Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 18
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Bramness, Jørgen 2012. Godt om cannabis og psykiatri. Tidsskrift for Den norske legeforening, Vol. 132, Issue. 4, p. 444.

    Bally, Nathalie Zullino, Daniele and Aubry, Jean-Michel 2014. Cannabis use and first manic episode. Journal of Affective Disorders, Vol. 165, p. 103.

    Rabin, Rachel A. Zakzanis, Konstantine K. and George, Tony P. 2011. The effects of cannabis use on neurocognition in schizophrenia: A meta-analysis. Schizophrenia Research, Vol. 128, Issue. 1-3, p. 111.

    Bahorik, A. L. Newhill, C. E. and Eack, S. M. 2014. Neurocognitive Functioning of Individuals With Schizophrenia: Using and Not Using Drugs. Schizophrenia Bulletin, Vol. 40, Issue. 4, p. 856.

    Braga, Raphael J. Abdelmessih, Sherif Tseng, Juliana and Malhotra, Anil 2015. Cannabinoids in Neurologic and Mental Disease.

    Potvin, Stéphane Stavro, Katherine and Pelletier, Julie 2012. Paradoxical Cognitive Capacities in Dual Diagnosis Schizophrenia: The Quest for Explanatory Factors. Journal of Dual Diagnosis, Vol. 8, Issue. 1, p. 35.

    Torres, Ivan J Kozicky, Jan Popuri, Swetha Bond, David J Honer, William G Lam, Raymond W and Yatham, Lakshmi N 2014. 12-month longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disorders, Vol. 16, Issue. 2, p. 159.

    Hanna, Rebecca C. Perez, Jessica M. and Ghose, Subroto 2016. Cannabis and development of dual diagnoses: A literature review. The American Journal of Drug and Alcohol Abuse, p. 1.

    Rabin, Rachel A. Zakzanis, Konstantine K. Daskalakis, Zafiris J. and George, Tony P. 2013. Effects of cannabis use status on cognitive function, in males with schizophrenia. Psychiatry Research, Vol. 206, Issue. 2-3, p. 158.

    Radhakrishnan, Rajiv Addy, Peter H. Sewell, R. Andrew Skosnik, Patrick D. Ranganathan, Mohini and D’Souza, Deepak Cyril 2014. The Effects of Drug Abuse on the Human Nervous System.

    Ferraro, Laura Russo, Manuela O'Connor, Jennifer Wiffen, Benjamin D.R. Falcone, Maria Aurora Sideli, Lucia Gardner-Sood, Poonam Stilo, Simona Trotta, Antonella Dazzan, Paola Mondelli, Valeria Taylor, Heather Friedman, Bess Sallis, Hannah La Cascia, Caterina La Barbera, Daniele David, Anthony S. Reichenberg, Abraham Murray, Robin M. and Di Forti, Marta 2013. Cannabis users have higher premorbid IQ than other patients with first onset psychosis. Schizophrenia Research, Vol. 150, Issue. 1, p. 129.

    Schoeler, Tabea Monk, Anna Sami, Musa B Klamerus, Ewa Foglia, Enrico Brown, Ruth Camuri, Giulia Altamura, A Carlo Murray, Robin and Bhattacharyya, Sagnik 2016. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. The Lancet Psychiatry, Vol. 3, Issue. 3, p. 215.

    Mueser, Kim T. and McGurk, Susan R. 2012. Cognitive Functioning in Schizophrenia and Co-occurring Substance Use Disorder: Where Do We Go From Here?. Journal of Dual Diagnosis, Vol. 8, Issue. 1, p. 48.

    Beblo, Thomas Sinnamon, Grant and Baune, Bernhard T. 2011. Specifying the Neuropsychology of Affective Disorders: Clinical, Demographic and Neurobiological Factors. Neuropsychology Review, Vol. 21, Issue. 4, p. 337.

    Benaiges, Irina Serra-Grabulosa, Josep Maria Prat, Gemma and Adan, Ana 2013. Executive functioning in individuals with schizophrenia and/or cocaine dependence. Human Psychopharmacology: Clinical and Experimental, Vol. 28, Issue. 1, p. 29.

