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Lesh TA, Rhilinger J, Brower R, Mawla AM, Ragland JD, Niendam TA, Carter CS. Using Task-fMRI to Explore the Relationship Between Lifetime Cannabis Use and Cognitive Control in Individuals With First-Episode Schizophrenia. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae016. [PMID: 39144106 PMCID: PMC11317632 DOI: 10.1093/schizbullopen/sgae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
While continued cannabis use and misuse in individuals with schizophrenia is associated with a variety of negative outcomes, individuals with a history of use tend to show higher cognitive performance compared to non-users. While this is replicated in the literature, few studies have used task-based functional magnetic resonance imaging (fMRI) to evaluate whether the brain networks underpinning these cognitive features are similarly impacted. Forty-eight first-episode individuals with schizophrenia (FES) with a history of cannabis use (FES + CAN), 28 FES individuals with no history of cannabis use (FES-CAN), and 59 controls (CON) performed the AX-Continuous Performance Task during fMRI. FES+CAN showed higher cognitive control performance (d'-context) compared to FES-CAN (P < .05, ηp 2 = 0.053), and both FES+CAN (P < .05, ηp 2 = 0.049) and FES-CAN (P < .001, ηp 2 = 0.216) showed lower performance compared to CON. FES+CAN (P < .05, ηp 2 = 0.055) and CON (P < 0.05, ηp 2 = 0.058) showed higher dorsolateral prefrontal cortex (DLPFC) activation during the task compared to FES-CAN, while FES+CAN and CON were not significantly different. Within the FES+CAN group, the younger age of initiation of cannabis use was associated with lower IQ and lower global functioning. More frequent use was also associated with higher reality distortion symptoms at the time of the scan. These data are consistent with previous literature suggesting that individuals with schizophrenia and a history of cannabis use have higher cognitive control performance. For the first time, we also reveal that FES+CAN have higher DLPFC brain activity during cognitive control compared to FES-CAN. Several possible explanations for these findings are discussed.
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Affiliation(s)
- Tyler A Lesh
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Joshua Rhilinger
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Rylee Brower
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Alex M Mawla
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Tara A Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
| | - Cameron S Carter
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
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Karpov B, Lindgren M, Kieseppä T, Wegelius A, Suvisaari J. Cognitive functioning and cannabis use in first-episode psychosis. Nord J Psychiatry 2022; 76:551-558. [PMID: 34964681 DOI: 10.1080/08039488.2021.2018038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Cannabis use is common in people with psychotic disorders. However, the effect of cannabis on cognition in psychosis remains unclear. Our study investigates relationships between the history of cannabis use and cognitive performance in patients with first-episode psychosis (FEP) during a one-year follow-up. METHODS The present study included FEP (N = 91) and control (N = 61) groups. Cannabis use was evaluated with a self-report questionnaire, clinical assessment, and medical records during a lifetime and 12 months prior to the treatment onset (recent). Symptoms of psychosis and anxiety were evaluated on the brief psychiatric rating scale. Negative symptoms were assessed using the scale for the assessment of negative symptoms. Cognitive tests were used to evaluate neurocognition (summarized in the g factor) and social cognition. Crude regression analyses for the g factor included variables of cannabis use as independent variables. Full regression models were controlled for gender, education, and clinical symptoms. RESULTS In the FEP group, men used cannabis more frequently than women. In the crude regression model for FEP patients, never having used cannabis was associated with a better neurocognitive profile at 12 months. In the full model, more severe anxiety symptoms were associated with better neurocognition at two months, and less severe negative symptoms were associated with better neurocognition at 12 months. Cannabis use was not associated with social cognition. No associations between cognitive performance and cannabis use emerged in the controls. CONCLUSION Negative and affective symptom severity in FEP was associated with cognitive performance to a greater degree than a lifetime history of cannabis use.
