Determining factors for Cannabis use among Moroccans Schizophrenic Patients: A cross sectional study

Document Type : Original Research Article

Authors

1 Department of Biology, Sidi Mohamed Ben Abdellah University, Laboratory of Physiology-Pharmacology & environmental Health, Faculty of Science Fez, BP 1796 Fez-Atlas 30003, Morocco.

2 Department of Psychiatry, University Hospital Hassan II Fez,BP 1893, road of Sidi Hrazem Fez 30000, Morocco.

3 Department of Epidemiology Public Health Pathway, Faculty of Medicine Fez, BP 1893, road of Sidi Hrazem Fez 30000, Morocco.

4 Department of Toxicology, University Hospital Hassan II Fez, BP 1893, road of Sidi Hrazem Fez 30000, Morocco.

Abstract

Objective: Cannabis use is considered a major clinical problem associated with a poorer outcome in patients with schizophrenia. The objective of the present study was to assess the prevalence of cannabis us among patients with schizophrenia. The assessment consists in comparing some factors related to substance use in a population of schizophrenic patients between cannabis users and non-users.
Materials and Methods: Four hundred and three participants who were examined prospectively during their hospitalization answered the PANNS scale of schizophrenia, GAF, BIS-10, CDSS, and MARS. The consumption of cannabis was investigated using urine toxicological analysis. Sociodemographic, clinical and therapeutic data were also recorded.
Results: The prevalence of cannabis use among schizophrenic inpatients was 49%. Patients with cannabis use were younger (31.7 vs 34.9 years old, p<0.001), more often male (52 vs 20% female, p<0.001), and they presented more often a history of imprisonment (68.8% vs 31.2%, p<0.001). Patients who were users of cannabis had a lower age at onset of the disease than non-users (23.6 vs 24.8 years, p=0.029), and more often with poor medication adherence (p=0.001). Logistic regression revealed that factors associated with cannabis use among schizophrenics were the age, gender, history of imprisonment and poor medication adherence.
Conclusion: The study showed that a high prevalence of cannabis use among patients with schizophrenia which was associated with negative overall outcomes. Determining comorbid substance use disorders among schizophrenic patients is crucial as it may contribute to establish a better therapeutic strategy.

