Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use.
OBJECTIVE
To examine the influence of cannabis use on long-term outcome in patients with a first psychotic episode, comparing patients who have never used cannabis with (a) those who used cannabis before the first episode but stopped using it during follow-up and (b) those who used cannabis both before the first episode and during follow-up.


METHODS
Patients were studied following their first admission for psychosis. They were interviewed at years 1, 3, and 5. At follow-up after 8 years, functional outcome and alcohol and drug abuse were recorded. Patients were classified according to cannabis use: 25 had cannabis use before their first psychotic episode and continuous use during follow-up (CU), 27 had cannabis use before their first episode but stopped its use during follow-up (CUS), and 40 never used cannabis (NU).


RESULTS
The 3 groups did not differ significantly in symptoms or functional outcome at baseline or during short-term follow-up. The CUS group exhibited better long-term functional outcome compared with the other 2 groups and had fewer negative symptoms than the CU group, after adjusting for potential confounders. For the CUS group, the effect size was 1.26 (95% confidence interval [CI]=0.65 to 1.86) for functional outcome and -0.72 (95% CI=-1.27 to -0.14) for negative symptoms. All patients experienced improvements in positive symptoms during long-term follow-up.


CONCLUSIONS
Cannabis has a deleterious effect, but stopping use after the first psychotic episode contributes to a clear improvement in outcome. The positive effects of stopping cannabis use can be seen more clearly in the long term.
González-Pinto
Ana
A
Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, Hospital Santiago Apóstol, University of the Basque Country, Olaguibel 29, Vitoria, Spain. anamaria.gonzalez-pintoarrillaga@osakidetza.net
Alberich
Susana
S
Barbeito
Sara
S
Gutierrez
Miguel
M
Vega
Patricia
P
Ibáñez
Berta
B
Haidar
Mahmoud Karim
MK
Vieta
Eduard
E
Arango
Celso
C
D000328:Adult; D002188:Cannabis / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D028321:Plant Preparations / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000517:prevention & control / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
D028321:Plant Preparations