Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-29T14:05:29.446Z Has data issue: false hasContentIssue false

Chapter 14 - Cannabis and Psychosis Proneness

from Part V - Cannabis and Psychosis

Published online by Cambridge University Press:  12 May 2023

By
Rajiv Radhakrishnan ,
Shubham Kamal ,
Sinan Guloksuz  and
Jim van Os
Edited by
Deepak Cyril D'Souza ,
David Castle  and
Sir Robin Murray
Deepak Cyril D'Souza
Affiliation:
Staff Psychiatrist, VA Connecticut Healthcare System; Professor of Psychiatry, Yale University School of Medicine
David Castle
Affiliation:
University of Tasmania, Australia
Sir Robin Murray
Affiliation:
Honorary Consultant Psychiatrist, Psychosis Service at the South London and Maudsley NHS Trust; Professor of Psychiatric Research at the Institute of Psychiatry
Get access

Summary

Cannabis use is associated with the development of psychosis in multiple studies. With increasing cannabis use worldwide, it is important to identify individuals who are at risk of developing psychosis following cannabis use. The concept of psychosis proneness has evolved over the past century from schizotypy, to denote people at clinical high risk for psychosis (CHR), those at genetic risk of schizophrenia (defined by polygenic risk score for schizophrenia), and those who experience attenuated psychotic symptoms in the general population. Across these definitions of psychosis proneness, cannabis use has been shown to increase the risk of psychosis expression. General population samples show that cannabis interacts with other environmental risk factors, such as childhood trauma and urbanicity, as well as with genetic liability in an additive manner, such that the risk of psychosis expression is greater with increasing number of risk factors. The role of affective dysregulation in increasing the risk of psychosis expression is also recognized. While biological and psychological studies suggest the role of striatal dopamine release, reasoning bias, impairment in face processing, and working memory, the precise biological underpinnings of the effects of cannabis use on psychosis proneness remain to be elucidated.

