Stopping cannabis use benefits outcome in psychosis: findings from 10‐year follow‐up study in the PAFIP‐cohort

Abstract

Objective: To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. Methods: Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. Results: Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x 2 = 15.583, P ≤ 0.001; SAPS: x 2 = 12.386, P = 0.002) and poorer functionality (DAS: x 2 = 6.067, P = 0.048; GAF: x 2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. Conclusion: The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease. Significant outcomes• Cannabis FEP patients have a worse course of the disease. • FEP patients who abandon cannabis do not differ from those who had never consumed. Limitations• The quality and quantity of cannabis used was not taken into account. This is a limitation, particularly because it has been found that cannabis potency can influence patient outcome.

Preventive interventions targeting cannabis use and related harms in people with psychosis: A systematic review

“…For example, a recent meta‐analysis confirmed a dose–response relationship between use level and psychosis risk (Marconi et al, 2016). Other recent reviews and trials suggest that stopping cannabis use in people with dual diagnosis can result in better symptoms and functionality than those with a CUD who continue to use cannabis (Marconi et al, 2016; Ouellet‐Plamondon et al, 2017; Setien‐Suero et al, 2019). Considering that the prognosis of dual diagnosis is worse than substance use disorders and mental health conditions occurring independently (Chilton et al, 2018), significant efforts are needed to better understand cannabis use and behaviours in people with psychosis before they develop CUD.…”

Entire duration of active psychosis and neurocognitive performance in first‐episode non‐affective psychosis

“…This evaluation included tests of (a) verbal memory (Rey Auditory Verbal Learning Test, RAVT) (Rey, 1964), (b) visual memory (Rey Complex Figure, RFC)(Osterrieth, 1944), (c) processing speed (WAIS‐III Digit Symbol subtest) (Wechsler, 1997), (d) working memory (WAIS‐III Digits Backward Subtest) (Wechsler, 1997), (e) executive function (Trail Making Test part B, TMTB) (Lezak, 1995), (f) motor dexterity (The Gooved Pegboard Test) (Lezak, 1995), and (g) attention (Continuous Performance Test, CPT) (Cegalis, 1991). Raw scores were transformed into Z scores, using a sample of 187 healthy volunteers described in previous studies (Ayesa‐Arriola et al, 2016; Setién‐Suero et al, 2019). The premorbid intelligence quotient (IQ) was estimated by the performance on the WAIS‐III vocabulary subtest at baseline (Wechsler, 1997).…”

Cognitive Behavioral Therapy Program for Cannabis Use Cessation in First-Episode Psychosis Patients: A 1-Year Randomized Controlled Trial

“…Its consumption has been associated with poor adherence to psychological and pharmacological treatment [ 15 , 16 , 17 ], increased severity of psychotic symptoms [ 11 , 18 , 19 ], and a greater risk of relapse and hospitalizations [ 20 , 21 , 22 ] in these patients. Moreover, patients with FEP who use cannabis have a poorer functional outcome at follow-up [ 18 , 19 , 23 , 24 , 25 , 26 ]. Cannabis use cessation, conversely, has been related to an improvement in clinical and functional outcomes and a lower risk of relapse in FEP [ 18 , 20 , 21 ].…”