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Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence

  • M. Harley (a1) (a2), I. Kelleher (a1), M. Clarke (a1), F. Lynch (a2), L. Arseneault (a3), D. Connor (a1), C. Fitzpatrick (a2) and M. Cannon (a1)...
Abstract
Background

Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence.

Method

Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence.

Results

In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use.

Conclusion

Our finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.

Copyright
Corresponding author
*Address for correspondence: Professor M. Cannon, Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. (Email: marycannon@rcsi.ie)
References
Hide All
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.
Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE (2002). Cannabis use in adolescence and risk for adult psychosis. British Medical Journal 325, 12121213.
Arseneault L, Cannon M, Witton J, Murray RM (2004). Causal association between cannabis and psychosis: examination of the evidence. British Journal of Psychiatry 184, 110117.
Bak M, Krabbendam L, Janssen I, de Graaf R, Vollebergh W, van Os J (2005). Early trauma may increase the risk for psychotic experiences by impacting on emotional response and perception of control. Acta Psychiatrica Scandinavica 112, 360366.
Bendall S, Jackson HJ, Hulbert CA, McGorry PD (2008). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Bossong MG, van Berckel BN, Boelhaard R, Zuurman L, Schuit RC, Windhorst AD, van Gerves JM, Ramsey NF, Lammerstsma AA, Kahn RS (2009). Delta-9-tetrahydrocannabinol induces dopamine release in the human striatum. Neuropsychopharmacology 34, 759766.
Cannon M, Harley M, Clarke MC, Arseneault L (2006). Genes, cannabis and psychosis. In Beyond Nature and Nurture in Psychiatry: Genes, Environment and their Interplay (ed. MacCabe J., O'Daly O., Murray R. M., McGuffin P. and Wright P.), ch. 16, pp. 141155. Informa UK Ltd: Abingdon, Oxon.
Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello MF, Anderson GM, Wilkinson CW, Price LH (2007). Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biological Psychiatry 62, 10801087.
Caspi A, Moffitt TE (2006). Gene–environment interactions in psychiatry: joining forces with neuroscience. Nature Reviews Neuroscience 7, 583590.
Central Statistics Office (1996). Census of Population in Ireland. Central Statistics Office: Dublin, Ireland.
Clarke MC, Tanskanen A, Huttunen M, Whittaker J, Cannon M (2009). Evidence for an interaction between familial liability and prenatal exposure to infection in the causation of schizophrenia. American Journal of Psychiatry 166, 10251030.
Cougnard A, Marcelis M, Myin-Germeys I, De Graaf R, Volleburgh W, Krabbendam L, Leb R, Wittchen HU, Henquiet C, Spauwen J, van Os J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513527.
Darroch J (1997). Biologic synergism and parallelism. American Journal of Epidemiology 145, 661668.
De Bellis MD (2002). Developmental traumatology: a contributory mechanism for alcohol and substances use disorders. Psychoneuroendocrinology 27, 155170.
Degenhardt L, Lynskey M, Hall W (2000). Cohort trends in the age of initiation of drug use in Australia. Australian and New Zealand Journal of Public Health 24, 421426.
Fergusson DM, Horwood LJ, Ridder EM (2005). Tests of causal linkages between cannabis use and psychotic symptoms. Addiction 100, 354366.
Giedd JN, Blumenthal J, Jeffries NO, Castellanos FX, Liu H, Zijdenbos A, Pano J, Evans AC, Rapoport JL (1999). Brain development during childhood and adolescence: a longitudinal MRI study. Nature Neuroscience 2, 861863.
Gledhill-Hoyt J, Lee H, Strote J, Wechsler H (2000). Increased use of marijuana and other illicit drugs at US colleges in the 1990s: results of three national surveys. Addiction 95, 16551667.
Goodman R (1997). The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry 38, 581586.
Goodman R, Ford T, Simmons H, Gatward R, Meitzer H (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry 177, 534539.
Gordon HW (2002). Early environmental stress and biological vulnerability to drug abuse. Psychoneuroendocrinology 27, 115126.
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Journal of the American Medical Association 284, 592597.
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J (2005). Prospective cohort study of cannabis use, predisposition for psychosis and psychotic symptoms in young people. British Medical Journal 330, 11.
Houston JE, Murphy J, Adamson G, Stringer M, Shevlin M (2008). Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophrenia Bulletin 34, 580585.
Kalinichev M, Easterling KW, Plotsky PM, Holtzman SG (2002). Long-lasting changes in stress-induced corticosterone response and anxiety-like behaviours as a consequence of neonatal maternal separation in Long-Evans rats. Pharmacology, Biochemistry and Behaviour 73, 131140.
Kapur S, Mizrahi R, Li M (2005). From dopamine to salience to psychosis: linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 5968.
