Assessing rates and predictors of cannabis-associated psychotic symptoms across observational, experimental and medical research

Cannabis, one of the most widely used psychoactive substances worldwide, can give rise to acute cannabis-associated psychotic symptoms (CAPS). While distinct study designs have been used to examine CAPS, an overarching synthesis of the existing findings has not yet been carried forward. To that end, we quantitatively pooled the evidence on rates and predictors of CAPS (k = 162 studies, n = 210,283 cannabis-exposed individuals) as studied in (1) observational research, (2) experimental tetrahydrocannabinol (THC) studies, and (3) medicinal cannabis research. We found that rates of CAPS varied substantially across the study designs, given the high rates reported by observational and experimental research (19% and 21%, respectively) but not medicinal cannabis studies (2%). CAPS was predicted by THC administration (for example, single dose, Cohen’s d = 0.7), mental health liabilities (for example, bipolar disorder, d = 0.8), dopamine activity (d = 0.4), younger age (d = −0.2), and female gender (d = −0.09). Neither candidate genes (for example, COMT, AKT1) nor other demographic variables (for example, education) predicted CAPS in meta-analytical models. The results reinforce the need to more closely monitor adverse cannabis-related outcomes in vulnerable individuals as these individuals may benefit most from harm-reduction efforts.

大麻是世界上使用最广泛的精神活性物质之一，可引发急性大麻相关精神病性症状（CAPS）。虽然已经使用了不同的研究设计来研究CAPS，但尚未对现有研究结果进行全面综合。为此，我们对（1）观察性研究、（2）实验性四氢大麻酚（THC）研究和（3）医用大麻研究中关于CAPS的发生率和预测因素的证据进行了定量汇总（k = 162项研究，n = 210283名接触过大麻的个体）。我们发现，鉴于观察性研究和实验性研究报告的发生率较高（分别为19%和21%），而医用大麻研究中并非如此（2%），不同研究设计中CAPS的发生率差异很大。THC的使用（例如，单剂量，科恩d值 = 0.7）、精神健康问题（例如，双相情感障碍，d值 = 0.8）、多巴胺活动（d值 = 0.4）、年龄较小（d值 = -0.2）和女性（d值 = -0.09）可预测CAPS。在荟萃分析模型中，候选基因（例如，COMT、AKT1）和其他人口统计学变量（例如，教育程度）均不能预测CAPS。这些结果强调了需要更密切地监测易感个体中与大麻相关的不良后果，因为这些个体可能从减少危害的努力中获益最大。