Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-08T22:35:42.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Cannabis use and transition to psychosis in individuals at ultra-high risk: review and meta-analysis

Published online by Cambridge University Press:  16 November 2015

T. Kraan ,
E. Velthorst ,
L. Koenders ,
K. Zwaart ,
H. K. Ising ,
D. van den Berg ,
L. de Haan  and
M. van der Gaag
T. Kraan*
Affiliation:
Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
E. Velthorst
Affiliation:
Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands Departments of Psychiatry and Preventive Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, USA
L. Koenders
Affiliation:
Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
K. Zwaart
Affiliation:
Department of Clinical Psychology, VU University and EMGO Institute of Health and Care Research, Amsterdam, The Netherlands Parnassia Psychiatric Institute, Psychosis Research, The Hague, The Netherlands
H. K. Ising
Affiliation:
Parnassia Psychiatric Institute, Psychosis Research, The Hague, The Netherlands
D. van den Berg
Affiliation:
Parnassia Psychiatric Institute, Psychosis Research, The Hague, The Netherlands
L. de Haan
Affiliation:
Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
M. van der Gaag
Affiliation:
Department of Clinical Psychology, VU University and EMGO Institute of Health and Care Research, Amsterdam, The Netherlands Parnassia Psychiatric Institute, Psychosis Research, The Hague, The Netherlands
*
*Address for correspondence: T. Kraan, Department of Psychiatry, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Previous research has established the relationship between cannabis use and psychotic disorders. Whether cannabis use is related to transition to psychosis in patients at ultra-high risk (UHR) for psychosis remains unclear. The present study aimed to review the existing evidence on the association between cannabis use and transition to psychosis in UHR samples.

Method

A search of PsychInfo, Embase and Medline was conducted from 1996 to August 2015. The search yielded 5559 potentially relevant articles that were selected on title and abstract. Subsequently 36 articles were screened on full text for eligibility. Two random-effects meta-analyses were performed. First, we compared transition rates to psychosis of UHR individuals with lifetime cannabis use with non-cannabis-using UHR individuals. Second, we compared transition rates of UHR individuals with a current DSM-IV cannabis abuse or dependence diagnosis with lifetime users and non-using UHR individuals.

Results

We found seven prospective studies reporting on lifetime cannabis use in UHR subjects (n = 1171). Of these studies, five also examined current cannabis abuse or dependence. Lifetime cannabis use was not significantly associated with transition to psychosis [odds ratio (OR) 1.14, 95% confidence interval (CI) 0.856–1.524, p = 0.37]. A second meta-analysis yielded an OR of 1.75 (95% CI 1.135–2.710, p = 0.01), indicating a significant association between current cannabis abuse or dependence and transition to psychosis.

Conclusions

Our results show that cannabis use was only predictive of transition to psychosis in those who met criteria for cannabis abuse or dependence, tentatively suggesting a dose–response relationship between current cannabis use and transition to psychosis.

Keywords

Cannabis usepsychosisultra-high risk
Type
Review Article
Information
Psychological Medicine , Volume 46 , Issue 4 , March 2016 , pp. 673 - 681
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

