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Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

  • Antti Mustonen (a1), Solja Niemelä (a2), Tanja Nordström (a1), Graham K. Murray (a3), Pirjo Mäki (a4), Erika Jääskeläinen (a5) and Jouko Miettunen (a5)...

The association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.


To examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.


The sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.


The risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).


Adolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.

Declaration of interest


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Corresponding author
Correspondence: Antti Mustonen, Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 University of Oulu, Finland. Email:
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Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

  • Antti Mustonen (a1), Solja Niemelä (a2), Tanja Nordström (a1), Graham K. Murray (a3), Pirjo Mäki (a4), Erika Jääskeläinen (a5) and Jouko Miettunen (a5)...
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Letter to editor

navya saluja, Junior Resident, Pt. B.D. Sharma PGIMS Rohtak
Hitesh Khurana, Senior Professor, Pt. B.D. Sharma PGIMS Rohtak
15 May 2018

Dear Editor

I read the article by Antti Mustonen et al(1) entitled "Adolecent cannabis use, baseline prodromal symptoms and the risk of psychosis" has been a tremendous study and is well conceptualised.with great interest. I would like to make certain comments.

In the section of Methods with the subheading of psychosis diagnosis - the ICD diagnosis have have been mentioned as (F22-29,F302, F312 ...) wheres The fourth character in ICD-10 codes is always a ‘dot’ Secondly the codes F302 and F312 are also mentioned under the category of psychoasis. If these codes refer to F30.2 and F31.2 respectively then these fall in the category of affective disorder without psychosis. These errors in reporting make the article quite difficult to follow.

There is also a mismatch between the figures and the text of article. In the results Figure 2 explaining the cumulative incidences of psychosis in four groups with and without cannabis use and prodromal symptoms in the Northern Finland Cohort 1986 is not self explanatory as the figures (n=13/134, 5/134...) has not been explained in the text and I found difficult to understand the origin and meaning of these figures.

Similarly, while mentioning about association between adolesecent cannabis use and subsequent psychosis (page 230 first paragraph of associations between adolescent cannabis use and subsequent

psychosis) the authors have mentioned that 18 out of 375 (4.8%) cannabis users received a diagnosis of psychosis during the 15-year follow-up (4 narrow-defined schizophrenia, 4 schizophrenia spectrum disorder, 0 bipolar disorder with psychotic features, 7 major depression with psychotic features, 3 other psychosis). As 7 out of 18 participants had major depression with psychotic features which is a mood disorder and inclusion of it in the criteria would lead to inaccurate results. If excluding the 7 participants, there would be 11 participants who had psychosis. The participants should have been more for better explanation of the hypothesis formulated for the study.

It would be of great help if the authors could clarify these points.

Thank you


1. Mustonen A, Niemelä S, Nordström T, Murray GK, Mäki P, Jääskeläinen E. Adolescent cannabis use , baseline prodromal symptoms and the risk of psychosis. Br J Psychiatry. 2018;212(4):227–33.

2. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Disgnostic Guidelines. Geneva. World Health Organisation. 1992.

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Conflict of interest: None declared

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