Keywords

cannabispsychosisschizophreniapsychosis pronenesspolygenic risk scorerisk factors
Type
Chapter
Information
Marijuana and Madness , pp. 139 - 147
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Airey, N. D., Hammersley, R., and Reid, M. (2020). Schizotypy but not cannabis use modestly predicts psychotogenic experiences: A cross-sectional study using the Oxford–Liverpool Inventory of Feelings and Experiences (O-LIFE). J Addict, 2020, 5961275.Google Scholar
Albert, N., Glenthoj, L. B., Melau, M., et al. (2017). Course of illness in a sample of patients diagnosed with a schizotypal disorder and treated in a specialized early intervention setting. Findings from the 3.5 year follow-up of the OPUS II study. Schizophr Res, 182, 24–30.Google Scholar
Albertella, L., Le Pelley, M. E., Yucel, M., et al. (2018). Age moderates the association between frequent cannabis use and negative schizotypy over time. Addict Behav, 87, 183–189.Google Scholar
Auther, A. M., Cadenhead, K. S., Carrion, R. E., et al. (2015). Alcohol confounds relationship between cannabis misuse and psychosis conversion in a high-risk sample. Acta Psychiatr Scand, 132, 60–68.Google Scholar
Auther, A. M., McLaughlin, D., Carrion, R. E., et al. (2012). Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychol Med, 42, 2485–2497.Google Scholar
Brooks, G. A., and Brenner, C. A. (2018). Is there a common vulnerability in cannabis phenomenology and schizotypy? The role of the N170 ERP. Schizophr Res, 197, 444–450.CrossRefGoogle Scholar
Carney, R., Cotter, J., Firth, J., et al. (2017). Cannabis use and symptom severity in individuals at ultra high risk for psychosis: A meta-analysis. Acta Psychiatr Scand, 136, 5–15.Google Scholar
Castle, D. J., and Buckley, P. F. (2015). Schizophrenia, 2nd ed. Oxford: Oxford University Press.Google Scholar
Chapman, L. J., Chapman, J. P., and Raulin, M. L. (1976). Scales for physical and social anhedonia. J Abnorm Psychol, 85, 374–382.Google Scholar
Claridge, G. (1994). Single indicator of risk for schizophrenia: probable fact or likely myth? Schizophr Bull, 20, 151–168.Google Scholar
Claridge, G., and Broks, P. (1984). Schizotypy and hemisphere function—I: Theoretical considerations and the measurement of schizotypy. Pers Individ Differ, 5, 633–648.Google Scholar
D’Souza, D. C., Radhakrishnan, R., Naganawa, M., et al. (2021). Preliminary in vivo evidence of lower hippocampal synaptic density in cannabis use disorder. Mol Psychiatry, 26, 3192–3200.CrossRefGoogle ScholarPubMed
Di Forti, M., Quattrone, D., Freeman, T. P., et al. (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): A multicentre case-control study. Lancet Psychiatry, 6, 427–436.CrossRefGoogle ScholarPubMed
Eckblad, M., and Chapman, L. J. (1983). Magical ideation as an indicator of schizotypy. J Consult Clin Psychol, 51, 215–225.Google Scholar
Eysenck, H. J. (1992). The definition and measurement of psychoticism. Pers Individ Differ, 13, 757–785.Google Scholar
Fergusson, D. M., Horwood, L. J., and Swain-Campbell, N. R. (2003). Cannabis dependence and psychotic symptoms in young people. Psychol Med, 33, 15–21.Google Scholar
Freeman, A. M., Mokrysz, C., Hindocha, C., et al. (2021). Does variation in trait schizotypy and frequency of cannabis use influence the acute subjective, cognitive and psychotomimetic effects of delta-9-tetrahydrocannabinol? A mega-analysis. J Psychopharmacol, 35, 804–813.Google Scholar
Gage, S. H., Jones, H. J., Burgess, S., et al. (2017). Assessing causality in associations between cannabis use and schizophrenia risk: A two-sample Mendelian randomization study. Psychol Med, 47, 971–980.Google Scholar
Ganesh, S., Cortes-Briones, J., Ranganathan, M., et al. (2020). Psychosis-relevant effects of intravenous delta-9-tetrahydrocannabinol: A mega analysis of individual participant-data from human laboratory studies. Int J Neuropsychopharmacol, 23, 559–570.Google Scholar
Genetic Risk and Outcome in Psychosis (GROUP) Investigators. (2011). Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: An analysis of patient-sibling and sibling-control pairs. Arch Gen Psychiatry, 68, 138–147.CrossRefGoogle Scholar
Giordano, G. N., Ohlsson, H., Sundquist, K., et al. (2015). The association between cannabis abuse and subsequent schizophrenia: A Swedish national co-relative control study. Psychol Med, 45, 407–414.Google Scholar
