Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Eur Arch Psychiatry Clin Neurosci. 2023 Jun;273(4):765-778. doi: 10.1007/s00406-022-01441-5. Epub 2022 Jul 28.
Cannabis use is common in first-episode psychosis (FEP) but evidence is mixed about the extent to which cannabis use predicts symptoms and functional outcomes among those who seek treatment. This study sought to characterize cannabis use patterns and examine the relationship with clinical outcomes, including interactions with early intervention services (EIS). Data were drawn from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study including FEP individuals receiving treatment at sites randomized to provide either EIS (NAVIGATE) or community care (CC). Cannabis use was assessed monthly and symptom and functioning data were collected at baseline, 6, 12, 18, and 24 months. Among the 404 participants enrolled, 334 were classified into four cannabis use groups (consistent, sporadic, stopped, and never users) based on their use during the first year. Consistent and sporadic cannabis users were younger, whereas those who had stopped using were older. Sporadic users had the highest depression and the lowest functioning at baseline and improved less during treatment in negative emotions and intrapsychic foundations (e.g., motivation and sense of purpose) than non-users. However, sporadic users who received NAVIGATE improved more in overall symptoms and functioning than those who received CC. Consistent users did not tend to differ in their trajectories from non-users. Individuals with FEP who use cannabis sporadically showed less clinical improvement than non-users. However, EIS treatment reduced the negative effects of sporadic cannabis use on clinical outcomes. Those who use cannabis sporadically may have unique needs that require attention in EIS.
大麻使用在首发精神病（FEP）中很常见，但关于大麻使用在寻求治疗的人群中预测症状和功能结局的程度，证据不一。本研究旨在描述大麻使用模式，并研究其与临床结局的关系，包括与早期干预服务（EIS）的相互作用。数据来自于首次精神分裂症发作后的康复-早期治疗计划（RAISE-ETP）研究，包括在被随机分配提供 EIS（NAVIGATE）或社区护理（CC）的地点接受治疗的 FEP 个体。大麻使用每月评估一次，症状和功能数据在基线、6、12、18 和 24 个月收集。在纳入的 404 名参与者中，根据他们在第一年的使用情况，将 334 名参与者分为四个大麻使用组（持续使用、偶发使用、停止使用和从不使用）。持续和偶发大麻使用者更年轻，而停止使用的人年龄更大。偶发使用者在基线时有更高的抑郁和更低的功能，在治疗期间，他们在消极情绪和内在心理基础（如动机和目标感）方面的改善不如非使用者。然而，接受 NAVIGATE 的偶发使用者在整体症状和功能方面的改善比接受 CC 的使用者更多。持续使用者在其轨迹上与非使用者没有太大区别。偶尔使用大麻的 FEP 个体在临床改善方面不如非使用者。然而，EIS 治疗减少了偶发大麻使用对临床结局的负面影响。那些偶尔使用大麻的人可能有独特的需求，需要在 EIS 中得到关注。
