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SO104

Clinical course of cannabis-related psychoses: a nationwide cohort study

CLINICAL TRAJECTORIES IN CANNABIS-RELATED PSYCHOSES – A NATIONWIDE COHORT STUDY

First-episode psychosis with comorbid cannabis use disorder and cannabis-induced psychosis are associated with higher risks of psychosis-related hospitalization and death than first-episode psychosis without a substance use disorder, but with fewer schizophrenia diagnoses.

The study aimed to characterize the long-term clinical course of cannabis-related psychoses. By linking Sweden's nationwide administrative and medical registers (MiDAS, LISA, CDR, NPR, PDR) for 2006–2021, the researchers identified 1,360 individuals (84.3% male) diagnosed with first-episode psychosis with comorbid cannabis use disorder (FEP&CUD), 1,772 individuals (84.1% male) diagnosed with cannabis-induced psychosis (CIP), and matched individuals with first-episode psychosis (FEP) without a substance use disorder (SUD), with follow-up continuing through 2023; annual prevalence of psychiatric diagnoses before and after cohort entry, occupational functioning, medication use, and risks of psychosis-related hospitalization and death were compared. Age at first diagnosis was 26.9 years for FEP&CUD and 26.6 years for CIP. Compared with the FEP group without SUD, the FEP&CUD and CIP groups had higher risks of psychosis-related hospitalization (adjusted hazard ratio, aHR 1.66 [95% confidence interval 1.49–1.86] and 1.47 [1.32–1.64], respectively) and death (aHR 2.02 [1.44–2.82] and 1.80 [1.30–2.50], respectively). Within the two years following cohort entry, schizophrenia diagnoses were recorded more frequently in the FEP group without SUD (10.9–14.4%) than in the FEP&CUD (6.3–7.1%) and CIP (2.4–3.3%) groups. Within 30 days of cohort entry, antipsychotic use was 57% in the FEP group without SUD, 48% in the FEP&CUD group, and 45% in the CIP group, while use of long-acting injectable (LAI) antipsychotics was very low across all groups (approximately 0.3–2.8%); at baseline, 10.96% of the FEP&CUD group and 6.94% of the comparison group received a disability pension. The authors suggest that cannabis-related psychoses may lie on a psychosis spectrum rather than constitute distinct clinical entities, and that these cases require earlier diagnostic attention and more proactive early treatment pathways with greater consideration of LAI options.

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