Hostname: page-component-7c8c6479df-995ml Total loading time: 0 Render date: 2024-03-28T14:50:02.044Z Has data issue: false hasContentIssue false

Cannabis use at a young age is associated with psychotic experiences

Published online by Cambridge University Press:  07 October 2010

C. D. Schubart*
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
W. A. van Gastel
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
E. J. Breetvelt
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
S. L. Beetz
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
R. A. Ophoff
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands UCLA Center for Neurobehavioral Genetics, Los Angeles, CA, USA Department of Medical Genetics, University Medical Centre Utrecht, The Netherlands
I. E. C. Sommer
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
R. S. Kahn
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands
M. P. M. Boks
Affiliation:
Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Department of Psychiatry, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
*
*Address for correspondence: C. D. Schubart, M.D., University Medical Centre Utrecht, HP. B.01.206, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. (Email: c.schubart@umcutrecht.nl)

Abstract

Background

Cannabis use is associated with psychosis and a range of subclinical psychiatric symptoms. The strength of this association depends on dosage and age at first use. The current study investigates whether level of cannabis exposure and starting age are associated with specific profiles of subclinical symptoms.

Method

We collected cross-sectional data from a young adult population sample by administering an online version of the Community Assessment of Psychic Experiences (CAPE). Cannabis exposure was quantified as the amount of Euros spent on cannabis per week and the age of initial cannabis use. The primary outcome measure was the odds ratio (OR) to belong to the highest 10% of scores on the total CAPE and the positive-, negative- and depressive symptom dimensions.

Results

In 17 698 adolescents (mean age 21.6, s.d.=4.2 years), cannabis use at age 12 years or younger was strongly associated with a top 10% score on psychotic experiences [OR 3.1, 95% confidence interval (CI) 2.1–4.3] and to a lesser degree with negative symptoms (OR 1.7, 95% CI 1.1–2.5). The OR of heavy users (>€25/week) for negative symptoms was 3.4 (95% CI 2.9–4.1), for psychotic experiences 3.0 (95% CI 2.4–3.6), and for depressive symptoms 2.8 (95% CI 2.3–3.3).

Conclusions

Early start of cannabis use is strongly associated with subclinical psychotic symptoms and to a lesser degree with negative symptoms, while smoking high amounts of cannabis is associated with increased levels of all three symptom dimensions: psychotic, negative and depressive. These results support the hypothesis that the impact of cannabis use is age specific.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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

