Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-12-03T19:09:21.876Z Has data issue: false hasContentIssue false
  • English
  • Français

Cannabis-induced attenuated psychotic symptoms: implications for prognosis in young people at ultra-high risk for psychosis

Published online by Cambridge University Press:  08 November 2016

M. J. McHugh ,
P. D. McGorry ,
A. R. Yung ,
A. Lin ,
S. J. Wood ,
J. A. Hartmann  and
B. Nelson
M. J. McHugh*
Affiliation:
Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
P. D. McGorry
Affiliation:
Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
A. R. Yung
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
A. Lin
Affiliation:
Telethon Kids Institute, University of Western Australia, WA 6008, Australia
S. J. Wood
Affiliation:
Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia School of Psychology, University of Birmingham, Birmingham, UK Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Australia
J. A. Hartmann
Affiliation:
Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
B. Nelson
Affiliation:
Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
*
*Address for correspondence: M. J. McHugh, Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS).

Method

Participants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4–8.7 years).

Results

A history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93–12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS.

Conclusions

Findings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.

Keywords

Cannabispsychosisultra-high risk
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 616 - 626
Copyright
Copyright © Cambridge University Press 2016 

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

Addington, J, Case, N, Saleem, MM, Auther, AM, Cornblatt, BA, Cadenhead, KS (2014). Substance use in clinical high risk for psychosis: a review of the literature. Early Intervention in Psychiatry 8, 104–112.Google Scholar
Auther, AM, McLaughlin, D, Carrión, RE, Nagachandran, P, Correll, CU, Cornblatt, BA (2012). Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychological Medicine 42, 2485–2497.Google Scholar
Bloomfield, MA, Morgan, CJ, Egerton, A, Kapur, S, Curran, HV, Howes, OD (2014). Dopaminergic function in cannabis users and its relationship to cannabis-induced psychotic symptoms. Biological Psychiatry 75, 470–478.CrossRefGoogle ScholarPubMed
Buchy, L, Perkins, D, Woods, SW, Liu, L, Addington, J (2014). Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophrenia Research 156, 277–280.Google Scholar
Carol, EE, Mittal, VA (2014). Self-reported cannabis use is inconsistent with the results from drug-screening in youth at ultra high-risk for psychosis in Colorado. Schizophrenia Research 157, 317–318.Google Scholar
Caspi, A, Moffitt, TE, Cannon, M, McClay, J, Murray, R, Harrington, H, Taylor, A, Arseneault, L, Williams, B, Braithwaite, A, Poulton, R, Craig, IW (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene x environment interaction. Biological Psychiatry 57, 1117–1127.Google Scholar
Colizzi, M, Iyegbe, C, Powell, J, Ursini, G, Porcelli, A, Bonvino, A, Taurisano, P, Romano, R, Masellis, R, Blasi, G, Morgan, C, Aitchison, K, Mondelli, V, Luzi, S, Kolliakou, A, David, A, Murray, RM, Bertolino, A, Di Forti, M (2015). Interaction between functional genetic variation of DRD2 and cannabis use on risk of psychosis. Schizophrenia Bulletin 41, 1171–1182.Google Scholar
Corcoran, CM, Kimhy, D, Stanford, A, Khan, S, Walsh, J, Thompson, J, Schobel, S, Harkavy-Friedman, J, Goetz, R, Colibazzi, T, Cressman, V, Malaspina, D (2008). Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis. Schizophrenia Research 106, 286–293.CrossRefGoogle ScholarPubMed
D'Souza, DC, Sewell, RA, Ranganathan, M (2009). Cannabis and psychosis/schizophrenia: human studies. European Archives of Psychiatry and Clinical Neuroscience 259, 413–431.CrossRefGoogle ScholarPubMed