Griffith-Lendering, M. F., Wigman, J. T., Prince van Leeuwen, A., et al. (2013). Cannabis use and vulnerability for psychosis in early adolescence: A TRAILS study. Addiction, 108, 733–740.Google Scholar
Guloksuz, S., Pries, L. K., Delespaul, P., et al. (2019). Examining the independent and joint effects of molecular genetic liability and environmental exposures in schizophrenia: Results from the EUGEI study. World Psychiatry, 18, 173–182.Google Scholar
Hindley, G., Beck, K., Borgan, F., et al. (2020). Psychiatric symptoms caused by cannabis constituents: A systematic review and meta-analysis. Lancet Psychiatry, 7, 344–353.Google Scholar
Hjorthoj, C., Albert, N., and Nordentoft, M. (2018). Association of substance use disorders with conversion from schizotypal disorder to schizophrenia. JAMA Psychiatry, 75, 733–739.Google Scholar
Johns, L. C., Cannon, M., Singleton, N., et al. (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. Br J Psychiatry, 185, 298–305.Google Scholar
Johnson, E. C., Hatoum, A. S., Deak, J. D., et al. (2021). The relationship between cannabis and schizophrenia: A genetically informed perspective. Addiction, 116, 3227–3234.Google Scholar
Kendler, K. S., Lieberman, J. A., and Walsh, D. (1989). The structured interview for schizotypy (SIS): A preliminary report. Schizophr Bull, 15, 559–571.Google Scholar
Kraan, T., Velthorst, E., Koenders, L., et al. (2016). Cannabis use and transition to psychosis in individuals at ultra-high risk: review and meta-analysis. Psychol Med, 46, 673–681.Google Scholar
Kuepper, R., Ceccarini, J., Lataster, J., et al. (2013). Delta-9-tetrahydrocannabinol-induced dopamine release as a function of psychosis risk: 18F-fallypride positron emission tomography study. PLoS ONE, 8, e70378.Google Scholar
Linscott, R. J., and van Os, J. (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med, 43, 1133–1149.Google Scholar
Marconi, A., Di Forti, M., Lewis, C. M., et al. (2016). Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull, 42, 1262–1269.Google Scholar
Mason, O., and Claridge, G. (2006). The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE): Further description and extended norms. Schizophr Res, 82, 203–211.Google Scholar
McHugh, M. J., McGorry, P. D., Yung, A. R., et al. (2017). Cannabis-induced attenuated psychotic symptoms: Implications for prognosis in young people at ultra-high risk for psychosis. Psychol Med, 47, 616–626.Google Scholar
Meehl, P. E. (1962). Schizotaxia, schizotypy, schizophrenia. Am Psychologist, 17, 827–838.Google Scholar
Minor, K. S., Firmin, R. L., Bonfils, K. A., et al. (2014). Predicting creativity: The role of psychometric schizotypy and cannabis use in divergent thinking. Psychiatry Res, 220, 205–210.Google Scholar
Myin-Germeys, I., Krabbendam, L., Delespaul, P., et al. (2003). The affective pathway to psychosis. Schizophr Res, 60, 47.Google Scholar
Nordentoft, M., Thorup, A., Petersen, L., et al. (2006). Transition rates from schizotypal disorder to psychotic disorder for first-contact patients included in the OPUS trial. A randomized clinical trial of integrated treatment and standard treatment. Schizophr Res, 83, 29–40.Google Scholar
O’Tuathaigh, C. M. P., Dawes, C., Bickerdike, A., et al. (2020). Does cannabis use predict psychometric schizotypy via aberrant salience? Schizophr Res, 220, 194–200.CrossRefGoogle ScholarPubMed
van Os, J., Bak, M., Hanssen, M., et al. (2002). Cannabis use and psychosis: A longitudinal population-based study. Am J Epidemiol, 156, 319–327.Google Scholar
van Os, J., Hanssen, M., Bijl, R. V., et al. (2000). Strauss (1969) revisited: A psychosis continuum in the general population? Schizophr Res, 45, 11–20.Google Scholar
van Os, J., Pries, L. K., Ten Have, M., et al. (2021). Schizophrenia and the environment: Within-person analyses may be required to yield evidence of unconfounded and causal association: The example of cannabis and psychosis. Schizophr Bull, 47, 594–603.Google Scholar
Parnas, J., Raballo, A., Handest, P., et al. (2011). Self-experience in the early phases of schizophrenia: 5-year follow-up of the Copenhagen Prodromal Study. World Psychiatry, 10, 200–204.Google Scholar
