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Do cannabis and urbanicity co-participate in causing psychosis? Evidence from a 10-year follow-up cohort study

Published online by Cambridge University Press:  05 April 2011

R. Kuepper ,
J. van Os ,
R. Lieb ,
H.-U. Wittchen  and
C. Henquet
R. Kuepper
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
J. van Os*
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
R. Lieb
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany University of Basel, Department of Psychology, Division of Epidemiology and Health Psychology, Basel, Switzerland
H.-U. Wittchen
Affiliation:
Max Planck Institute of Psychiatry, Munich, Germany Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden, Germany
C. Henquet
Affiliation:
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, Maastricht, The Netherlands Mondriaan Zorggroep, Division Addiction Care, South Limburg, The Netherlands
*
*Address for correspondence: J. van Os, Ph.D., Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (location DOT12), 6200 MD Maastricht, The Netherlands. (Email: [email protected])
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Abstract

Background

Cannabis use is considered a component cause of psychotic illness, interacting with genetic and other environmental risk factors. Little is known, however, about these putative interactions. The present study investigated whether an urban environment plays a role in moderating the effects of adolescent cannabis use on psychosis risk.

Method

Prospective data (n=1923, aged 14–24 years at baseline) from the longitudinal population-based German Early Developmental Stages of Psychopathology cohort study were analysed. Urbanicity was assessed at baseline and defined as living in the city of Munich (1562 persons per km2; 4061 individuals per square mile) or in the rural surroundings (213 persons per km2; 553 individuals per square mile). Cannabis use and psychotic symptoms were assessed three times over a 10-year follow-up period using the Munich version of the Composite International Diagnostic Interview.

Results

Analyses revealed a significant interaction between cannabis and urbanicity [10.9% adjusted difference in risk, 95% confidence interval (CI) 3.2–18.6, p=0.005]. The effect of cannabis use on follow-up incident psychotic symptoms was much stronger in individuals who grew up in an urban environment (adjusted risk difference 6.8%, 95% CI 1.0–12.5, p=0.021) compared with individuals from rural surroundings (adjusted risk difference −4.1%, 95% CI −9.8 to 1.6, p=0.159). The statistical interaction was compatible with substantial underlying biological synergism.

Conclusions

Exposure to environmental influences associated with urban upbringing may increase vulnerability to the psychotomimetic effects of cannabis use later in life.

Keywords

Cannabiscohort studyinteractionpsychosisurban environment
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2121 - 2129
Copyright
Copyright © Cambridge University Press 2011

