Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T13:54:17.996Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis

Published online by Cambridge University Press:  15 April 2020

B.G. Schimmelmann ,
P. Conus ,
S. Cotton ,
S. Kupferschmid ,
P.D. McGorry  and
M. Lambert
B.G. Schimmelmann*
Affiliation:
University Hospital of Child and Adolescent Psychiatry, Bolligenstr. 111, 3000Bern 60, Switzerland
P. Conus
Affiliation:
Treatment and early Intervention in Psychosis Program (TIPP), Department of Psychiatry, CHUV, Lausanne, Switzerland Orygen Youth Health and Research Centre, Centre for Youth Mental Health, Melbourne, Australia
S. Cotton
Affiliation:
Orygen Youth Health and Research Centre, Centre for Youth Mental Health, Melbourne, Australia
S. Kupferschmid
Affiliation:
University Hospital of Child and Adolescent Psychiatry, Bolligenstr. 111, 3000Bern 60, Switzerland
P.D. McGorry
Affiliation:
Orygen Youth Health and Research Centre, Centre for Youth Mental Health, Melbourne, Australia
M. Lambert
Affiliation:
Orygen Youth Health and Research Centre, Centre for Youth Mental Health, Melbourne, Australia Psychosis Early Detection and Intervention Centre (PEDIC), Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
*
*Corresponding author. Tel.: +41 31 932 8564; fax: +41 31 932 8569. E-mail address: [email protected]
Get access

Abstract

Background

Previous studies on the impact of cannabis use disorders (CU) on outcome in psychosis were predominantly based on non representative samples, often have not controlled for confounders and rarely focused on adolescent patients. Thus, the aims of the present study were to assess: (i) prevalence of CU; (ii) baseline and pretreatment differences between CU and those without CU (NCU); (iii) the impact of baseline and course of CU on 18-month outcomes in a representative cohort of adolescents with early onset first episode psychosis (EOP).

Methods

The sample comprised 99 adolescents (age 14 to 18) with EOP (onset age 14 to 17), admitted to the Early Psychosis Prevention and Intervention Centre in Australia. Data were collected from medical files using a standardized questionnaire.

Results

Prevalence of lifetime CU was 65.7%, of current CU at baseline 53.5%, and of persistent CU throughout treatment 26.3%. Baseline CU compared to NCU had significantly higher illness-severity, lower psychosocial functioning, less insight, lower premorbid functioning and longer duration of untreated psychosis. Compared to all other groups, only persistent CU was linked to worse outcomes and more service disengagement. Effect sizes were medium controlling for relevant confounders. Medication non-adherence did not explain the association between persistent CU and worse outcome.

Conclusions

Baseline CU was associated with worse baseline characteristics, but only persistent CU was linked with worse outcome. About half of those with baseline CU reduced cannabis during treatment. For these, effectively treating the psychotic disorder may already be beneficial. However, future research is necessary on the reasons for persistent CU in EOP and its treatment.

