Are cannabis use disorders associated with an earlier age at onset of psychosis? A study in first episode schizophrenia

Sevy, Serge; Robinson, Delbert G.; Napolitano, Barbara; Patel, Raman C.; Gunduz-Bruce, Handan; Miller, Rachel; McCormack, Joanne; Lorell, Beth S; Kane, John

doi:10.1016/j.schres.2010.03.037

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Volume 120, Issue 1 , Pages 101-107, July 2010

Are cannabis use disorders associated with an earlier age at onset of psychosis? A study in first episode schizophrenia

Serge Sevy
- The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, USA
- Albert Einstein College of Medicine, Department of Psychiatry, USA
- Corresponding author. Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA. Tel.: +1 718 470 8175; fax: +1 718 343 1659.
Delbert G. Robinson
- The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, USA
- Albert Einstein College of Medicine, Department of Psychiatry, USA
- Feinstein Institute for Medical Research, Center for Translational Psychiatry, USA
Barbara Napolitano
- The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, USA
- Feinstein Institute for Medical Research, Biostatistics Unit, USA
Raman C. Patel
- Bronx Lebanon Hospital, Psychiatry Department, USA
Handan Gunduz-Bruce
- Yale University School of Medicine, Psychiatry Department, USA
Rachel Miller
- National Institute of Mental Health, USA
Joanne McCormack
- The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, USA
Beth S Lorell
- Bronx Lebanon Hospital, Psychiatry Department, USA
John Kane
- The Zucker Hillside Hospital of the North Shore Long Island Jewish Health System, Psychiatry Research, USA
- Albert Einstein College of Medicine, Department of Psychiatry, USA
- Feinstein Institute for Medical Research, Center for Translational Psychiatry, USA

Received 15 January 2010; received in revised form 23 March 2010; accepted 26 March 2010. published online 17 May 2010.

Abstract

Introduction

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.

Discussion

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.

Keywords: Schizophrenia, First-episode, Onset, Cannabis, Abuse, Dependence