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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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 languageEnglish
Pages (from-to)1329 - 1337
JournalPsychological Medicine
Issue number8
Early online date18 Mar 2020
Publication statusPublished - 1 Jun 2021


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

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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