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Affiliation(s)
- Boris Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Lindgren
- Department of Mental Health and Substance Abuse Services, Public Health and Welfare, Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Asko Wegelius
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, Public Health and Welfare, Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
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Vázquez-Bourgon J, Setién-Suero E, Pilar-Cuéllar F, Romero-Jiménez R, Ortiz-García de la Foz V, Castro E, Crespo-Facorro B. Effect of cannabis on weight and metabolism in first-episode non-affective psychosis: Results from a three-year longitudinal study. J Psychopharmacol 2019; 33:284-294. [PMID: 30702972 DOI: 10.1177/0269881118822173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cannabis smoking is highly prevalent among patients with psychotic disorders. Its use has been found to be related to clinical characteristics and the prognosis of the disorder. Recent evidence indicates a protective effect of cannabis on weight gain and related metabolic alterations. However, there are no previous studies on the long-term longitudinal effects of cannabis on first-episode drug-naïve patients, which would thereby avoid the confounding effects of chronicity and previous treatment exposure. We aimed to explore the effect of cannabis smoking on weight and lipid/glycaemic metabolic measures in a sample of first-episode non-affective psychosis patients. METHOD Anthropometric measurements and glycaemic and lipid parameters were obtained at baseline and three years after initiation of treatment. Patients self-reported their cannabis use at both time points. To explore the longitudinal effect of cannabis, patients were divided into three groups: continuers, discontinuers and non-users. RESULTS Cannabis users at baseline presented a lower weight ( F=14.85, p<0.001), body mass index ( F=13.14, p<0.001), total cholesterol ( F=4.85, p=0.028) and low-density lipoprotein-cholesterol ( F=6.26, p=0.013) compared to non-users. These differences were also observed after three years: weight ( F=8.07, p=0.005), body mass index ( F=4.66, p=0.032) and low-density lipoprotein-cholesterol ( F=3.91, p=0.049). Moreover, those patients discontinuing cannabis use presented a higher increase in weight ( F=2.98, p=0.052), body mass index ( F=2.73, p=0.067) and triglyceride-high-density lipoprotein ratio ( F=2.72, p=0.067) than the 'non-users' and 'continuers'. CONCLUSIONS The study suggests that cannabis use may produce a protective effect against weight gain and related metabolic alterations in psychosis. However, these results need to be replicated in a larger sample size.
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Affiliation(s)
- Javier Vázquez-Bourgon
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Fuencisla Pilar-Cuéllar
- 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain.,4 Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.,5 Instituto de Biomedicina y Biotecnología de Cantabria, University of Cantabria-Consejo Superior de Investigaciones Científicas (CSIC)-Sociedad para el Desarrollo de Cantabria (SODERCAN), Santander, Spain
| | - Rodrigo Romero-Jiménez
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Víctor Ortiz-García de la Foz
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain
| | - Elena Castro
- 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain.,4 Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.,5 Instituto de Biomedicina y Biotecnología de Cantabria, University of Cantabria-Consejo Superior de Investigaciones Científicas (CSIC)-Sociedad para el Desarrollo de Cantabria (SODERCAN), Santander, Spain
| | - Benedicto Crespo-Facorro
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
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Bogaty SER, Crouse JJ, Hickie IB, Hermens DF. The neuropsychological profiles of young psychosis patients with and without current cannabis use. Cogn Neuropsychiatry 2019; 24:40-53. [PMID: 30621505 DOI: 10.1080/13546805.2018.1562887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Evidence suggests that patients with psychosis who have a history of cannabis use, but currently abstain, demonstrate superior cognitive performance than patients who have never used cannabis. The present study aimed to determine the neurocognitive profiles of patients who are in adolescence or early adulthood, when both illness- and drug-onset typically occur. METHODS Subjects were 24 cannabis-using and 79 cannabis-naïve psychosis patients between 16 and 25 years of age. Patients and controls were administered a neurocognitive battery, indexing estimated pre-morbid intelligence, psychomotor speed, mental flexibility, verbal learning and memory, verbal fluency, sustained attention, motor and mental response, and visuospatial learning and memory. RESULTS While healthy controls outperformed both patient groups across most cognitive measures, no significant differences between cannabis-using and cannabis-abstinent patients were evident. CONCLUSION Evidently although there may be a group of patients who are diagnosed with a non-affective psychosis disorder regardless of external factors (i.e. cannabis use), some may instead have their illness precipitated through cannabis use at a young age, presenting with unique cognitive and symptomatic repercussions later in life. These results demonstrate no cognitive differences between cannabis-using patients and abstinent patients at the time of illness-onset, providing partial support for an alternative pathway to schizophrenia through early cannabis use.
