Abstract
The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP. Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age. Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (β = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (β = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (β = 0.266, t = 2.06, p = 0.043). This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.
Highlights
In most countries, cannabis is categorized as a drug of abuse, and its recreational use is strictly prohibited [1], while in others it is perceived as a benign, relatively harmless substance [2,3]
Around 8.5% of the total variance in effect sizes was due to differences between studies, 86.7% of the total variance between effect sizes was attributed to differences within studies, and 4.8% of the observed variability was due to sampling variance
When analyzing the effects of the moderator variables on cannabis use and neurocognitive functioning, we found that a low frequency of use led to a more positive effect size, that is, the difference in the neurocognitive functioning between cannabis users (CU) and NU
Summary
Cannabis is categorized as a drug of abuse, and its recreational use is strictly prohibited [1], while in others it is perceived as a benign, relatively harmless substance [2,3]. In patients with first-episode psychosis (FEP), the various anomalies of the endogenous cannabinoid system include potentially increased levels of cannabinoids in the frontal cortex and cerebrospinal fluid even before the use of cannabis [24,25] This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. It highlights the deleterious effect of low doses of cannabis in some patients.
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