Keywords

Main Subjects

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2003. DSM-IV-TR 2ndéd. Paris: Masson.
Arndt S, Tyrrell G, Flaum M, Andreasen NC. 1992. Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychol Med, 22: 379-388.
Bessa MA, Mitsuhiro SS, Chalem E, Barros MM, Guinsburg R, Laranjeira R. 2010. Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents. Addict Behav, 35: 266-269.
Cantor-Graae E, Nordstrom LG, McNeil TF. 2001. Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res, 48: 69-82.
Carey KB, Carey MP, Chandra PS. 2003. Psychometric evaluation of the alcohol use disorders identification test and short drug abuse screening test with psychiatric patients in India. J Clin Psychiat, 64: 767-774.
Carey KB, Correia CJ. 1998. Severe mental illness and addictions: assessment considerations. Addict Behav, 23: 735-748.
Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H, Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig IW. 2005. Moderation of the effect of adolescent onset cannabis use on adult psychosis by a functional polymorphism in the catechol O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry, 57: 1117-1127.
Charles V, Weaver T. 2010. A qualitative study of illicit and non-prescribed drug use amongst people with psychotic disorders. J Ment Health, 19: 99-106.
Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML, Stewart T, Walker EF. 2009. Association of preonset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry, 166: 1251-1257.
Ddington D, Addington J, Maticka-Tyndale E. 1993. Assessing depression in schizophrenia: the calgary depression scale. Br J Psychiatry, 22: 39-44.
de Beaurepaire R, Lukasiewicz M, Beauverie P, Castéra S, Dagorne O, Espaze R, Falissard B, Giroult P, Houery M, Mahuzier G, Matheron I, Niel P, Padovani P, Poisson N, Richier JP, Rocher J, Ruetsh O, Touzeau D, Visinoni A, Molimard R. 2007. Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. Eur Psychiatry, 22: 540-548.
Degenhardt L, Coffey C, Romaniuk H, Swift W, Carlin JB, Hall WD, Patton GC. 2013. The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood. Addiction, 108: 124-133.
Degenhardt L, Hall W, Lynskey M. 2003. Testing hypotheses about the relationship between cannabis use and psychosis. Drug Alcohol Depend, 71 : 37-48
Dervaux A, Baylé FJ, Laqueille X, Bourdel MC, Le Borgne MH, Olié JP, Krebs MO. 2001. Is substance abuse in schizophrenia related to impulsivity, sensation seek­ing or anhedonia? Am J Psychiatry, 158: 492-494.
Di Forti M, Iyegbe C, Sallis H, Kolliakou A, Falcone MA, Paparelli A, Sirianni M, La Cascia C, Stilo SA, Marques TR, Handley R, Mondelli V, Dazzan P, Pariante C, David AS, Morgan C, Powell J, Murray RM. 2012. Confirmation that the AKT1 (rs2494732) genotype influences the risk of psychosis in cannabis users. Biol Psychiatry, 72: 811-816.
Di Forti M, Sallis H, Allegri F, Trotta A, Ferraro L, Stilo SA, Marconi A, La Cascia C, Reis Marques T, Pariante C, Dazzan P, Mondelli V, Paparelli A, Kolliakou A, Prata D, Gaughran F, David AS, Morgan C, Stahl D, Khondoker M, MacCabe JH, Murray RM. 2014. Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophr Bull, 40: 1509-1517.
Donoghue K, Doody GA, Murray RM, Jones PB, Morgan C, Dazzan P, Hart J, Mazzoncini R, Maccabe JH. 2014. Cannabis use, gender and age of onset of schizophrenia: data from the AESOP study. Psychiatry Res, 215: 528-532.
Drake RE. 2008. Management of substance use disorder in schizophrenia, patients: current guidelines. CNS Spectr, 12: 27-32.
D'Souza DC, Sewell RA, Ranganathan M. 2009. Cannabis and psychosis/schizophrenia: human studies. Eur Arch Psychiatry Clin Neurosci, 7: 413-431.
Dubertret C, Bidard I, Ades J, Gorwood P. 2006. Lifetime positive symptoms in patients with schizophrenia and cannabis abuse are partially explained by co-morbid addiction. Schizophr Res, 86 : 284-290.
Dugré JR, Dellazizzo L, Giguère C-É, Potvin S, Dumais A. 2017. Persistency of cannabis use predicts violence following acute psychiatric discharge. Front Psychiatry, 8: 176.
El ghazouaniF,Aarab C, Lahlou F, Elrhazi K, Aalouane R, Rammouz I. 2015. Substances use among inpatients with relapse of schizophrenia: Cross-sectional study. Ann Med Psychol, 6:415-519.
Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. 2009. Schizophrenia and violence: Systematic review and meta-analysis. PLoS Med, 6: e1000120.
Foglia E, Schoeler T, Klamerus E, Morgan K, Bhattacharyya S. 2017. Cannabis use and adherence to antipsychotic medication: a systematic review and meta-analysis. Psychol Med, 10:1691-1705.
Foti DJ, Kotov R, Guey LT, Bromet EJ. 2010. Cannabis use and the course of schizophrenia: 10-year follow-up after first hospitalization. Am J Psychiatry, 167: 987-993.
Grech A, Van Os J, Jones PB, Lewis SW, Murray RM. 2005. Cannabis use and outcome of recent onset psychosis. Eur Psychiatry, 20: 349-353.
Green B, Young R, Kavanagh D. 2005. Cannabis use and misuse prevalence among people with psychosis. Br J Psychiatry, 187: 306-313.
Gregg L, Barrowclough C, Haddock G.2007. Reasons for increased substance, use in psychosis. Clin Psycho Rev, 27 : 494-510.
Gut-Fayand A, Dervaux A, Olié JP, Lôo H, Poirier MF, Krebs MO. 2001. Substance abuse and suicidal­ity in schizophrenia: a common risk factor linked to impulsivity. Psychiatry Re, 102: 65-72.
Hambrecht M, Hafner H. 1996. Substance abuse and the onset of schizophrenia.Biol Psychiatry, 11:1155-1163.
