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Cannabis Abuse and the Course of Recent-Onset Schizophrenic Disorders

Cannabis Abuse and the Course of Recent-Onset Schizophrenic Disorders Abstract Objective: We sought to examine the relation between cannabis abuse and the symptomatic course of recent-onset schizophrenia and related disorders. Design: A prospective cohort study over a year using monthly Brief Psychiatric Rating Scale assessments. Participants: Cannabis-abusing patients (n=24) were compared with nonabusers (n=69). Eleven patients were mild and 13 were heavy cannabis-abusing patients. Results: Significantly more and earlier psychotic relapses occurred in the cannabis-abusing group (P=.03). This association became stronger when mild and heavy cannabis abuse were distinguished (P=.002). No confounding effect of other variables, eg, other street drugs, was found. In all but one patient, cannabis abuse preceded the onset of the first psychotic symptoms for at least 1 year. Conclusions: Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant. References 1. Weil AT. Adverse reactions to marijuana, classification and suggested treatment . N Engl J Med . 1970;282:997-1000.Crossref 2. Chopra GS, Smith JW. Psychotic reactions following cannabis use in East Indians . Arch Gen Psychiatry . 1974;30:24-27.Crossref 3. Treffert DA. Marijuana use in schizophrenia: a clear hazard . Am J Psychiatry . 1978;135:1213-1215. 4. Negrete JC, Knapp WP, Douglas DE, Smith B. Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey . Psychol Med . 1986;16:515-520.Crossref 5. Cleghorn JM, Kaplan RD, Szechtman B, Szechtman H, Brown GM, Franco S. Substance abuse and schizophrenia: effect on symptoms but not on neurocognitive function . J Clin Psychiatry . 1991;52:26-30. 6. Knudsen P, Vilmar T. Cannabis and neuroleptic agents in schizophrenia . Acta Psychiatr Scand . 1984;69:162-174.Crossref 7. Rottanburgh D, Robins AH, Ben-Arie O, Teggin A, Elk R. Cannabis-associated psychosis with hypomanic features . Lancet . 1982;2:1364-1366.Crossref 8. Peralta V, Cuesta MJ. Influence of cannabis abuse on schizophrenic psychopathology . Acta Psychiatr Scand . 1992;85:127-130.Crossref 9. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 10. Nuechterlein KH, Snyder KS, Dawson ME, Rappe S, Gitlin M, Fogelson D. Expressed emotion, fixed dose fluphenazine decanoate maintenance and relapse in recent-onset schizophrenia . Psychopharmacol Bull . 1986;22:663-639. 11. Kokes R, Strauss J, Klorman R. Measuring premorbid adjustment: the instruments and their development . Schizophr Bull . 1977;3:186-213.Crossref 12. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale . Psychol Rep . 1962;10:799-812.Crossref 13. Linszen DH, Dingemans PMAJ, Scholte WF, et al. Behandeling, 'expressed emotion' en recent ontstane schizofrenie en verwante stoornissen . Tijdschr Psychiatr . 1993;9:625-640. 14. Thiemann S, Csernansky JG, Berger PA. Rating scales in research: the case of negative symptoms . Psychiatry Res . 1987;20:47-55.Crossref 15. Czobor P, Bitter I, Volavka J. Relationship between Brief Psychiatric Rating Scale for the assessment of negative symptoms: a study of their correlation and redundancy . Psychiatry Res . 1991;36:129-139.Crossref 16. Norusis MJ. SPSSPC+ 4.0 Base Manual for the IBM PC/XT/AT and PS/2 . Chicago, Ill: SPSS Inc; 1990. 17. Dixon MJ, Brown MB, Engelman L, et al, eds. BMDP Statistical Software Manual . Berkeley: University of California Press; 1990;1-2. 18. Breier A, Schreiber JL, Dyer J, Pickar D. National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia: prognosis and predictors of outcome . Arch Gen Psychiatry . 1991;48:239-246.Crossref 19. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley & Sons Inc; 1968:387-397. 20. Strauss JS, Carpenter WT. Prediction of outcome in schizophrenia, III: Five-year outcome and its predictors . Arch Gen Psychiatr . 1977;34:159-163.Crossref 21. Martin GW, Wilkinson A, Kapur BM. Validation of self-reported cannabis use by urine analysis . Addict Behav . 1988;13:147-150.Crossref 22. Andreasson S, Allebeck P, Engström A, Rydberg U. Cannabis and schizophrenia: a longitudinal study of Swedish conscripts . Lancet . 1987;2:1483-1486.Crossref 23. Gardner EL, Lowinson JH. Marijuana's interaction with brain reward systems: update 1991 . Pharmacol Biochem Behav . 1991:40:571-580.Crossref 24. McKena PJ. Pathology, phenomenology and the dopamine hypothesis of schizophrenia . Br J Psychiatry . 1987;151:288-301.Crossref 25. Schneier FR, Siris SG. A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice . J Nerv Ment Dis . 1987;175:641-652.Crossref 26. Dixon L, Haas G, Weiden PJ, Sweeney J, Frances AJ. Drug abuse in schizophrenic patients: clinical correlates and reasons for use . Am J Psychiatry . 1991;148:224-230. 27. Thornicroft G. Cannabis and psychosis: is there epidemiological evidence for an association? Br J Psychiatry . 1990;157:25-33.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Cannabis Abuse and the Course of Recent-Onset Schizophrenic Disorders