Adlaf, EM, Begin, P, Sawka, E (2005). Canadian Addiction Survey (CAS): A National Survey of Canadians' Use of Alcohol and Other Drugs: Prevalence of Use and Related Harms: Detailed Report. Canadian Centre on Substance Abuse: Ottawa, Canada.Google Scholar
Arseneault, L, Cannon, M, Poulton, R, Murray, R, Caspi, A, Moffitt, TE (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 12121213.CrossRefGoogle ScholarPubMed
Balter, KA, Balter, O, Fondell, E, Lagerros, YT (2005). Web-based and mailed questionnaires: a comparison of response rates and compliance. Epidemiology 16, 577579.CrossRefGoogle ScholarPubMed
Buchanan, T, Smith, JL (1999). Using the Internet for psychological research: personality testing on the World Wide Web. British Journal of Psychology 90, 125144.CrossRefGoogle ScholarPubMed
CBS Statistics Netherlands (2008). Bijna evenveel hoogopgeleide als laagopgeleide Nederlanders (Almost as many high-skilled and unskilled Dutch). CBS Webmagazine publication no. 2436. Centraal Bureau voor de Statistiek (CBS; Dutch Central Bureau of Statistics): The Hague, The Netherlands.Google Scholar
CBS Statistics Netherlands (2009). Press Release, Oktober 28th 2009: Mediaproducten steeds meer via Internet (Media products are increasingly using the Internet). Publication no. PB08-071. Centraal Bureau voor de Statistiek (CBS; Dutch Central Bureau of Statistics): The Hague, The Netherlands.Google Scholar
Cha, YM, White, AM, Kuhn, CM, Wilson, WA, Swartzwelder, HS (2006). Differential effects of delta9-THC on learning in adolescent and adult rats. Pharmacology, Biochemistry and Behavior 83, 448455.CrossRefGoogle ScholarPubMed
Chapman, LJ, Chapman, JP, Kwapil, TR, Eckblad, M, Zinser, MC (1994). Putatively psychosis-prone subjects 10 years later. Journal of Abnormal Psychology 103, 171183.CrossRefGoogle ScholarPubMed
Chevaleyre, V, Takahashi, KA, Castillo, PE (2006). Endocannabinoid-mediated synaptic plasticity in the CNS. Annual Review of Neuroscience 29, 3776.CrossRefGoogle ScholarPubMed
Coles, ME, Cook, LM, Blake, TR (2007). Assessing obsessive compulsive symptoms and cognitions on the Internet: evidence for the comparability of paper and Internet administration. Behaviour Research and Therapy 45, 22322240.CrossRefGoogle ScholarPubMed
Cuijpers, P, Boluijt, P, van Straten, A (2008). Screening of depression in adolescents through the Internet: sensitivity and specificity of two screening questionnaires. European Child and Adolescent Psychiatry 17, 3238.CrossRefGoogle ScholarPubMed
Development Core Team (2005). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.Google Scholar
Donker, T, van Straten, A, Marks, I, Cuijpers, P (2009). Brief self-rated screening for depression on the Internet. Journal of Affective Disorders 122, 253259.CrossRefGoogle ScholarPubMed
Ekman, A, Dickman, PW, Klint, A, Weiderpass, E, Litton, JE (2006). Feasibility of using web-based questionnaires in large population-based epidemiological studies. European Journal of Epidemiology 21, 103111.CrossRefGoogle ScholarPubMed
European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA) (2008). Annual Report: The State of the Drugs Problem in Europe. EMCDDA: Lisbon, Portugal.Google Scholar
Fergusson, DM, Horwood, LJ, Swain-Campbell, NR (2003). Cannabis dependence and psychotic symptoms in young people. Psychological Medicine 33, 1521.CrossRefGoogle ScholarPubMed
Fernandez-Ruiz, J, Berrendero, F, Hernandez, ML, Ramos, JA (2000). The endogenous cannabinoid system and brain development. Trends in Neurosciences 23, 1420.CrossRefGoogle ScholarPubMed
Garcia-Gil, L, de Miguel, R, Munoz, RM, Cebeira, M, Villanua, MA, Ramos, JA, Fernandez-Ruiz, JJ (1997). Perinatal delta(9)-tetrahydrocannabinol exposure alters the responsiveness of hypothalamic dopaminergic neurons to dopamine-acting drugs in adult rats. Neurotoxicology and Teratology 19, 477487.CrossRefGoogle ScholarPubMed
Garcia-Gil, L, de Miguel, R, Romero, J, Perez, A, Ramos, JA, Fernandez-Ruiz, JJ (1999). Perinatal delta9-tetrahydrocannabinol exposure augmented the magnitude of motor inhibition caused by GABA(B), but not GABA(A), receptor agonists in adult rats. Neurotoxicology and Teratology 21, 277283.CrossRefGoogle Scholar
