title: Cannabis abuse is associated with decision-making impairment among first-episode patients with schizophrenia-spectrum psychosis.
abstract: BACKGROUND
  Cannabis use appears to be a risk factor for schizophrenia. Moreover, cannabis abusers show impaired decision-making capacities, linked to the orbitofrontal cortex (OFC). Although there is substantial evidence that first-episode schizophrenia patients show impairments in cognitive tasks associated with the dorsolateral prefrontal cortex (DLPFC), it is not clear whether decision making is impaired at schizophrenia onset. In this study, we examined the association between antecedents of cannabis abuse and cognitive impairment in cognitive tasks associated with the DLPFC and the OFC in a sample of first-episode patients with schizophrenia-spectrum disorders.
  
  
  METHODS
  One hundred and thirty-two patients experiencing their first episode of a schizophrenia-spectrum psychosis were assessed with a cognitive battery including DLPFC-related tasks [backward digits, verbal fluency (FAS) and the Trail Making Test (TMT)] and an OFC-related task [the Iowa Gambling Task (GT)]. Performance on these tasks was compared between patients who had and had not abused cannabis before their psychosis onset.
  
  
  RESULTS
  No differences were observed between the two groups on the performance of any of the DLPFC-related tasks. However, patients who had abused cannabis before their psychosis onset showed a poorer total performance on the gambling task and a lower improvement on the performance of the task compared to no-abusers.
  
  
  CONCLUSIONS
  Pre-psychotic cannabis abuse is associated with decision-making impairment, but not working memory and executive function impairment, among first-episode patients with a schizophrenia-spectrum psychosis. Further studies are needed to examine the direction of causality of this impairment; that is, does the impairment make the patients abuse cannabis, or does cannabis abuse cause the impairment?
authors.affiliation: University Hospital Marques de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Mata
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez-Sánchez
authors.forename: J M
authors.initials: JM
authors.lastname: Pelayo-Terán
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Iglesias
authors.forename: C
authors.initials: C
authors.lastname: González-Blanch
authors.forename: M
authors.initials: M
authors.lastname: Ramírez-Bonilla
authors.forename: O
authors.initials: O
authors.lastname: Martínez-García
authors.forename: J L
authors.initials: JL
authors.lastname: Vázquez-Barquero
authors.forename: B
authors.initials: B
authors.lastname: Crespo-Facorro
mesh_terms: D000328:Adult; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003657:Decision Making / Q000187:drug effects*; D005260:Female; D006801:Humans; D007361:Intelligence Tests / Q000706:statistics & numerical data; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000523:psychology*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D017397:Prefrontal Cortex / Q000187:drug effects; D011618:Psychotic Disorders / Q000523:psychology*; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications; D012565:Schizophrenic Psychology; D013647:Task Performance and Analysis; D014145:Trail Making Test / Q000706:statistics & numerical data