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Relationship between patterns of cannabis use and functional and symptomatic trajectories in first-episode psychosis

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Abstract

Cannabis use is common in first-episode psychosis (FEP) but evidence is mixed about the extent to which cannabis use predicts symptoms and functional outcomes among those who seek treatment. This study sought to characterize cannabis use patterns and examine the relationship with clinical outcomes, including interactions with early intervention services (EIS). Data were drawn from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study including FEP individuals receiving treatment at sites randomized to provide either EIS (NAVIGATE) or community care (CC). Cannabis use was assessed monthly and symptom and functioning data were collected at baseline, 6, 12, 18, and 24 months. Among the 404 participants enrolled, 334 were classified into four cannabis use groups (consistent, sporadic, stopped, and never users) based on their use during the first year. Consistent and sporadic cannabis users were younger, whereas those who had stopped using were older. Sporadic users had the highest depression and the lowest functioning at baseline and improved less during treatment in negative emotions and intrapsychic foundations (e.g., motivation and sense of purpose) than non-users. However, sporadic users who received NAVIGATE improved more in overall symptoms and functioning than those who received CC. Consistent users did not tend to differ in their trajectories from non-users. Individuals with FEP who use cannabis sporadically showed less clinical improvement than non-users. However, EIS treatment reduced the negative effects of sporadic cannabis use on clinical outcomes. Those who use cannabis sporadically may have unique needs that require attention in EIS.

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Acknowledgements

We thank and acknowledge all the staff who worked on the RAISE-ETP study at the participating sites.

Funding

Funding for the RAISE-ETP study was provided by the National Institute of Mental Health (NIMH), Bethesda, MD (HHSN-271-2009-00019C; PI: Dr. Kane). As a NIMH contract, NIMH had input into the design and conduct of the trial. NIMH staff did not participate in the analyses presented in this report. The contents of this report are solely the responsibility of the authors and do not necessarily represent the views of NIMH or the U.S. Department of Health and Human Services. This secondary data analysis project was supported by an internal fund from Massachusetts Department of Mental Health to Center of Excellence for Psychosocial and Systemic Research at Massachusetts General Hospital.

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Authors and Affiliations

  1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Abigail C. Wright, Julia Browne & Corinne Cather

  2. Harvard Medical School, Boston, MA, USA

    Abigail C. Wright, Julia Browne & Corinne Cather

  3. Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA

    Julia Browne

  4. Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA

    Piper Meyer-Kalos

  5. Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA

    Kim T. Mueser

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  1. Abigail C. Wright
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  2. Julia Browne
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  4. Piper Meyer-Kalos
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  5. Kim T. Mueser
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Correspondence to Abigail C. Wright or Kim T. Mueser.

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No sponsor or funder was involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Kim T. Mueser, Corinne Cather, and Piper Meyer-Kalos are the authors of the NAVIGATE manual.

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Wright, A.C., Browne, J., Cather, C. et al. Relationship between patterns of cannabis use and functional and symptomatic trajectories in first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 273, 765–778 (2023). https://doi.org/10.1007/s00406-022-01441-5

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