness 13.85 years. 53.7% were lifetime cannabis users and 8.9% last year users. Lifetime CUP had more hospitalizations (p = 0.013) at a younger age (p = 0.002), and showed better cognitive functioning globally (CGI-C: p = 0.045) and on working memory and processing speed (SCIP-2: p = 0.039; SCIP-5: p = 0.033) and worse functioning in socially useful activities (p = 0.014) than NCUP. All these differences remained after adjusting for antipsychotic doses. Last year cannabis users had worse mood (Hamilton Depression Rating Scale 9.66 vs. 5.64; p = 0.002), but this difference disappears when adjusting for antipsychotic doses. Conclusions: Lifetime cannabis use is associated with better working memory and processing speed and worse real-world functioning in the area of socially useful activities in patients with schizophrenia-related disorders. Clinicians should, therefore, be aware of it to provide patient-centred care in their daily clinical practice.

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“…In the general population, it was associated with both elevated psychoticism and detachment, although the latter effect was weaker 48,172‐174 . In patients, cannabis use was associated with more severe reality distortion symptoms and was not consistently linked to other symptoms 175‐179 .…”

Section: Validity Evidencementioning

confidence: 95%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

et al. 2020

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The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

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Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder

Cited by 41 publications

References 59 publications

Cannabis-associated symptom profiles in patients with first episode psychosis and population controls

Cannabis-associated symptom profiles in patients with first episode psychosis and population controls

History of Lifetime Cannabis Use Is Associated with Better Cognition and Worse Real-World Functioning in Schizophrenia Spectrum Disorders

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

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