Alcohol Confounds Relationship Between Cannabis Misuse and Psychosis Conversion in a High-risk Sample

Overview

Journal Acta Psychiatr Scand

Specialty Psychiatry

Date 2015 Jan 10

PMID 25572323

Citations 19

Authors

A M Auther

K S Cadenhead

R E Carrion

J Addington

C E Bearden

T D Cannon

T H McGlashan

D O Perkins

L Seidman

M Tsuang

E F Walker

S W Woods

B A Cornblatt

Affiliations

Soon will be listed here.

Abstract

Objective: Cannabis use has been examined as a predictor of psychosis in clinical high-risk (CHR) samples, but little is known about the impact of other substances on this relationship.

Method: Substance use was assessed in a large sample of CHR participants (N = 370, mean age = 18.3) enrolled in the multisite North American Prodrome Longitudinal Study Phase 1 project. Three hundred and forty-one participants with cannabis use data were divided into groups: No Use (NU, N = 211); Cannabis Use without impairment (CU, N = 63); Cannabis Abuse/Dependence (CA/CD, N = 67). Participants (N = 283) were followed for ≥2 years to determine psychosis conversion.

Results: Alcohol (45.3%) and cannabis (38.1%) were the most common substances. Cannabis use groups did not differ on baseline attenuated positive symptoms. Seventy-nine of 283 participants with cannabis and follow-up data converted to psychosis. Survival analysis revealed significant differences between conversion rates in the CA/CD group compared with the No Use (P = 0.031) and CU group (P = 0.027). CA/CD also significantly predicted psychosis in a regression analysis, but adjusting for alcohol use weakened this relationship.

Conclusion: The cannabis misuse and psychosis association was confounded by alcohol use. Non-impairing cannabis use was not related to psychosis. Results highlight the need to control for other substance use, so as to not overstate the cannabis/psychosis connection.

Citing Articles

Physical Health and Transition to Psychosis in People at Clinical High Risk.

De Micheli A, Provenzani U, Krakowski K, Oliver D, Damiani S, Brondino N Biomedicines. 2024; 12(3).

PMID: 38540135 PMC: 10968449. DOI: 10.3390/biomedicines12030523.

The impact of early factors on persistent negative symptoms in youth at clinical high risk for psychosis.

Devoe D, Lui L, Cannon T, Cadenhead K, Cornblatt B, Keshavan M Front Psychiatry. 2023; 14:1125168.

PMID: 37293402 PMC: 10244495. DOI: 10.3389/fpsyt.2023.1125168.

Neurobehavioral risk factors influence prevalence and severity of hazardous substance use in youth at genetic and clinical high risk for psychosis.

Amir C, Kapler S, Hoftman G, Kushan L, Zinberg J, Cadenhead K Front Psychiatry. 2023; 14:1143315.

PMID: 37151981 PMC: 10157227. DOI: 10.3389/fpsyt.2023.1143315.

Ethnoracial discrimination and the development of suspiciousness symptoms in individuals at clinical high-risk for psychosis.

Michaels T, Carrion R, Addington J, Bearden C, Cadenhead K, Cannon T Schizophr Res. 2023; 254:125-132.

PMID: 36857950 PMC: 10106391. DOI: 10.1016/j.schres.2023.02.021.

Physical Health in Clinical High Risk for Psychosis Individuals: A Cross-Sectional Study.

Provenzani U, De Micheli A, Damiani S, Oliver D, Brondino N, Fusar-Poli P Brain Sci. 2023; 13(1).

PMID: 36672109 PMC: 9857012. DOI: 10.3390/brainsci13010128.

References

Moore T, Zammit S, Lingford-Hughes A, Barnes T, Jones P, Burke M . Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007; 370(9584):319-28. DOI: 10.1016/S0140-6736(07)61162-3. View

Squeglia L, Jacobus J, Tapert S . The influence of substance use on adolescent brain development. Clin EEG Neurosci. 2009; 40(1):31-8. PMC: 2827693. DOI: 10.1177/155005940904000110. View

Williams J, GIBBON M, First M, Spitzer R, Davies M, Borus J . The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch Gen Psychiatry. 1992; 49(8):630-6. DOI: 10.1001/archpsyc.1992.01820080038006. View