Helle S, Ringen PA, Melle I, Larsen TK, Gjestad R, Johnsen E, Lagerberg TV, Andreassen OA, Kroken RA, Joa I, Ten VeldenHegelstad W, Løberg EM. 2016. Cannabis use is associated with 3 years earlier onset of schizophrenia spectrum disorder in a naturalistic, multi-site sample (N = 1119). Schizophr Res, 170: 217-221.
Henquet C, Murray R, Linszen D, van Os J. 2005a. The environment and schizophrenia: the role of cannabis use. Schizophr Bull, 31: 608-612.
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J. 2005b. Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. BMJ, 330: 11-14.
Hogarth L. 2011. The role of impulsivity in the aetiology of drug dependence: Reward sensitivity versus automaticity. Psychopharmacology, 215: 567-580.
Jimenez-Castro L, Hare E, Medina R, Raventos H, Nicolini H, Mendoza R, Escamilla M. 2010. Substance use disorder comorbidity with schizophrenia in families of Mexican and Central American ancestry. Schizophr Res, 120: 87-94.
Kay SR, Fizbein A, Opler LA. 1987. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull, 13: 261-276.
Kilpatrick B, Howlett M, Sedgwick P, Ghodse AH. 2000. Drug use, self-report and urinalysis. Drug Alcohol Depend, 58: 111-116.
Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. 2010. Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophr Bull, 36: 1115-1130.
Large M, Mullin K, Gupta P, Harris A, Nielssen O. 2014. Systematic meta-analysis of outcomes associated with psychosis and co-morbid substance use. Aust N Z J Psychiatry, 48: 418-432.
Large M, Sharma S, Compton MT, Slade T, Nielssen O. 2011. Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Arch Gen Psychiatry, 68: 555-561.
Larsen TK, Melle I, Auestad B, Friis S, Haahr U, Johannessen JO, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan TH. 2006. Substance abuse in first-episode non-affective psychosis. Schizophr Res, 88: 55-62.
Linszen DH, Dingermans PM, Lenior ME. 1994. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry, 4:273-279.
Liraud F, Verdoux H. 2000.Which temperamental characteristics are associated with substance use in subjects with psychotic and mood disorders? Psychiatry Res, 93: 63-72.
Lobban F, Barrowclough C, Jeffery S, Bucci S, Taylor K, Mallinson S, Fitzsimmons M, Marshall M. 2010. Understanding factors influencing substance use in people with recent onset psychosis. Soc Sci Med, 70: 1141-1147.
Marconi A, Di Forti M, Lewis CM, Murray RM, Vassos E. 2016.Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophr Bull, 42:1262-1269.
Mieczkowski T. 2010. Urinalysis and hair analysis for illicit drugs of driver applicants and drivers in the trucking industry. J Forensic Leg Med, 17: 254-260.
Miller R, Ream G, McCormack J, Gunduz-Bruce H, Sevy S, Robinsona D. 2009. A prospective study of cannabis use as a risk factor for non-adherence and treatment dropout in first-episode schizophrenia. Schizophr Res, 113: 138-144.
Møller T, Linaker OM. 2010. Using brief self-reports and clinician scales to screen for substance use disorders in psychotic patients. Nord J Psychiatry, 64: 130-135.
Mueser KT, Drake RE, Ackerson TH, Alterman AI, Miles KM, Noordsy DL. 1997. Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. J Abnorm Psychol, 106: 473-477.
Mustonen A, Niemelä S, Nordström T, Murray GK, Mäki P, Jääskeläinen E, Miettunen J. 2018. Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis. Br. J. Psychiatry, 212: 227-233.
Norström T, Pape H. 2010. Alcohol, suppressed anger and violence. Addiction, 105: 1580-1586.
Patton JH, Stanford MS, Barratt ES. 1995. Factor structure of the Barratt impulsiveness scale. J Clin Psychol, 51: 768-774.
Pedersen W, Skardhamar T. 2010. Cannabis and crime: findings from a longitudinal study. Addiction, 105: 109-118.
Potvin S, Sepehry AA, Stip E. 2006. A meta-analysis of negative symptoms in dual diagnosis schizophrenia.Psychol Med, 36: 431-440.
Reiger D, Farmer M, Rae D, Locke B, Keith S, Judd L, Goodwin F. 1990. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemologic Catchment Area (ECA) Study. JAMA, 264: 2511-2518.
Schanda H, Stompe T, Ortwein-Swoboda G. 2010. [Increasing criminality in patients with schizophrenia: fiction, logical consequence or avoidable side effect of the mental health reforms?]. Neuropsychiatr, 24: 170-181.
Schoeler T, Petros N, Bhattacharyya S. 2017. Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: a prospective analysis. Lancet psychiatry, 4: 627-633.
Schoeler T, Petros N, Di Forti M Klamerus E, Foglia E, Ajnakina O, Gayer-Anderson C, Colizzi M, Quattrone D, Behlke I, Shetty S, McGuire P, David AS, Murray R, Bhattacharyya S. 2016. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study. Lancet Psychiatry, 3: 947-953.
Seddon JL, Birchwood M, Copello A, Everard L, Jones PB, Fowler D, Amos T, Freemantle N, Sharma V, Marshall M, Singh SP. 2016. Cannabis use is associated with increased psychotic symptoms and poorer psychosocial functioning in first-episode psychosis: a report from the UK National EDEN study. Schizophr Bull, 42: 619-625.
Thompson K, Kulkarni J, Sergejew AA. 2000. Reliability and validity of a new medication adherence rating scale (MARS) for the psychoses. Schizophr Res, 42: 241-247.
Van DijkD, Koeter M JW, Hijman R, Kahn RS, van den Brin kW. 2012. Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Schizophr Res, 137: 50-57.
Volkow ND. 2009. Substance use disorders in schizophrenia clinical implications of comorbidity. Schizophr Bull, 35: 469-472.
Avicenna Journal of Phytomedicine
Volume 10, Issue 1
January and February 2020
Pages 89-100

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