Cannabis use and clinical outcome in people with first-episode schizophrenia spectrum disorders over 24 months of treatment

Scheffler, Frederika; Phahladira, Lebogang; Luckhoff, Hilmar; Plessis, Stéfan du; Asmal, Laila; Kilian, Sanja; Forti, Marta Di; Murray, Robin M.; Emsley, Robin

doi:10.1016/j.psychres.2021.114022

Cited by 11 publications

(7 citation statements)

References 42 publications

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“…This finding is, however, contrary to findings in the literature where studies have consistently found that schizophrenia and continued cannabis use leads to poorer outcomes, such as a more complicated course of illness, as evidenced by frequent relapses, shorter periods of time between relapses, longer hospitalisations and more intensive psychiatric care. 5,11,19,27 This is also consistent with both local as well as other international literature. 27,44,45 As the literature shows that discontinuing cannabis use has improved outcomes, it becomes essential that we review the modifiable factors associated with psychosis outcome.…”

Section: Discussionsupporting

confidence: 92%

“…24,25 Data from South Africa (SA) and other African countries have shown similar findings, with unemployment, being single, an inpatient status, and recurrent admissions being additional factors associated with cannabis use. 5,15,16,19,26,27 Hence we note a high comorbidity between cannabis use and psychosis, and that the dual diagnosis of a cannabis use and psychotic disorder is a poor prognostic factor. A study conducted in India had similar findings where cannabis use had a high prevalence for psychotic disorder and this co-occurrence is a poor prognostic factor.…”

Section: Introductionmentioning

confidence: 72%

“…Similar to our findings, other studies have also consistently reported cannabis users in populations with psychosis to be predominantly male, of young age, having a low level of education and unemployed. 5,15,16,19,24,25,26 In a USA community hospital cohort, the findings were that being male, young, unemployed and homeless was significantly associated with cannabis use in patients with schizophrenia spectrum disorders. 41 A study conducted in Spain in patients with FEP also found users to be predominantly male who started cannabis use earlier in life.…”

Section: Discussionmentioning

confidence: 99%

“…43 Local findings have also been consistent, with cannabis users being more likely to be young and male. 5,19 The vulnerability of young males suggests the need for earlier public health programmes on substance use among this cohort who may be at risk of psychosis to improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Cannabis users with psychosis have an earlier onset of illness, increased symptom severity, poorer adherence to psychiatric medication, poorer functional outcomes, higher relapse rates and longer hospital stays compared with non-users. 5,6,7,8,9,10,11 In addition, people with schizophrenia spectrum and other psychotic disorders and comorbid cannabis use tend to have poorer psychosocial functioning, homelessness, violence, incarceration and increased burden of care for families. 4,12,13,14 having been reported.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of cannabis use in people with psychosis in KwaZulu-Natal, South Africa

Mona

Ntlantsana²,

Tomita³

et al. 2022

South African Journal of Psychiatry

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Background: There is a high prevalence of cannabis use in patients with schizophrenia spectrum and other psychotic disorders, with comorbid cannabis use in this population being associated with poorer long-term outcomes.Aim: To determine the prevalence of cannabis use in patients with a schizophrenia spectrum and other psychotic disorders.Setting: The study was conducted at a psychiatric hospital in Durban, KwaZulu-Natal Province, South Africa.Methods: A review of clinical records of patients admitted to the hospital for the period, June 2018 to June 2020, was conducted.Results: A total of 370 clinical records were reviewed, of which 48.9% reported current and 51.1% lifetime cannabis use. Being male was significantly associated with current and lifetime cannabis use (OR = 4.90, 95% CI 2.49–9.62 and OR = 6.27, 95% CI 3.28–11.95, respectively). Current alcohol use was also associated with current cannabis use (CCU) (OR = 3.06, 95% CI 1.78–5.28), and age 45 years and older was associated with a lower odds of cannabis use (OR = 0.30, 95% CI 0.09–0.96). Forty-eight per cent of participants were admitted three or more times, and readmission was associated with cannabis use (p = 0.01). There was a lack of association between cannabis use, readmission and human immunodeficiency virus (HIV) status, after controlling for variables such as alcohol use and gender.Conclusion: Almost 50% of people admitted with schizophrenia spectrum and other psychotic disorders have comorbid current and lifetime cannabis use. There is a need for dual diagnosis units to address comorbid substance use in people with psychotic disorders, as it leads to poorer outcomes.Contribution: The study found that there is a high prevalence of cannabis use in people with psychosis. Therefore, it is imperative that we revise treatment programs in our psychiatric units and there is an urgent need for dual diagnosis programs that address substance use in this group of patients.

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