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Chapter 15 - Which Cannabis Users Develop Psychosis?

from Part V - Cannabis and Psychosis

Published online by Cambridge University Press:  12 May 2023

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
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Summary

The fact that not all cannabis users will develop psychosis suggests that cannabis may exert its causal role only in pre-disposed individuals. However, since the number of people who use cannabis worldwide is so high, those who will eventually develop psychosis, whilst still a minority, represent a large number. The evidence indicates that different patterns of cannabis use have a different impact on the risk of developing psychosis, with young age at first use, and a higher frequency of use of high-potency types of cannabis indicated as the most important risk factors. Nonetheless, given the complex nature of the association between cannabis use and psychosis, it is hard to determine which cannabis users will eventually develop psychosis. The link between cannabis use and schizophrenia is unlikely to be just the result of a genetic predisposition, it is more likely the result of Gene x Environment inter-play.

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Marijuana and Madness , pp. 148 - 155
Publisher: Cambridge University Press
Print publication year: 2023

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References

Agrawal, A., and Lynskey, M. T. (2014). Cannabis controversies: How genetics can inform the study of comorbidity. Addiction, 109, 360370.Google Scholar
Andréasson, S., Engström, A., Allebeck, P., et al. (1987). Cannabis and schizophrenia: A longitudinal study of Swedish conscripts. Lancet, 330, 14831486.Google Scholar
Archie, S., Boydell, K. M., Stasiulis, E., et al. (2013). Reflections of young people who have had a first episode of psychosis: What attracted them to use alcohol and illicit drugs? Early Interv Psychiatry, 7, 193199.Google Scholar
Arendt, M., Mortensen, P. B., Rosenberg, R., et al. (2008). Familial predisposition for psychiatric disorder. Arch Gen Psychiatry, 65, 1269.Google Scholar
Arseneault, L., Cannon, M., Poulton, R., et al. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. BMJ, 325, 12121213.CrossRefGoogle ScholarPubMed
Baselmans, B. M. L., Yengo, L., Van Rheenen, W., et al. (2021). Risk in relatives, heritability, SNP-based heritability, and genetic correlations in psychiatric disorders: A review. Biol Psychiatry, 89, 1119.Google Scholar
Bersani, G., Orlandi, V., Kotzalidis, G. D., et al. (2002). Cannabis and schizophrenia: Impact on onset, course, psychopathology and outcomes. Eur Arch Psychiatry Clin Neurosci, 252, 8692.CrossRefGoogle ScholarPubMed
Bhattacharyya, S., Morrison, P. D., Fusar-Poli, P., et al. (2010). Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology, 35, 764774.Google Scholar
Black, N., Stockings, E., Campbell, G., et al. (2019). Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic review and meta-analysis. Lancet Psychiatry, 6, 9951010.Google Scholar
Boydell, J., Dean, K., Dutta, R., et al. (2007). A comparison of symptoms and family history in schizophrenia with and without prior cannabis use: Implications for the concept of cannabis psychosis. Schizophr Res, 93, 203210.CrossRefGoogle ScholarPubMed
Caspi, A., Moffitt, T. E., Cannon, M., et al. (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorhpism in the cathecol-O-methiltransferase gene: Longitudinal evidence of a gene x environment interaction. Biol Psychiatry, 57, 11171127.Google Scholar
Colizzi, M., Carra, E., Fraietta, S., et al. (2016). Substance use, medication adherence and outcome one year following a first episode of psychosis. Schizophr Res, 170, 311317.CrossRefGoogle ScholarPubMed