Gosling, SD, Vazire, S, Srivastava, S, John, OP (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about Internet questionnaires. American Psychologist 59, 93–104.CrossRefGoogle ScholarPubMed
Graham, AL, Papandonatos, GD (2008). Reliability of Internet- versus telephone-administered questionnaires in a diverse sample of smokers. Journal of Medical Internet Research 10, e8.CrossRefGoogle Scholar
Graham, AL, Papandonatos, GD, Bock, BC, Cobb, NK, Baskin-Sommers, A, Niaura, R, Abrams, DB (2006). Internet- vs. telephone-administered questionnaires in a randomized trial of smoking cessation. Nicotine and Tobacco Research 8 (Suppl. 1), S49S57.CrossRefGoogle Scholar
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.CrossRefGoogle ScholarPubMed
Hanssen, M, Peeters, F, Krabbendam, L, Radstake, S, Verdoux, H, van Os, J (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149154.CrossRefGoogle ScholarPubMed
Hernandez, M, Berrendero, F, Suarez, I, Garcia-Gil, L, Cebeira, M, Mackie, K, Ramos, JA, Fernandez-Ruiz, J (2000). Cannabinoid CB(1) receptors colocalize with tyrosine hydroxylase in cultured fetal mesencephalic neurons and their activation increases the levels of this enzyme. Brain Research 857, 5665.CrossRefGoogle ScholarPubMed
Hides, L, Lubman, DI, Buckby, J, Yuen, HP, Cosgrave, E, Baker, K, Yung, AR (2009). The association between early cannabis use and psychotic-like experiences in a community adolescent sample. Schizophrenia Research 112, 130135.CrossRefGoogle Scholar
Houston, TK, Cooper, LA, Vu, HT, Kahn, J, Toser, J, Ford, DE (2001). Screening the public for depression through the Internet. Psychiatric Services 52, 362367.CrossRefGoogle ScholarPubMed
Johnston, LD, O'Malley, PM, Bachman, JG, Schulenberg, JE (2009). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2008. NIH publication no. 09-7401. National Institute on Drug Abuse: Bethesda, MD.Google Scholar
Joinson, A (1999). Social desirability, anonymity, and Internet-based questionnaires. Behavior Research Methods, Instruments, and Computers 31, 433438.CrossRefGoogle ScholarPubMed
Khazaal, Y, Chatton, A, Cochand, S, Zullino, D (2008). Quality of web-based information on cannabis addiction. Journal of Drug Education 38, 97–107.CrossRefGoogle ScholarPubMed
Konings, M, Bak, M, Hanssen, M, van Os, J, Krabbendam, L (2006). Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica 114, 5561.CrossRefGoogle Scholar
Konings, M, Henquet, C, Maharajh, HD, Hutchinson, G, van Os, J (2008). Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica 118, 209213.CrossRefGoogle ScholarPubMed
Lewis, DA (1997). Development of the prefrontal cortex during adolescence: insights into vulnerable neural circuits in schizophrenia. Neuropsychopharmacology 16, 385398.CrossRefGoogle ScholarPubMed
Lin, CC, Bai, YM, Liu, CY, Hsiao, MC, Chen, JY, Tsai, SJ, Ouyang, WC, Wu, CH, Li, YC (2007). Web-based tools can be used reliably to detect patients with major depressive disorder and subsyndromal depressive symptoms. BMC Psychiatry 7, 12.CrossRefGoogle ScholarPubMed
McGrath, J, Welham, J, Scott, J, Varghese, D, Degenhardt, L, Hayatbakhsh, MR, Alati, R, Williams, GM, Bor, W, Najman, JM (2010). Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Archives of General Psychiatry 67, 440447.CrossRefGoogle Scholar
Mechoulam, R, Gaoni, Y (1965). A total synthesis of dl-delta-1-tetrahydrocannabinol, the active constituent of hashish. Journal of the American Chemical Society 87, 32733275.CrossRefGoogle ScholarPubMed
Meyerson, P, Tryon, WW (2003). Validating Internet research: a test of the psychometric equivalence of Internet and in-person samples. Behavior Research Methods, Instruments, and Computers 35, 614620.CrossRefGoogle ScholarPubMed
Miettunen, J, Tormanen, S, Murray, GK, Jones, PB, Maki, P, Ebeling, H, Moilanen, I, Taanila, A, Heinimaa, M, Joukamaa, M, Veijola, J (2008). Association of cannabis use with prodromal symptoms of psychosis in adolescence. British Journal of Psychiatry 192, 470471.CrossRefGoogle ScholarPubMed
Molina-Holgado, F, Alvarez, FJ, Gonzalez, I, Antonio, MT, Leret, ML (1997). Maternal exposure to delta 9-tetrahydrocannabinol (delta 9-THC) alters indolamine levels and turnover in adult male and female rat brain regions. Brain Research Bulletin 43, 173178.CrossRefGoogle ScholarPubMed