Addington, J, Cadenhead, KS, Cannon, TD, Cornblatt, B, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, M, Walker, EF, Woods, SW (2007). North American Prodrome Longitudinal Study: a collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin 33, 665–672.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Addington, J, Stowkowy, J, Cadenhead, KS, Cornblatt, BA, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW (2013). Early traumatic experiences in those at clinical high risk for psychosis. Early Intervention in Psychiatry 7, 300–305.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). American Psychiatric Press Inc.: Washington, DC.Google Scholar
Arendt, M, Rosenberg, R, Foldager, L, Perto, G, Munk-Jørgensen, P (2005). Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases. British Journal of Psychiatry 187, 510–515.CrossRefGoogle ScholarPubMed
Arseneault, L, Cannon, M, Witton, J, Murray, RM (2004). Causal association between cannabis and psychosis: examination of the evidence. British Journal of Psychiatry 184, 110–117.CrossRefGoogle ScholarPubMed
Auther, AM, Cadenhead, KS, Carrión, RE, Addington, J, Bearden, CE, Cannon, TD, McGlashan, TH, Perkins, DO, Seidman, L, Tsuang, M, Walker, EF, Woods, SW, Cornblatt, BA (2015). Alcohol confounds relationship between cannabis misuse and psychosis conversion in a high-risk sample. Acta Psychiatrica Scandinavica 132, 60–68.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Buchy, L, Cadenhead, K, Cannon, T, Cornblatt, B, McGlashan, T, Perkins, D, Seidman, L, Tsuang, M, Walker, E, Woods, S (2015). Substance use in individuals at clinical high risk of psychosis. Psychological Medicine 45, 2275–2284.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.CrossRefGoogle ScholarPubMed
Burns, JK (2013). Pathways from cannabis to psychosis: a review of the evidence. Frontiers in Psychiatry 4, 128.CrossRefGoogle ScholarPubMed
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 28–37.CrossRefGoogle ScholarPubMed
Casadio, P, Fernandes, C, Murray, RM, Di Forti, M (2011). Cannabis use in young people: the risk for schizophrenia. Neuroscience and Biobehavioral Reviews 35, 1779–1787.CrossRefGoogle ScholarPubMed
Corcoran, CM, Kimhy, D, Stanford, A, Khan, S, Walsh, J, Thompson, J, Schobel, S, Harkavy-Friedman, J, Goetz, R, Colibazzi, T (2008). Temporal association of cannabis use with symptoms in individuals at clinical high risk for psychosis. Schizophrenia Research 106, 286–293.CrossRefGoogle ScholarPubMed
Degenhardt, L, Hall, W (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379, 55–70.CrossRefGoogle ScholarPubMed
Di Forti, M, Marconi, A, Carra, E, Fraietta, S, Trotta, A, Bonomo, M, Bianconi, F, Gardner-Sood, P, O'Connor, J, Russo, M (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, 233–238.CrossRefGoogle ScholarPubMed
Di Forti, M, Sallis, H, Allegri, F, Trotta, A, Ferraro, L, Stilo, SA, Marconi, A, La Cascia, C, Marques, TR, Pariante, C (2014). Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophrenia Bulletin 40, 1509–1517.CrossRefGoogle ScholarPubMed
Dragt, S, Nieman, D, Schultze-Lutter, F, Van Der Meer, F, Becker, H, De Haan, L, Dingemans, P, Birchwood, M, Patterson, P, Salokangas, R (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
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.CrossRefGoogle ScholarPubMed
Dragt, S, Nieman, DH, Veltman, D, Becker, HE, van de Fliert, R, de Haan, L, Linszen, DH (2011). Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk. Schizophrenia Research 125, 69–76.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R (2000 a). A nonparametric ‘trim and fill’ method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association 95, 89–98.Google Scholar
Duval, S, Tweedie, R (2000 b). Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.CrossRefGoogle ScholarPubMed
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rössler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ (2013). The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107–120.CrossRefGoogle Scholar
Hall, W, Degenhardt, L (2000). Cannabis use and psychosis: a review of clinical and epidemiological evidence. Australian and New Zealand Journal of Psychiatry 34, 26–34.CrossRefGoogle ScholarPubMed
Hall, W, Degenhardt, L (2009). Adverse health effects of non-medical cannabis use. Lancet 374, 1383–1391.CrossRefGoogle ScholarPubMed
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. BMJ: British Medical Journal 327, 557.CrossRefGoogle ScholarPubMed
Kirkbride, J, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, P, Coid, J (2008). Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry 193, 18–24.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555–561.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, 319–328.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Riecher-Rössler, A, Aston, J, Ventura, J, Merlo, M, Borgwardt, S, Gschwandtner, U, Stieglitz, R (2008). The Basel Screening Instrument for Psychosis (BSIP): development, structure, reliability and validity. Fortschritte der Neurologie-Psychiatrie 76, 207–216.CrossRefGoogle ScholarPubMed
Schultze-Lutter, F, Addington, J, Ruhrmann, S, Klosterkötter, J (2007). Schizophrenia Proneness Instrument, Adult Version (SPI-A). Giovanni Fioriti Editore srl: Rome.Google Scholar
Schultze-Lutter, F, Marshall, M, Koch, E (2012). Schizophrenia Proneness Instrument, Child and Youth Version (SPI-CY), Extended English Translation. Giovanni Fiorito Editore: Rome.Google Scholar
Sinha, R (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences 1141, 105–130.CrossRefGoogle ScholarPubMed
Smit, F, Bolier, L, Cuijpers, P (2004). Cannabis use and the risk of later schizophrenia: a review. Addiction 99, 425–430.CrossRefGoogle ScholarPubMed
Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T (2013). Early interventions to prevent psychosis: systematic review and meta-analysis. British Medical Journal 346, f185.CrossRefGoogle ScholarPubMed
Thompson, AD, Nelson, B, Yuen, HP, Lin, A, Amminger, GP, McGorry, PD, Wood, SJ, Yung, AR (2014). Sexual trauma increases the risk of developing psychosis in an ultra high-risk ‘prodromal’ population. Schizophrenia Bulletin 40, 697–706.CrossRefGoogle Scholar
Valmaggia, L, Day, F, Jones, C, Bissoli, S, Pugh, C, Hall, D, Bhattacharyya, S, Howes, O, Stone, J, Fusar-Poli, P (2014). Cannabis use and transition to psychosis in people at ultra-high risk. Psychological Medicine 44, 2503–2512.CrossRefGoogle ScholarPubMed
van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, McGorry, P, Cuijpers, P (2013). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 56–62.CrossRefGoogle ScholarPubMed
van der Meer, FJ, Velthorst, E, Meijer, CJ, Machielsen, MW, de Haan, L (2012). Cannabis use in patients at clinical high risk of psychosis: impact on prodromal symptoms and transition to psychosis. Current Pharmaceutical Design 18, 5036–5044.CrossRefGoogle ScholarPubMed
Van Os, J, Bak, M, Hanssen, M, Bijl, R, De Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319–327.CrossRefGoogle ScholarPubMed
von Sydow, K, Lieb, R, Pfister, H, Höfler, M, Wittchen, H-U (2002). What predicts incident use of cannabis and progression to abuse and dependence?: A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and Alcohol Dependence 68, 49–64.CrossRefGoogle Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.CrossRefGoogle ScholarPubMed
Zammit, S, Allebeck, P, Andreasson, S, Lundberg, I, Lewis, G (2002). Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ: British Medical Journal 325, 1199.CrossRefGoogle ScholarPubMed