Keywords

First-episode psychosisEarly onset psychosisSchizophreniaSubstance useSymptomatic remissionAdolescence
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 6 , August 2012 , pp. 463 - 469
Copyright
Copyright © Elsevier Masson SAS 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association 4th edTask Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association; 1994.Google Scholar
Baeza, I., Graell, M., Moreno, D., Castro-Fornieles, J., Parellada, M., Gonzalez-Pinto, A.et al.Cannabis use in children and adolescents with first episode psychosis: influence on psychopathology and short-term outcome (CAFEPS study). Schizophr Res. 2009; 113: 129–137.CrossRefGoogle ScholarPubMed
Baker, A.L., Hides, L., Lubman, D.I.Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review. J Clin Psychiatry. 2010; 71: 247–254.CrossRefGoogle ScholarPubMed
Barnes, T.R.E., Mutsatsa, S.H., Hutton, S.B., Watt, H.C., Joyce, E.M.Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry. 2006; 188: 237–242.CrossRefGoogle ScholarPubMed
Conus, P., Cotton, S., Schimmelmann, B.G., McGorry, P.D., Lambert, M.The First-Episode Psychosis Outcome Study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients. Early Interv Psychiatry. 2007; 1: 191–200.CrossRefGoogle Scholar
Cotton, S.M., Lambert, M., Schimmelmann, B.G., Foley, D.L., Morley, K.I., McGorry, P.D.et al.Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis. Schizophr Res. 2009; 114: 17–24.CrossRefGoogle Scholar
Edwards, J., Hinton, M., Elkins, K. and Athanasopoulos, O. (2008) Cannabis and First-Episode Psychosis: The CAP Project, in Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery (eds H. L. Graham, A. Copello, M. J. Birchwood and K. T. Mueser), John Wiley & Sons, Ltd, West Sussex, London, doi:10.1002/9780470713846.ch16.CrossRefGoogle Scholar
Friis, S., Larsen, T.K., Melle, I., Opjordsmoen, S., Johannessen, J.O., Haahr, U.et al.Methodological pitfalls in early detection studies – the NAPE Lecture 2002. Acta Psychiatr Scand. 2003; 107: 3–9.CrossRefGoogle ScholarPubMed
Grech, A., Van Os, J., Jones, P.B., Lewis, S.W., Murray, R.M.Cannabis use and outcome of recent onset psychosis. Eur Psychiatry. 2005; 20: 349–353.CrossRefGoogle ScholarPubMed
Guy, W.ECDEC Assesment manual for psychopharmacology, revised. Rockville, MD: National Institute of Mental Health; 1976.Google Scholar
Kane, J.M., Leucht, S., Carpenter, D., Docherty, J.P.The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003; 64: 5–19.Google ScholarPubMed
Koskinen, J., Lohonen, J., Koponen, H., Isohanni, M., Miettunen, J.Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophr Bull. 2010; 36: 1115–1130.CrossRefGoogle ScholarPubMed
Lambert, M., Conus, P., Lubman, D.I., Wade, D., Yuen, H., Moritz, S.et al.The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatr Scand. 2005; 112: 141–148.CrossRefGoogle ScholarPubMed
McGorry, P.D., Edwards, J., Mihalopoulos, C., Harrigan, S.M., Jackson, H.J.EPPIC: an evolving system of early detection and optimal management. Schizophr Bull. 1996; 22: 305–326.CrossRefGoogle ScholarPubMed
McGorry, P.D., Singh, B.S., Copolov, D.L., Kaplan, I., Dossetor, C.R., Vanriel, R.J.Royal Park multidiagnostic instrument for psychosis. 2. Development, reliability, and validity. Schizophr Bull. 1990; 16: 517–536.CrossRefGoogle Scholar
Meister, K., Burlon, M., Rietschel, L., Gouzoulis-Mayfrank, E., Bock, T., Lambert, M.Dual diagnosis psychosis and substance use disorders in adolescents – part 1. Fortschr Neurol Psychiatr. 2010; 78: 81–89.CrossRefGoogle ScholarPubMed
Meister, K., Rietschel, L., Burlon, M., Gouzoulis-Mayfrank, E., Bock, T., Lambert, M.Dual diagnosis psychosis and substance use disorders in adolescents – part 2. Fortschr Neurol Psychiatr. 2010; 78: 90–100.CrossRefGoogle ScholarPubMed