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1994.03950040017002
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: We sought to examine the relation between cannabis abuse and the symptomatic course of recent-onset schizophrenia and related disorders. Design: A prospective cohort study over a year using monthly Brief Psychiatric Rating Scale assessments. Participants: Cannabis-abusing patients (n=24) were compared with nonabusers (n=69). Eleven patients were mild and 13 were heavy cannabis-abusing patients. Results: Significantly more and earlier psychotic relapses occurred in the cannabis-abusing group (P=.03). This association became stronger when mild and heavy cannabis abuse were distinguished (P=.002). No confounding effect of other variables, eg, other street drugs, was found. In all but one patient, cannabis abuse preceded the onset of the first psychotic symptoms for at least 1 year. Conclusions: Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant. References 1. Weil AT. Adverse reactions to marijuana, classification and suggested treatment . N Engl J Med . 1970;282:997-1000.Crossref 2. Chopra GS, Smith JW. Psychotic reactions following cannabis use in East Indians . Arch Gen Psychiatry . 1974;30:24-27.Crossref 3. Treffert DA. Marijuana use in schizophrenia: a clear hazard . Am J Psychiatry . 1978;135:1213-1215. 4. Negrete JC, Knapp WP, Douglas DE, Smith B. Cannabis affects the severity of schizophrenic symptoms: results of a clinical survey . Psychol Med . 1986;16:515-520.Crossref 5. Cleghorn JM, Kaplan RD, Szechtman B, Szechtman H, Brown GM, Franco S. Substance abuse and schizophrenia: effect on symptoms but not on neurocognitive function . J Clin Psychiatry . 1991;52:26-30. 6. Knudsen P, Vilmar T. Cannabis and neuroleptic agents in schizophrenia . Acta Psychiatr Scand . 1984;69:162-174.Crossref 7. Rottanburgh D, Robins AH, Ben-Arie O, Teggin A, Elk R. Cannabis-associated psychosis with hypomanic features . Lancet . 1982;2:1364-1366.Crossref 8. Peralta V, Cuesta MJ. Influence of cannabis abuse on schizophrenic psychopathology . Acta Psychiatr Scand . 1992;85:127-130.Crossref 9. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition . Washington, DC: American Psychiatric Association; 1987. 10. Nuechterlein KH, Snyder KS, Dawson ME, Rappe S, Gitlin M, Fogelson D. Expressed emotion, fixed dose fluphenazine decanoate maintenance and relapse in recent-onset schizophrenia . Psychopharmacol Bull . 1986;22:663-639. 11. Kokes R, Strauss J, Klorman R. Measuring premorbid adjustment: the instruments and their development . Schizophr Bull . 1977;3:186-213.Crossref 12. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale . Psychol Rep . 1962;10:799-812.Crossref 13. Linszen DH, Dingemans PMAJ, Scholte WF, et al. Behandeling, 'expressed emotion' en recent ontstane schizofrenie en verwante stoornissen . Tijdschr Psychiatr . 1993;9:625-640. 14. Thiemann S, Csernansky JG, Berger PA. Rating scales in research: the case of negative symptoms . Psychiatry Res . 1987;20:47-55.Crossref 15. Czobor P, Bitter I, Volavka J. Relationship between Brief Psychiatric Rating Scale for the assessment of negative symptoms: a study of their correlation and redundancy . Psychiatry Res . 1991;36:129-139.Crossref 16. Norusis MJ. SPSSPC+ 4.0 Base Manual for the IBM PC/XT/AT and PS/2 . Chicago, Ill: SPSS Inc; 1990. 17. Dixon MJ, Brown MB, Engelman L, et al, eds. BMDP Statistical Software Manual . Berkeley: University of California Press; 1990;1-2. 18. Breier A, Schreiber JL, Dyer J, Pickar D. National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia: prognosis and predictors of outcome . Arch Gen Psychiatry . 1991;48:239-246.Crossref 19. Hollingshead AB, Redlich FC. Social Class and Mental Illness . New York, NY: John Wiley & Sons Inc; 1968:387-397. 20. Strauss JS, Carpenter WT. Prediction of outcome in schizophrenia, III: Five-year outcome and its predictors . Arch Gen Psychiatr . 1977;34:159-163.Crossref 21. Martin GW, Wilkinson A, Kapur BM. Validation of self-reported cannabis use by urine analysis . Addict Behav . 1988;13:147-150.Crossref 22. Andreasson S, Allebeck P, Engström A, Rydberg U. Cannabis and schizophrenia: a longitudinal study of Swedish conscripts . Lancet . 1987;2:1483-1486.Crossref 23. Gardner EL, Lowinson JH. Marijuana's interaction with brain reward systems: update 1991 . Pharmacol Biochem Behav . 1991:40:571-580.Crossref 24. McKena PJ. Pathology, phenomenology and the dopamine hypothesis of schizophrenia . Br J Psychiatry . 1987;151:288-301.Crossref 25. Schneier FR, Siris SG. A review of psychoactive substance use and abuse in schizophrenia: patterns of drug choice . J Nerv Ment Dis . 1987;175:641-652.Crossref 26. Dixon L, Haas G, Weiden PJ, Sweeney J, Frances AJ. Drug abuse in schizophrenic patients: clinical correlates and reasons for use . Am J Psychiatry . 1991;148:224-230. 27. Thornicroft G. Cannabis and psychosis: is there epidemiological evidence for an association? Br J Psychiatry . 1990;157:25-33.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Apr 1, 1994

References