title: Temporal relationship of first-episode non-affective psychosis with cannabis use: a clinical verification of an epidemiological hypothesis.
abstract: BACKGROUND
  We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.
  
  
  METHODS
  We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use.
  
  
  RESULTS
  We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank chi(2)=23.43, df=1, p<0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5years (27, 45) (for log-transformed AOPT, t=5.6, df=110, p<0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05).
  
  
  CONCLUSIONS
  Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.
authors.affiliation: Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Barrigón
authors.forename: Manuel
authors.initials: M
authors.lastname: Gurpegui
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Veguilla
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Diaz
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Fernando
authors.initials: F
authors.lastname: Sarramea
authors.forename: Jorge
authors.initials: J
authors.lastname: Cervilla
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D055815:Young Adult