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Nils Håvard Dahl, psykiater

NEW YORK (Reuters Health) - Using cannabis increases the risk of developing psychosis in psychosis-free subjects, according to a report in the August 15th issue of the American Journal of Epidemiology. Those with an established vulnerability to psychotic disorders are especially sensitive to the effects of the drug, resulting in a poor prognosis.

Dr. Jim van Os, of Maastricht University, the Netherlands, and colleagues report on a 3-year follow-up of 4045 psychosis-free subjects and 59 subjects with a baseline diagnosis of psychotic disorder. They assessed substance use at baseline, 1 year, and 3 years.

The investigators found that baseline cannabis use predicted the presence of any psychosis at follow-up (adjusted odds ratio [OR] = 2.76) and a severe level of psychosis (OR = 24.17). In addition, baseline cannabis use predicted the clinically assessed need for care for symptoms of psychosis (OR = 12.01).

"The effect of baseline cannabis use was stronger than the effect at 1-year and 3-year follow-up, and more than 50% of the psychosis diagnoses could be attributed to cannabis use," the team reports. Those with a baseline diagnosis of psychotic disorder were more strongly affected by the use of cannabis than were their counterparts (risk difference 54.7% versus 2.2%, respectively; p = 0.001).

"Long-term effects of cannabis on the risk of psychosis outcome may be due to long-lasting dysregulation of endogenous anandamide/cannabinoid systems mediating the effects of tetrahydrocannabinol on the brain," Dr. van Os and colleagues suggest. "Other neurotransmission systems modulated by cannabinoid receptors may also be involved."

Source: Am J Epidemiol 2002;156:319-327.

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