Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study

Diego Quattrone; Laura Ferraro; Giada Tripoli; Caterina La Cascia; Harriet Quigley; Andrea Quattrone; Hannah E Jongsma; Simona Del Peschio; Giusy Gatto; Charlotte Gayer-Anderson; Peter B Jones; James B Kirkbride; Daniele La Barbera; Ilaria Tarricone; Domenico Berardi; Sarah Tosato; Antonio Lasalvia; Andrei Szöke; Celso Arango; Miquel Bernardo; Julio Bobes; Cristina Marta Del Ben; Paulo Rossi Menezes; Pierre-Michel Llorca; Jose Luis Santos; Julio Sanjuán; Andrea Tortelli; Eva Velthorst; Lieuwe de Haan; Bart P F Rutten; Michael T Lynskey; Tom P Freeman; Pak C Sham; Alastair G Cardno; Evangelos Vassos; Jim van Os; Craig Morgan; Ulrich Reininghaus; Cathryn M Lewis; Robin M Murray; Marta Di Forti

doi:10.1017/S0033291720000082

Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study

Diego Quattrone, Laura Ferraro, Giada Tripoli, Caterina La Cascia, Harriet Quigley, Andrea Quattrone, Hannah E Jongsma, Simona Del Peschio, Giusy Gatto, Charlotte Gayer-Anderson, Peter B Jones, James B Kirkbride, Daniele La Barbera, Ilaria Tarricone, Domenico Berardi, Sarah Tosato, Antonio Lasalvia, Andrei Szöke, Celso Arango, Miquel BernardoJulio Bobes, Cristina Marta Del Ben, Paulo Rossi Menezes, Pierre-Michel Llorca, Jose Luis Santos, Julio Sanjuán, Andrea Tortelli, Eva Velthorst, Lieuwe de Haan, Bart P F Rutten, Michael T Lynskey, Tom P Freeman, Pak C Sham, Alastair G Cardno, Evangelos Vassos, Jim van Os, Craig Morgan, Ulrich Reininghaus, Cathryn M Lewis, Robin M Murray, Marta Di Forti

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Abstract

BACKGROUND: Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.

METHOD: We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.

RESULTS: In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14-0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = -0.22; 95% CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.

CONCLUSIONS: Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.

Original language	English
Pages (from-to)	1329 - 1337
Journal	Psychological Medicine
Volume	51
Issue number	8
Early online date	18 Mar 2020
DOIs	https://doi.org/10.1017/S0033291720000082
Publication status	Published - 1 Jun 2021

Funding

Financial support. The work was supported by: Clinician Scientist Medical Research Council fellowship (project reference MR/M008436/1) to MDF; the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust to DQ; DFG Heisenberg professorship (no. 389624707) to UR. National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The EU-GEI Project is funded by the European Community’s Seventh Framework Programme under grant agreement No. HEALTH-F2-2010-241909 (Project EU-GEI). The Brazilian study was funded by the São Paulo Research Foundation under grant number 2012/0417-0. Funders were not involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

Keywords

Cannabis use
cannabis-associated psychosis
first episode psychosis
psychopathology
psychotic experiences
symptom dimensions

ASJC Scopus subject areas

Applied Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/S0033291720000082Licence: CC BY

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Quattrone, D., Ferraro, L., Tripoli, G., La Cascia, C., Quigley, H., Quattrone, A., Jongsma, H. E., Del Peschio, S., Gatto, G., Gayer-Anderson, C., Jones, P. B., Kirkbride, J. B., La Barbera, D., Tarricone, I., Berardi, D., Tosato, S., Lasalvia, A., Szöke, A., Arango, C., ... Di Forti, M. (2021). Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study. Psychological Medicine, 51(8), 1329 - 1337. https://doi.org/10.1017/S0033291720000082

Quattrone, D, Ferraro, L, Tripoli, G, La Cascia, C, Quigley, H, Quattrone, A, Jongsma, HE, Del Peschio, S, Gatto, G, Gayer-Anderson, C, Jones, PB, Kirkbride, JB, La Barbera, D, Tarricone, I, Berardi, D, Tosato, S, Lasalvia, A, Szöke, A, Arango, C, Bernardo, M, Bobes, J, Del Ben, CM, Menezes, PR, Llorca, P-M, Santos, JL, Sanjuán, J, Tortelli, A, Velthorst, E, de Haan, L, Rutten, BPF, Lynskey, MT, Freeman, TP, Sham, PC, Cardno, AG, Vassos, E, van Os, J, Morgan, C, Reininghaus, U, Lewis, CM, Murray, RM & Di Forti, M 2021, 'Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study', Psychological Medicine, vol. 51, no. 8, pp. 1329 - 1337. https://doi.org/10.1017/S0033291720000082