Kaufman JBB, Brent D, Rao U, Ryan N (1996). The Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version. University of Pittsburgh, Western Psychiatric Institute and Clinic: Pittsburgh.
Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M (2008). Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. British Journal of Psychiatry 193, 378382.
Kovacs M (1985). The Children's Depression Inventory (CDI). Psychopharmacology Bulletin 21, 995998.
Ladd CO, Owens MJ, Nemeroff CB (1996). Persistent changes in corticotropin-releasing factor neuronal symptoms induced by maternal deprivation. Endocrinology 137, 12121218.
Laruelle M (2000). The role of endogenous sensitization in the pathophysiology of schizophrenia: implications from recent brain imaging studies. Brain Research Reviews 31, 371384.
Liu D, Caldji C, Sharma S, Plotzky PM, Meaney MJ (2000). Influence of neonatal rearing conditions on stress-induced adrenocorticotropin responses and norepinepherine release in the hypothalamic paraventricular nucleus. Journal of Neuroendocrinology 12, 5–12.
Luzi S, Morrison PD, Powell J, di Forti M, Murray RM (2008). What is the mechanism whereby cannabis use increases risk of psychosis? Neurotoxicity Research 14, 105112.
Lynch F, Mills C, Daly I, Fitzpatrick C (2004). Challenging times: a study to detect Irish adolescents at risk of psychiatric disorders and suicidal ideation. Journal of Adolescence 27, 441451.
Lynch F, Mills C, Daly I, Fitzpatrick C (2006). Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. Journal of Adolescence 29, 555573.
Macleod J, Davey Smith G, Hickman M (2006). Does cannabis use cause schizophrenia? Lancet 367, 1055.
Macleod J, Oakes R, Copello A, Crome I, Egger M, Hickman M, Oppenkovski T, Stokes-Lampard H, Davey Smith G (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet 363, 15791588.
Mills CGS, Lynch F, Daly I, Fitzpatrick C (2004). The relationship between bullying, depression and suicidal thoughts/behaviour in Irish adolescents. Irish Journal of Psychological Medicine 21, 112116.
Moffitt TE, Caspi A, Rutter M (2005). Strategy for investigating interactions between measured genes and measured environments. Archives of General Psychiatry 62, 473481.
Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, Lewis G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
Morgan C, Fisher H (2007). Environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.
Plotsky PM, Meaney MJ (1993). Early, postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Brain Research. Molecular Brain Research 18, 195200.
Poulton R, Caspi A, Moffitt TE, Cannon M, Murray R, Harrington H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Read J, Perry BD, Moskowitz A, Connolly J (2001). The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry 64, 319345.
Read J, van Os J, Morrison AP, Ross CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Risch N, Herrell R, Lehner T, Liang KY, Eaves L, Hoh J, Griem A, Kovacs M, Ott J, Merikangas KR (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events and risk of depression: a meta-analysis. Journal of the American Medical Association 310, 24622471.
Rothman K, Greenland S (1998). Modern Epidemiology, 2nd edn. Lippincott-Raven: Philadelphia.
Schwartz S, Susser E (2006). Causal explanation with a risk factor framework. In Psychiatric Epidemiology: Searching for the Causes of Mental Disorders (ed. Susser E., Schwartz S., Morabia A. and Bromet E. J.), pp. 422440. Oxford University Press: New York.
Scott J, Martin G, Welham J, Bor W, Najman J, O'Callaghan M, Williams G, Aird R, McGrath J (2009). Psychopathology during childhood and adolescence predicts delusional-like experiences in adults: a 21-year birth cohort study. American Journal of Psychiatry 166, 567574.
Shevlin M, Murphy J, Houston JE, Adamson G (2009). Childhood sexual abuse, early cannabis use, and psychosis: testing the effects of different temporal orderings based on the National Comorbidity Survey. Psychosis: Psychological, Social and Integrative Approaches 1, 1928.
van Os J, Rutten BP, Poulton R (2008). Gene–environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 6682.
van Os J, Sham P (2003). Gene–environment correlation and interaction in schizophrenia. In The Epidemiology of Schizophrenia (ed. Murray R. M., Jones P. B., Susser E., van Os J. and Cannon M.), pp. 235253. Cambridge University Press: Cambridge, UK.
Verrico CD, Jentsch JD, Roth RH (2003). Persistent and anatomically selective reduction in prefrontal cortical dopamine metabolism after repeated intermittent cannabinoid administration in rats. Synapse 49, 6166.
Zammit S, Wiles N, Lewis G (2009). The study of gene–environment interactions in psychiatry: limited gains at a substantial cost? Psychological Medicine. Published online: 24 September 2009. doi:10.1017/S0033291709991280.
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Psychological Medicine
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