Decoster, J, Van Os, J, Kenis, G, Henquet, C, Peuskens, J, De Hert, M, Van Winkel, R (2011). Age at onset of psychotic disorder: cannabis, BDNF Val66Met, and sex-specific models of gene–environment interaction. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics 156, 363–369.Google Scholar
Donoghue, BO, Nelson, B, Pan, H, Lane, A, Wood, S, Thompson, A, Lin, A, McGorry, P, Yung, AR (2015). Social environmental risk factors for transition to psychosis in an ultra-high risk population. Schizophrenia Research 161, 150–155.Google Scholar
Dragt, S, Nieman, DH, Becker, HE, van de Fliert, R, Dingemans, PM, de Haan, L, van Amelsvoort, TA, Linszen, DH (2010). Age of onset of cannabis use is associated with age of onset of high-risk symptoms for psychosis. Canadian Journal of Psychiatry. Revue canadienne de psychiatrie 55, 165–171.Google Scholar
Dragt, S, Nieman, DH, Schultze-Lutter, F, van der Meer, F, Becker, H, de Haan, L, Dingemans, PM, Birchwood, M, Patterson, P, Salokangas, RKR, Heinimaa, M, Heinz, A, Juckel, G, Graf von Reventlow, H, French, P, Stevens, H, Ruhrmann, S, Klosterkötter, J, Linszen, DH (2012). Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatrica Scandinavica 125, 45–53.CrossRefGoogle ScholarPubMed
Di Forti, M, Iyegbe, C, Sallis, H, Kolliakou, A, Falcone, MA, Paparelli, A, Sirianni, M, La Cascia, C, Stilo, SA, Marques, TR, Handley, R, Mondelli, V, Dazzan, P, Pariante, C, David, AS, Morgan, C, Powell, J, Murray, RM (2012). Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biological Psychiatry 72, 811–816.Google Scholar
Di Forti, M, Sallis, H, Allegri, F, Trotta, A, Ferraro, L, Stilo, SA, Marconi, A, La Cascia, C, Reis Marques, T, Pariante, C, Dazzan, P, Mondelli, V, Paparelli, A, Kolliakou, A, Prata, D, Gaughran, F, David, AS, Morgan, C, Stahl, D, Khondoker, M, MacCabe, JH, Murray, RM (2014). Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophrenia Bulletin 40, 1509–1517.Google Scholar
Egerton, A, Chaddock, CA, Winton-Brown, TT, Bloomfield, MA, Bhattacharyya, S, Allen, P, McGuire, PK, Howes, OD (2013). Presynaptic striatal dopamine dysfunction in people at ultra-high risk for psychosis: findings in a second cohort. Biological Psychiatry 74, 106–112.Google Scholar
Gurillo, P, Jauhar, S, Murray, RM, MacCabe, JH (2015). Does tobacco use cause psychosis? Systematic review and meta-analysis. Lancet Psychiatry 2, 718–725.Google Scholar
Henry, LP, Harris, MG, Amminger, GP, Yuen, HP, Harrigan, SM, Lambert, M, Conus, P, Schwartz, O, Prosser, A, Farrelly, S, Purcell, R, Herrman, H, Jackson, HJ, McGorry, PD (2007). Early Psychosis Prevention and Intervention Centre long-term follow-up study of first-episode psychosis: methodology and baseline characteristics. Early Intervention in Psychiatry 1, 49–60.CrossRefGoogle ScholarPubMed
Hjorthøj, CR, Hjorthøj, AR, Nordentoft, M (2012). Validity of timeline follow-back for self-reported use of cannabis and other illicit substances - systematic review and meta-analysis. Addictive Behaviors 37, 225–233.Google Scholar
Howes, OD, Bose, SK, Turkheimer, F, Valli, I, Egerton, A, Valmaggia, LR, Murray, RM, McGuire, P (2011). Dopamine synthesis capacity before onset of psychosis: a prospective [18F]-DOPA PET imaging study. American Journal of Psychiatry 168, 1311–1317.Google Scholar
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 59–68.Google Scholar
Korver, N, Nieman, DH, Becker, HE, van de Fliert, JR, Dingemans, PH, de Haan, L, Spiering, M, Schmitz, N, Linszen, DH (2010). Symptomatology and neuropsychological functioning in cannabis using subjects at ultra-high risk for developing psychosis and healthy controls. Australian and New Zealand Journal of Psychiatry 44, 230–236.CrossRefGoogle ScholarPubMed
Kristensen, K, Cadenhead, KS (2007). Cannabis abuse and risk for psychosis in a prodromal sample. Psychiatry Research 151, 151–154.Google Scholar