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title = "Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study",

abstract = "BACKGROUND: Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.METHOD: We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.RESULTS: In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14-0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = -0.22; 95% CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.CONCLUSIONS: Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.",

keywords = "Cannabis use, cannabis-associated psychosis, first episode psychosis, psychopathology, psychotic experiences, symptom dimensions",

author = "Diego Quattrone and Laura Ferraro and Giada Tripoli and {La Cascia}, Caterina and Harriet Quigley and Andrea Quattrone and Jongsma, {Hannah E} and {Del Peschio}, Simona and Giusy Gatto and Charlotte Gayer-Anderson and Jones, {Peter B} and Kirkbride, {James B} and {La Barbera}, Daniele and Ilaria Tarricone and Domenico Berardi and Sarah Tosato and Antonio Lasalvia and Andrei Sz{\"o}ke and Celso Arango and Miquel Bernardo and Julio Bobes and {Del Ben}, {Cristina Marta} and Menezes, {Paulo Rossi} and Pierre-Michel Llorca and Santos, {Jose Luis} and Julio Sanju{\'a}n and Andrea Tortelli and Eva Velthorst and {de Haan}, Lieuwe and Rutten, {Bart P F} and Lynskey, {Michael T} and Freeman, {Tom P} and Sham, {Pak C} and Cardno, {Alastair G} and Evangelos Vassos and {van Os}, Jim and Craig Morgan and Ulrich Reininghaus and Lewis, {Cathryn M} and Murray, {Robin M} and {Di Forti}, Marta",

year = "2021",

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doi = "10.1017/S0033291720000082",

language = "English",

volume = "51",

pages = "1329 -- 1337",

journal = "Psychological Medicine",

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T1 - Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients

T2 - the EU-GEI case-control study

AU - Quattrone, Diego

AU - Ferraro, Laura

AU - Tripoli, Giada

AU - La Cascia, Caterina

AU - Quigley, Harriet

AU - Quattrone, Andrea

AU - Jongsma, Hannah E

AU - Del Peschio, Simona

AU - Gatto, Giusy

AU - Gayer-Anderson, Charlotte

AU - Jones, Peter B

AU - Kirkbride, James B

AU - La Barbera, Daniele

AU - Tarricone, Ilaria

AU - Berardi, Domenico

AU - Tosato, Sarah

AU - Lasalvia, Antonio

AU - Szöke, Andrei

AU - Arango, Celso

AU - Bernardo, Miquel

AU - Bobes, Julio

AU - Del Ben, Cristina Marta

AU - Menezes, Paulo Rossi

AU - Llorca, Pierre-Michel

AU - Santos, Jose Luis

AU - Sanjuán, Julio

AU - Tortelli, Andrea

AU - Velthorst, Eva

AU - de Haan, Lieuwe

AU - Rutten, Bart P F

AU - Lynskey, Michael T

AU - Freeman, Tom P

AU - Sham, Pak C

AU - Cardno, Alastair G

AU - Vassos, Evangelos

AU - van Os, Jim

AU - Morgan, Craig

AU - Reininghaus, Ulrich

AU - Lewis, Cathryn M

AU - Murray, Robin M

AU - Di Forti, Marta

PY - 2021/6/1

Y1 - 2021/6/1

N2 - BACKGROUND: Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.METHOD: We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.RESULTS: In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14-0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = -0.22; 95% CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.CONCLUSIONS: Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.

AB - BACKGROUND: Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.METHOD: We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.RESULTS: In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14-0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = -0.22; 95% CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.CONCLUSIONS: Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.

KW - Cannabis use

KW - cannabis-associated psychosis

KW - first episode psychosis

KW - psychopathology

KW - psychotic experiences

KW - symptom dimensions

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DO - 10.1017/S0033291720000082

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SN - 1469-8978

VL - 51

SP - 1329

EP - 1337

JO - Psychological Medicine

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ER -

Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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