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Affiliation(s)
- Sophia E R Bogaty
- a Youth Mental Health Team, Brain and Mind Centre , University of Sydney , Sydney , Australia
| | - Jacob J Crouse
- a Youth Mental Health Team, Brain and Mind Centre , University of Sydney , Sydney , Australia
| | - Ian B Hickie
- a Youth Mental Health Team, Brain and Mind Centre , University of Sydney , Sydney , Australia
| | - Daniel F Hermens
- a Youth Mental Health Team, Brain and Mind Centre , University of Sydney , Sydney , Australia.,b Sunshine Coast Mind and Neuroscience Thompson Institute , University of the Sunshine Coast , Birtinya , Australia
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Mouhamed Y, Vishnyakov A, Qorri B, Sambi M, Frank SMS, Nowierski C, Lamba A, Bhatti U, Szewczuk MR. Therapeutic potential of medicinal marijuana: an educational primer for health care professionals. Drug Healthc Patient Saf 2018; 10:45-66. [PMID: 29928146 PMCID: PMC6001746 DOI: 10.2147/dhps.s158592] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
With the proposed Canadian July 2018 legalization of marijuana through the Cannabis Act, a thorough critical analysis of the current trials on the efficacy of medicinal marijuana (MM) as a treatment option is necessary. This review is particularly important for primary care physicians whose patients may be interested in using MM as an alternative therapy. In response to increased interest in MM, Health Canada released a document in 2013 for general practitioners (GPs) as an educational tool on the efficacy of MM in treating some chronic and acute conditions. Although additional studies have filled in some of the gaps since the release of the Health Canada document, conflicting and inconclusive results continue to pose a challenge for physicians. This review aims to supplement the Health Canada document by providing physicians with a critical yet concise update on the recent advancements made regarding the efficacy of MM as a potential therapeutic option. An update to the literature of 2013 is important given the upcoming changes in legislation on the use of marijuana. Also, we briefly highlight the current recommendations provided by Canadian medical colleges on the parameters that need to be considered prior to authorizing MM use, routes of administration as well as a general overview of the endocannabinoid system as it pertains to cannabis. Lastly, we outline the appropriate medical conditions for which the authorization of MM may present as a practical alternative option in improving patient outcomes as well as individual considerations of which GPs should be mindful. The purpose of this paper is to offer physicians an educational tool that provides a necessary, evidence-based analysis of the therapeutic potential of MM and to ensure physicians are making decisions on the therapeutic use of MM in good faith.
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Affiliation(s)
- Yara Mouhamed
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Andrey Vishnyakov
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Bessi Qorri
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - Manpreet Sambi
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
| | - SM Signy Frank
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Catherine Nowierski
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Anmol Lamba
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Umrao Bhatti
- Graduate Diploma & Professional Master in Medical Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Myron R Szewczuk
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
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Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res 2018; 99:22-32. [PMID: 29407284 DOI: 10.1016/j.jpsychires.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adult psychosis patients (i.e. over the age of 25 years) who are also lifetime cannabis users (CANN±) appear to exhibit superior cognition compared to never-using patients (CANN-). The objective of this meta-analysis was to evaluate the cognitive differences between CANN- and patients who currently use cannabis (CANN+) (i.e. during the CANN± patients' cannabis-using stage). Specifically, focusing on young patients under the age of 25 years, the typical stage of both psychosis- and cannabis-onset. METHOD Of the 308 studies identified through database searches and secondary referencing, 14 compared neurocognition of CANN+ and CANN- in young people with psychotic disorders (mean age between 15 and 45 years). Effect sizes were extracted using neurocognitive test performance between CANN+ and CANN- and random effects modelling was conducted on pooled ES and moderator analyses. RESULTS CANN+ performed worse on several cognitive domains (i.e. premorbid IQ, current IQ, verbal learning, verbal working memory, motor inhibition) compared to CANN-. The association between age and performance in CANN+ cognition was varied, with older age predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and very fluency. Of note, CANN+ outperformed CANN- in tests of conceptual set-shifting. CONCLUSION These results are consistent with previous findings indicating that CANN+ demonstrate poorer neurocognition than CANN-; and that this is exacerbated with increasing age. Our findings demonstrate significant cognitive differences between patients with CANN+ versus CANN- even at early-onset psychosis, which could suggest a different underlying mechanism towards psychosis for cannabis users.
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Affiliation(s)
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Brain and Mental Health Laboratory, Monash University, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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