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Course of cannabis use and clinical outcome in patients with non-affective psychosis: a 3-year follow-up study

  • F. J. van der Meer (a1) and E. Velthorst (a1) (a2)
Abstract
Background

Prospective studies on the relationship between course of cannabis use and clinical outcome in patients with non-affective psychotic disorders are inconclusive. The current study examined whether (1) persistent, recently started, discontinued and non-cannabis-using patients with a psychotic disorder differed with regard to illness outcome at 3-year follow-up, and (2) whether timing of cannabis discontinuation was associated with course of clinical outcome.

Method

This 3-year follow-up study was part of a multi-center study in the Netherlands and Belgium (Genetic Risk and Outcome of Psychosis; GROUP). We used mixed-model analyses to investigate the association between pattern of cannabis use and symptoms, global functioning and psychotic relapse.

Results

In our sample of 678 patients, we found persistent users to have more positive and general symptoms, worse global functioning and more psychotic relapses compared with non-users and discontinued users [Positive and Negative Syndrome Scale (PANSS) positive, p < 0.001; PANSS general, p < 0.001; Global Assessment of Functioning (GAF) symptoms, p = 0.017; GAF disability, p < 0.001; relapses, p = 0.038]. Patients who started using cannabis after study onset were characterized by worse functioning at baseline and showed an increase in general symptoms (including depression and anxiety) at the 3-year follow-up (p = 0.005). Timing of cannabis discontinuation was not associated with clinical outcome.

Conclusions

These findings suggest that cannabis use in patients with a psychotic disorder has a long-lasting negative effect on illness outcome, particularly when persistent. Treatment should focus on discouraging cannabis use.

Copyright
Corresponding author
*Address for correspondence: F. J. van der Meer, AMC – Academisch Psychiatrisch Centrum, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands. (Email: FloorvanderMeer@amc.uva.nl)
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V Agosti , E Nunes , F Levin (2002). Rates of psychiatric comorbidity among U.S. residents with lifetime cannabis dependence. American Journal of Drug and Alcohol Abuse 28, 643652.

NC Andreasen , M Flaum , S Arndt (1992). The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.

I Baeza , M Graell , D Moreno , J Castro-Fornieles , M Parellada , A Gonzalez-Pinto , B Paya , C Soutullo , E de la Serna , C Arango (2009). Cannabis use in children and adolescents with first episode psychosis: influence on psychopathology and short-term outcome (CAFEPS study). Schizophrenia Research 113, 129137.

AL Baker , L Hides , DI Lubman (2010). Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review. Journal of Clinical Psychiatry 71, 247254.

S Barbeito , P Vega , S Ruiz de Azúa , M Saenz , M Martinez-Cengotitabengoa , I González-Ortega , C Bermudez , M Hernanz , BF Corres , A González-Pinto (2013). Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study. BMC Psychiatry 13, 326.

C Barrowclough , R Emsley , E Eisner , R Beardmore , T Wykes (2013). Does change in cannabis use in established psychosis affect clinical outcome? Schizophrenia Bulletin 39, 339348.

MF Brunette , KT Mueser , H Xie , RE Drake (1997). Relationships between symptoms of schizophrenia and substance abuse. Journal of Nervous and Mental Disease 185, 1320.

O Caseiro , R Perez-Iglesias , I Mata , O Martinez-Garcia , JM Pelayo-Teran , R Tabares-Seisdedos , V Ortiz-Garcia de la Foz , JL Vazquez-Barquero , B Crespo-Facorro (2012). Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. Journal of Psychiatric Research 46, 10991105.

LE DeLisi (1992). The significance of age of onset for schizophrenia. Schizophrenia Bulletin 18, 209215.

L Dixon (1999). Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophrenia Research 35 (Suppl.), S93S100.

DC D'Souza , E Perry , L MacDougall , Y Ammerman , T Cooper , YT Wu , G Braley , R Gueorguieva , JH Krystal (2004). The psychotomimetic effects of intravenous Δ−9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 29, 15581572.

G Faber , HG Smid , AR Van Gool , L Wunderink , RJ van den Bosch , D Wiersma (2012). Continued cannabis use and outcome in first-episode psychosis: data from a randomized, open-label, controlled trial. Journal of Clinical Psychiatry 73, 632638.

DM Fergusson , LJ Horwood , N Swain-Campbell (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction (Abingdon, England) 97, 11231135.

DJ Foti , R Kotov , LT Guey , EJ Bromet (2010). Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. American Journal of Psychiatry 167, 987993.

A Gonzalez-Pinto , S Alberich , S Barbeito , M Gutierrez , P Vega , B Ibanez , MK Haidar , E Vieta , C Arango (2011). Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophrenia Bulletin 37, 631639.

A Grech , J Van Os , PB Jones , SW Lewis , RM Murray (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry: The Journal of the Association of European Psychiatrists 20, 349353.

J Hettema , J Steele , WR Miller (2005). Motivational interviewing. Annual Review of Clinical Psychology 1, 91111.

L Hides , S Dawe , DJ Kavanagh , RM Young (2006). Psychotic symptom and cannabis relapse in recent-onset psychosis. Prospective study. British Journal of Psychiatry: The Journal of Mental Science 189, 137143.