Di Forti, M., Iyegbe, C., Sallis, H., et al. (2012). Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biol Psychiatry, 72, 811816.Google Scholar
Di Forti, M., Marconi, A., Carra, E., et al. (2015). Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry, 2, 233238.Google Scholar
Di Forti, M., Morgan, C., Dazzan, P., et al. (2009). High-potency cannabis and the risk of psychosis. Br J Psychiatry, 195, 488491.Google Scholar
Di Forti, M., and Murray, R. M. (2005). Cannabis consumption and risk of developing schizophrenia: Myth or reality? Epidemiol Psychiatric Sci, 14, 184187.Google Scholar
Di Forti, M., Quattrone, D., Freeman, T. P., et al. (2019a). 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, 427436.Google Scholar
Di Forti, M., Sallis, H., Allegri, F., et al. (2014). Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophr Bull, 40, 15091517.CrossRefGoogle ScholarPubMed
Di Forti, M., Wu-Choi, B., Quattrone, D., et al. (2019b). The Independent and Combined Influence of Schizophrenia Polygenic Risk Score and Heavy Cannabis Use on Risk for Psychotic Disorder: A Case-Control Analysis from the EUGEI Study. Cold Spring Harbor Laboratory.Google Scholar
Dragt, S., Nieman, D. H., Schultze-Lutter, F., et al. (2012). Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand, 125, 4553.Google Scholar
Elkrief, L., Lin, B., Marchi, M., et al. (2021). Independent contribution of polygenic risk for schizophrenia and cannabis use in predicting psychotic-like experiences in young adulthood: Testing gene × environment moderation and mediation. Psychol Med, 1–11.Google Scholar
Englund, A., Morrison, P. D., Nottage, J., et al. (2013). Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. J Psychopharmacol, 27, 1927.CrossRefGoogle ScholarPubMed
Ferdinand, R. F., Sondeijker, F., Van Der Ende, J., et al. (2005). Cannabis use predicts future psychotic symptoms, and vice versa. Addiction, 100, 612618.Google Scholar
Ferraro, L., La Cascia, C., La Barbera, D., et al. (2021). The relationship of symptom dimensions with premorbid adjustment and cognitive characteristics at first episode psychosis: Findings from the EU-GEI study. Schizophr Res, 236, 6979.Google Scholar
Ferraro, L., La Cascia, C., Quattrone, D., et al. (2020). Premorbid adjustment and IQ in patients with first-episode psychosis: A multisite case-control study of their relationship with cannabis use. Schizophr Bull, 46, 517529.Google Scholar
Ferraro, L., Russo, M., O’Connor, J., et al. (2013). Cannabis users have higher premorbid IQ than other patients with first onset psychosis. Schizophr Res, 150, 129135.Google Scholar
Freeman, T. P., Craft, S., Wilson, J., et al. (2021). Changes in delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in cannabis over time: Systematic review and meta-analysis. Addiction, 116, 10001010.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, 138147.Google Scholar
Gillespie, N. A., and Kendler, K. S. (2021). Use of genetically informed methods to clarify the nature of the association between cannabis use and risk for schizophrenia. JAMA Psychiatry, 78, 467468.CrossRefGoogle ScholarPubMed
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, 407414.Google Scholar
Gonçalves‐Pinho, M., Bragança, M., and Freitas, A. (2020). Psychotic disorders hospitalizations associated with cannabis abuse or dependence: A nationwide big data analysis. Int J Methods Psychiatr Res, 29, e1813.Google Scholar
Goodman, S., Wadsworth, E., Leos-Toro, C., et al. (2020). Prevalence and forms of cannabis use in legal vs. illegal recreational cannabis markets. Int J Drug Policy, 76, 102658.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, 173182.CrossRefGoogle ScholarPubMed
Harley, M., Kelleher, I., Clarke, M., et al. (2010). Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychol Med, 40, 16271634.Google Scholar