    Power, Brian D. Dragovic, Milan Badcock, Johanna C. Morgan, Vera A. Castle, David Jablensky, Assen and Stefanis, Nikos C. 2015. No additive effect of cannabis on cognition in schizophrenia. Schizophrenia Research, Vol. 168, Issue. 1-2, p. 245.

    Núñez, Christian Ochoa, Susana Huerta-Ramos, Elena Baños, Iris Barajas, Ana Dolz, Montserrat Sánchez, Bernardo del Cacho, Núria and Usall, Judith 2016. Cannabis use and cognitive function in first episode psychosis: differential effect of heavy use. Psychopharmacology, Vol. 233, Issue. 5, p. 809.

    Braga, Raphael J. Burdick, Katherine E. DeRosse, Pamela and Malhotra, Anil K. 2012. Cognitive and clinical outcomes associated with cannabis use in patients with bipolar I disorder. Psychiatry Research, Vol. 200, Issue. 2-3, p. 242.


Opposite relationships between cannabis use and neurocognitive functioning in bipolar disorder and schizophrenia

  • P. A. Ringen (a1) (a2), A. Vaskinn (a2), K. Sundet (a3), J. A. Engh (a1) (a4), H. Jónsdóttir (a1) (a4), C. Simonsen (a3) (a4), S. Friis (a1) (a4), S. Opjordsmoen (a1) (a4), I. Melle (a1) (a4) and O. A. Andreassen (a1) (a4)
  • DOI:
  • Published online: 06 November 2009

Cannabis use is associated with altered neurocognitive functioning in severe mental disorders, but data are still inconclusive and there are no studies of bipolar disorder. The aim of this study was to investigate the association between cannabis use and neurocognition in bipolar disorder compared with schizophrenia in a naturalistic setting.


A total of 133 patients with bipolar disorder and 140 patients with schizophrenia underwent neuropsychological assessments and clinical characterization including measures of substance use. Relationships between cannabis users and neurocognitive function were explored in the two diagnostic groups. Possible interactions between diagnosis and cannabis use were investigated, and findings were controlled for possible confounders.


In bipolar disorder subjects, cannabis use was associated with better neurocognitive function, but the opposite was the case for the schizophrenia subjects. There was a statistically significant interaction effect of diagnosis and cannabis use on focused attention (p=0.019), executive functioning (verbal fluency – set shifting) (p=0.009), logical memory-learning (p=0.007) and on logical memory-recall (p=0.004). These differences in neurocognitive function could not be explained by putative confounders.


The findings suggest that cannabis use may be related to improved neurocognition in bipolar disorder and compromised neurocognition in schizophrenia. The results need to be replicated in independent samples, and may suggest different underlying disease mechanisms in the two disorders.

Corresponding author
*Address for correspondence: O. A. Andreassen, Psychosis Research Section – TOP, Building 49, Department of Psychiatry, Oslo University Hospital – Ulleval, Kirkeveien 166, N-0407Oslo, Norway. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

N Brill , A Reichenberg , J Rabinowitz , E Harary , G Lubin , M Davidson , M Weiser (2007). Accuracy of self-reported premorbid functioning in schizophrenia. Schizophrenia Research 97, 103108.

CM Cahill , GS Malhi , B Ivanovski , J Lagopoulos , M Cohen (2006). Cognitive compromise in bipolar disorder with chronic cannabis use: cause or consequence? Expert Review of Neurotherapeutics 6, 591598.

HE Cannon-Spoor , SG Potkin , RJ Wyatt (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.

KB Carey , MP Carey , JS Simons (2003). Correlates of substance use disorder among psychiatric outpatients: focus on cognition, social role functioning, and psychiatric status. Journal of Nervous and Mental Disease 191, 300308.

MA Cerullo , SM Strakowski (2007). The prevalence and significance of substance use disorders in bipolar type I and II disorder. Substance Abuse Treatment, Prevention, and Policy 2, 29.

CM Coulston , M Perdices , CC Tennant (2007 a). The neuropsychological correlates of cannabis use in schizophrenia: lifetime abuse/dependence, frequency of use, and recency of use. Schizophrenia Research 96, 169184.