Menezes, N.M., Arenovich, T., Zipursky, R.B.A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med. 2006; 36: 1349–1362.CrossRefGoogle ScholarPubMed
Meng, H., Schimmelmann, B.G., Mohler, B., Lambert, M., Branik, E., Koch, E.et al.Pretreatment social functioning predicts 1-year outcome in early onset psychosis. Acta Psychiatr Scand. 2006; 114: 249–256.CrossRefGoogle ScholarPubMed
Pencer, A., Addington, J., Addington, D.Outcome of a first episode of psychosis in adolescence: a 2-year follow-up. Psychiatry Res. 2005; 133: 35–43.CrossRefGoogle ScholarPubMed
Robinson, D.G., Woerner, M.G., Alvir, J.M., Bilder, R.M., Hinrichsen, G.A., Lieberman, J.A.Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder. Schizophr Res. 2002; 57: 209–219.CrossRefGoogle ScholarPubMed
Robinson, J., Cotton, S., Conus, P., Schimmelmann, B.G., McGorry, P., Lambert, M.Prevalence and predictors of suicide attempt in an incidence cohort of 661 young people with first-episode psychosis. Aust N Z J Psychiatry. 2009; 43: 149–157.CrossRefGoogle Scholar
Rosenthal, R.Meta-analytic procedures for social research (revised). Newbury Park, CA: Sage; 1991.CrossRefGoogle Scholar
Roxburgh, A., Hall, W.D., Degenhardt, L., McLaren, J., Black, E., Copeland, J.et al.The epidemiology of cannabis use and cannabis-related harm in Australia 1993–2007. Addiction. 105 6: 2010 1071–1079.CrossRefGoogle ScholarPubMed
Schimmelmann, B.G., Conus, P., Cotton, S., McGorry, P.D., Lambert, M.Pretreatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophr Res. 2007; 95: 1–8.CrossRefGoogle Scholar
Schimmelmann, B.G., Conus, P., Edwards, J., McGorry, P.D., Lambert, M.Diagnostic stability 18months after treatment initiation for first-episode psychosis. J Clin Psychiatry. 2005; 66: 1239–1246.CrossRefGoogle Scholar
Schimmelmann, B.G., Conus, P., Schacht, M., McGorry, P., Lambert, M.Predictors of service disengagement in first-admitted adolescents with psychosis. J Am Acad Child Adolesc Psychiatry. 2006; 45: 990–999.CrossRefGoogle ScholarPubMed
Schimmelmann, B.G., Huber, C.G., Lambert, M., Cotton, S., McGorry, P.D., Conus, P.Impact of duration of untreated psychosis on pretreatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort. J Psychiatr Res. 2008; 42: 982–990.CrossRefGoogle Scholar
Sevy, S., Robinson, D.G., Holloway, S., Alvir, J.M., Woerner, M.G., Bilder, R.et al.Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatr Scand. 2001; 104: 367–374.CrossRefGoogle ScholarPubMed
Tohen, M., Hennen, J., Zarate, C.M. Jr.Baldessarini, R.J., Strakowski, S.M., Stoll, A.L.et al.Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. Am J Psychiatry. 2000; 157: 220–228.CrossRefGoogle ScholarPubMed
Ventura, J., Liberman, R.P., Green, M.F., Shaner, A., Mintz, J.Training and quality assurance with the structured clinical interview for DSM-IV (SCID-I/P). Psychiatry Res. 1998; 79: 163–173.CrossRefGoogle ScholarPubMed
Wade, D., Harrigan, S., Edwards, J., Burgess, P.M., Whelan, G., McGorry, P.D.Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophr Res. 2006; 81: 145–150.CrossRefGoogle ScholarPubMed
Yücel M, Bora E, Lubman DI, Solowij N, Brewer WJ, Cotton SM, et al. The impact of cannabis use on cognitive functioning in patients with schizophrenia: a meta-analysis of existing findings and new data in a first-episode sample. Schizophr Bull 2010;Epub Jul 25.CrossRefGoogle Scholar
Yung, A.R., Phillips, L.J., McGorry, P.D.et al.Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl. 1998; 172: 14–20.CrossRefGoogle ScholarPubMed
Zammit, S., Moore, T.H.M., Lingford-Hughes, A., Barnes, T.R.E., Jones, P.B., Burke, M.et al.Effects of cannabis use on outcomes of psychotic disorders: systematic review. Br J Psychiatry. 2008; 193: 357–363.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.