title: Effects of cannabis use on outcomes of psychotic disorders: systematic review.
abstract: BACKGROUND
  It is unclear if research findings support clinical opinion that cannabis use leads to worse outcomes in people with psychosis, or whether this impression is confounded by other factors.
  
  
  OBJECTIVE
  To systematically review the evidence pertaining to whether cannabis affects outcome of psychotic disorders.
  
  
  METHODS
  We searched 10 relevant databases (to November 2006), reference lists of included studies and contacted experts. We included 13 longitudinal studies from 15,303 references. Data extraction and quality assessment were conducted independently and in duplicate.
  
  
  RESULTS
  Cannabis use was consistently associated with increased relapse and non-adherence. Associations with other outcome measures were more disparate. Few studies adjusted for baseline illness severity, and most made no adjustment for alcohol, or other potentially important confounders. Adjusting for even a few confounders often resulted in substantial attenuation of results.
  
  
  CONCLUSIONS
  Confidence that most associations reported were specifically due to cannabis is low. Despite clinical opinion, it remains important to establish whether cannabis is harmful, what outcomes are particularly susceptible, and how such effects are mediated. Studies to examine this further are eminently feasible.
authors.affiliation: Academic Unit of Psychiatry, University of Bristol, UK. zammits@cardiff.ac.uk
authors.forename: Stanley
authors.initials: S
authors.lastname: Zammit
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Moore
authors.forename: Anne
authors.initials: A
authors.lastname: Lingford-Hughes
authors.forename: Thomas R E
authors.initials: TR
authors.lastname: Barnes
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.forename: Margaret
authors.initials: M
authors.lastname: Burke
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D002189:Marijuana Abuse / Q000523:psychology*; D011618:Psychotic Disorders / Q000523:psychology*; D012008:Recurrence; D012720:Severity of Illness Index