CM Coulston , M Perdices , CC Tennant (2007 b). The neuropsychology of cannabis and other substance use in schizophrenia: review of the literature and critical evaluation of methodological issues. Australian and New Zealand Journal of Psychiatry 41, 869884.

N Craddock , MC O'Donovan , MJ Owen (2006). Genes for schizophrenia and bipolar disorder? Implications for psychiatric nosology. Schizophrenia Bulletin 32, 9–16.

TJ Crow (1986). The continuum of psychosis and its implication for the structure of the gene. British Journal of Psychiatry 149, 419429.

TJ Crow (2008). The ‘big bang’ theory of the origin of psychosis and the faculty of language. Schizophrenia Research 102, 3152.

DC D'Souza , WM Abi-Saab , S Madonick , K Forselius-Bielen , A Doersch , G Braley , R Gueorguieva , TB Cooper , JH Krystal (2005). Δ9-Tetrahydrocannabinol effects in schizophrenia: implications for cognition, psychosis, and addiction. Biological Psychiatry 57, 594608.

C Daban , A Martinez-Aran , C Torrent , R Tabares-Seisdedos , V Balanza-Martinez , J Salazar-Fraile , G Selva-Vera , E Vieta (2006). Specificity of cognitive deficits in bipolar disorder versus schizophrenia. A systematic review. Psychotherapy and Psychosomatics 75, 7284.

MW Eysenck , N Derakshan , R Santos , MG Calvo (2007). Anxiety and cognitive performance: attentional control theory. Emotion 7, 336353.

II Gottesman , TD Gould (2003). The endophenotype concept in psychiatry: etymology and strategic intentions. American Journal of Psychiatry 160, 636645.

B Green , R Young , D Kavanagh (2005). Cannabis use and misuse prevalence among people with psychosis. British Journal of Psychiatry 187, 306313.

C Henquet , L Krabbendam , R de Graaf , M ten Have , J van Os (2006). Cannabis use and expression of mania in the general population. Journal of Affective Disorders 95, 103110.

M Herman (2004). Neurocognitive functioning and quality of life among dually diagnosed and non-substance abusing schizophrenia inpatients. International Journal of Mental Health Nursing 13, 282291.

K Hugdahl , BR Rund , A Lund , A Asbjornsen , J Egeland , L Ersland , NI Landro , A Roness , KI Stordal , K Sundet , T Thomsen (2004). Brain activation measured with fMRI during a mental arithmetic task in schizophrenia and major depression. American Journal of Psychiatry 161, 286293.

AB Ilan , ME Smith , A Gevins (2004). Effects of marijuana on neurophysiological signals of working and episodic memory. Psychopharmacology (Berlin) 176, 214222.

E Ivleva , G Thaker , CA Tamminga (2008). Comparing genes and phenomenology in the major psychoses: schizophrenia and bipolar 1 disorder. Schizophrenia Bulletin 34, 734742.

CC Joyal , P Halle , D Lapierre , S Hodgins (2003). Drug abuse and/or dependence and better neuropsychological performance in patients with schizophrenia. Schizophrenia Research 63, 297299.

DJ Kavanagh , G Waghorn , L Jenner , DC Chant , V Carr , M Evans , H Hemnan , A Jablensky , JJ McGrath (2004). Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research 66, 115124.

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

RS Keefe , RM Bilder , PD Harvey , SM Davis , BW Palmer , JM Gold , HY Meltzer , MF Green , DD Miller , JM Canive , LW Adler , TC Manschreck , M Swartz , R Rosenheck , DO Perkins , TM Walker , TS Stroup , JP McEvoy , JA Lieberman (2006). Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology 31, 20332046.

TK Larsen , S Friis , U Haahr , JO Johannessen , I Melle , S Opjordsmoen , BR Rund , E Simonsen , PV Vaglum , TH McGlashan (2004). Premorbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course. British Journal of Psychiatry 185, 108115.

