Brain functional & structural patterns predicting outcome in cannabis-induced psychosis
Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
Human Cognitive and Systems Neuroscience
Final Report Abstract
One of the main factors in the development of psychosis is suggested to be the consumption of cannabis. However, the neurobiological basis of the connection between psychosis and cannabis use is still poorly understood. Due to a high rate of CIP patients (up to 50%) that go on to develop a permanent form of psychosis this project aimed to investigate this group of patients in the context of a longitudinal neuroimaging study. In addition to clinical and neuropsychological testing, patients with CIP were be examined using structural and functional imaging at baseline and followed up with behavioral measures after 9 months. The data were analyzed using multivariate pattern analysis (MVPA) to identify how clinical, cognitive and structural MRI data can contribute in prediction of continuous cannabis (CC) use. The results indicate that clinical data and in particular lower psychosocial functioning, urbanicity, lack of coping strategies have a strong potential in prediction of CC. In addition, specific consumption behavior including lifetime diagnosis of cannabis dependence and lower alcohol consumption significantly contributed to the model’s balanced accuracy of 73%. While neuroimaging data did not show superior predictive accuracy, applying source-based morphometry enabled us to deeper investigate at the GM covariance which underlies shared maturational processes. The neuroimaging findings of the current project suggest that early initiation of cannabis perturbs the developmental trajectory of certain structural brain networks which is in turn related more severe psychotic symptoms later in life. Specifically, we find the link to the initiation of cannabis use during adolescence to long-lasting structural brain effects, manifesting in greater Grey Matter Volume in cerebral network and increased GMV in temporal component in in patients with an earlier age of cannabis initiation. Notably, this effect was specific for the age of initiation, and was robust to several possible confounding factors often discussed in the literature. Furthermore, in this project we provide evidence that an earlier age of initiation is specifically associated with more severe positive psychotic symptoms in recent onset psychosis (ROP) individuals. Finally, we investigated if the individuals with CIP are exposed to early adversities to a greater extent than CC without mental health disorders. In this case-control study of 294 individuals and 4 study groups: individuals with first episode psychosis, individuals with cannabis induced psychosis, consuming individuals with cannabis dependency but no psychotic symptoms and healthy participants. CC were to a lesser extent affected by early adverse experiences but showed significantly higher depressive symptoms as compared to healthy controls (HC). While effects of cannabis consumption pertain to selective aspects of childhood trauma and resilience the emergence of psychosis exerts manifold effects to decrease cognitive performance, resilience and coping strategies. Reduction in social resources might be specifically relevant in cannabis consumers who later develop a psychotic episode. These last finding highlight the importance of early adversities absence; effective stress coping strategies and intact cognitive performance may lead to more resilient behavior counteracting adverse outcomes.
Publications
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Brain structural patterns classifying the age of onset of first cannabis consumption in psychotic patients with cannabis abuse – preliminary results from the PRONIA study. Schizophrenia International Research Society (SIRS), April 2018
Penzel N., Falkai P., Koutsouleris N. & Kambeitz J.
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“Brain structural patterns classifying the age of onset of first cannabis consumption in psychotic patients with cannabis abuse – preliminary results from the PRONIA study” German Association of Psychiatry, Psychotherapy and Psychosomatic, Berlin, Germany Selected Oral Abstract
Nora Penzel
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Association between age of cannabis initiation and gray matter covariance networks in recent onset psychosis. Neuropsychopharmacology, 46(8), 1484-1493.
Penzel Nora; Antonucci Linda A.; Betz Linda T.; Sanfelici Rachele; Weiske Johanna; Pogarell Oliver; Cumming Paul; Quednow Boris B.; Howes Oliver; Falkai Peter; Upthegrove Rachel; Bertolino Alessandro; Borgwardt Stefan; Brambilla Paolo; Lencer Rebekka; Meisenzahl Eva; Rosen Marlene; Haidl Theresa; Kambeitz-Ilankovic Lana; ... & Rohner Henrik
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Clinical symptoms, cognition and resilience in cannabis consumers: a cross German Association of Psychiatry, Psychotherapy and Psychosomatic, Berlin, Germany Selected Oral Abstract
Julian Wenzel
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Pattern of predictive features of continued cannabis use in patients with recent-onset psychosis and clinical high-risk for psychosis. Schizophrenia, 8(1).
Penzel, Nora; Sanfelici, Rachele; Antonucci, Linda A.; Betz, Linda T.; Dwyer, Dominic; Ruef, Anne; Cho, Kang Ik K.; Cumming, Paul; Pogarell, Oliver; Howes, Oliver; Falkai, Peter; Upthegrove, Rachel; Borgwardt, Stefan; Brambilla, Paolo; Lencer, Rebekka; Meisenzahl, Eva; Schultze-Lutter, Frauke; Rosen, Marlene; Lichtenstein, Theresa; ... & Rohner, Henrik
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“Multimodal prediction of continued cannabis use in individuals with recentonset psychosis and clinical high-risk for psychosis” Annual Meeting of the Schizophrenia International Research Society, Florence, Italy Selected Oral Abstract
Nora Penzel
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“Specific patterns of cannabis use as risk factors for psychosis” Ph.D., Ludwig Maximilians University, Munich – Germany, 2022
Penzel, Nora
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Neurocognitive Performance and Resilience in Psychosis IEPA, Lausanne, Switzerland Selected Talk, Symposium
Lana Kambeitz-Ilankovic