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References

Allardyce, J, Gilmour, H, Atkinson, J, Rapson, T, Bishop, J, McCreadie, RG (2005). Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. British Journal of Psychiatry 187, 401–406.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Clarke, MC, Tanskanen, A, Huttunen, M, Whittaker, JC, Cannon, M (2009). Evidence for an interaction between familial liability and prenatal exposure to infection in the causation of schizophrenia. American Journal of Psychiatry 166, 1025–1030.CrossRefGoogle ScholarPubMed
Collip, D, Myin-Germeys, I, van Os, J (2008). Does the concept of ‘sensitization’ provide a plausible mechanism for the putative link between the environment and schizophrenia? Schizophrenia Bulletin 34, 220–225.CrossRefGoogle ScholarPubMed
Corcoran, C, Malaspina, D (2001). Traumatic brain injury and schizophrenia. International Journal of Mental Health 30, 17–33.CrossRefGoogle Scholar
Cottler, LB, Helzer, JE, Mager, D, Spitznagel, EL, Compton, WM (1991). Agreement between DSM-III and III-R substance use disorders. Drug and Alcohol Dependence 29, 17–25.CrossRefGoogle ScholarPubMed
Cougnard, A, Marcelis, M, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, C, Spauwen, J, van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513–527.CrossRefGoogle ScholarPubMed
Darroch, J (1997). Biologic synergism and parallelism. American Journal of Epidemiology 145, 661–668.CrossRefGoogle ScholarPubMed
Dominguez, MD, Wichers, M, Lieb, R, Wittchen, HU, van Os, J (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin 37, 84–93.CrossRefGoogle ScholarPubMed
Ellett, L, Freeman, D, Garety, PA (2008). The psychological effect of an urban environment on individuals with persecutory delusions: the Camberwell walk study. Schizophrenia Research 99, 77–84.CrossRefGoogle ScholarPubMed
Genetic Risk and Outcome in Psychosis (GROUP) Investigators (2011). Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient–sibling and sibling–control pairs. Archives of General Psychiatry 68, 138–147.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, 181–191.CrossRefGoogle ScholarPubMed
Harley, M, Kelleher, I, Clarke, M, Lynch, F, Arseneault, L, Connor, D, Fitzpatrick, C, Cannon, M (2009). Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychological Medicine 40, 1627–1634.CrossRefGoogle ScholarPubMed
Henquet, C, Di Forti, M, Morrison, P, Kuepper, R, Murray, RM (2008). Gene–environment interplay between cannabis and psychosis. Schizophrenia Bulletin 34, 1111–1121.CrossRefGoogle ScholarPubMed
Henquet, C, Krabbendam, L, Spauwen, J, Kaplan, C, Lieb, R, Wittchen, HU, van Os, J (2005 a). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal 330, 11.CrossRefGoogle ScholarPubMed
Henquet, C, Murray, R, Linszen, D, van Os, J (2005 b). The environment and schizophrenia: the role of cannabis use. Schizophrenia Bulletin 31, 608–612.CrossRefGoogle ScholarPubMed
Henquet, C, Rosa, A, Krabbendam, L, Papiol, S, Fananas, L, Drukker, M, Ramaekers, JG, van Os, J (2006). An experimental study of catechol-O-methyltransferase Val158Met moderation of Δ-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology 31, 2748–2757.CrossRefGoogle ScholarPubMed
Houston, JE, Murphy, J, Adamson, G, Stringer, M, Shevlin, M (2008). Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophrenia Bulletin 34, 580–585.CrossRefGoogle ScholarPubMed
Kelly, BD, O'Callaghan, E, Waddington, JL, Feeney, L, Browne, S, Scully, PJ, Clarke, M, Quinn, JF, McTigue, O, Morgan, MG, Kinsella, A, Larkin, C (2010). Schizophrenia and the city: a review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophrenia Research 116, 75–89.CrossRefGoogle ScholarPubMed
Krabbendam, L, van Os, J (2005). Schizophrenia and urbanicity: a major environmental influence–conditional on genetic risk. Schizophrenia Bulletin 31, 795–799.CrossRefGoogle Scholar
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. British Medical Journal 342, d738.CrossRefGoogle ScholarPubMed
Lardinois, M, Lataster, T, Mengelers, R, van Os, J, Myin-Germeys, I (2011). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatrica Scandinavica 123, 28–35.CrossRefGoogle ScholarPubMed
Lieb, R, Isensee, B, von Sydow, K, Wittchen, HU (2000). The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. European Addiction Research 6, 170–182.CrossRefGoogle ScholarPubMed
Mackie, CJ, Castellanos-Ryan, N, Conrod, PJ (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 47–58.CrossRefGoogle ScholarPubMed
