Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T11:00:33.243Z Has data issue: false hasContentIssue false

Course of cannabis use and clinical outcome in patients with non-affective psychosis: a 3-year follow-up study

Published online by Cambridge University Press:  05 February 2015

F. J. van der Meer*
Affiliation:
Department of Early Psychosis, Academic Medical Center, Amsterdam, The Netherlands
E. Velthorst
Affiliation:
Department of Early Psychosis, Academic Medical Center, Amsterdam, The Netherlands Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine, New York, USA
*
*Address for correspondence: F. J. van der Meer, AMC – Academisch Psychiatrisch Centrum, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands. (Email: FloorvanderMeer@amc.uva.nl)

Abstract

Background

Prospective studies on the relationship between course of cannabis use and clinical outcome in patients with non-affective psychotic disorders are inconclusive. The current study examined whether (1) persistent, recently started, discontinued and non-cannabis-using patients with a psychotic disorder differed with regard to illness outcome at 3-year follow-up, and (2) whether timing of cannabis discontinuation was associated with course of clinical outcome.

Method

This 3-year follow-up study was part of a multi-center study in the Netherlands and Belgium (Genetic Risk and Outcome of Psychosis; GROUP). We used mixed-model analyses to investigate the association between pattern of cannabis use and symptoms, global functioning and psychotic relapse.

Results

In our sample of 678 patients, we found persistent users to have more positive and general symptoms, worse global functioning and more psychotic relapses compared with non-users and discontinued users [Positive and Negative Syndrome Scale (PANSS) positive, p < 0.001; PANSS general, p < 0.001; Global Assessment of Functioning (GAF) symptoms, p = 0.017; GAF disability, p < 0.001; relapses, p = 0.038]. Patients who started using cannabis after study onset were characterized by worse functioning at baseline and showed an increase in general symptoms (including depression and anxiety) at the 3-year follow-up (p = 0.005). Timing of cannabis discontinuation was not associated with clinical outcome.

Conclusions

These findings suggest that cannabis use in patients with a psychotic disorder has a long-lasting negative effect on illness outcome, particularly when persistent. Treatment should focus on discouraging cannabis use.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

