Am J Epidemiol 2002; 156:319-327.
Copyright © 2002 by the
Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Cannabis Use and Psychosis: A Longitudinal Population-based Study
1 Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, Maastricht, the Netherlands.
2 Division of Psychological Medicine, Institute of Psychiatry, London, United Kingdom.
3 The Netherlands Institute of Mental Health and Addiction, Trimbos-Instituut, Utrecht, the Netherlands.
4 Research and Documentation Centre (WODC), Ministry of Justice, The Hague, the Netherlands.
5 Department of Psychiatry, Victor Segalen Bordeaux 2 University, and Hôpital Charles Perrens, Bordeaux, France.
Cannabis use may increase the risk of psychotic disorders and result in a poor prognosis for those with an established vulnerability to psychosis. A 3-year follow-up (1997–1999) is reported of a general population of 4,045 psychosis-free persons and of 59 subjects in the Netherlands with a baseline diagnosis of psychotic disorder. Substance use was assessed at baseline, 1-year follow-up, and 3-year follow-up. Baseline cannabis use predicted the presence at follow-up of any level of psychotic symptoms (adjusted odds ratio (OR) = 2.76, 95% confidence interval (CI): 1.18, 6.47), as well as a severe level of psychotic symptoms (OR = 24.17, 95% CI: 5.44, 107.46), and clinician assessment of the need for care for psychotic symptoms (OR = 12.01, 95% CI: 2.24, 64.34). The effect of baseline cannabis use was stronger than the effect at 1-year and 3-year follow-up, and more than 50% of the psychosis diagnoses could be attributed to cannabis use. On the additive scale, the effect of cannabis use was much stronger in those with a baseline diagnosis of psychotic disorder (risk difference, 54.7%) than in those without (risk difference, 2.2%; p for interaction = 0.001). Results confirm previous suggestions that cannabis use increases the risk of both the incidence of psychosis in psychosis-free persons and a poor prognosis for those with an established vulnerability to psychotic disorder. Am J Epidemiol 2002;156:319–27.
cannabis; drug utilization; psychoses, substance-induced; psychotic disorders; schizophrenia
Abbreviations: Abbreviations: BPRS, Brief Psychiatric Rating Scale; CI, confidence interval; CIDI, Composite International Diagnostic Interview; DSM-III-R, Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; OR, odds ratio; T1, time 1 (between baseline and 1997); T2, time 2 (between 1997 (T1) and 1999).
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