Pasman, J. A., Verweij, K. J. H., Gerring, Z., et al. (2018). GWAS of lifetime cannabis use reveals new risk loci, genetic overlap with psychiatric traits, and a causal influence of schizophrenia. Nat Neurosci, 21, 1161–1170.Google Scholar
Pearson, J. S., and Kley, I. B. (1957). On the application of genetic expectancies as age-specific base rates in the study of human behavior disorders. Psychol Bull, 54, 406–420.Google Scholar
Pries, L. K., Guloksuz, S., Ten Have, M., et al. (2018). Evidence that environmental and familial risks for psychosis additively impact a multidimensional subthreshold psychosis syndrome. Schizophr Bull, 44, 710–719.Google Scholar
Quattrone, D., Reininghaus, U., Richards, A. L., et al. (2021). The continuity of effect of schizophrenia polygenic risk score and patterns of cannabis use on transdiagnostic symptom dimensions at first-episode psychosis: Findings from the EU-GEI study. Transl Psychiatry, 11, 423.Google Scholar
Radhakrishnan, R., Addy, P. H., Sewell, R. A., et al. (2014a). Cannabis, cannabinoids, and the association with psychosis. In Madras, B., and Kuhar, M. (eds.), The Effects of Drug Abuse on the Human Nervous System (pp. 423–458). Amsterdam: Academic Press.Google Scholar
Radhakrishnan, R., Guloksuz, S., Ten Have, M., et al. (2019). Interaction between environmental and familial affective risk impacts psychosis admixture in states of affective dysregulation. Psychol Med, 49, 1879–1889.Google Scholar
Radhakrishnan, R., Pries, L-K., Erzin, G., et al. Bidirectional relationships between cannabis use, anxiety and depressive symptoms in mediation of the association with psychotic experience: further support for an affective pathway to psychosis. Psychol Med, 1–7 doi: 10.1017/S0033291722002756 (Online ahead of print).Google Scholar
Radhakrishnan, R., Skosnik, P. D., Ranganathan, M., et al. (2021). In vivo evidence of lower synaptic vesicle density in schizophrenia. Mol Psychiatry, 26, 7690–7698.Google Scholar
Radhakrishnan, R., Wilkinson, S. T., and D’Souza, D. C. (2014b). Gone to pot: A review of the association between cannabis and psychosis. Front Psychiatry, 5, 54.Google Scholar
Rado, S. (1953). Dynamics and classification of disordered behavior. Am J Psychiatry, 110, 406–416.Google Scholar
Raine, A. (1991). The SPQ: A scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr Bull, 17, 555–564.CrossRefGoogle ScholarPubMed
Raine, A. (2006). Schizotypal personality: Neurodevelopmental and psychosocial trajectories. Annu Rev Clin Psychol, 2, 291–326.Google Scholar
Reininghaus, U., Rauschenberg, C., Ten Have, M., et al. (2019). Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population. Psychol Med, 49, 1799–1809.Google Scholar
Schafer, G., Feilding, A., Morgan, C. J., et al. (2012). Investigating the interaction between schizotypy, divergent thinking and cannabis use. Conscious Cogn, 21, 292–298.Google Scholar
Stefanis, N. C., Hanssen, M., Smirnis, N. K., et al. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med, 32, 347–358.Google Scholar
Szoke, A., Galliot, A. M., Richard, J. R., et al. (2014). Association between cannabis use and schizotypal dimensions: A meta-analysis of cross-sectional studies. Psychiatry Res, 219, 58–66.CrossRefGoogle ScholarPubMed
Vadhan, N. P., Corcoran, C. M., Bedi, G., et al. (2017). Acute effects of smoked marijuana in marijuana smokers at clinical high-risk for psychosis: A preliminary study. Psychiatry Res, 257, 372–374.Google Scholar
Valmaggia, L. R., Day, F. L., Jones, C., et al. (2014). Cannabis use and transition to psychosis in people at ultra-high risk. Psychol Med, 44, 2503–2512.Google Scholar
Vaucher, J., Keating, B. J., Lasserre, A. M., et al. (2018). Cannabis use and risk of schizophrenia: A Mendelian randomization study. Mol Psychiatry, 23, 1287–1292.CrossRefGoogle ScholarPubMed
Verdoux, H., Sorbara, F., Gindre, C., et al. (2003). Cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Schizophr Res, 59, 77–84.Google Scholar
Verweij, K. J., Abdellaoui, A., Nivard, M. G., et al. (2017). Short communication: Genetic association between schizophrenia and cannabis use. Drug Alcohol Depend, 171, 117–121.Google Scholar
Wuthrich, V. M., and Bates, T. C. (2006). Confirmatory factor analysis of the three-factor structure of the schizotypal personality questionnaire and Chapman schizotypy scales. J Pers Assess, 87, 292–304.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×