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

Agosti, V, Nunes, E, Levin, F (2002). Rates of psychiatric comorbidity among U.S. residents with lifetime cannabis dependence. American Journal of Drug and Alcohol Abuse 28, 643652.Google Scholar
Andreasen, NC, Flaum, M, Arndt, S (1992). The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Baeza, I, Graell, M, Moreno, D, Castro-Fornieles, J, Parellada, M, Gonzalez-Pinto, A, Paya, B, Soutullo, C, de la Serna, E, Arango, C (2009). Cannabis use in children and adolescents with first episode psychosis: influence on psychopathology and short-term outcome (CAFEPS study). Schizophrenia Research 113, 129137.CrossRefGoogle ScholarPubMed
Baker, AL, Hides, L, Lubman, DI (2010). Treatment of cannabis use among people with psychotic or depressive disorders: a systematic review. Journal of Clinical Psychiatry 71, 247254.CrossRefGoogle ScholarPubMed
Barbeito, S, Vega, P, Ruiz de Azúa, S, Saenz, M, Martinez-Cengotitabengoa, M, González-Ortega, I, Bermudez, C, Hernanz, M, Corres, BF, González-Pinto, A (2013). Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study. BMC Psychiatry 13, 326.Google Scholar
Barrowclough, C, Emsley, R, Eisner, E, Beardmore, R, Wykes, T (2013). Does change in cannabis use in established psychosis affect clinical outcome? Schizophrenia Bulletin 39, 339348.CrossRefGoogle ScholarPubMed
Brunette, MF, Mueser, KT, Xie, H, Drake, RE (1997). Relationships between symptoms of schizophrenia and substance abuse. Journal of Nervous and Mental Disease 185, 1320.CrossRefGoogle ScholarPubMed
Burns, JK, Jhazbhay, K, Emsley, R (2010). Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis: a South African study. African Journal of Psychiatry 13, 395399.Google Scholar
Caseiro, O, Perez-Iglesias, R, Mata, I, Martinez-Garcia, O, Pelayo-Teran, JM, Tabares-Seisdedos, R, Ortiz-Garcia de la Foz, V, Vazquez-Barquero, JL, Crespo-Facorro, B (2012). Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. Journal of Psychiatric Research 46, 10991105.CrossRefGoogle ScholarPubMed
Clausen, L, Hjorthoj, CR, Thorup, A, Jeppesen, P, Petersen, L, Bertelsen, M, Nordentoft, M (2014). Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial. Psychological Medicine 44, 117126.CrossRefGoogle ScholarPubMed
Degenhardt, L, Tennant, C, Gilmour, S, Schofield, D, Nash, L, Hall, W, McKay, D (2007). The temporal dynamics of relationships between cannabis, psychosis and depression among young adults with psychotic disorders: findings from a 10-month prospective study. Psychological Medicine 37, 927934.CrossRefGoogle ScholarPubMed
DeLisi, LE (1992). The significance of age of onset for schizophrenia. Schizophrenia Bulletin 18, 209215.CrossRefGoogle ScholarPubMed
Dixon, L (1999). Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophrenia Research 35 (Suppl.), S93S100.CrossRefGoogle ScholarPubMed
D'Souza, DC, Perry, E, MacDougall, L, Ammerman, Y, Cooper, T, Wu, YT, Braley, G, Gueorguieva, R, Krystal, JH (2004). The psychotomimetic effects of intravenous Δ−9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology 29, 15581572.CrossRefGoogle ScholarPubMed
Faber, G, Smid, HG, Van Gool, AR, Wunderink, L, van den Bosch, RJ, Wiersma, D (2012). Continued cannabis use and outcome in first-episode psychosis: data from a randomized, open-label, controlled trial. Journal of Clinical Psychiatry 73, 632638.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Swain-Campbell, N (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction (Abingdon, England) 97, 11231135.CrossRefGoogle ScholarPubMed
Foti, DJ, Kotov, R, Guey, LT, Bromet, EJ (2010). Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. American Journal of Psychiatry 167, 987993.CrossRefGoogle ScholarPubMed
Gonzalez-Pinto, A, Alberich, S, Barbeito, S, Gutierrez, M, Vega, P, Ibanez, B, Haidar, MK, Vieta, E, Arango, C (2011). Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophrenia Bulletin 37, 631639.CrossRefGoogle ScholarPubMed
Grech, A, Van Os, J, Jones, PB, Lewis, SW, Murray, RM (2005). Cannabis use and outcome of recent onset psychosis. European Psychiatry: The Journal of the Association of European Psychiatrists 20, 349353.CrossRefGoogle ScholarPubMed
Hettema, J, Steele, J, Miller, WR (2005). Motivational interviewing. Annual Review of Clinical Psychology 1, 91111.CrossRefGoogle ScholarPubMed
Hides, L, Dawe, S, Kavanagh, DJ, Young, RM (2006). Psychotic symptom and cannabis relapse in recent-onset psychosis. Prospective study. British Journal of Psychiatry: The Journal of Mental Science 189, 137143.CrossRefGoogle ScholarPubMed
Hinton, M, Edwards, J, Elkins, K, Harrigan, SM, Donovan, K, Purcell, R, McGorry, PD (2007). Reductions in cannabis and other illicit substance use between treatment entry and early recovery in patients with first-episode psychosis. Early Intervention in Psychiatry 1, 259266.CrossRefGoogle Scholar
Howes, OD, Montgomery, AJ, Asselin, MC, Murray, RM, Valli, I, Tabraham, P, Bramon-Bosch, E, Valmaggia, L, Johns, L, Broome, M, McGuire, PK, Grasby, PM (2009). Elevated striatal dopamine function linked to prodromal signs of schizophrenia. Archives of General Psychiatry 66, 1320.CrossRefGoogle ScholarPubMed
Jones, SH, Thornicroft, G, Coffey, M, Dunn, G (1995). A brief mental health outcome scale – reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry: The Journal of Mental Science 166, 654659.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.CrossRefGoogle ScholarPubMed
Knudsen, P, Vilmar, T (1984). Cannabis and neuroleptic agents in schizophrenia. Acta Psychiatrica Scandinavica 69, 162174.Google Scholar