Henquet, C., Di Forti, M., Morrison, P., et al. (2008). Gene–environment interplay between cannabis and psychosis. Schizophr Bull, 34, 11111121.Google Scholar
Henquet, C., Murray, R., Linszen, D., et al. (2005). The environment and schizophrenia: The role of cannabis use. Schizophr Bull, 31, 608612.CrossRefGoogle ScholarPubMed
Hindocha, C., Quattrone, D., Freeman, T. P., et al. (2020). Do AKT1, COMT and FAAH influence reports of acute cannabis intoxication experiences in patients with first episode psychosis, controls and young adult cannabis users? Transl Psychiatry, 10, 143.Google Scholar
Hjorthøj, C., Larsen, M. O., Starzer, M. S. K., et al. (2021a). Annual incidence of cannabis-induced psychosis, other substance-induced psychoses and dually diagnosed schizophrenia and cannabis use disorder in Denmark from 1994 to 2016. Psychol Med, 51, 617622.Google Scholar
Hjorthøj, C., Uddin, M. J., Wimberley, T., et al. (2021b). No evidence of associations between genetic liability for schizophrenia and development of cannabis use disorder. Psychol Med, 51, 479484.Google Scholar
Houston, J. E., Murphy, J., Adamson, G., et al. (2008). Childhood sexual abuse, early cannabis use, and psychosis: Testing an interaction model based on the National Comorbidity Survey. Schizophr Bull, 34, 580585.Google Scholar
Jones, H. J., Hammerton, G., Mccloud, T., et al. (2020). Examining pathways between genetic liability for schizophrenia and patterns of tobacco and cannabis use in adolescence. Psychol Med, 1–8.Google Scholar
Kendler, K. S., Ohlsson, H., Sundquist, J., et al. (2019). Prediction of onset of substance-induced psychotic disorder and its progression to schizophrenia in a Swedish national sample. Am J Psychiatry, 176, 711719.Google Scholar
Kolliakou, A., Joseph, C., Ismail, K., et al. (2011). Why do patients with psychosis use cannabis and are they ready to change their use? Int J Dev Neurosci, 29, 335346.CrossRefGoogle ScholarPubMed
Large, M., Sharma, S., Compton, M. T., et al. (2011). Cannabis use and earlier onset of psychosis: A systematic meta-analysis. Arch Gen Psychiatry, 68, 555561.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, 12621269.Google Scholar
McGuire, P. K., Jones, P., Harvey, I., et al. (1995). Morbid risk of schizophrenia for relatives of patients with cannabis-associated psychosis. Schizophr Res, 15, 277281.Google Scholar
Morgan, C. J. A., Freeman, T. P., Powell, J., et al. (2016). AKT1 genotype moderates the acute psychotomimetic effects of naturalistically smoked cannabis in young cannabis smokers. Translat Psychiatry, 6, e738e738.Google Scholar
Murray, R. M., Bhavsar, V., Tripoli, G., et al. (2017a). 30 Years on: How the neurodevelopmental hypothesis of schizophrenia morphed into the developmental risk factor model of psychosis. Schizophr Bull, 43, 11901196.Google Scholar
Murray, R. M., Englund, A., Abi-Dargham, A., et al. (2017b). Cannabis-associated psychosis: Neural substrate and clinical impact. Neuropharmacology, 124, 89104.Google Scholar
Murray, R. M., and Lewis, S. W. (1987). Is schizophrenia a neurodevelopmental disorder? BMJ, 295, 681682.Google Scholar
van Os, J., Bak, M., Hanssen, M., et al. (2002). Cannabis use and psychosis: A longitudinal population-based study. Am J Epidemiology, 156, 319327.Google Scholar
van Os, J., Kenis, G., and Rutten, B. P. F. (2010). The environment and schizophrenia. Nature, 468, 203212.CrossRefGoogle ScholarPubMed
Potter, D. J., Clark, P., and Brown, M. B. (2008). Potency of delta 9-THC and other cannabinoids in cannabis in England in 2005: Implications for psychoactivity and pharmacology. J Forensic Sci, 53, 9094.Google Scholar
