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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: t.kraan@parnassia.nl)
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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 

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