Korver, N, Quee, PJ, Boos, HB, Simons, CJ, de Haan, L, GROUP Investigators (2012). Genetic Risk and Outcome of Psychosis (GROUP), a multi site longitudinal cohort study focused on gene–environment interaction: objectives, sample characteristics, recruitment and assessment methods. International Journal of Methods in Psychiatric Research 21, 205221.CrossRefGoogle Scholar
Koskinen, J, Lohonen, J, Koponen, H, Isohanni, M, Miettunen, J (2010). Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophrenia Bulletin 36, 11151130.CrossRefGoogle ScholarPubMed
Kuepper, R, van Os, J, Lieb, R, Wittchen, HU, Hofler, 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.CrossRefGoogle ScholarPubMed
Kuepper, R, van Winkel, R, Henquet, C (2013). Cannabis use and the risk of psychotic disorders. An update. Tijdschrift voor Psychiatrie 55, 867872.Google ScholarPubMed
Lincoln, TM, Lullmann, E, Rief, W (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin 33, 13241342.CrossRefGoogle ScholarPubMed
Linszen, DH, Dingemans, PM, Lenior, ME (1994). Cannabis abuse and the course of recent-onset schizophrenic disorders. Archives of General Psychiatry 51, 273279.CrossRefGoogle ScholarPubMed
Maremmani, I, Lazzeri, A, Pacini, M, Lovrecic, M, Placidi, GF, Perugi, G (2004). Diagnostic and symptomatological features in chronic psychotic patients according to cannabis use status. Journal of Psychoactive Drugs 36, 235241.CrossRefGoogle ScholarPubMed
Martinez-Arevalo, MJ, Calcedo-Ordonez, A, Varo-Prieto, JR (1994). Cannabis consumption as a prognostic factor in schizophrenia. British Journal of Psychiatry: The Journal of Mental Science 164, 679681.CrossRefGoogle ScholarPubMed
Mullin, K, Gupta, P, Compton, MT, Nielssen, O, Harris, A, Large, M (2012). Does giving up substance use work for patients with psychosis? A systematic meta-analysis. Australian and New Zealand Journal of Psychiatry 46, 826839.Google Scholar
Negrete, JC, Knapp, WP (1986). The effects of cannabis use on the clinical condition of schizophrenics. NIDA Research Monograph 67, 321327.Google ScholarPubMed
Peralta, V, Cuesta, MJ (1992). Influence of cannabis abuse on schizophrenic psychopathology. Acta Psychiatrica Scandinavica 85, 127130.CrossRefGoogle ScholarPubMed
Pijlman, F, Rigter, S, Hoek, J, Goldschmidt, H, Niesink, R (2005). Strong increase in total Δ-THC in cannabis preparations sold in Dutch coffee shops. Addiction Biology 10, 171180.CrossRefGoogle ScholarPubMed
Poulin, C, Hand, D, Boudreau, B, Santor, D (2005). Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population. Addiction (Abingdon, England) 100, 525535.CrossRefGoogle Scholar
Regier, DA, Farmer, ME, Rae, DS, Locke, BZ, Keith, SJ, Judd, LL, Goodwin, FK (1990). Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA: The Journal of the American Medical Association 264, 25112518.CrossRefGoogle ScholarPubMed
Rey, JM, Tennant, CC (2002). Cannabis and mental health. BMJ (Clinical Research ed.) 325, 11831184.Google Scholar
Smeerdijk, M, Keet, R, de Haan, L, Barrowclough, C, Linszen, D, Schippers, G (2014). Feasibility of teaching motivational interviewing to parents of young adults with recent-onset schizophrenia and co-occurring cannabis use. Journal of Substance Abuse Treatment 46, 340345.CrossRefGoogle ScholarPubMed
Smeerdijk, M, Keet, R, Dekker, N, van Raaij, B, Krikke, M, Koeter, M, de Haan, L, Barrowclough, C, Schippers, G, Linszen, D (2012). Motivational interviewing and interaction skills training for parents to change cannabis use in young adults with recent-onset schizophrenia: a randomized controlled trial. Psychological Medicine 42, 16271636.CrossRefGoogle ScholarPubMed
Stirling, J, Lewis, S, Hopkins, R, White, C (2005). Cannabis use prior to first onset psychosis predicts spared neurocognition at 10-year follow-up. Schizophrenia Research 75, 135137.CrossRefGoogle Scholar
Swartz, MS, Wagner, HR, Swanson, JW, Stroup, TS, McEvoy, JP, Reimherr, F, Miller, DD, McGee, M, Khan, A, Canive, JM, Davis, SM, Hsiao, JK, Lieberman, JA, CATIE Investigators (2008). The effectiveness of antipsychotic medications in patients who use or avoid illicit substances: results from the CATIE study. Schizophrenia Research 100, 3952.Google Scholar
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203212.CrossRefGoogle ScholarPubMed
Wade, D, Harrigan, S, McGorry, PD, Burgess, PM, Whelan, G (2007). Impact of severity of substance use disorder on symptomatic and functional outcome in young individuals with first-episode psychosis. Journal of Clinical Psychiatry 68, 767774.Google Scholar
Wilk, J, Marcus, SC, West, J, Countis, L, Hall, R, Regier, DA, Olfson, M (2006). Substance abuse and the management of medication nonadherence in schizophrenia. Journal of Nervous and Mental Disease 194, 454457.CrossRefGoogle ScholarPubMed
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.CrossRefGoogle ScholarPubMed
World Health Organization (1990). Composite International Diagnostic Interview (CIDI): (a) CIDI-interview (version 1.0), (b) CIDI-user manual, (c) CIDI-training manual, (d) CIDI-computer programs. World Health Organization: Geneva.Google Scholar
Zammit, S, Moore, TH, Lingford-Hughes, A, Barnes, TR, Jones, PB, Burke, M, Lewis, G (2008). Effects of cannabis use on outcomes of psychotic disorders: systematic review. British Journal of Psychiatry: The Journal of Mental Science 193, 357363.CrossRefGoogle ScholarPubMed
Supplementary material: File

van der Meer supplementary material

Table

Download van der Meer supplementary material(File)
File 43.5 KB