Moore, TH, Zammit, S, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.CrossRefGoogle ScholarPubMed
Niesink, R, Rigter, S, Hoek, J, den Boer, N (2009). THC-concentraties in wiet, nederwiet en hasj in Nederlands coffeeshops (2008–2009). Trimbos Institute, The Netherlands Institute of Mental Health and Addiction: Utrecht, The Netherlands.Google Scholar
O'Shea, M, Singh, ME, McGregor, IS, Mallet, PE (2004). Chronic cannabinoid exposure produces lasting memory impairment and increased anxiety in adolescent but not adult rats. Journal of Psychopharmacology 18, 502508.CrossRefGoogle Scholar
Patton, GC, Coffey, C, Carlin, JB, Degenhardt, L, Lynskey, M, Hall, W (2002). Cannabis use and mental health in young people: cohort study. British Medical Journal 325, 11951198.CrossRefGoogle ScholarPubMed
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.CrossRefGoogle ScholarPubMed
Quinn, HR, Matsumoto, I, Callaghan, PD, Long, LE, Arnold, JC, Gunasekaran, N, Thompson, MR, Dawson, B, Mallet, PE, Kashem, MA, Matsuda-Matsumoto, H, Iwazaki, T, McGregor, IS (2008). Adolescent rats find repeated delta(9)-THC less aversive than adult rats but display greater residual cognitive deficits and changes in hippocampal protein expression following exposure. Neuropsychopharmacology 33, 11131126.CrossRefGoogle ScholarPubMed
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.CrossRefGoogle ScholarPubMed
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys (1st edn). John Wiley & Sons: New York.CrossRefGoogle Scholar
Schneider, M, Koch, M (2003). Chronic pubertal, but not adult chronic cannabinoid treatment impairs sensorimotor gating, recognition memory, and the performance in a progressive ratio task in adult rats. Neuropsychopharmacology 28, 17601769.CrossRefGoogle ScholarPubMed
Spek, V, Nyklicek, I, Cuijpers, P, Pop, V (2008). Internet administration of the Edinburgh Depression Scale. Journal of Affective Disorders 106, 301305.CrossRefGoogle ScholarPubMed
Stefanis, NC, Delespaul, P, Henquet, C, Bakoula, C, Stefanis, CN, van Os, J (2004). Early adolescent cannabis exposure and positive and negative dimensions of psychosis. Addiction 99, 13331341.CrossRefGoogle ScholarPubMed
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347358.CrossRefGoogle ScholarPubMed
Suarez, I, Bodega, G, Fernandez-Ruiz, J, Ramos, JA, Rubio, M, Fernandez, B (2004). Down-regulation of the AMPA glutamate receptor subunits GluR1 and GluR2/3 in the rat cerebellum following pre- and perinatal delta9-tetrahydrocannabinol exposure. Cerebellum 3, 6674.Google ScholarPubMed
Substance Abuse and Mental Health Services Administration (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-34. DHHS publication no. SMA 08-4343. SAMHSA, Office of Applied Studies: Rockville, MD.Google Scholar
Trezza, V, Cuomo, V, Vanderschuren, LJ (2008). Cannabis and the developing brain: insights from behavior. European Journal of Pharmacology 585, 441452.CrossRefGoogle ScholarPubMed
United Nations Office on Drugs and Crime (2009). World Drug Report 2009. UNODC: Vienna, Austria.Google Scholar
Vallejo, MA, Jordan, CM, Diaz, MI, Comeche, MI, Ortega, J (2007). Psychological assessment via the Internet: a reliability and validity study of online (vs paper-and-pencil) versions of the General Health Questionnaire-28 (GHQ-28) and the Symptoms Check-List-90 – Revised (SCL-90-R). Journal of Medical Internet Research 9, e2.CrossRefGoogle ScholarPubMed
van Laar, MW, Cruts, AAN, Verdurmen, JEE, van Ooyen-Houben, MMJ, Meijer, RF (2008). National Drugs Monitor 2007. Trimbos Institute, The Netherlands Institute of Mental Health and Addiction: Utrecht, The Netherlands.Google Scholar
van Os, J, Kapur, S (2009). Schizophrenia. Lancet 374, 635645.CrossRefGoogle ScholarPubMed
Verdoux, H, Sorbara, F, Gindre, C, Swendsen, JD, van Os, J (2003). Cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Schizophrenia Research 59, 7784.CrossRefGoogle Scholar
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519526.CrossRefGoogle ScholarPubMed
Yung, AR, Nelson, B, Baker, K, Buckby, JA, Baksheev, G, Cosgrave, EM (2009). Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Australian and New Zealand Journal of Psychiatry 43, 118128.CrossRefGoogle Scholar