M Hinton , J Edwards , K Elkins , SM Harrigan , K Donovan , R Purcell , PD McGorry (2007). Reductions in cannabis and other illicit substance use between treatment entry and early recovery in patients with first-episode psychosis. Early Intervention in Psychiatry 1, 259266.

OD Howes , AJ Montgomery , MC Asselin , RM Murray , I Valli , P Tabraham , E Bramon-Bosch , L Valmaggia , L Johns , M Broome , PK McGuire , PM Grasby (2009). Elevated striatal dopamine function linked to prodromal signs of schizophrenia. Archives of General Psychiatry 66, 1320.

SH Jones , G Thornicroft , M Coffey , G Dunn (1995). A brief mental health outcome scale – reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry: The Journal of Mental Science 166, 654659.

SR Kay , A Fiszbein , LA Opler (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.

P Knudsen , T Vilmar (1984). Cannabis and neuroleptic agents in schizophrenia. Acta Psychiatrica Scandinavica 69, 162174.

N Korver , PJ Quee , HB Boos , CJ Simons , L de Haan , GROUP Investigators (2012). Genetic Risk and Outcome of Psychosis (GROUP), a multi site longitudinal cohort study focused on gene–environment interaction: objectives, sample characteristics, recruitment and assessment methods. International Journal of Methods in Psychiatric Research 21, 205221.

J Koskinen , J Lohonen , H Koponen , M Isohanni , J Miettunen (2010). Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophrenia Bulletin 36, 11151130.

R Kuepper , J van Os , R Lieb , HU Wittchen , M Hofler , C Henquet (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ (Clinical Research ed.) 342, d738.

TM Lincoln , E Lullmann , W Rief (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin 33, 13241342.

DH Linszen , PM Dingemans , ME Lenior (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.

I Maremmani , A Lazzeri , M Pacini , M Lovrecic , GF Placidi , G Perugi (2004). Diagnostic and symptomatological features in chronic psychotic patients according to cannabis use status. Journal of Psychoactive Drugs 36, 235241.

MJ Martinez-Arevalo , A Calcedo-Ordonez , JR Varo-Prieto (1994). Cannabis consumption as a prognostic factor in schizophrenia. British Journal of Psychiatry: The Journal of Mental Science 164, 679681.

K Mullin , P Gupta , MT Compton , O Nielssen , A Harris , M Large (2012). Does giving up substance use work for patients with psychosis? A systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 46, 826839.

V Peralta , MJ Cuesta (1992). Influence of cannabis abuse on schizophrenic psychopathology. Acta Psychiatrica Scandinavica 85, 127130.

F Pijlman , S Rigter , J Hoek , H Goldschmidt , R Niesink (2005). Strong increase in total Δ-THC in cannabis preparations sold in Dutch coffee shops. Addiction Biology 10, 171180.

C Poulin , D Hand , B Boudreau , D Santor (2005). Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population. Addiction (Abingdon, England) 100, 525535.

DA Regier , ME Farmer , DS Rae , BZ Locke , SJ Keith , LL Judd , FK Goodwin (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA: The Journal of the American Medical Association 264, 25112518.

JM Rey , CC Tennant (2002). Cannabis and mental health. BMJ (Clinical Research ed.) 325, 11831184.

M Smeerdijk , R Keet , L de Haan , C Barrowclough , D Linszen , G Schippers (2014). Feasibility of teaching motivational interviewing to parents of young adults with recent-onset schizophrenia and co-occurring cannabis use. Journal of Substance Abuse Treatment 46, 340345.

J Stirling , S Lewis , R Hopkins , C White (2005). Cannabis use prior to first onset psychosis predicts spared neurocognition at 10-year follow-up. Schizophrenia Research 75, 135137.

MS Swartz , HR Wagner , JW Swanson , TS Stroup , JP McEvoy , F Reimherr , DD Miller , M McGee , A Khan , JM Canive , SM Davis , JK Hsiao , JA Lieberman , CATIE Investigators (2008). The effectiveness of antipsychotic medications in patients who use or avoid illicit substances: results from the CATIE study. Schizophrenia Research 100, 3952.

J van Os , G Kenis , BP Rutten (2010). The environment and schizophrenia. Nature 468, 203212.

D Wade , S Harrigan , PD McGorry , PM Burgess , G Whelan (2007). Impact of severity of substance use disorder on symptomatic and functional outcome in young individuals with first-episode psychosis. Journal of Clinical Psychiatry 68, 767774.

J Wilk , SC Marcus , J West , L Countis , R Hall , DA Regier , M Olfson (2006). Substance abuse and the management of medication nonadherence in schizophrenia. Journal of Nervous and Mental Disease 194, 454457.

JK Wing , T Babor , T Brugha , J Burke , JE Cooper , R Giel , A Jablenski , D Regier , N Sartorius (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.

S Zammit , TH Moore , A Lingford-Hughes , TR Barnes , PB Jones , M Burke , G Lewis (2008). Effects of cannabis use on outcomes of psychotic disorders: systematic review. British Journal of Psychiatry: The Journal of Mental Science 193, 357363.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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