Potter, D. J., Hammond, K., Tuffnell, S., et al. (2018). Potency of Delta(9) -tetrahydrocannabinol and other cannabinoids in cannabis in England in 2016: Implications for public health and pharmacology. Drug Test Anal, 10, 628635.Google Scholar
Power, R. A., Verweij, K. J., Zuhair, M., et al. (2014). Genetic predisposition to schizophrenia associated with increased use of cannabis. Mol Psychiatry, 19, 12011204.Google Scholar
Quattrone, D., Ferraro, L., Tripoli, G., et al. (2020). Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: The EU-GEI case-control study. Psychol Med, 51, 19.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., Wilkinson, S. T., and D’Souza, D. C. (2014). Gone to pot: A review of the association between cannabis and psychosis. Front Psychiatry, 5, 54.Google Scholar
Ruiz-Veguilla, M., Callado, L. F., and Ferrin, M. (2012). Neurological soft signs in patients with psychosis and cannabis abuse: A systematic review and meta-analysis of paradox. Curr Pharm Des, 18, 51565164.Google Scholar
Schaefer, J. D., Jang, S. K., Vrieze, S., et al. (2021). Adolescent cannabis use and adult psychoticism: A longitudinal co-twin control analysis using data from two cohorts. J Abnorm Psychol, 130, 691701.Google Scholar
Schoeler, T., Petros, N., Di Forti, M., et al. (2016). Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: An observational study. Lancet Psychiatry, 3, 947953.Google Scholar
Schoeler, T., Petros, N., Di Forti, M., et al. (2017). Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: A prospective analysis. Lancet Psychiatry, 4, 627633.Google Scholar
Sideli, L., Fisher, H. L., Murray, R. M., et al. (2018). Interaction between cannabis consumption and childhood abuse in psychotic disorders: Preliminary findings on the role of different patterns of cannabis use. Early Interv Psychiatry, 12, 135142.Google Scholar
Sideli, L., Quigley, H., La Cascia, C., et al. (2020). Cannabis use and the risk for psychosis and affective disorders. J Dual Diagn, 16, 2242.Google Scholar
Sideli, L., Trotta, G., Spinazzola, E., et al. (2021). Adverse effects of heavy cannabis use: Even plants can harm the brain. Pain, 162, S97S104.Google Scholar
Smith, N. (2005). High potency cannabis: The forgotten variable. Addiction, 100, 15581560.Google Scholar
Stefanis, N. C., Dragovic, M., Power, B. D., et al. (2013). Age at initiation of cannabis use predicts age at onset of psychosis: The 7- to 8-year trend. Schizophr Bull, 39, 251254.Google Scholar
Urban, N. B. L., Slifstein, M., Thompson, J. L., et al. (2012). Dopamine release in chronic cannabis users: A [11C]Raclopride positron emission tomography study. Biol Psychiatry, 71, 677683.CrossRefGoogle ScholarPubMed
Van Winkel, R., Van Beveren, N. J. M., and Simons, C. (2011). AKT1 moderation of cannabis-induced cognitive alterations in psychotic disorder. Neuropsychopharmacology, 36, 25292537.CrossRefGoogle ScholarPubMed
Volkow, N. D., Wang, G. J., Telang, F., et al. (2014). Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity. Proc Natl Acad Sci, 111, E3149E3156.Google Scholar
Wainberg, M., Jacobs, G. R., Di Forti, M., et al. (2021). Cannabis, schizophrenia genetic risk, and psychotic experiences: A cross-sectional study of 109,308 participants from the UK Biobank. Transl Psychiatry, 11, 211.Google Scholar
Zammit, S. (2002). Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: Historical cohort study. BMJ, 325, 1199.Google Scholar
Zammit, S., Moore, T. H. M., Lingford-Hughes, A., et al. (2008). Effects of cannabis use on outcomes of psychotic disorders: Systematic review. Br J Psychiatry, 193, 357363.Google Scholar
Zammit, S., Spurlock, G., Williams, H., et al. (2007). Genotype effects of CHRNA7, CNR1 and COMT in schizophrenia: Interactions with tobacco and cannabis use. Br J Psychiatry, 191, 402407.Google Scholar

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