Daily use of high-potency cannabis is associated with more positive symptoms in first-episode psychosis patients: the EU-GEI case-control study

D. Quattrone*, L. Ferraro, G. Tripoli, C. La Cascia, H. Quigley, A. Quattrone*, H.E. Jongsma, S. Del Peschio, G. Gatto, C. Gayer-Anderson, P.B. Jones, J.B. Kirkbride, D. La Barbera, I. Tarricone, D. Berardi, S. Tosato, A. Lasalvia, A. Szoke, C. Arango, M. BernardoJ. Bobes, C.M. Del Ben, P.R. Menezes, P.M. Llorca, J.L. Santos, J. Sanjuan, A. Tortelli, E. Velthorst, L. de Haan, B.P.F. Rutten, M.T. Lynskey, T.P. Freeman, P.C. Sham, A.G. Cardno, E. Vassos, J. van Os, C. Morgan, U. Reininghaus, C.M. Lewis, R.M. Murray, M. Di Forti, EU-GEI group

*Corresponding author for this work

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Background Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients. Method We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses. Results In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14-0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = -0.22; 95% CI -0.37 to -0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use. Conclusions Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.
Original languageEnglish
Article number0033291720000082
Pages (from-to)1329-1337
Number of pages9
JournalPsychological Medicine
Issue number8
Publication statusPublished - 1 Jun 2021


  • Cannabis use
  • cannabis-associated psychosis
  • psychopathology
  • psychotic experiences
  • symptom dimensions
  • first episode psychosis
  • RISK

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