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Daily use of high potency cannabis is associated with more positive symptoms in first episode psychosis patients: the EU-GEI case-control study

Research output: Contribution to journalArticle

Original languageEnglish
JournalPsychological Medicine
Publication statusAccepted/In press - 8 Jan 2020


King's Authors


Background: Daily use of high potency cannabis has been reported to carry a high risk for psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first episode psychosis (FEP) patients.
Method: We analysed data from 901 patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed effects models analyses.
Results: In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high potency cannabis having the highest score (B=0.35; 95%CI 0.14 to 0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B=-0.22; 95%CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.
Conclusions: Our findings provide the first large scale evidence that first episode psychotic patients with a history of daily use of high potency cannabis present with more positive and less negative symptoms than those who never used cannabis or used low potency types.

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