Callaghan R, Cunningham J, Allebeck P, Arenovich T, Sajeev G, Remington G . Methamphetamine use and schizophrenia: a population-based cohort study in California. Am J Psychiatry. 2011; 169(4):389-96. DOI: 10.1176/appi.ajp.2011.10070937. View

Zammit S, Moore T, Lingford-Hughes A, Barnes T, Jones P, Burke M . Effects of cannabis use on outcomes of psychotic disorders: systematic review. Br J Psychiatry. 2008; 193(5):357-63. DOI: 10.1192/bjp.bp.107.046375. View

van Gastel W, MacCabe J, Schubart C, Vreeker A, Tempelaar W, Kahn R . Cigarette smoking and cannabis use are equally strongly associated with psychotic-like experiences: a cross-sectional study in 1929 young adults. Psychol Med. 2013; 43(11):2393-401. DOI: 10.1017/S0033291713000202. View

Zeigler D, Wang C, Yoast R, Dickinson B, McCaffree M, Robinowitz C . The neurocognitive effects of alcohol on adolescents and college students. Prev Med. 2004; 40(1):23-32. DOI: 10.1016/j.ypmed.2004.04.044. View

Auther A, McLaughlin D, Carrion R, Nagachandran P, Correll C, Cornblatt B . Prospective study of cannabis use in adolescents at clinical high risk for psychosis: impact on conversion to psychosis and functional outcome. Psychol Med. 2012; 42(12):2485-97. PMC: 3459073. DOI: 10.1017/S0033291712000803. View

Yung A, Phillips L, Yuen H, McGorry P . Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res. 2004; 67(2-3):131-42. DOI: 10.1016/S0920-9964(03)00192-0. View

10.

Valmaggia L, Day F, Jones C, Bissoli S, Pugh C, Hall D . Cannabis use and transition to psychosis in people at ultra-high risk. Psychol Med. 2014; 44(12):2503-12. DOI: 10.1017/S0033291714000117. View

11.

Klosterkotter J, Ruhrmann S, Schultze-Lutter F, Salokangas R, Linszen D, Birchwood M . The European Prediction of Psychosis Study (EPOS): integrating early recognition and intervention in Europe. World Psychiatry. 2006; 4(3):161-7. PMC: 1414769. View

12.

Koskinen J, Lohonen J, Koponen H, Isohanni M, Miettunen J . Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophr Bull. 2009; 36(6):1115-30. PMC: 2963055. DOI: 10.1093/schbul/sbp031. View

13.

Dragt S, Nieman D, Schultze-Lutter F, van der Meer F, Becker H, de Haan L . Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand. 2011; 125(1):45-53. DOI: 10.1111/j.1600-0447.2011.01763.x. View

14.

Kuepper R, van Os J, Lieb R, Wittchen H, Hofler M, Henquet C . Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ. 2011; 342:d738. PMC: 3047001. DOI: 10.1136/bmj.d738. View

15.

Cannon T, Cadenhead K, Cornblatt B, Woods S, Addington J, Walker E . Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry. 2008; 65(1):28-37. PMC: 3065347. DOI: 10.1001/archgenpsychiatry.2007.3. View

16.

Buchy L, Perkins D, Woods S, Liu L, Addington J . Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophr Res. 2014; 156(2-3):277-80. PMC: 4082820. DOI: 10.1016/j.schres.2014.04.021. View

17.

Jacobus J, Squeglia L, Bava S, Tapert S . White matter characterization of adolescent binge drinking with and without co-occurring marijuana use: a 3-year investigation. Psychiatry Res. 2013; 214(3):374-81. PMC: 3900025. DOI: 10.1016/j.pscychresns.2013.07.014. View

18.

Ruhrmann S, Schultze-Lutter F, Salokangas R, Heinimaa M, Linszen D, Dingemans P . Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry. 2010; 67(3):241-51. DOI: 10.1001/archgenpsychiatry.2009.206. View

19.

Phillips L, Curry C, Yung A, Yuen H, Adlard S, McGorry P . Cannabis use is not associated with the development of psychosis in an 'ultra' high-risk group. Aust N Z J Psychiatry. 2002; 36(6):800-6. DOI: 10.1046/j.1440-1614.2002.01089.x. View

20.

Steinhausen H, Eschmann S, Heimgartner A, Metzke C . Frequency, course and correlates of alcohol use from adolescence to young adulthood in a Swiss community survey. BMC Psychiatry. 2008; 8:5. PMC: 2253536. DOI: 10.1186/1471-244X-8-5. View