Marcelis, M, Takei, N, van Os, J (1999). Urbanization and risk for schizophrenia: does the effect operate before or around the time of illness onset? Psychological Medicine 29, 1197–1203.CrossRefGoogle ScholarPubMed
March, D, Hatch, SL, Morgan, C, Kirkbride, JB, Bresnahan, M, Fearon, P, Susser, E (2008). Psychosis and place. Epidemiologic Reviews 30, 84–100.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
Pedersen, CB, Mortensen, PB (2001). Evidence of a dose–response relationship between urbanicity during upbringing and schizophrenia risk. Archives of General Psychiatry 58, 1039–1046.CrossRefGoogle ScholarPubMed
Polanczyk, G, Moffitt, TE, Arseneault, L, Cannon, M, Ambler, A, Keefe, RS, Houts, R, Odgers, CL, Caspi, A (2010). Etiological and clinical features of childhood psychotic symptoms: results from a birth cohort. Archives of General Psychiatry 67, 328–338.CrossRefGoogle ScholarPubMed
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330–350.CrossRefGoogle ScholarPubMed
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA, Sartorius, N, Towle, LH (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, 1069–1077.CrossRefGoogle ScholarPubMed
Semple, DM, McIntosh, AM, Lawrie, SM (2005). Cannabis as a risk factor for psychosis: systematic review. Journal of Psychopharmacology 19, 187–194.CrossRefGoogle ScholarPubMed
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2004). Does urbanicity shift the population expression of psychosis? Journal of Psychiatric Research 38, 613–618.CrossRefGoogle ScholarPubMed
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment. Psychological Medicine 36, 407–415.CrossRefGoogle Scholar
van Os, J, Bak, M, Hanssen, M, Bijl, RV, de Graaf, R, Verdoux, H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319–327.CrossRefGoogle ScholarPubMed
van Os, J, Driessen, G, Gunther, N, Delespaul, P (2000). Neighbourhood variation in incidence of schizophrenia. Evidence for person–environment interaction. British Journal of Psychiatry 176, 243–248.CrossRefGoogle ScholarPubMed
van Os, J, Hanssen, M, Bak, M, Bijl, RV, Vollebergh, W (2003). Do urbanicity and familial liability coparticipate in causing psychosis? American Journal of Psychiatry 160, 477–482.CrossRefGoogle ScholarPubMed
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203–212.CrossRefGoogle ScholarPubMed
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine 39, 179–195.CrossRefGoogle ScholarPubMed
van Os, J, Pedersen, CB, Mortensen, PB (2004). Confirmation of synergy between urbanicity and familial liability in the causation of psychosis. American Journal of Psychiatry 161, 2312–2314.CrossRefGoogle ScholarPubMed
van Winkel, R; Genetic Risk and Outcome in Psychosis (GROUP) Investigators (2011). Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis: sibling analysis and proband follow-up. Archives of General Psychiatry 68, 148–157.CrossRefGoogle ScholarPubMed
van Winkel, R, Stefanis, NC, Myin-Germeys, I (2008). Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene–stress interaction. Schizophrenia Bulletin 34, 1095–1105.CrossRefGoogle ScholarPubMed
Weiser, M, van Os, J, Reichenberg, A, Rabinowitz, J, Nahon, D, Kravitz, E, Lubin, G, Shmushkevitz, M, Knobler, HY, Noy, S, Davidson, M (2007). Social and cognitive functioning, urbanicity and risk for schizophrenia. British Journal of Psychiatry 191, 320–324.CrossRefGoogle ScholarPubMed
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, 519–526.CrossRefGoogle ScholarPubMed
Wittchen, HU (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatry Research 28, 57–84.CrossRefGoogle ScholarPubMed
Wittchen, HU, Lachner, G, Wunderlich, U, Pfister, H (1998 a). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568–578.CrossRefGoogle ScholarPubMed
Wittchen, HU, Perkonigg, A, Lachner, G, Nelson, CB (1998 b). Early developmental stages of psychopathology study (EDSP): objectives and design. European Addiction Research 4, 18–27.CrossRefGoogle ScholarPubMed
Wittchen, HU, Robins, LN, Cottler, LB, Sartorius, N, Burke, JD, Regier, D (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. British Journal of Psychiatry 159, 645–653, 658.CrossRefGoogle ScholarPubMed
Zammit, S, Lewis, G, Rasbash, J, Dalman, C, Gustafsson, JE, Allebeck, P (2010). Individuals, schools, and neighborhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Archives of General Psychiatry 67, 914–922.CrossRefGoogle ScholarPubMed