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Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation

Published online by Cambridge University Press:  24 May 2013

J. M. Stone ,
H. L. Fisher ,
B. Major ,
B. Chisholm ,
J. Woolley ,
J. Lawrence ,
N. Rahaman ,
J. Joyce ,
M. Hinton  and
S. Johnson
...Show all authors
J. M. Stone*
Affiliation:
Imperial College London, London, UK West London Mental Health NHS Trust, London, UK
H. L. Fisher
Affiliation:
Institute of Psychiatry, King's College London, London, UK
B. Major
Affiliation:
EQUIP, East London NHS Foundation Trust, London, UK
B. Chisholm
Affiliation:
Wandsworth Early Intervention Service, South West London and St George's Mental Health NHS Trust, London, UK
J. Woolley
Affiliation:
Wandsworth Early Intervention Service, South West London and St George's Mental Health NHS Trust, London, UK
J. Lawrence
Affiliation:
Southwark Early Intervention Service, South London and Maudsley NHS Foundation Trust, London, UK
N. Rahaman
Affiliation:
Westminster and Kensington & Chelsea Early Intervention Service, London, UK Central & North West London NHS Foundation Trust, London, UK
J. Joyce
Affiliation:
Lewisham Early Intervention Service, London, UK
M. Hinton
Affiliation:
University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK
S. Johnson
Affiliation:
University College London, London, UK Camden and Islington NHS Foundation Trust, London, UK
A. H. Young
Affiliation:
Imperial College London, London, UK West London Mental Health NHS Trust, London, UK
*
*Address for correspondence: J. M. Stone, Ph.D., E517, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. (Email: james.m.stone@imperial.ac.uk)
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Abstract

Background

Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.

Method

Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.

Results

Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.

Conclusions

Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

Keywords

Bipolar affective disordercannabismaniapsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 3 , February 2014 , pp. 499 - 506
Copyright
Copyright © Cambridge University Press 2013 

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