A Martinez-Aran , E Vieta , C Torrent , J Sanchez-Moreno , JM Goikolea , M Salamero , GS Malhi , A Gonzalez-Pinto , C Daban , S Varez-Grandi , K Fountoulakis , G Kaprinis , R Tabares-Seisdedos , JL Yuso-Mateos (2007). Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disorders 9, 103113.

TH Moore , S Zammit , A Lingford-Hughes , TR Barnes , PB Jones , M Burke , G Lewis (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.

CJ Morgan , HV Curran (2008). Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis. British Journal of Psychiatry 192, 306307.

MC O'Donovan , N Craddock , N Norton , H Williams , T Peirce , V Moskvina , I Nikolov , M Hamshere , L Carroll , L Georgieva , S Dwyer , P Holmans , JL Marchini , CCA Spencer , B Howie , HT Leung , AM Hartmann , HJ Moller , DW Morris , Y Shi , G Feng , P Hoffmann , P Propping , C Vasilescu , W Maier , M Rietschel , S Zammit , J Schumacher , EM Quinn , TG Schulze , NM Williams , I Giegling , N Iwata , M Ikeda , A Darvasi , S Shifman , L He , J Duan , AR Sanders , DF Levinson , PV Gejman , S Cichon , MM Nothen , M Gill , A Corvin , D Rujescu , G Kirov , MJ Owen (2008). Identification of loci associated with schizophrenia by genome-wide association and follow-up. Nature Genetics 40, 10531055.

G Pedersen , KA Hagtvet , S Karterud (2007). Generalizability studies of the Global Assessment of Functioning-Split version. Comprehensive Psychiatry 48, 8894.

S Potvin , CC Joyal , J Pelletier , E Stip (2008). Contradictory cognitive capacities among substance-abusing patients with schizophrenia: a meta-analysis. Schizophrenia Research 100, 242251.

M Ranganathan , DC D'Souza (2006). The acute effects of cannabinoids on memory in humans: a review. Psychopharmacology (Berlin) 188, 425444.

PA Ringen , I Melle , AB Birkenæs , JA Engh , A Færden , H Jönsdóttir , R Nesvåg , A Vaskinn , S Friis , F Larsen , S Opjordsmoen , K Sundet , OA Andreassen (2007). Illicit drug use in patients with psychotic disorders compared with that in the general population: a cross-sectional study. Acta Psychiatrica Scandinavica 117, 133138.

S Sevy , KE Burdick , H Visweswaraiah , S Abdelmessih , M Lukin , E Yechiam , A Bechara (2007). Iowa gambling task in schizophrenia: a review and new data in patients with schizophrenia and co-occurring cannabis use disorders. Schizophrenia Research 92, 7484.

NM Simon , MW Otto , SR Wisniewski , M Fossey , K Sagduyu , E Frank , GS Sachs , AA Nierenberg , ME Thase , MH Pollack (2004). Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry 161, 22222229.

C Simonsen , K Sundet , A Vaskinn , AB Birkenaes , JA Engh , CF Hansen , H Jonsdottir , PA Ringen , S Opjordsmoen , S Friis , OA Andreassen (2008). Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disorders 10, 245255.

SH Snyder (1973). Amphetamine psychosis: a ‘model’ schizophrenia mediated by catecholamines. American Journal of Psychiatry 130, 6167.

P Thoma , B Wiebel , I Daum (2007). Response inhibition and cognitive flexibility in schizophrenia with and without comorbid substance use disorder. Schizophrenia Research 92, 168180.

DC Turner , L Clark , E Pomarol-Clotet , P McKenna , TW Robbins , BJ Sahakian (2004). Modafinil improves cognition and attentional set shifting in patients with chronic schizophrenia. Neuropsychopharmacology 29, 13631373.

J Ventura , RP Liberman , MF Green , A Shaner , J Mintz (1998). Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research 79, 163173.

RD Weiss , LM Najavits , SF Greenfield , JA Soto , SR Shaw , D Wyner (1998). Validity of substance use self-reports in dually diagnosed outpatients. American Journal of Psychiatry 155, 127128.

T Wobrock , H Sittinger , B Behrendt , R D'Amelio , P Falkai , D Caspari (2007). Comorbid substance abuse and neurocognitive function in recent-onset schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 257, 203210.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *