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Kennedy L, Ku BS, Addington J, Amir CM, Bearden CE, Cannon TD, Carrión R, Cornblatt B, Keshavan M, Perkins D, Mathalon D, Stone W, Walker E, Woods S, Cadenhead KS. Occasional cannabis use is associated with higher premorbid functioning and IQ in youth at clinical high-risk (CHR) for psychosis: Parallel findings to psychosis cohorts. Schizophr Res 2024; 271:319-331. [PMID: 39084107 PMCID: PMC11955428 DOI: 10.1016/j.schres.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Neurocognitive deficits have been widely reported in clinical high-risk for psychosis (CHR) populations. Additionally, rates of cannabis use are high among CHR youth and are associated with greater symptom severity. Cannabis use has been sometimes shown to be associated with better neurocognition in more progressed psychosis cohorts, therefore in this study we aimed to determine whether a similar pattern was present in CHR. METHODS CHR participants ages 12-30 from the North American Prodromal Longitudinal Study (NAPLS-3) (N = 698) were grouped according to: "minimal to no cannabis use" (n = 406), "occasional use" (n = 127), or "frequent use" (n = 165). At baseline, cannabis use groups were compared on neurocognitive tests, clinical, and functional measures. Follow-up analyses were used to model relationships between cannabis use frequency, neurocognition, premorbid, and social functioning. RESULTS Occasional cannabis users performed significantly better than other use-groups on measures of IQ, with similar trend-level patterns observed across neurocognitive domains. Occasional cannabis users demonstrated better social, global, and premorbid functioning compared to the other use-groups and less severe symptoms compared to the frequent use group. Follow-up structural equation modeling/path analyses found significant positive associations between premorbid functioning, social functioning, and IQ, which in turn was associated with occasional cannabis use frequency. DISCUSSION Better premorbid functioning positively predicts both better social functioning and higher IQ which in turn is associated with a moderate cannabis use pattern in CHR, similar to reports in first-episode and chronic psychosis samples. Better premorbid functioning likely represents a protective factor in the CHR population and predicts a better functional outcome.
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Affiliation(s)
- L Kennedy
- Department of Psychiatry, University of California San Diego, United States
| | - B S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | | | - C M Amir
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, United States
| | - C E Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, United States
| | - T D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States; Department of Psychiatry, Yale University, New Haven, CT, United States
| | - R Carrión
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - B Cornblatt
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - M Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - D Perkins
- University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - D Mathalon
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
| | - W Stone
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - E Walker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - S Woods
- Department of Psychology, Yale University, New Haven, CT, United States; Department of Psychiatry, Yale University, New Haven, CT, United States
| | - K S Cadenhead
- Department of Psychiatry, University of California San Diego, United States.
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Volkov I, Schreiber S, Adelson M, Shoshan S, Peles E. Cannabis use is associated with lower retention in methadone maintenance treatment, but not among schizophrenic- and other chronically psychotic patients. J Addict Dis 2021; 40:183-191. [PMID: 34379049 DOI: 10.1080/10550887.2021.1962209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The findings of studies on cannabis use and retention in methadone maintenance treatment (MMT) are inconsistent. To study cannabis use and its relationship to patients' outcomes in MMT with/without lifetime DSM-IV-TR schizophrenia/chronic-psychosis diagnosis. Since June 1993, 877 patients with available lifetime DSM-IV-TR psychiatric diagnosis were followed-up until December 2017. Urine drug screens on admission and after one year were analyzed. Lifetime schizophrenia/psychosis was diagnosed in 50 (5.7%) patients. They did not differ from the other 827 by admission cannabis use (18.0% vs. 12.3%) and had similar 1-year retention rates (76.0% vs.77.0%, respectively). Cumulative retention of the cohort excluding schizophrenia/chronic-psychosis was longer for the 667 patients who did not use cannabis after 1-year (9.1 years, 95%CI 8.4-9.9) compared with the 118 cannabis-users after 1-year (6.0 years, 95% CI 4.8-7.2, p<.001). Among the schizophrenia/chronic-psychosis group, cannabis was not related to retention (38 non-users, 7.9 years 95%CI 5.2-10.5 vs. 9 cannabis-users, 9.9 years, 95% CI 3.8-16.0, p=.5). Survival was shorter for the 41 schizophrenia/chronic-psychosis non-users (15.2 years, 95% CI 12.8-17.7) than for the 719 non-schizophrenia/chronic-psychosis non-users (18.5, 95%CI 17.9-19.2, p = 0.009). However, survival was comparable among the 9 cannabis-users with schizophrenia/chronic-psychosis (20.1, 95% CI 16.2-24.1) and 101 other cohort users (18.6, 95% CI 16.9-20.4). Cannabis use is associated with decreased retention among MMT patients, however the effects of cannabis on schizophrenia/psychosis patients on retention and survival cannot be verified due to the small sample size and the limited data regarding chronicity of cannabis use. Future larger, prospective studies are needed.
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Affiliation(s)
- Ilan Volkov
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shaul Schreiber
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel
| | - Stacy Shoshan
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
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3
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Barrios M, Guilera G, Hidalgo MD, Cheung ECF, Chan RCK, Gómez-Benito J. The Most Commonly Used Instruments in Research on Functioning in Schizophrenia. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. A comprehensive assessment of functioning in schizophrenia is essential to plan appropriate interventions for helping individuals with this health condition. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. Our aim was to identify the most frequently used measurement instruments reported in studies on functioning in schizophrenia, to conduct a content comparison with respect to the ICF, and to compare the categories extracted from these instruments with those covered by the Brief ICF-Core Set for schizophrenia. A structured literature search of studies on functioning in schizophrenia was conducted using Medline, CINAHL, and PsycINFO. The items of the top 20 measurement instruments were then linked to the ICF classification system. The most commonly used instruments were neuropsychological tests (i.e., Wisconsin Card Sorting Test and Trail Making Test) and measures of clinical symptoms (i.e., PANSS) and general functioning (i.e., GAF). The linking process resulted in 45 ICF categories (25 from Body functions, 1 from Body structures, 14 from Activities and Participation, and 5 from the Environmental factors component). Most of the top 20 instruments are not specifically designed for patients with schizophrenia or for assessing functioning, but rather are general standardized tests widely used to measure a broad range of outcome variables in several health conditions. Our results suggest a lack of an internationally accepted, commonly used, specific and comprehensive gold standard to assess functioning in individuals with schizophrenia.
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Affiliation(s)
- Maite Barrios
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Georgina Guilera
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - M. Dolores Hidalgo
- Department of Methodology and Basic Psychology, Faculty of Psychology, University of Murcia, Spain
| | - Eric C. F. Cheung
- Kwong Wah Hospital, Hong Kong Special Administrative Region, PR China
| | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Juana Gómez-Benito
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Spain
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Petersen SM, Toftdahl NG, Nordentoft M, Hjorthøj C. Schizophrenia is associated with increased risk of subsequent substance abuse diagnosis: A nation-wide population-based register study. Addiction 2019; 114:2217-2226. [PMID: 31301685 DOI: 10.1111/add.14746] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 07/05/2019] [Indexed: 01/18/2023]
Abstract
AIMS We aimed to investigate whether or not a diagnosis of schizophrenia increases the risk of a substance abuse diagnosis. DESIGN Prospective cohort study using a longitudinal study design. SETTING AND PARTICIPANTS Individuals born in Denmark from 1955 to 1999 and registered in the Danish registers between 1 January 1968 and 1 July 2013. MEASUREMENTS We investigated the associations between schizophrenia and ICD diagnoses of substance abuse, both established through various Danish registers. The Cox regression model was used and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnoses, parents' substance abuse and psychiatric history, parents' immigration and parents' socio-economic position. Individuals diagnosed with substance abuse less than a year after diagnosis of schizophrenia were classified as not diagnosed with schizophrenia. FINDINGS The cohort consisted of 3 133 968 individuals. During follow-up (103 212 328 person-years at risk), a total of 14 007 individuals developed schizophrenia, with 2885 subsequently diagnosed with substance abuse. A diagnosis of schizophrenia was positively associated with the risk of developing substance abuse [hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 3.56-3.83]. Additionally, adjusting for a co-abuse markedly affected the associations, making schizophrenia primarily associated with an increased risk of abuse of cannabis, alcohol, stimulants and other substances (adjusted HR = 2.48, 95% CI = 2.34-2.64 for cannabis; HR = 1.94, 95% CI = 1.87-2.02 for alcohol; HR = 1.77, 95% CI = 1.61-1.95 for stimulants; HR = 1.36, 95% CI = 1.20-1.54 for other substances). The association was still significant 10-15 years subsequent a diagnosis of schizophrenia (HR = 2.50, 95% CI = 2.26-2.76). CONCLUSIONS In Denmark a diagnosis of schizophrenia is significantly associated with increased risk of subsequent diagnosis of substance abuse.
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Affiliation(s)
- Stine Mai Petersen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Nanna Gilliam Toftdahl
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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5
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A comparison of regional brain volumes and white matter connectivity in subjects with stimulant induced psychosis versus schizophrenia. Psychopharmacology (Berl) 2019; 236:3385-3399. [PMID: 31230145 DOI: 10.1007/s00213-019-05298-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/05/2019] [Indexed: 12/31/2022]
Abstract
RATIONALE Schizophrenia and stimulant-induced psychosis (SIP) represent two different forms of psychotic disorder, with different etiologies. While many of the symptoms of psychosis are common to both disorders, there have been few direct comparisons between these conditions, especially when controlling for stimulant use in individuals with schizophrenia. OBJECTIVES We directly compared both psychotic disorders with a comprehensive battery of clinical, neurocognitive and neuroanatomical measures. This included one group with SIP (and concurrent stimulant dependence) and two groups with schizophrenia (either with or without concurrent stimulant dependence). METHODS Ninety-six participants were recruited from a marginalized urban population, which included 39 with SIP (and concurrent stimulant dependence), 18 with schizophrenia (without stimulant dependence), and 39 with schizophrenia (with concurrent stimulant dependence). All subjects had extensive clinical and neurocognitive evaluations, complemented with structural MRI including diffusion tensor imaging (DTI) sequences to determine regional brain volumes and white matter connectivity. RESULTS Both positive and negative symptoms were greater in the SZ-dependent group than the other two. Neurocognitive function was broadly similar. The structural brain imaging revealed lateralized changes to the left parietal/temporal lobe, in which regional volumes were smaller in the SZ-dependent than the SZ-non-dependent group. DTI analysis indicated extensive decreases in fractional anisotropy, with parallel increases in radial diffusivity, in the SIP group compared to the SZ-dependent group. CONCLUSIONS These findings reveal both similarities and differences between SIP and schizophrenia. Furthermore, schizophrenia with concurrent stimulant dependence may be associated with a different clinical and neuroanatomical profile as compared to schizophrenia alone.
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Rojnic Kuzman M, Bosnjak Kuharic D, Ganoci L, Makaric P, Kekin I, Rossini Gajsak L, Prpic N, Bozina T, Bajic Z, Bozina N. Association of CNR1 genotypes with changes in neurocognitive performance after eighteen-month treatment in patients with first-episode psychosis. Eur Psychiatry 2019; 61:88-96. [DOI: 10.1016/j.eurpsy.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
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Bosia M, Buonocore M, Bechi M, Stere LM, Silvestri MP, Inguscio E, Spangaro M, Cocchi F, Bianchi L, Guglielmino C, Cavallaro R. Schizophrenia, cannabis use and Catechol-O-Methyltransferase (COMT): Modeling the interplay on cognition. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:363-368. [PMID: 30790675 DOI: 10.1016/j.pnpbp.2019.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/17/2022]
Abstract
Cognitive impairments are considered core features of schizophrenia and are recognized as the most important predictors of functional outcome and quality of life. A better study of the mechanisms underlying the cognition is of extreme relevance. Literature has shown that several genetic and environmental factors affect cognitive performance. In particular, the interaction between Catechol-O-Methyltransferase (COMT) gene and cannabis use has gained increasing attention in the past years. Based on these premises, the present study, aimed to analyze the interplay between cannabis use and COMT polymorphism on cognitive performance in a sample of 135 patients with chronic schizophrenia. Patients were assessed for neurocognitive measures with a broad battery, genotyped for COMT Val158Met polymorphism from peripheral blood sample, and evaluated with a semi-structured interview in order to establish the history of cannabis abuse. Results showed a significant interaction effect between COMT polymorphism and cannabis use on verbal fluency and speed of processing. The analysis revealed significant differences between subjects COMT Val/Val homozygous and Met carriers with history of cannabis use, with a better performance on both tasks among the Met carriers group. These data are in line with literature on healthy subjects that suggests a more detrimental effect of cannabis among subjects with Val/Val genotype. In conclusions, results highlight the need to better disentangle the biological pathways in which cannabis use and COMT are converging, as possible treatment targets, as well as the importance to assess these factors in clinical to optimize individualized interventions.
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Affiliation(s)
- Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita -Salute San Raffaele University, Milan, Italy
| | - Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Emanuela Inguscio
- School of Psychology, Vita -Salute San Raffaele University, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bianchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Guglielmino
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita -Salute San Raffaele University, Milan, Italy
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8
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Weibell MA, Johannessen JO, Auestad B, Bramness J, Brønnick K, Haahr U, Joa I, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Vaglum P, Stain H, Friis S, Hegelstad WTV. Early Substance Use Cessation Improves Cognition-10 Years Outcome in First-Episode Psychosis Patients. Front Psychiatry 2019; 10:495. [PMID: 31354551 PMCID: PMC6640174 DOI: 10.3389/fpsyt.2019.00495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.
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Affiliation(s)
- Melissa A Weibell
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Jørgen Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innland Hospital Trust, Hamar, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kolbjørn Brønnick
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Ulrik Haahr
- Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.,Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Helen Stain
- School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Wenche Ten Velden Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
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9
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Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res 2018; 99:22-32. [PMID: 29407284 DOI: 10.1016/j.jpsychires.2018.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adult psychosis patients (i.e. over the age of 25 years) who are also lifetime cannabis users (CANN±) appear to exhibit superior cognition compared to never-using patients (CANN-). The objective of this meta-analysis was to evaluate the cognitive differences between CANN- and patients who currently use cannabis (CANN+) (i.e. during the CANN± patients' cannabis-using stage). Specifically, focusing on young patients under the age of 25 years, the typical stage of both psychosis- and cannabis-onset. METHOD Of the 308 studies identified through database searches and secondary referencing, 14 compared neurocognition of CANN+ and CANN- in young people with psychotic disorders (mean age between 15 and 45 years). Effect sizes were extracted using neurocognitive test performance between CANN+ and CANN- and random effects modelling was conducted on pooled ES and moderator analyses. RESULTS CANN+ performed worse on several cognitive domains (i.e. premorbid IQ, current IQ, verbal learning, verbal working memory, motor inhibition) compared to CANN-. The association between age and performance in CANN+ cognition was varied, with older age predictive of worse performance in processing speed, sustained attention, verbal memory, and better performance in verbal learning and very fluency. Of note, CANN+ outperformed CANN- in tests of conceptual set-shifting. CONCLUSION These results are consistent with previous findings indicating that CANN+ demonstrate poorer neurocognition than CANN-; and that this is exacerbated with increasing age. Our findings demonstrate significant cognitive differences between patients with CANN+ versus CANN- even at early-onset psychosis, which could suggest a different underlying mechanism towards psychosis for cannabis users.
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Affiliation(s)
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Brain and Mental Health Laboratory, Monash University, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Stratton J, Cobia DJ, Reilly J, Brook M, Hanlon RE. Differences in Neuropsychological Functioning Between Homicidal and Nonviolent Schizophrenia Samples. J Forensic Sci 2018; 63:1435-1443. [PMID: 29411382 DOI: 10.1111/1556-4029.13750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/17/2018] [Indexed: 11/29/2022]
Abstract
Few studies have compared performance on neurocognitive measures between violent and nonviolent schizophrenia samples. A better understanding of neurocognitive dysfunction in violent individuals with schizophrenia could increase the efficacy of violence reduction strategies and aid in risk assessment and adjudication processes. This study aimed to compare neuropsychological performance between 25 homicide offenders with schizophrenia and 25 nonviolent schizophrenia controls. The groups were matched for age, race, sex, and handedness. Independent t-tests and Mann-Whitney U-tests were used to compare the schizophrenia groups' performance on measures of cognition, including composite scores assessing domain level functioning and individual neuropsychological tests. Results indicated the violent schizophrenia group performed worse on measures of memory and executive functioning, and the Intellectual Functioning composite score, when compared to the nonviolent schizophrenia sample. These findings replicate previous research documenting neuropsychological deficits specific to violent individuals with schizophrenia and support research implicating fronto-limbic dysfunction among violent offenders with schizophrenia.
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Affiliation(s)
- John Stratton
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611.,Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd., Suite C, Ann Arbor, Michigan, 48105
| | - Derin J Cobia
- Department of Psychology, Brigham Young University, 1036 SWKT, Provo, UT, 84602
| | - James Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
| | - Michael Brook
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611
| | - Robert E Hanlon
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611.,Neuropsychological Associates of Chicago, Chicago, IL
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Cannabis use in male and female first episode of non-affective psychosis patients: Long-term clinical, neuropsychological and functional differences. PLoS One 2017; 12:e0183613. [PMID: 28832666 PMCID: PMC5568402 DOI: 10.1371/journal.pone.0183613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous studies show the existence of a high prevalence of cannabis use among patients with psychosis. However, the differences between men and women who debut with a first episode of psychosis (FEP) regarding cannabis use have not been largely explored. The aim of this study was to identify the specific sex factors and differences in clinical evolution associated with cannabis use. METHOD Sociodemographic characteristics at baseline were considered in our sample of FEP patients to find differences depending on sex and the use of cannabis. Clinical, functional and neurocognitive variables at baseline, 1-year, and 3-years follow-up were also explored. RESULTS A total of 549 patients, of whom 43% (N = 236) were cannabis users, 79% (N = 186) male and 21% (N = 50) female, were included in the study. There was a clear relationship between being male and being a user of cannabis (OR = 5.6). Cannabis users were younger at illness onset. Longitudinal analysis showed that women significantly improved in all three dimensions of psychotic symptoms, both in the subgroup of cannabis users and in the non-users subgroup. Conversely, subgroups of men did not show improvement in the negative dimension. In cognitive function, only men presented a significant time by group interaction in processing speed, showing a greater improvement in the subgroup of cannabis users. CONCLUSION Despite knowing that there is a relationship between cannabis use and psychosis, due to the high prevalence of cannabis use among male FEP patients, the results showed that there were very few differences in clinical and neurocognitive outcomes between men and women who used cannabis at the start of treatment compared to those who did not.
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12
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Motivation deficits and use of alcohol and illicit drugs among individuals with schizophrenia. Psychiatry Res 2017; 253:391-397. [PMID: 28441618 PMCID: PMC5503109 DOI: 10.1016/j.psychres.2017.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/13/2017] [Accepted: 04/04/2017] [Indexed: 11/23/2022]
Abstract
This study examined the impact of substance use on intrinsic motivation and evaluated the association between intrinsic motivation and substance use recovery among individuals with schizophrenia. Alcohol and illicit drug use and intrinsic motivation were evaluated at baseline and 6-months for 1434 individuals with schizophrenia from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) using self-rated substance use assessments and a derived motivation measure from the Heinrichs-Carpenter Quality of Life Scale. Results revealed patients had moderate motivation deficits overall and a considerable number were using alcohol or illicit drugs at baseline (n=576; 40.2%). Regression models at baseline showed patients with low levels of motivation had higher odds of substance use and those who were using substances had greater motivation deficits. At 6-months, substance using patients continued to demonstrate greater motivation deficits; however, those with high levels of motivation exhibited a greater reduction in their use of substances. Findings remained significant after adjusting for clinical confounds and were consistent across any substance, alcohol, and cannabis use. Our results emphasize concerns about substance use compounding motivation deficits in schizophrenia, and suggest that disentangling the motivation-substance use relationship in schizophrenia may facilitate efforts aimed at ameliorating these challenges and improving outcomes.
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Kake TR, Garrett N, Te Aonui M. Cognitive neuropsychological functioning in New Zealand Māori diagnosed with schizophrenia. Aust N Z J Psychiatry 2016; 50:566-76. [PMID: 26494850 DOI: 10.1177/0004867415607986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous research suggests that New Zealand Māori may have an elevated rate of schizophrenia. However, there is limited evidence on important clinical features of the illness in this population. This study examined cognitive neuropsychological functioning in 54 adult Māori diagnosed with schizophrenia and 56 Māori controls. This study also examined associations between cognition, medication and symptoms of psychosis in the schizophrenia group. METHOD The groups were matched on socio-demographic variables, handedness and premorbid cognitive ability. Participants were assessed on neuropsychological tests of attention, executive ability, motor, premorbid ability, verbal/non-verbal memory and verbal fluency (English/Māori versions). The Positive and Negative Syndrome Scale was used to assess psychotic symptoms. Information on cultural identity, duration of illness, duration of untreated psychosis, medication and substance abuse was collected. RESULTS The performance of the schizophrenia group was significantly lower than the control group on all the neuropsychological tests, except the test of attention. The effect sizes were moderate to large: 0.78 for motor function; 1.3 for executive ability, verbal fluency and visual memory; 1.6 for verbal learning and 1.8 for verbal memory. These differences remained after adjustment for multiple comparisons and covariates. A higher dose of antipsychotic medication and a higher anticholinergic load were associated with greater verbal memory impairment (r = -0.38 and r = -0.38, respectively). A longer duration of illness was associated with greater impairment of verbal memory (rho = -0.48), verbal learning (rho = -0.41) and visual memory (rho = -0.44). CONCLUSION The findings for the schizophrenia group show a profile of generalised cognitive impairment with greater impairment of verbal memory. The cognitive impairment in this group was independent of psychotic symptoms, but was associated with a higher antipsychotic dose, higher anticholinergic load and longer duration of illness. These findings have implications for clinical prescribing practices and rehabilitation for New Zealand Māori diagnosed with schizophrenia.
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Affiliation(s)
- Tai R Kake
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Nicholas Garrett
- Department of Biostatistics and Epidemiology, AUT University, Auckland, New Zealand
| | - Menetta Te Aonui
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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14
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Abstract
Interest in the relationship between cannabis use and psychosis has increased dramatically in recent years, in part because of concerns related to the growing availability of cannabis and potential risks to health and human functioning. There now exists a plethora of scientific articles addressing this issue, but few provide a clear verdict about the causal nature of the cannabis-psychosis association. Here, we review recent research reports on cannabis and psychosis, giving particular attention to how each report provides evidence relating to two hypotheses: (1) cannabis as a contributing cause and (2) shared vulnerability. Two primary kinds of data are brought to bear on this issue: studies done with schizophrenic patients and studies of first-episode psychosis. Evidence reviewed here suggests that cannabis does not in itself cause a psychosis disorder. Rather, the evidence leads us to conclude that both early use and heavy use of cannabis are more likely in individuals with a vulnerability to psychosis. The role of early and heavy cannabis use as a prodromal sign merits further examination, along with a variety of other problem behaviors (e.g., early or heavy use of cigarettes or alcohol and poor school performance). Future research studies that focus exclusively on the cannabis-psychosis association will therefore be of little value in our quest to better understand psychosis and how and why it occurs.
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Affiliation(s)
- Charles Ksir
- Department of Psychology and Neuroscience Program, University of Wyoming, Laramie, WY, USA
| | - Carl L Hart
- Division on Substance Abuse, New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., Unit 120, New York, NY, 10032, USA. .,Department of Psychology, Columbia College, 1190 Amsterdam Ave, Schermerhorn #406, New York, NY, 10027, USA. .,Department of Psychiatry, Columbia University, 1051 Riverside Dr., Unit 120, New York, NY, 10032, USA. .,Brocher Foundation, Geneva, Switzerland.
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Eack SM, Hogarty SS, Bangalore SS, Keshavan MS, Cornelius JR. Patterns of Substance Use During Cognitive Enhancement Therapy: An 18-Month Randomized Feasibility Study. J Dual Diagn 2016; 12:74-82. [PMID: 27089154 PMCID: PMC4837677 DOI: 10.1080/15504263.2016.1145778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Substance use problems are common among people with schizophrenia, as are significant cognitive impairments. Because of potential shared neurobiological pathways, it is possible that cognitive remediation interventions may be associated with improvements in both substance use and cognition. This study examined the impact of cognitive remediation on alcohol and cannabis use and the cognitive correlates of changes in substance use among outpatients with schizophrenia. METHODS Individuals with schizophrenia who were receiving outpatient services at a psychiatric clinic and had moderate or higher addiction severity scores (N = 31) were randomized to 18 months of cognitive enhancement therapy (n = 22) or usual care (n = 9). Cognitive enhancement therapy is a cognitive remediation approach that integrates computer-based training in attention, memory, and problem solving with a group-based social cognition curriculum. Usual care was provided to all participants and consisted of routine psychiatric care. Primary outcomes included days of alcohol and cannabis use, assessed with the Timeline Followback method every six months and modeled using penalized quasi-likelihood growth curves. RESULTS Participants were on average 38.23 (SD = 13.44) years of age, had been ill for 14.19 (SD = 11.28) years, and were mostly male (n = 22, 71%), and about half were Caucasian (n = 16, 52%). Temporal patterns of substance use days were highly variable and followed nonlinear trajectories. Intent-to-treat analyses indicated that, compared to patients only receiving usual care, those receiving cognitive enhancement therapy were significantly less likely to use alcohol (OR = .22; 95% CI: .05, .90; p = .036), but not cannabis (OR = 1.89; 95% CI: .02, 142.99; p = .774) over time, and they reduced their alcohol use at significantly accelerated rates (OR = 1.02; 95% CI: 1.01, 1.03; p = .003). Changes in cognition were variably associated with substance use outcomes, although improvements in visual learning and reasoning and problem solving were both consistently related to reduced alcohol and cannabis use. CONCLUSIONS Cognitive remediation may be effective for improving some substance use problems in schizophrenia. Visual learning and problem-solving deficits may be particularly important targets of such interventions, given their association with reduced alcohol and cannabis use. This study is registered at clinicaltrials.gov under #NCT01292577.
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Affiliation(s)
- Shaun M Eack
- a School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Susan S Hogarty
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Srihari S Bangalore
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
| | - Matcheri S Keshavan
- c Department of Psychiatry , Harvard Medical School , Boston , Massachussetts , USA
| | - Jack R Cornelius
- b Department of Psychiatry , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA
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Schoeler T, Kambeitz J, Behlke I, Murray R, Bhattacharyya S. The effects of cannabis on memory function in users with and without a psychotic disorder: findings from a combined meta-analysis. Psychol Med 2016; 46:177-188. [PMID: 26353818 DOI: 10.1017/s0033291715001646] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Effect of cannabis use on memory function is a contentious issue, with effects being different in healthy individuals and patients with psychosis. METHOD Employing a meta-analytic approach we investigated the effects of cannabis use on memory function in patients with psychosis and healthy individuals, and the effect of diagnosis, memory dimension and moderating factors. A total of 88 studies were identified through a systematic literature search, investigating healthy (n = 7697) and psychotic (n = 3261) individuals. Standardized mean differences between the cannabis user and non-user groups on memory tasks were estimated using random-effects models and the effect-size statistic Cohen's d. Effects of potential moderating factors were tested using mixed-effects models and subgroup analyses. RESULTS We found that cannabis use was associated with significantly (p ⩽ 0.05) impaired global (d = 0.27) and prospective memory (d = 0.61), verbal immediate (d = 0.40) and delayed (d = 0.36) recall as well as visual recognition (d = 0.41) in healthy individuals, but a better global memory (d = -0.11), visual immediate recall (d = -0.73) and recognition (d = -0.42) in patients. Lower depression scores and younger age appeared to attenuate the effects of cannabis on memory. Cannabis-using patients had lower levels of depression and were younger compared with non-using patients, whilst healthy cannabis-users had higher depression scores than age-matched non-users. Longer duration of abstinence from cannabis reduced the effects on memory in healthy and patient users. CONCLUSIONS These results suggest that cannabis use is associated with a significant domain-specific impairment in memory in healthy individuals but not in cannabis-using patients, suggesting that they may represent a less developmentally impaired subgroup of psychotic patients.
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Affiliation(s)
- T Schoeler
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,De Crespigny Park,London SE5 8AF,UK
| | - J Kambeitz
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,De Crespigny Park,London SE5 8AF,UK
| | - I Behlke
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,De Crespigny Park,London SE5 8AF,UK
| | - R Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,De Crespigny Park,London SE5 8AF,UK
| | - S Bhattacharyya
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,De Crespigny Park,London SE5 8AF,UK
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17
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Buchy L, Seidman LJ, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Stone W, Tsuang MT, Walker EF, Woods SW, Bearden CE, Mathalon DH, Addington J. Evaluating the relationship between cannabis use and IQ in youth and young adults at clinical high risk of psychosis. Psychiatry Res 2015; 230:878-84. [PMID: 26626949 PMCID: PMC5037441 DOI: 10.1016/j.psychres.2015.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/28/2022]
Abstract
Among people with psychosis, those with a history of cannabis use show better cognitive performance than those who are cannabis naïve. It is unknown whether this pattern is present in youth at clinical high risk (CHR) of psychosis. We evaluated relationships between IQ and cannabis use while controlling for use of other substances known to impact cognition in 678 CHR and 263 healthy control (HC) participants. IQ was estimated using the Vocabulary and Block Design subtests of the Wechsler Abbreviated Scale of Intelligence. Drug and alcohol use severity and frequency were assessed with the Alcohol and Drug Use Scale, and we inquired participants' age at first use. CHR were further separated into early and late age at onset of cannabis use sub-groups, and low-, moderate- and high-frequency sub-groups. No significant differences in IQ emerged between CHR or HC cannabis users vs. non-users, or between use frequency groups. CHR late-onset users showed significantly higher IQ than CHR early-onset users. Age at onset of cannabis use was significantly and positively correlated with IQ in CHR only. Results suggest that age at onset of cannabis may be a more important factor for IQ than use current use or use frequency in CHR.
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Affiliation(s)
- Lisa Buchy
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States; Massachusetts General Hospital, Boston, MA, United States
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, La Jolla, CA, United States
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, CA, United States
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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18
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Arnold C, Allott K, Farhall J, Killackey E, Cotton S. Neurocognitive and social cognitive predictors of cannabis use in first-episode psychosis. Schizophr Res 2015; 168:231-7. [PMID: 26260081 DOI: 10.1016/j.schres.2015.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Findings are unclear as to whether cannabis use is associated with better cognitive functioning in individuals with psychosis. OBJECTIVES To elucidate the association between cannabis use, neurocognition and social cognition in first-episode psychosis (FEP). METHODS Secondary data analysis was conducted on data from 133 FEP participants who had enrolled in a randomized controlled trial of a vocational intervention. Participants completed a neurocognitive and social cognitive battery and characteristics of cannabis use were documented (disorder, recency, frequency and dose). Principal axis factor analysis was used to determine the underlying structure of the cognitive batteries. Regression techniques were used to examine cognitive predictors of current cannabis use disorder (CUD), and recency and frequency of cannabis use. Bivariate correlations were used to examine associations between cognition and dose of cannabis consumption. RESULTS Male gender (p=.037) was the only significant predictor of having a current CUD. Better processing speed (p=.022) and social cognition (p=.039), male gender (p<.001), and fewer negative symptoms (p=.036) predicted recency of cannabis use. Faster processing speed (p=.007) and male gender (p=.006) also predicted frequency of cannabis use. No variables were significantly associated with dose of cannabis consumption. CONCLUSIONS Better social cognition and processing speed abilities predicting recency and frequency of cannabis use are consistent with cannabis users having higher cognitive abilities. A positive relationship between cannabis use and cognition may be the result of more drug taking opportunities in less cognitively impaired individuals with psychosis.
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Affiliation(s)
- Chelsea Arnold
- Department of Psychology & Counselling, La Trobe University, Bundoora, VIC 3086, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - John Farhall
- Department of Psychology & Counselling, La Trobe University, Bundoora, VIC 3086, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Rd, Parkville, VIC 3052, Australia.
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19
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Zhang T, Li H, Stone WS, Woodberry KA, Seidman LJ, Tang Y, Guo Q, Zhuo K, Qian Z, Cui H, Zhu Y, Jiang L, Chow A, Tang Y, Li C, Jiang K, Yi Z, Xiao Z, Wang J. Neuropsychological Impairment in Prodromal, First-Episode, and Chronic Psychosis: Assessing RBANS Performance. PLoS One 2015; 10:e0125784. [PMID: 25973925 PMCID: PMC4431726 DOI: 10.1371/journal.pone.0125784] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive deficits are observed throughout all developmental phases of psychosis. However, prior studies have usually focused on a limited illness period and used a wide variety of cognitive instruments. Therefore, it has been difficult to characterize or highlight cognitive functioning in different stages of psychosis. METHOD We administered the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) tests to 4 participant subgroups, including healthy volunteers (controls, HC, n = 28), subjects at high risk for clinical psychosis (prodrome, CHR, n = 27), first-episode schizophrenia patients (FE-Sz, n = 26), and mid-term and long-term chronic schizophrenia patients (Ch-Sz, n =147). Comparison, correlation, and regression analyses of RBANS index scores were assessed among groups. We examined clinical outcomes over 2 years between the CHR and HC subjects, and RBANS domains were used as possible predictors for conversion to psychosis. RESULTS Performance on all RBANS domains was significantly impaired during a post-onset stage of psychosis (FE-Sz and Ch-Sz), and RBANS scores declined along with disease progression. Regression analyses showed that for CHR and HC subjects, baseline impairment in delayed memory (DM) significantly predicted conversion to psychosis. Additionally, partial correlations showed that for FE-Sz and Ch-Sz subjects, DM was the only correlate with a later stage of psychosis. CONCLUSIONS Cognitive deficits broadly emerged, and diminished functioning followed along with disease progression. Impairment in DM is perhaps one domain that helps us understand the development of psychosis. A critical need is to monitor and treat memory functioning for psychotic patients throughout all phases of the disease.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - HuiJun Li
- Florida A & M University, Department of Psychology, Tallahassee, Florida 32307, United States of America
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, United States of America
| | - William S. Stone
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, United States of America
| | - Kristen A. Woodberry
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, United States of America
| | - Larry J. Seidman
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, United States of America
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Qian Guo
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - KaiMing Zhuo
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - ZhenYing Qian
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - YiKang Zhu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - LiJuan Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Annabelle Chow
- Changi General Hospital, Department of psychological medicine, Singapore, Singapore
| | - YunXiang Tang
- Department of medical psychology, Faculty of Mental Health, Second Military Medical University, Shanghai 200433, China
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - KaiDa Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - ZhengHui Yi
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
- * E-mail: (JJW); (ZPX); (ZHY)
| | - ZePing Xiao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
- * E-mail: (JJW); (ZPX); (ZHY)
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
- * E-mail: (JJW); (ZPX); (ZHY)
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20
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Greydanus DE, Kaplan G, Baxter LE, Patel DR, Feucht CL. Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know? Dis Mon 2015; 61:118-75. [DOI: 10.1016/j.disamonth.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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21
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Eack SM, Hogarty SS, Greenwald DP, Litschge MY, McKnight SAF, Bangalore SS, Pogue-Geile MF, Keshavan MS, Cornelius JR. Cognitive Enhancement Therapy in substance misusing schizophrenia: results of an 18-month feasibility trial. Schizophr Res 2015; 161:478-83. [PMID: 25510926 PMCID: PMC4308498 DOI: 10.1016/j.schres.2014.11.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 01/15/2023]
Abstract
Substance use is a frequent problem in schizophrenia, and although many substance misusing patients with the disorder also experience considerable cognitive impairments, such individuals have been routinely excluded from clinical trials of cognitive remediation that could support their functional and addiction recoveries. This study conducted a small-scale feasibility trial of Cognitive Enhancement Therapy (CET) in substance misusing schizophrenia patients to assess the feasibility and efficacy of implementing comprehensive neurocognitive and social-cognitive remediation in this population. A total of 31 schizophrenia outpatients meeting addiction severity criteria for alcohol and/or cannabis use were randomized to 18months of CET or usual care. Feasibility findings indicated high degrees of satisfaction with CET, but also presented significant challenges in the recruitment and retention of substance misusing patients, with high levels of attrition (50%) over the study period, primarily due to positive symptom exacerbation. Intent-to-treat efficacy analyses showed large and significant improvements in neurocognition (d=.86), social cognition (d=1.13), and social adjustment (d=.92) favoring CET. Further, individuals treated with CET were more likely to reduce alcohol use (67% in CET vs. 25% in usual care) during treatment (p=.021). These results suggest that once engaged and stabilized, CET is a feasible and potentially effective treatment for cognitive impairments in patients with schizophrenia who misuse alcohol and/or cannabis. Substance misusing patients who are able to engage in treatment may be able to benefit from cognitive remediation, and the treatment of cognitive impairments may help improve substance use outcomes among this underserved population.
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Affiliation(s)
- Shaun M. Eack
- School of Social Work, University of Pittsburgh,Department of Psychiatry, University of Pittsburgh School of Medicine,Address correspondence to Shaun M. Eack, Ph.D., School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260. Phone: 412-648-9029.
| | - Susan S. Hogarty
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Summer A. F. McKnight
- School of Social Work, University of Pittsburgh,Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | | | - Jack R. Cornelius
- Department of Psychiatry, University of Pittsburgh School of Medicine
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22
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Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission. J Nerv Ment Dis 2015; 203:33-6. [PMID: 25489749 DOI: 10.1097/nmd.0000000000000231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs. 11.83 ± 1.83 days; p < 0.001) and adjusted (β = 0.69; confidence interval, 0.63-0.76; p < 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders.
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Helle S, Gjestad R, Johnsen E, Kroken RA, Jørgensen HA, Løberg EM. Cognitive changes in patients with acute phase psychosis--effects of illicit drug use. Psychiatry Res 2014; 220:818-24. [PMID: 25240944 DOI: 10.1016/j.psychres.2014.08.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/26/2022]
Abstract
Illicit drug use may influence cognition in non-affective psychosis. Previous studies have shown better cognition in psychosis with illicit drug use as compared to psychosis only. Possibly, illicit drug using patients have more transient drug-related cognitive deficits. Thus, the aim of the present study was to examine cognitive change the first weeks after admission to a psychiatric emergency ward, expecting more cognitive improvement at follow-up in the illicit drug group as compared to psychosis only. Patients with acute non-affective psychosis with (26%) and without illicit drug use were examined at baseline (n=123) and follow-up (n=67), with alternative forms of the Repeatable Battery for the Assessment of Neuropsychological Status. Latent Growth Curve models, controlling for cognition at baseline and age differences between the groups, were used to analyze cognitive change. The illicit drug using patients showed the largest improvement in cognition, especially among the youngest patients. Younger patients with non-affective psychosis and illicit drug use showed more cognitive improvement the first weeks after acute psychosis as compared to psychosis only. This suggests that the illicit drug users constitute a sub-group with less stable cognitive deficits and less cognitive vulnerability.
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Affiliation(s)
- Siri Helle
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Rune Andreas Kroken
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway
| | | | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
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Bahorik AL, Cornelius JR, Bangalore SS, Newhill CE, Keshavan MS, Eack SM. BRIEF REPORT: THE IMPACT OF ALCOHOL AND CANNABIS MISUSE ON COGNITION AMONG INDIVIDUALS WITH SCHIZOPHRENIA. Schizophr Res Cogn 2014; 1:160-163. [PMID: 25419516 PMCID: PMC4235155 DOI: 10.1016/j.scog.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Amber L. Bahorik
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, United States, 15260
| | - Jack R. Cornelius
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811, O’Hara St, Pittsburgh PA, United States, 15213
| | - Srihari S. Bangalore
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811, O’Hara St, Pittsburgh PA, United States, 15213
| | - Christina E. Newhill
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, United States, 15260
| | - Matcheri S. Keshavan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811, O’Hara St, Pittsburgh PA, United States, 15213
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States, 02215
| | - Shaun M. Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, United States, 15260
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811, O’Hara St, Pittsburgh PA, United States, 15213
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