Kuepper, R, Morrison, PD, van Os, J, Murray, RM, Kenis, G, Henquet, C (2010). Does dopamine mediate the psychosis-inducing effects of cannabis? A review and integration of findings across disciplines. Schizophrenia Research 121, 107–117.CrossRefGoogle ScholarPubMed
Kuepper, R, van Os, J, Lieb, R, Wittchen, H-U, Höfler, M, Henquet, C (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.Google Scholar
Lange, T, Vansteelandt, S, Bekaert, M (2012). A simple unified approach for estimating natural direct and indirect effects. American Journal of Epidemiology 176, 190–195.Google Scholar
McGorry, PD, Nelson, B, Phillips, LJ, Yuen, HP, Francey, SM, Thampi, A, Berger, GE, Amminger, P, Simmons, MB, Kelly, D, Thompson, AD, Yung, AR (2013). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome. Journal of Clinical Psychiatry 74, 349–356.Google Scholar
Moore, THM, Zammit, S, Lingford-Hughes, A, Barnes, TRE, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319–328.Google Scholar
Nelson, B, Yuen, HP, Wood, SJ, Lin, A, Spiliotacopoulos, D, Bruxner, A, Broussard, C, Simmons, M, Foley, DL, Brewer, WJ, Francey, SM, Amminger, GP, Thompson, A, McGorry, PD, Yung, AR (2013). Long-term follow-up of a group at ultra high risk (‘prodromal’) for psychosis: the PACE 400 study. JAMA Psychiatry 70, 793–802.Google Scholar
Phillips, LJ, Curry, C, Yung, AR, Yuen, HP, Adlard, S, McGorry, PD (2002). Cannabis use is not associated with the development of psychosis in an “ultra” high-risk group. Australian and New Zealand Journal of Psychiatry 36, 800–806.Google Scholar
Phillips, LJ, Nelson, B, Yuen, HP, Francey, SM, Simmons, M, Stanford, C, Ross, M, Kelly, D, Baker, K, Conus, P, Amminger, P, Trumpler, F, Yun, Y, Lim, M, McNab, C, Yung, AR, McGorry, PD (2009). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Australian and New Zealand Journal of Psychiatry 43, 818–829.Google Scholar
Power, RA, Verweij, KJH, Zuhair, M, Montgomery, GW, Henders, AK, Heath, AC, Madden, PAF, Medland, SE, Wray, NR, Martin, NG (2014). Genetic predisposition to schizophrenia associated with increased use of cannabis. Molecular Psychiatry 19, 1201–1204.Google Scholar
R Core Team (2013). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria.Google Scholar
Rochon, J, du Bois, A, Lange, T (2014). Mediation analysis of the relationship between institutional research activity and patient survival. BMC Medical Research Methodology 14, 9.CrossRefGoogle ScholarPubMed
Semple, DM, McIntosh, AM, Lawrie, SM (2005). Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology 19, 187–194.Google Scholar
Talbot, J, Teague, J (1969). Marijuana, psychosis: acute toxic psychosis associated with the use of cannabis derivatives. Journal of the American Medical Association 210, 299–302.Google Scholar
Valmaggia, LR, Day, FL, Jones, C, Bissoli, S, Pugh, C, Hall, D, Bhattacharyya, S, Howes, O, Stone, J, Fusar-Poli, P, Byrne, M, McGuire, PK (2014). Cannabis use and transition to psychosis in people at ultra-high risk. Psychological Medicine 44, 2503–2512.Google Scholar
van Hell, HH, Vink, M, Ossewaarde, L, Jager, G, Kahn, RS, Ramsey, NF (2010). Chronic effects of cannabis use on the human reward system: an fMRI study. European Neuropsychopharmacology: Journal of the European College of Neuropsychopharmacology 20, 153–163.CrossRefGoogle ScholarPubMed
Warnock, J (1903). Insanity from Hasheesh. Journal of Mental Sciences 49, 589–593.Google Scholar
Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283–303.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 21–32.Google Scholar
Yung, AR, Phillips, LJ, Yuen, HP, McGorry, PD (2004). Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophrenia Research 67, 131–142.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, S, Cosgrove, E, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At Risk Mental States (CAARMS). Schizophrenia Research 60, 30–31.Google Scholar
Supplementary material: File

McHugh supplementary material

McHugh supplementary material 1

Download McHugh supplementary material(File)
File 64 KB