Are cannabis use disorders associated with an earlier age at onset of psychosis? A study in first episode schizophrenia.
BACKGROUND
The purpose of this study is to determine if an earlier age at onset of positive symptoms in schizophrenia is associated with cannabis use disorders (CUD).


METHODS
49 first-episode schizophrenia subjects with CUD were compared to 51 first-episode schizophrenia subjects with no substance use disorders for demographic and clinical variables. A multivariate logistic regression was performed to determine the joint relationship between variables significantly associated with CUD on univariate testing and ascertain if these variables independently predict CUD. Significance level was set at p<0.05.


RESULTS
74% of CUD subjects had the onset of CUD before the onset of positive symptoms. Compared to non-substance abusing subjects, CUD subjects were predominantly male, younger at study entry, had an earlier age at onset of positive symptoms, less educational attainment, a lower self-socioeconomic status, better premorbid childhood social adjustment, a trend for poorer premorbid childhood academic adjustment, less motor abnormalities but more severe hallucinations and delusions. In the multivariate analysis, only male gender, worse socio-economic status, better premorbid childhood social adjustment, and more severe positive symptoms at study entry were associated with a lifetime history of CUD.


CONCLUSIONS
Although cannabis use precedes the onset of illness in most patients, there was no significant association between onset of illness and CUD that was not accounted for by demographic and clinical variables. Previous studies implicating CUD in the onset of schizophrenia may need to more comprehensively assess the relationship between CUD and schizophrenia, and take into account additional variables that we found associated with CUD.
Sevy
Serge
S
The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, Glen Oaks, NY 11004, USA. Sevy@lij.edu
Robinson
Delbert G
DG
Napolitano
Barbara
B
Patel
Raman C
RC
Gunduz-Bruce
Handan
H
Miller
Rachel
R
McCormack
Joanne
J
Lorell
Beth S
BS
Kane
John
J
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D039721:Diagnostic and Statistical Manual of Mental Disorders; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000209:etiology*; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D000077152:Olanzapine; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology; D055815:Young Adult
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine
Psychol Med. 1998 Nov;28(6):1411-9
9854282
Schizophr Bull. 2008 Jan;34(1):52-9
18024468
Psychiatry Res. 2007 May 15;155(1):57-66
17398079
Br J Psychiatry. 2006 Sep;189:229-34
16946357
Am J Psychiatry. 1993 May;150(5):752-7
8480821
Acta Psychiatr Scand. 2001 Nov;104(5):367-74
11722318
BMC Neurol. 2009 Dec 04;9:59
19961570
Schizophr Bull. 1997;23(2):195-201
9165630
Acta Psychiatr Scand. 1993 Jul;88(1):21-4
8372691
Am J Epidemiol. 2002 Aug 15;156(4):319-27
12181101
Schizophr Res. 2009 Feb;107(2-3):173-8
18945593
Schizophr Res. 1996 May;20(1-2):21-8
8794490
Clin Psychol Rev. 2000 Mar;20(2):207-34
10721498
Br J Psychiatry. 1999 Feb;174:150-3
10211169
BMJ. 2002 Nov 23;325(7374):1212-3
12446537
Psychol Med. 1974 Aug;4(3):255-61
4427973
Lancet. 1987 Dec 26;2(8574):1483-6
2892048
Acta Psychiatr Scand. 1998 Aug;98(2):156-64
9718243
Biol Psychiatry. 2001 Jul 15;50(2):71-83
11526998
Arch Gen Psychiatry. 1994 Apr;51(4):273-9
8161287
Front Hum Neurosci. 2009 Nov 24;3:53
19956405
Schizophr Res. 2006 Jan 31;81(2-3):157-66
16309895
Br J Psychiatry. 2007 Jun;190:515-20
17541112
Arch Gen Psychiatry. 1982 Feb;39(2):141-7
7065828
J Clin Psychiatry. 2003 Apr;64(4):459-65
12716250
Br J Psychiatry Suppl. 1989 Nov;(7):49-58
2695141
Psychiatr Rehabil J. 2001 Summer;25(1):60-7
11529454
Br J Pharmacol. 2009 Apr;156(7):1029-40
19220290
Neuropsychiatry Neuropsychol Behav Neurol. 1997 Apr;10(2):107-12
9150511
Schizophr Res. 2006 Jan 31;81(2-3):145-50
16298107
Schizophr Bull. 1982;8(3):470-84
7134891
Acta Psychiatr Scand Suppl. 1970;212:11-9
4917967
Schizophr Res. 2007 May;92(1-3):74-84
17379482
Pharmacopsychiatry. 2002 Mar;35(2):57-61
11951146
BMJ. 2002 Nov 23;325(7374):1199
12446534
Psychol Med. 1992 May;22(2):379-88
1615105
Am J Psychiatry. 1998 Oct;155(10):1392-7
9766771
Clin Pract Epidemiol Ment Health. 2006 Mar 23;2:4
16556300
Am J Public Health. 2007 Oct;97(10):1756-7
17895405
Mov Disord. 2010 Jun 15;25(8):1068-76
20222137
Am J Psychiatry. 1977 May;134(5):546-9
848583
Br J Psychiatry. 2000 Dec;177:511-5
11102325
Br J Psychiatry. 1989 May;154:672-6
2574607
Am J Psychiatry. 2006 Dec;163(12):2096-102
17151160
Schizophr Res. 2004 Feb 1;66(2-3):125-35
15061244
Schizophr Bull. 2000;26(3):551-6
10993396
Br J Psychiatry. 2004 Sep;185:215-9
15339825
Biol Psychiatry. 1996 Dec 1;40(11):1155-63
8931919
Acta Psychiatr Scand. 1989 May;79(5):505-10
2787581
Br J Psychiatry. 2006 Mar;188:237-42
16507965
Nat Neurosci. 1999 Apr;2(4):358-63
10204543
J Psychopharmacol. 2005 May;19(3):277-85
15888513
Am J Psychiatry. 2008 May;165(5):579-87
18413704
Am J Psychiatry. 1991 Feb;148(2):224-30
1987823
Biol Psychiatry. 2005 May 15;57(10):1117-27
15866551
Am J Med Genet. 2002 Dec 8;114(8):949-55
12457392
Schizophr Res. 2002 Apr 1;54(3):243-51
11950549
Soc Psychiatry Psychiatr Epidemiol. 2004 Jan;39(1):69-72
15022049
Am J Psychiatry. 2004 Mar;161(3):501-6
14992976
Science. 1997 Jun 27;276(5321):2048-50
9197269
Neuroscience. 2001;103(1):9-15
11311783
J Clin Psychiatry. 2000;61 Suppl 4:10-4
10739325
Schizophr Res. 2008 Nov;106(1):29-32
18207703
Psychol Med. 2009 Jul;39(7):1065-76
19000340
Biol Psychiatry. 2006 Sep 1;60(5):463-71
16566898
Am J Psychiatry. 1995 May;152(5):698-703
7726309
J Nerv Ment Dis. 1990 Oct;178(10):642-8
2230749