Abstract
ObjectivesBoth substance use, on the one hand, and the first signs of psychosis, on the other, commonly begin in adolescence. Adolescents with substance use disorder (SUD) frequently show recreational use of cannabis and 3,4-methylenedioxymethamphetamine (MDMA). When attenuated psychotic symptoms (APS) occur during the course of SUD, they are commonly attributed to the cannabis use, neglecting the role of other substances abused, such as MDMA in the risk of psychosis.MethodsWe analyzed retrospective self-reports on APS (Prodromal Questionnaire, PQ-16) and amount of cannabis and MDMA use in n = 46 adolescent psychiatry outpatients with SUD. N = 17 (35%) individuals reported MDMA consume additional to cannabis. Furthermore, we examined the associations of APS with cannabis and MDMA use in stepwise hierarchical regressions while controlling for trauma history, birth complications and gender.ResultsAPS were not related to cannabis (B = 0.04, p = 0.842), but to MDMA use (B = 4.88, p = 0.001) and trauma history (B = 0.72, p = 0.001). Gender (B = −0.22, p = 0.767) and birth complications (B = −0.68, p = 0.178) were not associated with APS.DiscussionOur results indicate that MDMA use additional to cannabis use is associated with APS among adolescent SUD patients. Contrary to our expectations, we did not see an association of cannabis use and APS. We speculate that cannabis increases the risk for psychosis after a longer period of use and in combination with other risk factors, such as trauma history. Clinicians should screen for APS among SUD patients using MDMA and cannabis in order to adapt treatment plans of SUDs. Future research should validate these findings in longitudinal studies including polysubstance use and trauma history.
Highlights
Adolescence is typically characterized by physical and psychological changes leading to impulsive and hazardous behaviors, such as increased involvement in unintentional accidents, violence, high-risk sexual behavior as well as substance use [1]
During the development of psychotic disorders (PDs) non-specific and negative psychotic symptoms, which are defined as a lessening or absence of normative behaviors and functions related to motivation and interest [5], usually develop first and are followed by attenuated positive symptoms [6]. 80–90% of patients suffering from schizophrenia report a period of attenuated psychotic symptoms (APS) including changes in perception, beliefs cognition, affect, mood before developing full-blown psychosis [7]
Average amount of past year MDMA use additional to cannabis use showed the strongest relationship with APS (r = 0.68, p < 0.001; see Table 2)
Summary
Adolescence is typically characterized by physical and psychological changes leading to impulsive and hazardous behaviors, such as increased involvement in unintentional accidents, violence, high-risk sexual behavior as well as substance use [1]. PDs are a group of illnesses described by the presence of unusual belief systems which do not conform to societal norms (delusions), hallucinations ( auditory), and disorders of thought and cognition Both substance use, on the one hand, and the first signs of PDs, on the other, commonly begin in late adolescence and early adult life [4]. Individuals that share a first-degree relative with a psychotic disorder (PD) are being considered at high-risk for PDs and with transition rates ranging from 18% within 6 months to 36% within 3 years [10] Another even more vulnerable group for developing PDs has been defined that is considered to be at “ultra-high-risk” [7]. More recent definitions of UHR include substance use among other environmental factors as well since individuals with UHR for psychosis often show increased rates of substance use [6]
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